MRCP PACES communication stations: skills, framework and marking

What the communication encounters test

There are two communication encounters in the carousel, and each one hands you a person and a task rather than a body to examine. The recurring tasks are breaking bad news, counselling a patient about a new condition or lifestyle change, taking consent for a procedure or treatment, explaining a diagnosis, test result or treatment plan, and steering a difficult conversation — an angry relative, a request for something you cannot offer, or a disclosure that has gone wrong. You are usually told not to examine and not to take a full history; the clinical facts are given to you.

This is deliberately low on data and high on emotion. The marks do not come from getting a diagnosis right — they come from how you gather what the person already knows, deliver information plainly, detect the real worry underneath, and leave a safe, shared plan. Fluency, empathy and structure are the currency.

How the encounter runs

Each communication encounter gives you 5 minutes of reading time with the scenario, followed by roughly 10 minutes of interaction with the patient or relative (a role-player). Use the reading time deliberately: fix who you are speaking to, the single task set, the concern most likely to surface, and any ethical or legal thread lurking in the stem — consent, capacity, confidentiality or candour. Jot a two-line plan before you walk in.

The clock is unforgiving. A classic failure is spending eight minutes building rapport and reciting facts, then running out of time before you have addressed the concern, negotiated a plan or safety-netted. Structure is what buys you the time to finish.

The four skills you are marked on

Unlike the focused system examinations (marked on A, B, D, E, G) and the two consultation stations (marked on all seven skills), the communication encounters are scored on just four skills — C, E, F and G. Skills A (Physical Examination), B (Identifying Signs) and D (Differential Diagnosis) do not apply, because you neither examine nor diagnose. Direct all your energy at these four.

• C — Clinical Communication. Gather any needed history in an orderly, professional way, then hand information back plainly — no jargon, well organised, with the person drawn into the plan rather than talked at. You lose it by lecturing, using unexplained terms, or leaving them unsure what happens next.
• E — Clinical Judgement (including law and ethics). Offer a sensible, correct plan that carries a timescale and engages any legal or ethical dimension the scenario raises. Walking past an obvious consent, capacity or confidentiality issue drops the grade.
• F — Managing Patients' Concerns. Actively seek out, acknowledge and address the person's specific worry — not a generic reassurance. Ask what they most fear, listen, reflect it back, confirm understanding. Missing the real concern is the single most common way candidates lose marks here.
• G — Maintaining Patient Welfare. Beyond treating the person respectfully, the part you can most clearly demonstrate by voice is clinical safety: safety-net sensibly, give a clear disposition, say what to watch for and when to seek help, and never leave them at risk.

A reusable framework

One sequence covers almost every communication task. Set the agenda — introduce yourself, confirm who you are speaking to, and state what you would like to cover. Elicit their starting point and concerns (ICE) — ask what they already know, what they believe is going on, and what they are most worried about, before you commit to anything. Chunk and check — deliver information in small, plain-language pieces and confirm understanding after each. Empathy — when emotion arrives, stop talking, allow the silence, then name and validate the feeling rather than arguing it down. Shared plan — negotiate concrete next steps with a timescale, involving the patient in the decision. Safety-net — close with what to look out for, when and how to seek help, a named contact and follow-up, then summarise and check they have understood.

The order matters: concerns before information, empathy before facts, and the plan agreed rather than imposed.

Common scenarios and how to score

The encounters recur around a predictable set: breaking bad news or a serious result, counselling on a new chronic diagnosis, consent for a procedure or treatment with its risks, explaining why a treatment is or is not appropriate, addressing non-adherence, capacity and confidentiality dilemmas, an angry or colluding relative, and end-of-life or resuscitation conversations. See the dedicated guide to breaking bad news for a worked structure you can rehearse and adapt.

Each skill is graded Satisfactory (2), Borderline (1) or Unsatisfactory (0), and any grade below Satisfactory carries an examiner comment. To score well, protect time for the concern and the plan, surface the hidden worry early, keep your language plain, and never leave the person without a safe, shared next step. Rehearse out loud and timed, with someone who can throw in an unexpected concern — fluency and the ability to pivot to the real fear only come from repetition.

How this differs from a consultation station

Do not confuse the communication encounters with the two consultation stations. A consultation station is an integrated encounter: you take a focused history, perform a focused examination and negotiate a management plan, and it is marked on all seven skills (A–G). A communication encounter has no examination and no diagnosis to reach, and is marked on only C, E, F and G. The communication task is purely the conversation — explaining, counselling, consenting or breaking news — whereas the consultation is a compressed clinic review. See the consultation stations guide for that separate format.