PACES carousel
The new format of the exam, detailed below, will be introduced from the third Diet of 2023.
You will be marked at each of the five clinical stations, assessed by two independent examiners. You can start at any one of the stations and move to the next every 20 minutes until you have completed the cycle. There is a 5-minute period between each station.
Carousel of PACES stations
Skills
| Clinical Skill | Skill Descriptor | |
| A | Physical Examination | Demonstrate correct, thorough, systematic (or focused in Station 2&5 encounters), appropriate, fluent, and professional technique of physical examination. |
| B | Identifying Physical Signs | Identify physical signs correctly, and not find physical signs that are not present. |
| C | Clinical Communication | Elicit a clinical history relevant to the patient’s complaints, in a systematic, thorough, fluent and professional manner. Explain relevant clinical information in an accurate, clear, structured, comprehensive, fluent and professional manner. |
| D | Differential Diagnosis | Create a sensible differential diagnosis for a patient that the candidate has personally clinically assessed. |
| E | Clinical Judgement | Select or negotiate a sensible and appropriate management plan for a patient, relative or clinical situation. Select appropriate investigations or treatments for a patient that the candidate has personally clinically assessed. Apply clinical knowledge, including knowledge of law and ethics, to the case. |
| F | Managing Patients' Concerns | Managing Patients' Concerns Seek, detect, acknowledge and address patients’ or relatives’ concerns. Listen to a patient or relative, confirm their understanding of the matter under discussion and demonstrate empathy. |
| G | Maintaining Patient Welfare | Treat a patient or relative respectfully and sensitively and in a manner that ensures their comfort, safety and dignity. |
Different numbers and combinations of skills are assessed at each encounter, as per the table below:
| Station | Encounter | Skills Assessed |
| 1 | Communication | C:E:F:G |
| 1 | Respiratory examination | A:B:D:E:G |
| 2 | Consultation | All seven |
| 3 | Cardiovascular examination | A:B:D:E:G |
| 3 | Nervous System examination | A:B:D:E:G |
| 4 | Communication | C:E:F:G |
| 4 | Abdominal examination | A:B:D:E:G |
| 5 | Consultation | All seven |
Mark scheme
You will be assessed by ten examiners, two at each of the stations. For each of the eight encounters they will complete a marksheet assessing a combination of skills. Each is graded Satisfactory (2 marks), Borderline (1 mark) or Unsatisfactory (0 marks). Examiners will review the patients at all 5 stations to establish the criteria for a satisfactory grade. This is known as calibration.
Patient encounters
An encounter is an interaction with a patient or surrogate. Stations 2 and 5 involve one encounter, whereas stations 1, 3 and 4 have two encounters. There are therefore a total of eight encounters throughout the exam organised into stations:
| Station | Encounter | Duration of encounter | Download sample scenarios |
| 1 | Communication Respiratory examination | 10 minutes 10 minutes | |
| 2 | Consultation | 20 minutes | Example Consultation scenarios |
| 3 | Cardiovascular examination Neurological examination | 10 minutes 10 minutes | |
| 4 | Communication Abdominal examination | 10 minutes 10 minutes | Example communication scenarios |
| 5 | Consultation | 20 minutes | Example Consultation scenarios |
| Total time | 125 minutes (including 5 minutes between each station) |
Stations 1 and 4 Communication encounters:
The communication encounters aim to assess your ability to:
- guide and organise the interview with the subject (who may be a patient, relative, or surrogate, such as a healthcare worker)
- explain clinical information
- apply clinical knowledge, including knowledge of ethics, to the management of the case or situation
- provide emotional support
- treat the patient with dignity and respect.
The station features:
- written instructions for the case are given to the candidate during the five-minute interval before this station
- 10 minutes are allowed for the patient interaction. There will be no examiner-candidate interaction. Marks will be based on examiner observation alone
Stations 2 & 5 Consultation:
These 2 stations aim to assess the way in which the candidate approaches a clinical problem in an integrated manner, using history-taking, examination, and communication with a patient or a surrogate. On some occasions the history will be delivered by a surrogate on behalf of the patient. Alternatively the patient may provide the history. One of these stations is likely to be a patient with an acute presentation whilst the other is likely to be less acute.
The station features:
- written instructions for the case, usually in the form of a short note or referral letter given to the candidate during the 5-minute interval before this station.
- for each case, 20 minutes are given with each patient to take a detailed history, carry out a relevant examination, and respond to the patient’s concerns. 15 minutes will be allowed for history taking, examination and discussion with the patient followed by a 5 minute question and answer with a lead examiner.
Clinical System examination
| Respiratory system examination | Station 1 |
| Cardiovascular and neurological systems examination | Station 3 |
| Abdominal system examination | Station 4 |
These are known as the “physical examination” encounters. The emphasis in these stations is on the:
- demonstration of a comprehensive and correct physical examination technique
- ability to detect physical signs
- ability to construct a differential diagnosis
- ability to suggest sensible and appropriate treatment and investigation plans
- ability to treat a patient with dignity and respect.
Before seeing each case, you will receive written instructions as to what is required for example:
Example of written instructions to the candidate at the cardiovascular station
This 45-year-old woman is short of breath on exercise. Please examine her cardiovascular system
The station structure is that;
- 10 minutes are spent with each patient
- for each case, a maximum of 6 minutes are allowed for the physical examination, followed by a minimum of 4 minutes for questioning from the examiners.
You will be expected to differentiate normal from abnormal findings. Examiners and candidates are reminded that the inclusion of a patient with no abnormal findings is permissible.