Registration & Pathways
MRCP PACES Overview and Preparation Strategy | Membership of the Royal College of Physicians
Dec
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For IMGs who aim to pursue specialist training in the UK, there is one unavoidable milestone: passing the MRCP (Membership of the Royal College of Physicians) examination conducted by the Royal College of Physicians (RCP).
The MRCP is the standard postgraduate certification pathway for internal medicine and consists of the following three stages:
- MRCP Part 1 (Written examination)
- MRCP Part 2 (Written examination)
- MRCP PACES (Clinical examination)
Among these three steps, the final stage — PACES (Practical Assessment of Clinical Examination Skills) — is widely regarded as the most challenging.
In this article, we provide a comprehensive overview of MRCP PACES and practical strategies for exam preparation.
MRCP PACES Overview
The MRCP PACES examination is conducted at centers worldwide. Candidates are not required to travel to the UK — in nearby regions, it may be taken in locations such as Hong Kong, Malaysia, and Singapore.
Exams are held two to three times per year, depending on the test center. Examination fees are:
- £698 for candidates testing within the UK
- £1,397 for candidates testing overseas
The purpose of PACES is to confirm that candidates can understand and practically manage conditions commonly encountered during specialty training. Therefore, the exam uses a face-to-face OSCE-style format that assesses practical clinical competence.
Detailed Examination Format
To visualize the overall structure:
Candidates rotate through five stations, each lasting 20 minutes. Some stations are divided into two 10-minute segments, meaning candidates interact with a total of eight patients throughout the exam cycle.
There is a 5-minute rest period between stations, and each station is assessed by two examiners.
Station Structure and Content
The examination is organized into the following station types:
Physical Examination Stations (4 stations)
- Clinical Examination (6 minutes)
Clinical examination focused on one major organ system. - Viva (4 minutes)
Discussion covering examination findings, diagnosis, and management plans.
Communication Stations (2 stations)
- Total duration: 10 minutes
- Topics include:
- Breaking bad news
- Motivating behavioral change
- Ethical and legal dilemmas
Consultation Stations (2 stations)
- Consultation (15 minutes)
Targeted history-taking, focused examination, and explanation of diagnosis and next steps to the patient. - Viva (5 minutes)
Summary, differential diagnoses, and management discussion.
PACES is designed to reflect the multifaceted skill set required of 21st-century physicians, evaluating not only medical knowledge, but also communication ability, diagnostic reasoning, and patient-centered care.
Recent Changes to PACES
In response to evolving medical education standards, a new examination format was introduced in 2023. Key changes include:
- Removal of former Station 2 (history-taking skills only)
- Removal of former Station 4 (communication and ethics interviews)
- Removal of former Station 5 (seven skills assessed within 10 minutes)
New additions:
- Two 10-minute Communication Stations (observational communication assessment)
- Two 20-minute Consultation Stations (integrated assessment across all seven skills)
These changes preserve the core clinical assessment objectives while better aligning the exam with modern physician competencies.
Due to pandemic-related delays, full implementation occurred beginning with the third diet of 2023. (Singapore candidates transitioned to the new format in early 2024.)
Marking and Scoring
PACES assesses candidates across seven skills (A–G):
- Skill A – Physical Examination
Stations 1, 3, 5 - Skill B – Identification of Physical Signs
Stations 1, 3, 5 (widely considered the most difficult skill to pass) - Skill C – Clinical Communication
Stations 2, 4, 5 - Skill D – Differential Diagnosis
Stations 1, 2, 3, 5 - Skill E – Clinical Judgement
All stations - Skill F – Addressing Patient Concerns
All stations - Skill G – Maintaining Patient Welfare
All stations
Each skill is graded as:
- Satisfactory
- Borderline
- Unsatisfactory
Examiners utilize standardized mark sheets containing structured descriptors to guide grading.
Performance at one station does not dictate outcomes at subsequent stations. Candidates are therefore advised to mentally reset during the 5-minute break before focusing fully on the next task.
The Seven Core Skills
Below is a targeted look at the competencies required:
Skill A: Physical Examination
- Practise comprehensive and efficient full-system examinations.
- Ensure all required anatomical areas are assessed methodically.
Skill B: Identification of Physical Signs
- Develop sharp observational skills.
- Interpret subtle findings and their clinical relevance accurately.
Skill C: Clinical Communication
- Rehearse diverse patient-facing scenarios.
- Communicate information clearly, compassionately, and confidently.
Skill D: Differential Diagnosis
- Build speed and accuracy in diagnostic reasoning.
- Justify decisions using structured clinical logic.
Skill E: Clinical Judgement
- Apply current guidelines and best practices.
- Make sound management decisions based on real clinical contexts.
Skill F: Addressing Patient Concerns
- Maintain a truly patient-centered approach.
- Respond respectfully to emotional or safety concerns.
Skill G: Maintaining Patient Welfare
- Prioritize patient safety and comfort in all encounters.
- Demonstrate ongoing attention to overall patient wellbeing.
Mastering these competencies substantially improves the likelihood of PACES success.
Examination Results
Results are published online approximately 15 days after the exam. Official release schedules are available on the Royal Colleges Federation website.
To pass PACES, candidates must:
- Achieve at least 130 points out of 172
- Meet the minimum standard across all clinical skills
Even if a candidate underperforms at a complete station, overall success is possible provided all core skills meet the pass threshold.
Scores are summarized using an official results matrix, a sample of which can be viewed below:
https://www.thefederation.uk/examinations/paces/marksheets
https://www.thefederation.uk/document/paces-marksheets-sample-2023
MRCP PACES Preparation Strategies
Because PACES is a highly practical examination, preparation is best conducted primarily through video-based learning and simulated practice rather than textbook study alone.
Below are three widely used preparation platforms for IMGs.
1. Pastest
Pastest provides:
- 125 patient cases
- 340+ PACES clinical videos demonstrating exemplary examination technique
- Downloadable PDF role-play materials
- Case podcasts featuring candidate presentations and examiner feedback
A built-in progress dashboard allows candidates to monitor readiness at each station and identify weaknesses efficiently.
2. Quesmed
Quesmed offers:
- 100+ clinical scenario videos
- A dedicated PACES reference textbook
- Direct advice and strategy tutorials from physicians who have successfully obtained MRCP
This platform provides grounded insights into real examination performance expectations.
3. SsAcademy
SsAcademy is a highly affordable India-based service, featuring:
- Coverage of all five stations across 32 modules
- 200+ clinical cases and over 100 scenarios
- 500+ hours of video instruction
Dr. Saha’s mentorship program offers structured coaching and strategy insights, forming a thorough curriculum for PACES mastery.
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Primary References
https://www.thefederation.uk/examinations/paces/exam-dates-and-fees
https://www.thefederation.uk/examinations/paces/marksheets
https://www.thefederation.uk/document/paces-marksheets-sample-2023
https://www.thefederation.uk/sites/default/files/MRCP%28UK%29%20PACES%2023-2%20feedback%20report.pdf
