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MRCP PACES Format: Five Stations and What Examiners Test

Specialty Exam Guides Internal Medicine

MRCP PACES Format: Five Stations and What Examiners Test

UK trainees: a clear guide to the current MRCP PACES format — five stations, eight encounters, timing, and what examiners score in each station.

The current MRCP(UK) Part 2 Clinical Examination (PACES) format is a five-station carousel with eight patient encounters, two independent examiners at each station, and a total running time of 125 minutes including the 5-minute intervals between stations. If you understand which of the seven scored skills are actually being tested at each encounter, your preparation becomes much sharper: you stop revising for a vague clinical exam and start rehearsing the exact behaviours the examiners can mark.

Why the format matters

A lot of older PACES advice is now out of date. The Federation’s current PACES pages all refer to the new format introduced from the third diet of 2023; if a resource talks about a separate history-taking station or the old brief clinical consultation layout, it is describing an older carousel rather than the current exam.

Examiners do not mark by vague overall impression. They calibrate cases before the circuit starts, use station-specific marksheets, and judge you against the expected standard of an Internal Medicine trainee working with indirect supervision. That is why understanding the format is not admin trivia; it tells you what to practise, how long to spend, and what a satisfactory performance actually looks like.

MRCP PACES format at a glance

Here is the current carousel.

  • Station 1: Communication encounter (10 minutes) + Respiratory examination (10 minutes)
  • Station 2: Consultation (20 minutes)
  • Station 3: Cardiovascular examination (10 minutes) + Neurological examination (10 minutes)
  • Station 4: Communication encounter (10 minutes) + Abdominal examination (10 minutes)
  • Station 5: Consultation (20 minutes)

Stations 1, 3 and 4 each contain two encounters; Stations 2 and 5 each contain one 20-minute consultation, giving eight encounters in total. You move every 20 minutes, with a 5-minute interval between stations; the full cycle lasts 125 minutes.

That 5-minute interval matters. Before the Communication and Consultation stations you use it to read the written scenario, and the current candidate advice states that you may make notes and take them into the encounter. There is no comparable scenario-reading task before Station 3, so that interval is best used to reset and refocus.

The seven skills examiners score in the MRCP PACES format

The exam is built around seven core skills. In plain English, examiners are asking seven repeated questions.

  • A. Physical examination: Is your technique correct, fluent, appropriate and professional?
  • B. Identifying physical signs: Did you find the real signs, and avoid inventing signs that are not there?
  • C. Clinical communication: Can you take a relevant history and explain clearly, in language the patient or surrogate can understand?
  • D. Differential diagnosis: Can you build a sensible diagnosis from the patient you have actually assessed?
  • E. Clinical judgement: Can you choose appropriate investigations, management and next steps, including ethical reasoning where needed?
  • F. Managing patients’ concerns: Do you notice, acknowledge and address worries rather than talking past them?
  • G. Maintaining patient welfare: Are you respectful, safe, gentle and professional throughout?

The important pattern is this: communication encounters score C, E, F and G; physical examination encounters score A, B, D, E and G; consultation encounters score all seven skills. If you know that grid, you can tailor your practice properly.

Five stations: what examiners test and how to approach them

Station 1

Station 1 combines a 10-minute communication encounter with a 10-minute respiratory examination. In the communication half, there is no examiner-candidate interaction and marks are based on observation alone; in the respiratory half, you have up to 6 minutes for examination and at least 4 minutes for questioning.

What are examiners really testing here? First, can you run a structured, humane conversation under time pressure. Then, can you switch gear and produce a clean respiratory examination, identify signs accurately, and defend a sensible differential. Official communication samples include discussing tube feeding and hydration in severe dementia, or explaining a wrong-patient antibiotic error.

A useful rehearsal script for the communication half is: set the agenda -> find out what the person understands -> explain clearly -> address concerns early -> agree a plan. In the respiratory half, practise saying your findings out loud in one crisp summary before you launch into differentials.

Station 2

Station 2 is a 20-minute Consultation. The current format gives you 15 minutes with the patient or surrogate to take a relevant history, perform a focused examination, discuss the problem and respond to concerns, followed by 5 minutes of questions with a lead examiner.

This is where candidates often underperform by treating the case as either a history station or a mini long case. It is neither. Examiners want an integrated consultation: focused information gathering, a relevant examination, a reasoned differential, and a plan the patient can understand. In the official sample material, that means handling cases such as haemoptysis with suspected bronchiectasis or nausea and anorexia with abnormal liver function tests while still addressing the patient’s fear of cancer or other serious disease.

A strong consultation structure is: open broadly -> narrow intelligently -> examine with purpose -> state the leading diagnosis plus serious alternatives -> explain investigation and initial management -> check concerns and safety-net. That sounds simple, but it maps neatly to all seven skills.

