PACES 2020

As a consequence of the ongoing global COVID-19 situation the introduction of the new PACES 2020 examination has been further delayed. Further updates will be provided once an implementation date has been confirmed, and sufficient notice (a minimum of two diets) will be given to allow candidates to adequately prepare for the change of format.

The examination will still test the same clinical skills, and there will still be five stations.  However, some of the encounters are changing – more details of this are provided below.

Why are we changing the examination?

Postgraduate medical education has undergone significant changes in the ten years since the current MRCP(UK) Part 2 Clinical Examination (Practical Assessment of Clinical Examination Skills), commonly known as PACES, was introduced. The new Internal Medicine Curriculum, Shape of Training and other reviews have helped us to better understand the competences required of doctors in the 21st century. 

The changes to PACES are the product of a 12 month review of the examination by MRCP(UK) to ensure that it remains fair, relevant and fit for purpose. The changes build on the current format but develop some elements to make them more realistic for examiners and trainees. It now better reflects the new Internal Medicine stage 1 curriculum, developed by the JRCPTB on behalf of the Federation of the Royal Colleges of Physicians. The curriculum, implemented in August 2019, is designed to produce doctors with the generic professional and clinical capabilities needed to manage patients presenting with a wide range of general medical symptoms and conditions and holistic decisions on progress will be made for high level capabilities in practice.

What is being removed?

1. Station 2
The history-taking station was considered to be artificial with structured history-taking skills being tested in isolation and not representative of modern practice.
2. Station 4
20 minutes for a single communication and ethics encounter was felt to be rather long and in particular, the five-minute examiner/candidate interaction added little value to the overall assessment.
3. Station 5
Testing all seven skills in an integrated manner was very like real life but was very pressured in 10 minutes.

What is being introduced?

1. Communication 
Two 10-minute communication encounters. These will no longer include a question and answer section with the examiners. Instead, the encounter will be judged on observation alone.
2. Consultations
Two 20-minute clinical consultations will assess candidates across all seven skills in a realistic and integrated manner. Candidates will have 15 minutes to take a structured history, examine the patient, explain the likely diagnosis and management and address any questions or concerns raised. There will then be a five minute question and answer section with the examiners. 
3. Encounter sequencing across the carousel
The new carousel will alter the sequencing of the encounters through the carousel. Some stations will include physical examination and communication encounters. This will ensure that examiners at each station contribute more judgements in each of the skills for each candidate, improving the reliability of the exam.

This is best illustrated by the following diagram:

What is next?

We will be providing a comprehensive range of resources for candidates and examiners to ensure that they are prepared for the new format of PACES. These will include informative videos of the new encounters, an examiner webinar, written guidance and attendance at events and training days. 

UK trainees should now start discussing with their educational supervisors when they plan to sit PACES.