MRCP PACES Exam Format and Marking: Stations, Encounters and the Seven Skills

The carousel and the eight marked encounters

PACES is run as a timed carousel of five stations. You rotate through them in a fixed sequence, each station lasts twenty minutes, and short gaps let you reset and read the next brief before you walk in. Two examiners mark you independently at every station, so nobody's off day sinks you. Across those five stations you meet eight separately marked encounters, and it is the encounters — not the stations — that generate your marks.

The eight encounters come in three types, and knowing the type tells you immediately what will be tested. First are the four focused system examinations. These are the classic short cases: a respiratory examination (Station 1), a cardiovascular examination and a nervous system examination (both at Station 3), and an abdominal examination (Station 4). In each you get a few minutes to examine, then a short spell of questions on your findings and reasoning.

Second are the two communication encounters. Here there is no hands-on examination — you talk. You might be counselling a patient, explaining a diagnosis or treatment, or handling a difficult conversation, always with a focus on how clearly and humanely you communicate.

Third are the two consultation stations. These are the integrated encounters, and they are the closest thing PACES has to real clinical life: you take a focused history, perform a focused examination, and then negotiate a sensible management plan with the patient — all inside one station. Because they combine everything, they are marked on all seven skills, whereas the focused exams and communication encounters are each marked on a smaller subset.

• Four focused system exams — respiratory (Station 1), cardiovascular and neurology (Station 3), abdominal (Station 4)
• Two communication encounters — counselling and explaining, with no physical examination
• Two consultation stations — integrated history, focused examination and management, marked on all seven skills

The seven skills (A to G) in plain terms

Every mark you earn is filed under one of seven skills. Learn them by heart, because they are the language examiners think in and the axes along which you will be judged.

A — Physical Examination: whether you examine correctly and thoroughly, looking for the signs that actually matter for the case in front of you. B — Identifying Physical Signs: whether you find the signs that are present and do not invent ones that are not. C — Clinical Communication: whether you take a relevant history systematically and explain things clearly, without jargon. D — Differential Diagnosis: whether you offer a sensible differential that includes the correct diagnosis. E — Clinical Judgement: whether you apply accurate knowledge — including law and ethics where relevant — to choose or negotiate a reasonable, time-bound management plan. F — Managing Patients' Concerns: whether you seek out, acknowledge and address what the patient is actually worried about, with genuine listening and empathy. G — Maintaining Patient Welfare: whether you keep the patient safe, comfortable and treated with dignity throughout.

• Focused system exams are marked on A, B, D, E and G
• Communication encounters are marked on C, E, F and G
• Consultation stations are marked on all seven, A through G

How the grading works

Within each encounter, the examiner scores every applicable skill on a simple three-point scale: Satisfactory earns 2, Borderline earns 1, and Unsatisfactory earns 0. Any grade below Satisfactory must carry a written comment — examiners cannot mark you down silently, which is one reason feedback tends to be specific and fair.

Because different encounters are marked on different numbers of skills, their maximum scores differ. A focused system examination is marked on five skills, so it tops out at ten. A communication encounter is marked on four skills, so its ceiling is eight. A consultation station is marked on all seven skills, giving a maximum of fourteen. That is also why the consultation stations carry so much weight and reward all-round performance.

A word of caution: passing PACES is not simply a matter of hitting one magic total. The standard is set by examiner calibration against the real patients you meet, and it demands consistency across the whole carousel together with clearing the exam's skill-level minima. Treat every encounter as if it matters, because it does — a run of Borderlines in one skill can undo strong marks elsewhere.

• Satisfactory = 2, Borderline = 1, Unsatisfactory = 0 for each skill
• A comment is required for any grade below Satisfactory
• Maximums: focused exam 10, communication encounter 8, consultation station 14

How to prepare efficiently

The format itself tells you where to aim. Skills B (reading signs) and D (reaching the right differential) are where candidates most often come unstuck, so drill them hardest: examine real or simulated patients repeatedly until spotting and naming signs is automatic, then force yourself to commit to a differential out loud rather than hedging.

Do not neglect the integrated skills. The consultation stations reward candidates who can move smoothly from history to examination to a management plan the patient actually agrees to — that flow only comes from rehearsal under time pressure. For the communication encounters, practise addressing the person's real concern, not just reciting facts at them.

Finally, train against the clock. Twenty minutes disappears fast, and fluency under time pressure is a skill in its own right. Rehearse whole encounters end to end, get feedback tied to the seven skills, and after each one name the single change that would push your weakest skill up a grade. That habit — always improving one thing — is what turns steady practice into a pass.