Two problems with MRCP PACES and how you can use them to your advantage

No exam is ever going to be perfect and I’m sure you’ve noticed the constant stream of errors  high schools and universities make when organising and setting exam papers. Clinical exams such as OSCEs and PACES are even more complicated and heavily rely on numerous people (clinical skills staff, examiners and patients) working hard to try and make the day work out. I certainly learnt this the hard way being the organising registrar for the PACES diet at my hospital last week!

Here are two problems I perceive to be inherently wrong with MRCP PACES and how you can take advantage of each to improve your chances of passing.

MRCP PACES doesn’t reflect real life

As a FY1 in 2012 I was terrified of the medical high dependency unit. I had very little knowledge, was completely out of my depth and couldn’t even gain peripheral intravenous access properly, let alone do the complex procedures required by sick patients.

It probably took me until CT2 before I become slightly more comfortable managing complex patients with multiple comorbidities. Although I can now insert arterial lines, central venous catheters and chest drains with relative ease, very complicated patients still stress me out. Especially the ones with great tomes for their notes.

The fact is that medical patients are very complicated. The population is becoming more and more elderly and with age normally follows ailments. It’s very common to see a patient with at least 3 or 4 co-existing conditions and a list of ten or more medications.

The good news is that in MRCP PACES patients tend to only have 1 or 2 conditions plus a couple of medications because there is no time for complexity.

This is great news. Immerse yourself in the acute take whenever you can and try to familiarise yourself with common conditions. If a real life patient has two conditions such as rheumatoid arthritis and peripheral neuropathy, use this opportunity to hit two birds with one stone.

Not only is the exam easier than real life, you’ll also have more opportunity to study specific conditions due to the complexity of our acute takes.

Relax, MRCP PACES isn’t ALS

Another piece of good news is that PACES isn’t advanced life support. You’ve already passed ALS so don’t worry. That actually reminds me to renew mine since it was 4 years ago…

Anyway that is MRCP PACES – you won’t get a MHDU patient with stage 3 acute kidney injury and severe septic shock requiring inotropes on a background of recent MI and pulmonary fibrosis. Your PACES patient probably won’t have a cardiac arrest I hope.

It’s very important to remember this point because regardless of what situation comes up, you can reassure yourself that you have plenty of time. You don’t have to act now.

If the examiner is stressing you out, simply pause, take a deep breath and smile. In one of my stations I gave a very silly answer to the examiners but I refused to panic. Instead I immediately paused, apologised and asked to start again and ended up acing that station.

If you’re not happy with an answer or you messed up an examination technique then just apologise to the examiner, smile and ask for a second chance. In some ways, it’s far easier than a driving test!

If you’ve passed the written exams then How to Pass MRCP PACES in 8 Weeks 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.

Image by Melinda Harr Dental