The MRCP(UK) Part 2 Clinical Examination (Practical Assessment of Clinical Examination Skills – PACES) is designed to test the clinical knowledge and skills of trainee doctors who hope to enter higher specialist training at ST3. Trainees must have passed the Part 1 written examination within the last seven years before taking PACES.
PACES is a half-day examination which takes place in a clinical setting such as a hospital or skills centre. The exam tests seven core skills over five stations, each with two independent examiners. Each station lasts for 20 minutes, with a 5-minute preparation window between each. The candidate will demonstrate their abilities when working with a patient encounter.
The PACES exam covers the following seven core skills:
- Physical Examination (A), during which candidates must demonstrate a thorough and systematic physical examination technique;
- Identifying Physical Signs (B), during which candidates must correctly identify signs, and not identify any which are not present;
- Clinical Communication (C), during which candidates must gather a fluent and professional clinical history;
- Differential Diagnosis (D), during which candidates must create a sensible diagnosis for a patient they have assessed;
- Clinical Judgement (E), during which candidates must negotiate or select an appropriate management plan for a patient or situation, and apply clinical knowledge, including that of law and ethics, to the case;
- Managing Patient’s Concerns (F), during which candidates must identify and manage a patient’s concerns by listening to them or their relatives, and demonstrate empathy; and
- Managing Patient Welfare (G), during which candidates must treat patients and relatives respectfully, and ensure they are comfortable, safe, and treated with dignity.
An encounter is when a candidate interacts with a patient or a surrogate. Stations 2 and 4 involve one encounter, whereas stations 1, 3 and 5 have two encounters. There is therefore a total of eight encounters throughout the exam, assessing the following core skills:
- Respiratory, and Abdomen – A B D E G;
- History – A B D E G;
- Cardiovascular, and Nervous System – A B D E G;
- Communication – C E F G; and
- New Station, Parts 1 & 2 – A B C D E F G,
Stations 1 & 3
Stations 1 & 3 are the physical examination stations, all with an emphasis on
- demonstration of a comprehensive and correct physical examination technique,
- ability to detect physical signs,
- ability to construct a differential diagnosis,
- capacity to suggest sensible and appropriate treatment and investigation plans, and
- ability to treat a patient with dignity and respect.
The candidate will read instructions on upcoming cases before entering the station. They will then spend 10 minutes with each patient, with a maximum of six minutes allowed for the examination, and a minimum of four for questioning from the examiners.
Station 2 is the history-taking skills station, which examines a candidates’ ability to
- gather data from the patient,
- construct a differential diagnosis,
- deal with concerns the patient may have, and
- construct a management plan and explain it to the patient clearly, and to treat the patient with dignity and respect.
Candidates will study a GP referral letter during the 5-minute interval, and then allowed 14 minutes for history-taking. The candidate will then conduct a one-minute reflection period, and five minutes of discussion with the examiners.
Station 4 is the communication skills station, which aims to asses a candidate’s ability to
- guide and organise the interview with the subject,
- explain clinical information,
- apply clinical and ethical knowledge to the management of the case or situation,
- provide emotional support, and
- treat the patient with dignity and respect.
Candidates consult written instructions before the station and spend 14 minutes on the patient interaction. The candidate will then conduct a one-minute reflection period, and five minutes of discussion with the examiners.
Station 5 is an integrated clinical assessment station and aims to assess how a candidate approaches a clinical problem – including their history-taking, examination, and communication skills. Each candidate reads instructions on both cases, then spends eight minutes with each patient. The candidate then spends two minutes describing the positive physical findings, and giving a diagnosis.
Although dates vary slightly year on year, applicants must attend the date for which they registered. Current upcoming dates for PACES may be found in the table below.
|Exam||Application Period||Assessment Period||Fee
|2018/3||23 July - 6 August 2018||29 September - 2 December ||£657
Additional dates, including those for international applicants, may be found here.