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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

Carousel of PACES stations


Clinical SkillSkill Descriptor 
APhysical ExaminationDemonstrate correct, thorough, systematic (or focused in Station 2&5 encounters), appropriate, fluent, and professional technique of physical examination.
BIdentifying Physical SignsIdentify physical signs correctly, and not find physical signs that are not present.
CClinical CommunicationElicit 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.
DDifferential DiagnosisCreate a sensible differential diagnosis for a patient that the candidate has personally clinically assessed.
EClinical JudgementSelect 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.
FManaging Patients' ConcernsManaging 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.
GMaintaining Patient WelfareTreat 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:

StationEncounterSkills Assessed
1Respiratory examinationA:B:D:E:G
2ConsultationAll seven
3Cardiovascular examinationA:B:D:E:G
3Nervous System examinationA:B:D:E:G
4Abdominal examinationA:B:D:E:G
5ConsultationAll 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:

StationEncounterDuration of encounterDownload sample scenarios


Respiratory examination

10 minutes

10 minutes

2Consultation20 minutesExample Consultation scenarios

Cardiovascular examination

Neurological examination

10 minutes

10 minutes



Abdominal examination

10 minutes

10 minutes

Example communication scenarios
5Consultation20 minutesExample Consultation scenarios
 Total time125 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 examinationStation 3
Abdominal system examinationStation 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.