This page contains information on the changes we have made to the UK PACES as a consequence of COVID-19. We have a few helpful videos for you to watch and some guidance on remote stations 2 and 4.
International candidates will continue to sit the previous carousel format of the exam.
PACES during COVID-19
Changes to mini carousel stations 1, 3 and 5
Mini carousel stations 2 and 4
Infection control during the exam
Stations 1, 3 and 5
Stations 1, 3 and 5 will run as a mini carousel, retaining the existing format, using real patients and assessing the same seven skills as before. The content and timing of the stations will be unchanged but additional time will be added between the clinical encounters to permit the donning and doffing of PPE and for items such as stethoscopes to be cleaned.
Remote stations 2 and 4
Stations 2 and 4 will, together with a 20 minute rest station, form part of a 3 station mini-cycle. This will run in the same centre and on the same day as the other mini-cycle, which consists of stations 1,3 and 5. These two mini-cycles may be sat in any order.
The timings for the actual encounters in the 2,4, rest mini-cycle remain unchanged but there may well be additional time before or between encounters to allow for cleaning or IT checks etc. As before, there will be 5 minutes reading time in advance of the station, 14 minutes with the patient/surrogate, 1 minute reflection and 5 minutes questioning from the examiners. The skills tested at these stations are unchanged and will be assessed in the same way as usual
These stations will be run remotely. You will interact with the patient or surrogate via video link, and your questioning from the examiners will also be via video link.
Many of you will have become familiar with telephone and video consultations since the start of the Covid-19 pandemic. The skills required are the same as for face to face consultations, but the remote nature of the consultation means that you may need to modify your approach. Here are some hints and tips to help you perform well in the remote stations 2 and 4.
Infection control measures will have taken place before you enter the room. There will be an administrator on hand to deal with any issues that may arise. The computer, camera and microphone will already have been set up and tested before you enter the room, but do take a few seconds to ensure that the patient /surrogate can see and hear you and vice versa. If there are any problems with this, please bring them to the attention of the administrator immediately. You will not have to do any of the setting-up yourself.
Adjust your position so that your head is central in the patient’s view. The patient should be able to see your facial expressions without straining, and preferably also your hands, as hand gestures are an important part of communication.
With some video platforms, or if bandwidth is an issue, there may be a small time delay in the system, or picture and sound may be out of synch, or the picture may periodically 'freeze'. Be aware of the danger of missing significant information because of these distractions. If in doubt, ask for clarification or repeat your question.
Introduce yourself and confirm the identity of the patient /surrogate and ask them what they would like you to call them. Tell the patient or surrogate to advise you if they are having difficulty hearing or seeing you.
Be aware of pacing cues – these are the verbal and non-verbal signals we give when conversing that show we are listening or wanting to interrupt. They include nods, facial expressions, noises like ‘uh-huh’ or ‘mmm’, and words like ‘right’ or ‘OK’. On a video link, these cues may not have their usual effect. Visual cues may be harder to see on screen. The other person’s speech over the link may not be as loud or as distinct as we are used to. If there is even a slight time lag between vision and sound, our ‘uh-huh’s and ‘mmm’s may become distracting interruptions. To minimise the effect of these problems:
- Try to make sure only one person is talking at a time.
- Keep your vocal cues to a minimum – a slow nod or a smile is better.
- Show your interest and attentiveness by eye contact and facial expression
- If you need to interrupt the patient/surrogate, try a visual signal such as raising your hand
- Rapid gestures or body movements can be distracting – try to slow them down.
If you want to make eye contact with the patient/surrogate, remember to look at the webcam, not at the image of the patient’s face on the screen.
In a video consultation, it helps the patient/surrogate if you ‘signpost’, i.e. tell them what you want to do or say next, and why. E.g. ‘Now I’d like to ask you some questions to see if this could be anything serious.’
Check for understanding
Before finishing, summarise the consultation’s main points, and ask the patient/surrogate if they have any questions, or if there is anything they would you like to explain again. Allow time for them to think before they answer.
Closing the consultation
Be particularly careful to summarise key points, since it's possible something could have been missed due to technical interference.
- Ask the patient if they need anything clarified.
- If possible, end with a friendly sign-off, e.g. ‘I’ve enjoyed talking with you. I hope that’s been helpful.’