MRCP PACES · PRACTICAL PREPARATION GUIDE
Prepare for PACES by practising observable decisions.
PACES is not a test of how many polished scripts you can remember. It asks you to examine, interpret, communicate and make safe decisions while two examiners observe. This guide turns the current PACES23 structure into a repeatable revision method.
KNOW THE TASK
The PACES23 format, without the noise
The carousel contains five 20-minute stations. Stations 1 and 4 combine a 10-minute communication encounter with a 10-minute system examination. Station 3 contains two 10-minute system examinations. Stations 2 and 5 are 20-minute consultations that integrate focused history, relevant examination, explanation and management.
Communication + respiratory
Two distinct 10-minute encounters. Change gear deliberately between conversation and physical examination.
Consultation
Focused history, relevant examination, differential, plan and the patient’s concerns in one 20-minute encounter.
Neurology + cardiovascular
Two system examinations. Demonstrate technique, identify signs and defend your interpretation.
Communication + abdominal
A second communication challenge followed by a focused abdominal system examination.
Consultation
A further integrated consultation. Across Stations 2 and 5, one scenario is acute and one non-acute.
Important: Confirm administrative details, regulations and any later format changes on the official MRCP(UK) website before your sitting.
MARK THE PERFORMANCE
Train all seven skills—not only diagnosis
A candidate must meet the required standard across the assessed skills as well as overall. A correct diagnosis cannot repair unsafe technique, missed concerns or poor welfare.
Physical examination
Use a correct, systematic and fluent technique while protecting comfort and dignity.
Identifying physical signs
Recognise signs that are present without inventing findings that are not.
Clinical communication
Elicit and explain relevant information clearly, accurately and professionally.
Differential diagnosis
Build and prioritise a sensible differential from your own assessment.
Clinical judgement
Choose appropriate investigations and management, including ethical judgement.
Managing concerns
Seek, acknowledge and respond to what matters to the patient or relative.
Maintaining patient welfare
Protect safety, comfort, dignity and respect throughout the encounter.
BUILD A DELIBERATE LOOP
A revision method that produces visible improvement
Commit before reveal
Read only the candidate brief. Say your opening, questions, examination sequence and initial problem representation aloud before seeing more information.
Work to the real constraint
Use the encounter timer. Do not stop it while thinking. Practise a controlled close: diagnosis, uncertainty, plan, concerns and safety net.
Score behaviours, not confidence
For each of the seven skills, record one observable strength and one missed behaviour. “Felt poor” is not useful feedback; “did not check understanding” is.
Repeat the same case
Re-run the encounter within 48 hours using the same patient information. The aim is a cleaner decision pathway—not memorisation of a model answer.
FOUR-WEEK EXAMPLE
Depth before volume
- Week 1: baseline recordings across examinations, communication and consultation; identify the weakest two skills.
- Week 2: targeted technique and presentation practice; repeat cases until the weak behaviours improve.
- Week 3: mixed timed encounters with an examiner or study partner and explicit patient-concern practice.
- Week 4: full circuits, fatigue management, concise closes and review of recurrent safety errors.
REHEARSE THE TRANSITIONS
Three practical encounter playbooks
Inspect → examine → synthesise
- Confirm identity, task, consent, pain and positioning.
- Use a fluent sequence that answers the clinical question.
- Protect dignity and notice discomfort throughout.
- Present discriminating findings, not a transcript.
- State the leading diagnosis, alternatives and next discriminating test.
Agenda → dialogue → agreement
- Establish what the person knows, wants and fears.
- Give information in small, accurate sections.
- Respond to emotion before adding more facts.
- Explain benefits, harms, alternatives and uncertainty.
- Check understanding and agree a safe next step.
Focus → integrate → decide
- Form an early problem representation without premature closure.
- Take a discriminating history and perform a relevant examination.
- Prioritise the differential and identify immediate risk.
- Explain a definite plan in language the patient can use.
- Address concerns, safety-net and close within time.
PUT THE METHOD INTO PRACTICE
Choose the rehearsal you need today
COMMON QUESTIONS
What candidates ask about PACES preparation
How many stations are in MRCP PACES?
PACES23 uses five stations. Across the carousel there are eight encounters: two communication encounters, four system examinations and two 20-minute consultations.
What should I practise first?
Start by recording one timed consultation. Score the seven skills separately. Fix the weakest observable behaviour—such as an unfocused examination or an unclear closing plan—before adding more cases.
How should I structure a PACES presentation?
Open with a one-sentence problem representation, give the most discriminating positive and negative findings, state a prioritised differential and finish with an immediate and longer-term plan. Avoid reciting every normal finding.
How do I improve PACES communication?
Ask what the patient understands and what worries them, use short explanations, check understanding and negotiate the next step. Communication is not a speech: the patient’s priorities should change how you conduct the consultation.
Should I learn scripts for PACES?
Use repeatable structures, not memorised speeches. Scripts often fail when the patient introduces uncertainty, emotion or a competing priority. Practise adapting your explanation while preserving safety.
How can I practise PACES without a study partner?
Speak aloud against a timer, reveal information only after committing to your question or examination step, then compare your response with a marking framework. A partner remains valuable for realism and feedback.