The third and final part of the Membership of Royal College of Physicians (MRCP) exam is the Practical Assessment of Clinical Examination Skills (PACES). Although you have the option to either sit Part 2 written or PACES after passing Part 1, I would recommend you take MRCP PACES as your very last hurdle. Refer to my recent post on when to take PACES for more info.
With Parts 1 and 2 written, consistently working through hundreds of practice questions and diligently absorbing current guidelines seems to be the key to success.
Unfortunately for MRCP PACES this tactic is unlikely to succeed.
The exam consists of five 20-minute clinical stations each separated by a 5-minute break:
Station 1 – Respiratory 10 minutes; Abdominal 10 minutes
Station 2 – History taking 20 minutes
Station 3 – Cardiovascular 10 minutes; Neurology 10 minutes
Station 4 – Communication skills and ethics 20 minutes
Station 5 – Brief clinical consultation 1 10 minutes; Brief clinical consultation 2 10 minutes
The entire duration of MRCP PACES is 2 hours and 5 minutes but hopefully you can comfort yourself by comparing it to the 9-hour Part 2 Written exam! In the actual exam, two hours will feel like 10 minutes with the worst part often being the awkward small talk with other similarly nervous medics.
In contrast to the written exams, you cannot pass with reading alone. Let’s crack on with my top three tips on how to pass MRCP PACES.
3 Top Tips For Passing MRCP PACES
Firstly find a practice partner or group at the earliest opportunity and begin
hunting searching on the wards for interesting cases but remember not to neglect common cases like pleural effusions and rheumatoid arthritis. Generally it’s better to find people who are similarly or more motivated than you so you’re held accountable or feel guilty if you don’t turn up for a session.
Secondly, as with the written parts, you’ll need plenty of practice for every step of the exam. Ensure you have an automatic system of introducing yourself, washing your hands and putting the patient or actor at ease so this will come out naturally during the exam when the pressure will be x100.
I cannot stress how important this is but you must ensure you’ve performed at least 10 full examinations of each ‘system’ before attempting the exam. For the first few, take your time and double check you haven’t missed any pertinent steps before beginning to time your examinations. Remember that 1-minute examinations on ward rounds do not count! It isn’t mandatory to direct these at patients with pathology – the aim of this exercise is to ingrain the motions until they become automatic like signaling and checking the mirrors before you change lanes on a busy motorway.
Remember that only if the above becomes automatic can you then stand a chance and concentrate on the more difficult aspects of the exam such as detecting physical signs and formulating a diagnosis. If your mind is preoccupied with what follows tone and power in neurology or you cannot remember the correct way to assess a collapsing pulse then you should probably save your £657 exam fee until the next diet.
Finally, don’t neglect repetitive practice of presentation after each patient encounter. Ironically, most candidates feel comfortable with this aspect of the exam as they believe they have enough experience from their daily clinical work on ward rounds and discussing referrals with other specialties.
The problem with this is that presenting patients on a consultant ward round is becoming an ever rarer occurrence. In general, newer consultants, especially in Scotland, prefer to read notes and would rather ask specific questions such as “What did PT say?” than listen to the senior house officer talk for 2 – 3 minutes. I’m sure you’ll agree that discussing referrals on the phone whilst having all the notes and observations in front of you is a very different animal from being interrogated by two professors with clipboards.
If you’re a quiet person like me and find that you rarely have or want the opportunity to present patients then a good place to start is with this series. Read each scenario (set yourself a reasonable time limit) and begin presenting to yourself either in a quiet room or in front of the mirror. Assess yourself in terms of eye contact, body language, volume of speech and continuation of speech i.e. stuttering or pauses.
You can then go one step further by recording each presentation on a dictaphone. Play it back and critique yourself. This is the one I used for MRCP PACES that does the job well.
This is essentially how I achieved very fluent presentation skills for this exam and went on to pass PACES on my first attempt.
When you’re ready, combine all of the above and start presenting cases in front of ward patients and two other candidates whilst under strict exam conditions. Good luck!
If you liked this article make sure you check out How to Pass MRCP PACES in 8 Weeks as it will take you through your next and final hurdle. The reason an entire new guide has been written about this mammoth clinical exam reflects the different skills and attitude you need when tackling MRCP PACES. Instead of simply relying on reading textbooks, you’ll need to utilise a concept called the PACES Triangle to successfully navigate the examiners’ obstacles.