How to Pass PACES First Time: 10 Proven Strategies

Why First-Time Pass Matters

Failing PACES costs more than the re-sit fee. It delays your CCT date, affects your confidence, and adds months to your training timeline. With a first-time pass rate of approximately 47%, the odds are not in your favour — but candidates who prepare strategically pass at significantly higher rates.

Here are 10 strategies used by candidates who pass first time.

1. Start Preparation 12 Weeks Before Your Exam

The most common mistake is starting too late. PACES requires building physical examination skills, communication frameworks, and clinical reasoning — none of which can be crammed in a weekend.

Recommended timeline:

2. Examine Real Patients, Not Just Peers

Practising examination technique on your registrar colleague is useful for learning the sequence, but it will not prepare you for finding real clinical signs. You need exposure to:

• Genuine murmurs (not simulated with a stethoscope app)
• Real neurological signs (UMN vs LMN patterns)
• Actual respiratory crackles and effusions
• Visible dermatological signs

Seek out patients on your ward rounds, attend outpatient clinics, and use teaching hospital resources. This is where courses at teaching hospitals [blocked] become invaluable — they guarantee exposure to patients with confirmed, examinable signs.

3. Develop a Systematic Routine for Every System

Examiners mark you on your approach before they mark your findings. A smooth, systematic examination demonstrates competence even if you miss a subtle sign.

For each system, your routine should be:

• Reproducible — identical every time regardless of what you find
• Efficient — completable in 6-7 minutes leaving time for presentation
• Patient-centred — demonstrating consent, comfort, and dignity throughout

Write out your routine, practise it until it's automatic, then forget about it and focus on what you find.

4. Master the Communication Stations

Stations 2 and 4 (History Taking and Communication Skills) account for 40% of your total marks. Many candidates over-invest in clinical examination and under-prepare for communication.

Key frameworks to internalise:

• ICE (Ideas, Concerns, Expectations) — use in every history
• SPIKES — for breaking bad news
• Chunk and check — deliver information in small pieces, confirm understanding
• Signposting — tell the patient what you're about to discuss

The difference between pass and fail in Station 4 is often empathy. Practise saying: "I can see this is difficult for you" or "It's completely understandable to feel that way."

5. Get Feedback from Consultants, Not Just Peers

Peer practice is valuable for repetition, but only senior clinicians can tell you whether your technique is correct, your presentation is at the right level, and your clinical reasoning is sound.

Seek feedback from:

• Your educational supervisor
• Consultants on ward rounds (ask to present your findings)
• PACES course faculty (ideally current or recent examiners)
• Senior registrars who have recently passed

6. Practise Presenting Under Time Pressure

In the exam, you have approximately 2-3 minutes to present your findings and answer questions. Many candidates can examine well but fall apart when presenting because they haven't practised under pressure.

Tips for presentation:

• Lead with your diagnosis, not a list of findings
• Use "the important positives are..." and "the relevant negatives are..."
• Have 2-3 differential diagnoses ready with reasons to distinguish them
• Prepare for "what would you do next?" — always have an investigation plan

7. Know the Common Cases

PACES is not designed to trick you with rare diagnoses. The same conditions appear repeatedly because they produce reliable signs. Focus your preparation on:

Respiratory: Pulmonary fibrosis, COPD, pleural effusion, bronchiectasis, lobectomy Cardiovascular: Aortic stenosis, mitral regurgitation, prosthetic valves, AF Abdominal: Hepatomegaly, splenomegaly, transplant kidney, polycystic kidneys Neurological: Peripheral neuropathy, cerebellar signs, old stroke, Parkinson's, MS

If you can confidently examine and present these conditions, you will pass.

8. Attend a Structured Revision Course

Data consistently shows that candidates who attend structured courses pass at higher rates than those who self-study alone. A good course provides:

• Guaranteed exposure to patients with real signs
• Expert feedback on your technique in real time
• Mock exam conditions to build confidence
• A structured framework that covers all stations

Look for courses with small group sizes (1:2 patient-to-candidate ratio or better) and faculty who are current or recent PACES examiners.

9. Simulate Exam Conditions

In the weeks before your exam, replicate the pressure:

• Time every practice examination (10 minutes per station)
• Practise with an "examiner" watching you
• Do full carousel run-throughs if possible
• Wear your exam clothes and use your own stethoscope

The goal is to make the exam feel familiar, not novel. Anxiety decreases when the environment matches your preparation.

10. Look After Yourself

PACES preparation is intense, but burnout will hurt your performance. In the final two weeks:

• Maintain regular sleep (7-8 hours)
• Exercise — even a 20-minute walk improves cognitive performance
• Eat well on exam day (protein-rich breakfast, avoid sugar crashes)
• Arrive early and do a brief warm-up routine (examine your own hands, check your stethoscope)

The Bottom Line

Passing PACES first time is achievable with 12 weeks of structured preparation, real patient exposure, and expert feedback. The candidates who fail are typically those who start too late, practise only with peers, or neglect the communication stations.

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Ready to prepare? View our upcoming PACES course dates at Guy's Hospital [blocked] or read The Complete Guide to MRCP PACES 2026 [blocked].