Examination Format

Summary

The PACES carousel

The PACES examination consists of five clinical stations, each assessed by two independent examiners. Candidates will start at any one of the five stations, and then move round the carousel of stations, at 20 minute intervals (Figure 1), until they have completed the cycle. There is a five-minute period between each Station.

Only one of the Stations, Station 5, will change in the new format of the examination.

Figure 1 : The carousel of PACES stations

Stations 1 and 3

These are often known as the “physical examination” stations. The emphasis in these stations is on the demonstration of comprehensive and correct physical examination technique, the ability to detect physical signs, the ability to construct a differential diagnosis, the ability to suggest sensible and appropriate treatment and investigation plans, and the ability to treat a patient with dignity and respect.

Before seeing each case, the candidate will receive written instructions as to what is required of him/her (see Figure 2).

Figure 2: 

The features are as follows:

• ten minutes are spent with each patient (see Figure 1)
• 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
• there are written instructions for each case (see Figure 2)
• each examiner has a structured marksheet for the case
• every candidate on the carousel will be examined by the same two examiners at each station.

Candidates will be expected to differentiate the normal from the abnormal appearances of the optic fundus. Examiners and candidates are reminded that the inclusion of a normal optic fundus in Station 5 is permissible.

Station 2

The history-taking skills station aims to assess the candidate's ability to gather data from the patient, to construct a differential diagnosis, to deal with concerns the patient may have, and to construct a management plan that is explained to the patient clearly, and to treat the patient with dignity and respect.

The features are: 

• written instructions for the case, usually in the form of a letter from the patient's GP are given to the candidate during the five-minute interval before the station
• 14 minutes are allowed for the history-taking, followed by a 1-minute period of reflection  followed by five minutes for discussion with the examiners 
• the two examiners are present throughout observing the interaction with the patient. Each examiner has a structured marksheet for the case.

Download sample scenarios 

Station 4

The communication skills and ethics station aims to assess the candidate's ability to guide and organise the interview with the subject (who may be a patient, relative, or surrogate, such as a health care worker), explain clinical information, apply clinical knowledge, including knowledge of ethics, to the management of the case or situation, provide emotional support and treat the patient with dignity and respect.

Other features are as follows:

• written instructions for the case are given to the candidate during the five-minute interval before this station
• the two examiners are present throughout
• 14 minutes are allowed for the patient interaction, followed by one minute to reflect, followed by five minutes for discussion (after the patient has left the station)
• each examiner has a structured marksheet for the case.

Download sample scenarios

Station 5

The integrated clinical assessment station aims 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 patient. Other features are as follows:

• written instructions for each of the two cases, usually in the form of short notes or referral letters are given to the candidate during the five minute interval before this station.
• the two examiners are present throughout
• for each case, 8 minutes are given with each patient to take a focussed history, carry out a relevant examination, and respond to the patient’s concerns. Two minutes are for describing the positive physical findings and to give your preferred diagnosis and any differential diagnosis (after the patient has left the station)
• each examiner has a structured marksheet for the case.

Download sample scenarios
 

Marksheets

Each candidate receives structured marksheets for each station prior to the start of the PACES examination. The candidate has to complete the same details (i.e. add his/her personal information) and then hand the appropriate sheets to the examiners at each station. In the event of failing the examination, the marksheets will form the basis for feedback to the candidate.