Station 3

Station 3 contains cardiovascular and neurological physical examination encounters, each lasting 10 minutes. This is classic PACES sign-detection territory: technique, identification of signs, differential diagnosis and clinical judgement, all under tight timing.

The trap here is doing a beautiful but overlong examination and leaving no time for interpretation. The examiners need to hear what you found, what you think it means, and what you would do next. In other words: not just hands, but brain.

Station 4

Station 4 mirrors Station 1 in shape: a 10-minute communication encounter followed by a 10-minute abdominal examination. The communication half again tests explanation, ethics, judgement, empathy and professionalism rather than raw medical recall alone.

This is a good station to remember that communication in PACES is not a soft extra. In the official sample material, scenarios include difficult conversations where candour, responsibility and emotional handling matter. The current preparatory advice also recommends that, toward the end of the communication encounter, you sum up what has been agreed and confirm a way forward, because that helps examiners assess your clinical judgement as well as your communication.

Station 5

Station 5 is the second 20-minute Consultation. Official guidance says that one of the two consultation stations is likely to involve a more acute presentation and the other a less acute presentation, so you should expect a different tempo and emphasis rather than a repeat of Station 2.

The official examples show how broad this can be. One sample consultation involves a 64-year-old man with worsening breathlessness after previous myocardial infarction, where the task is to take a targeted history, perform a focused examination, separate likely from dangerous causes, and answer questions about cancer or serious heart disease without false reassurance.

Fast frameworks that fit the marksheet

You do not need a different personality for each station. You need a station-specific framework that helps you show the right skill cluster. The marksheets reward structure.

Communication encounters

Use:

  • set the purpose
  • check prior understanding
  • explain in plain English
  • pause for concerns
  • acknowledge emotion
  • agree next steps

That helps you cover Clinical Communication, Clinical Judgement, Managing Patients’ Concerns, and Maintaining Patient Welfare.

Consultation encounters

Use:

  • open with the main problem
  • take a focused history driven by the referral and the red flags
  • examine only what is relevant
  • state your leading diagnosis and important alternatives
  • explain investigations and initial treatment
  • check worries, preferences and practical questions

That is how you show the examiners that you can integrate all seven skills rather than performing them in fragments. Official examiner guidance in the sample consultations explicitly expects a history broad enough to explore alternatives, a management plan agreed with the patient, and time given for questions before closure.

Physical examination encounters

Use:

  • expose properly and respectfully
  • perform the core examination fluently
  • present the key signs clearly
  • give the most likely diagnosis first
  • add sensible alternatives
  • suggest relevant investigations and initial management

The preparation material repeatedly stresses two points here: do not examine through clothing, and do not claim signs you did not find. Those are reliable ways to lose marks.

Common mistakes

The official preparation material and sample cases point to the same failure patterns again and again.

  • Revising from pre-2023 station maps instead of the current five-station carousel.
  • Using the consultation station to prove your first hunch rather than explore realistic alternatives.
  • Missing the patient’s or relative’s main concern until the last 30 seconds.
  • Giving false reassurance when a serious diagnosis is still on the table.
  • Reporting physical signs that are not present.
  • Examining through clothing or with poor exposure.
  • Finishing a communication station without a clear summary and agreed plan.
  • Spending so long on examination technique that you leave too little time for interpretation.

If you want one practical rule, make it this: every mock should end with the question, “Which skill did I fail?” not just, “Did that feel okay?”

Practice workflow

Base your mocks on the official sample scenarios and official marksheets, not on random cases from group chats. The Federation provides sample communication and consultation material as well as station-specific marksheets, so you can rehearse against the same domains examiners use.

A realistic workflow for a busy trainee looks like this:

  • Twice a week: one 10-minute communication case and one 10-minute system examination with a hard timer.
  • Once a week: one full 20-minute consultation plus a 5-minute examiner question phase.
  • Every 1 to 2 weeks: a half-carousel or full-carousel mock to practise transitions, fatigue and recovery after a bad station.
  • After every mock: score yourself against the seven skills, then write one thing to keep, one thing to stop, and one thing to change next time.
  • In the final month: prioritise fluency, timing, and clarity over collecting yet more rare cases.

If your study group is short of time, practise by encounter type rather than by specialty silo. That is much closer to how this exam is marked.

Summary

  • Learn the current MRCP PACES carousel: five stations, eight encounters, 125 minutes.
  • Remember the skill clusters: communication encounters score C/E/F/G; physical examination encounters score A/B/D/E/G; consultations score all seven.
  • Station 2 and Station 5 are integrated consultations, and one is likely to feel more acute than the other.
  • Use the 5-minute reading time well. In communication and consultation stations, you can make short notes and carry them in.
  • Debrief against the seven skills, because that is how examiners think.

References

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