Mastering The PACES Exam.

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The coveted MRCP diploma is one of those elite titles, which most doctors training in Medicine, dream about writing beside their name. For UK trainees, it is a mandatory requirement to enter Higher Specialty Training, whereas for non-UK based doctors it is more of an acknowledgement, of their knowledge and standard of training being at par with their UK counterparts.

This title can only be obtained after clearing all the 3 parts of the MRCP exam. Part 1 and 2 are theoretical but PACES is a fully clinical OSCE based exam which demands a completely different approach of preparation. PACES not only tests clinical knowledge, but also one's presence of mind, analytical skills, presentation, and most importantly communication. As a result, the preparation is much more intense and doctors find this part of the exam very intense and challenging - which has led to PACES being named as “The Final Hurdle” among the medic community.

How To Approach PACES

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Now the million-dollar question – is PACES actually tough, or is it more of a rumour than a fact? Labelling something as tough is a very subjective matter. Whilst it can be very intense and sometimes appear quite difficult, the fact is every problem has its solution and PACES is no different. It is absolutely possible to ace this exam, master the PACES and earn the coveted MRCP title. Let’s emphasize further on how this can be achieved.

1.    Dream: This might sound like a fantasy land but in order to motivate yourself and achieve something, it’s important to dream about it. Unless you dream about writing your name with the coveted 4 letters MRCP beside it, being convocated in front of your loved ones by the president of the Royal College of Physicians, you won’t get the ultimate motivation to work towards it. So dreaming about this title is the first step towards success, which should keep on continuing till you have passed the exam.

2.    Planning: Now it’s time to turn your dreams to reality, and thus it is time to wake up and start working towards it. Like any successful project, proper planning makes the ultimate difference. Planning to achieve your objectives in the SMART way (Specific, Measurable, Achievable, Relevant and Time-Bound). This goes a long way in terms of a plan coming to fruition.

3.    Smart work – Working hard is no longer the way ahead, working smart is. Too much hard work, induces monotony and makes your brain refractive to learning. This can set in a lot of anxiety, which would further impair learning. Thus, setting up a vicious cycle, which is quite difficult to break. The key here is to prevent it from setting in at all.

4.    Relax: This is very important in the context of your preparation and your exam. Just as continuously stretching an elastic band makes it lose its elasticity, similarly it's important to allow the brain to relax and sometimes get it to enjoy things that it likes to.

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Ideal Paces Preparation

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Bearing in mind the above points, our personal recommendation for the ideal PACES preparation is below. Make sure to tweak certain aspects as per your own strengths and weaknesses.

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1.    Plan well in advance - ideally 1 year before but at least 6 months before your intended exam window / diet. A perfect and well-made plan is a strong foundation upon which your preparation will be built with the maximum reassurance.

2.    Start watching PACES videos on YouTube and other video libraries. This is to understand how to do a sleek examination of the patient without missing anything significant, and then presenting the relevant findings to the examiner.

3.    Once you watch the videos, start doing the same on your patients on the ward. Don’t worry about timing initially, what matters is getting into the flow. Once the examination technique is mastered, you would start picking up abnormal / pathological signs. While examining patients, you cannot be thinking about the next step you must take while examining, you will inevitably miss out signs.

4.    A study partner is strongly recommended. So that both of you can examine and present to each other, that would result in a high-quality practice session. Motivate each other during difficult times, when the going seems to get tough.

5.    Focus on your communication skills – it is a highly significant aspect of the exam. Especially for non-UK trained doctors, we recommend practicing presenting a case to yourself bystanding in front of the mirror or your study partner if you have one. We cannot emphasize enough about this, as far too many non-UK doctors fail because of this.

6.    Attend a course where you will see a wide variety of patients, all with niche and different diagnoses, and thus different clinical findings. On top of that, there will be mock sessions and communication stations to help you get exam ready.

7.    Do not cram anything new in your brain in the last 2 weeks prior to exam. Strictly NO. Both relaxing and revising is an equally important part of preparation and need to be done definitely for everyone.  

8.    Keep yourself well hydrated and nourished. Your brain needs all the energy it can during the exam and the period leading to the exam, for optimal preparation and revision. Equally sleeping for 5-6 hours a day and definitely at least 6 hours on the night before the exam is of utmost importance.

9.    Try not to study at all on the evening before the exam, rather relax and allow the brain some rest before the actual exam. It does help a lot.

10.  Once the exam is finished, just forget about it and go on with your life till the results are out. This is to maintain your own sanity, as candidates become overly self-critical following the exam. Just relax and think about anything else but PACES.

11.  Last but not the least, failure is not the end of the road. The mere preparation for the exam will upgrade you as a clinician, which will then reflect in your daily practice of medicine. There is always a next time, you will be surprised to know how many successful consultants, needed to sit for more than one attempt. One consultant once said “The ones who pass in their first attempt are excellent doctors, but the ones who need two attempts are great doctors, and more than 2 attempts are legendary doctors . “ Get the fear of failure out of your mind, because apart from some monetary and time loss, you are not losing anything else.

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All the very best for your exam and we hope to see you writing the post-nominal MRCP beside your name soon.

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