What is MRCP PACES?
MRCP PACES (Practical Assessment of Clinical Examination Skills) is the final component of the MRCP(UK) diploma. It is a clinical examination that tests your ability to examine patients, interpret findings, communicate effectively, and manage clinical scenarios in real time.
Unlike written exams, PACES assesses you face-to-face with real patients and examiners. This makes it uniquely challenging — and uniquely rewarding to pass.
PACES Exam Format in 2026
The exam consists of 5 stations, each lasting between 10 and 20 minutes. You rotate through all stations in a single carousel. The 2026 format remains consistent with recent years:
| Station | Duration | What's Tested |
|---|---|---|
| Station 1: Respiratory & Abdominal | 20 min (10 min each) | Clinical examination of two systems |
| Station 2: History Taking | 20 min | Taking a focused history from a patient |
| Station 3: Cardiovascular & Neurological | 20 min (10 min each) | Clinical examination of two systems |
| Station 4: Communication Skills & Ethics | 20 min | Explaining, breaking bad news, consent |
| Station 5: Integrated Clinical Assessment | 20 min | Brief clinical assessment + management discussion |
Each station is marked by two examiners independently. You are scored across seven clinical skills domains.
The Seven Clinical Skills Domains
Every encounter is assessed against these domains, each scored on a scale of Satisfactory, Borderline, or Unsatisfactory:
- Physical Examination — systematic approach, correct technique, patient comfort
- Identifying Physical Signs — detecting and correctly interpreting clinical findings
- Clinical Communication — rapport, empathy, clarity, and structure
- Differential Diagnosis — generating appropriate differentials from findings
- Clinical Judgement — prioritising investigations and management
- Managing Patient Concerns — addressing the patient's agenda and expectations
- Maintaining Patient Welfare — consent, dignity, and safety throughout
PACES Pass Rates
The overall pass rate for PACES in 2025 was approximately 47% for first-time UK candidates. International Medical Graduates (IMGs) typically see lower pass rates of around 35-40% on first attempt.
Key factors that correlate with passing first time:
- Attending a structured revision course (candidates who attend courses pass at rates 15-20% higher than those who self-study alone)
- Practising with real patients rather than solely with peers
- Receiving consultant-level feedback on technique
- Covering all stations systematically rather than focusing only on perceived weaknesses
How to Prepare for Each Station
Stations 1 & 3: Clinical Examination
These stations test your examination technique and ability to identify physical signs. The key to success:
- Develop a systematic routine for each system that you can perform smoothly under time pressure
- Practise on real patients with genuine clinical signs — this is where courses at teaching hospitals are invaluable
- Present your findings confidently — examiners want to hear a structured presentation followed by a sensible differential
Common pitfalls: rushing through the examination, missing signs due to poor technique, and failing to demonstrate a logical approach to the examiners.
Station 2: History Taking
You have 14 minutes with the patient and 1 minute for reflection before 5 minutes of examiner questions. Structure is everything:
- Open with broad questions, then funnel to specifics
- Cover the patient's Ideas, Concerns, and Expectations (ICE)
- Summarise back to the patient before the bell
- Have a clear differential and investigation plan for the examiners
Station 4: Communication Skills
This station often determines pass or fail. Scenarios include breaking bad news, explaining diagnoses, discussing treatment options, and ethical dilemmas.
The SPIKES framework works well:
- Setting — introduce yourself, ensure privacy
- Perception — what does the patient already know?
- Invitation — how much do they want to know?
- Knowledge — deliver information in chunks
- Empathy — acknowledge emotions explicitly
- Summary — agree a plan and safety-net
Station 5: Integrated Clinical Assessment
This combines a brief focused examination (5 minutes) with a discussion of diagnosis, investigations, and management (10 minutes). It tests your ability to think like a registrar making real clinical decisions.
When to Take PACES
Most candidates sit PACES during ST3-ST5 of their medical training. The exam runs in three diets per year (typically January-February, May-June, and September-October).
For the 2026 exam cycle, key dates to be aware of:
- Diet 1: January–February 2026 (applications closed)
- Diet 2: May–June 2026 (current window)
- Diet 3: September–October 2026 (applications open July)
Choosing a PACES Course
Not all PACES courses are equal. When evaluating options, consider:
- Patient-to-candidate ratio — you need hands-on time, not just observation. Look for 1:2 or better.
- Real patients vs simulated — real patients with genuine signs are irreplaceable for Stations 1 and 3.
- Faculty credentials — are the teachers current PACES examiners or recent consultants?
- Post-course support — does the course offer ongoing mentorship or just a one-off day?
- Location — teaching hospitals with diverse patient populations offer the best variety of signs.
At BitePACES, we offer both a 1-Day Intensive and 3-Day Comprehensive course [blocked] at Guy's Hospital, London, with a 1:2 patient-to-candidate ratio and post-course mentorship included.
Summary
PACES is a challenging but passable exam when approached systematically. Focus on developing smooth examination routines, practising communication frameworks, and getting expert feedback on your technique. The candidates who pass first time are those who invest in structured preparation rather than relying on ad-hoc practice alone.
Ready to start your PACES preparation? View our upcoming course dates [blocked] or read our tips on passing first time [blocked].
