PACES examination format

Candidates are marked on clinical skills at each encounter in the examination.

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 (see below), until they have completed the cycle. There is a 5-minute period between each station. More details about how the exam runs on the day are available in the Exam Preparation section with some sample scenarios.

Carousel of PACES stations

PACES carousel

Skills

The skills are:

  Clinical Skill Skill Descriptor

A

Physical Examination Demonstrate correct, thorough, systematic (or focused in Station 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 (or focused in Station 5 encounters), 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 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 the skills are assessed at each encounter, as per the table below:

Station Encounter Skills Assessed
1 Respiratory A:B:D:E:G
1 Abdomen A:B:D:E:G
2 History C:D:E:F:G
3 Cardiovascular A:B:D:E:G
3 Nervous System A:B:D:E:G
4 Communication C:E:F:G
5 New Station 5 (1) All seven
5 New Station 5 (2) All seven

Mark scheme

Ten examiners will independently assess the candidate, two at each of the five stations. For each of the eight encounters they will complete a marksheet. Candidates are assessed at each encounter on seven skills. Each skill is graded Satisfactory (2 marks), Borderline (1 mark) or Unsatisfactory (0 marks). Examiners review the cases beforehand in the process known as calibration. This involves examining the patients at stations 1, 3 and 5, and establishing criteria for a satisfactory grade.

Patient encounters

An encounter is an interaction with a patient or surrogate. Stations 2 and 4 involve one encounter, whereas stations 1, 3 and 5 have two encounters. There are therefore a total of eight encounters throughout the exam.

The encounters are organised in stations:

Station Encounter Duration of examiner-to-candidate contact Download sample scenarios
1
  • respiratory system examination
  • abdominal system examination

10 minutes


10 minutes

 
2
  • history-taking skills
20 minutes Station 2 example scenarios
3
  • cardiovascular system examination
  • nervous system examination

10 minutes


10 minutes

 
4
  • communication skills and ethics
20 minutes Station 4 example scenarios
5
  • integrated clinical assessment
    • brief clinical consultation 1
    • brief clinical consultation 2

10 minutes

10 minutes

Station 5 example scenarios
  Total time 125 minutes (including 5 minutes between each station)  

The sample scenarios are provided to help candidates who are preparing to sit PACES. 
 

Stations 1 and 3

These are known as the “physical examination” stations. 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, the candidate will receive written instructions as to what is required of him/her, for example:

Example of written instructions to the candidate at the cardiac station

This 45-year-old woman is thought to have a heart murmur. She is short of breath on exercise. Please palpate and auscultate her heart, and tell the examiners what signs you find, and discuss your proposed management.

The features are as follows:

  • 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
  • there are written instructions for each case
  • 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,
  • construct a differential diagnosis,
  • deal with concerns the patient may have,
  • 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 5-minute interval before the station
  • 14 minutes are allowed for the history-taking, followed by a 1-minute period of reflection followed by 5 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.

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 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.

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 1 minute to reflect, followed by 5 minutes for discussion (after the patient has left the station)
  • each examiner has a structured marksheet for the case.

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 5-minute interval before this station
  • the two examiners are present throughout
  • for each case, 8 minutes are given with each patient to take a focused 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.