How to Prepare for PACES

The PACES exam is challenging for many candidates, but it can be beaten with the right approach. To give yourself the best chance of success, it’s important to learn how to study for PACES effectively. 

Dr Atef El Dean MBBCh MSc MRCP(UK), who scored an impressive 165 out of 172 on his first attempt at PACES, attributes his success to the methods he used to prepare for the exam. Notably, he recommends starting your study early and making it a part of your daily routine.

This guide draws on his experience to give you a practical framework for MRCP PACES preparation, from how long to allow for study to making the most of every hour on the ward.

How long do you need to prepare for MRCP PACES?

Most candidates allow between 3 and 6 months to prepare for the PACES exam. Dr Atef El Dean recommends starting no later than 3 months out, but ideally 6. The right window depends on how many hours a week you can realistically commit, whether you're working full-time, and how much clinical exposure you're getting day to day.

UK trainees in busy medical rotations often average closer to 3 months, whereas international medical graduates typically need longer. This is purely because they have more limited access to ward environments and PACES teaching groups, which form the backbone of solid preparation. If that's your situation, build extra time into your plan from the start.

One practical point worth making early: don't measure your preparation in hours. Measure it in patients examined. Two hours of reading about cardiovascular examination will not make you better at cardiovascular examination, but fifty patients examined under time pressure will. 

If you want a structured week-by-week framework, the Complete MRCP PACES Strategy Guide sets out a full 4-month preparation timeline.

Why PACES revision is different from MRCP Part 1 and Part 2

The methods that got you through the written MRCP exams (Part 1 and Part 2) are also helpful for MRCP PACES revision, but they're not enough on their own. 

QBanks, past papers and textbook reading give you the underpinning knowledge you need, but PACES assesses what you do, not just what you know. You're being assessed in real time on technique, timing, communication and clinical judgement. There is a shift that makes PACES study different from anything you've done before.

Candidates who fail PACES often know the medicine. They fail because their examination overruns, their presentation is disorganised, or their communication lets them down in the consultation stations. How to revise for PACES is really a matter of building clinical behaviours and repeating them until they become automatic. 

How to prepare for MRCP PACES stations

PACES comprises five stations and eight patient encounters in total. Some stations contain two back-to-back encounters, with each testing a different set of skills. For a full breakdown of the marking criteria for each clinical skill, The Pastest Guide to the MRCP PACES Exam covers that in detail. Here, the focus is on how to prepare for each.

Clinical examination stations

Physical examination encounters appear in Stations 1, 3, and 4. Each runs for 10 minutes: a maximum of 6 minutes for the examination itself, followed by at least 4 minutes of questioning from the examiners.

• Station 1 tests respiratory examination.

• Station 3 tests cardiovascular and neurological examinations — two separate 10-minute encounters back-to-back.

• Station 4 tests abdominal examination.

That 6-minute window is tighter than most candidates expect, and the only way to get comfortable with it is repetition under time pressure.

Neurology deserves particular attention in your PACES preparation. Most trainees don't rotate through neurology during Core Medical Training, so the neurological examination in Station 3 can feel unfamiliar even for otherwise well-prepared candidates. Build neurology examinations into your ward routine from early on. The MRCP PACES online revision course covers neurology cases in depth for exactly this reason.

Communication skills stations

Communication encounters appear in both Station 1 and Station 4. Each runs for 10 minutes, assessed by examiner observation alone, with no question-and-answer section. Scenarios typically involve breaking bad news, managing patient concerns, or navigating ethical dilemmas.

Each appears in the same station as a physical examination encounter. In Station 1, you move between a communication encounter and a respiratory examination; in Station 4, between a communication encounter and an abdominal examination. That transition, switching mental register between a consultation and a clinical examination, is worth practising.

Communication skills are the most common failure point for international graduates, as Dr El Dean notes from his own experience. The issue is rarely clinical language. It's building rapport quickly and demonstrating empathy while being observed under time pressure. And the best way to prepare for this is through repeated roleplay.

Clinical consultation stations

Stations 2 and 5 are the integrated consultation stations. Each runs for 20 minutes: 15 minutes with the patient to take a history, conduct a relevant examination, and respond to their questions and concerns, followed by a 5-minute question-and-answer session with the lead examiner. All seven clinical skills are assessed at both stations.

These are the most demanding encounters in the carousel because nothing is siloed. A missed diagnosis in the history phase affects your differential, your management plan, and multiple skill marks simultaneously.

Practise the full consultation as a single continuous flow. A useful habit: treat every patient you see on the ward as a potential Station 2 or 5 encounter. Take the history, examine them and mentally construct how you'd present the case and discuss next steps.

How to revise for PACES on the ward

Daily clinical work is your most important resource when studying for PACES. Done passively, it adds experience without building exam-readiness. Done intentionally, it's the most efficient type of MRCP PACES revision available to you.

Dr El Dean's core advice is to make preparation part of your routine instead of a separate activity you switch on for an hour after a shift. While on the ward, examine patients as you would in the exam. Same structure, same timing, same discipline, every time.

Practise running a 6-minute exam 

Six minutes sounds manageable, but for a complete and systematic clinical examination, it's a hard constraint to meet. Candidates who haven't timed themselves regularly tend to discover this for the first time in a mock, when it is too late to fix it.

Set a timer every time you examine a patient. Go through your full sequence without cutting corners. Over time, you'll identify where you're losing time. Often, it is in transitions between components, or in steps that add nothing to your findings. Strip those out. Do this across enough patients and the timing becomes instinctive.

Learn how to present in under 1 minute

After the examination, you have 1 minute to present your findings clearly before the viva begins. Most candidates initially run over, either because they're including too much detail, or because they haven't decided what the headline finding is before they start speaking.

Practise presenting to a colleague immediately after examining each patient. Lead with the most likely diagnosis, then support it with the signs you found. If you can't do it in 60 seconds in a low-pressure setting, you won't do it cleanly under exam conditions.

Seek feedback from seniors

Examining patients alone builds habits, but not necessarily good ones. Ask a senior colleague, registrar, or consultant to watch you examine a patient and then question you as an examiner would. This can be uncomfortable, but that is the point.

Dr El Dean recommends building this into your preparation throughout rather than arranging it in the final weeks only. If you can identify consultants at your trust who have sat on PACES examining panels, prioritise them. They know precisely what passes and what doesn't. One session with someone who can give you that level of specific, examiner-calibrated feedback is worth more than many hours of unobserved practice.

MRCP PACES online revision

Online revision is a core part of studying for PACES, and it works best as a complement to ward practice. Its specific value is access to clinical cases you won't see regularly on your wards, to rare signs, and to the kind of structured examiner commentary that's hard to get from a busy registrar between jobs.

Dr Al Dean recommends the MRCP PACES online revision course to give you an idea about what the examiners expect while dealing with different clinical and ethical dilemmas. 

The course offers over 130 patient ‘gold-standard’ examination videos covering more than 80 textbook topics, along with downloadable roleplay exercises for communication skills practice. You’ll also have access to exam marksheets and a question bank with over 170 spot diagnosis flashcards.

When ward cases are hard to find

Two areas where online revision is particularly valuable are neurology and Station 5. As Dr El Dean notes, you can see patients from most specialties during your working week. But good Station 5 cases are rare even in large teaching hospitals, and neurology simply doesn't appear on most Core Medical Training rotations.

The result is that many candidates arrive at PACES having examined very few neurological patients under anything resembling exam conditions. Neurology is also unforgiving; even candidates who have done a neurology post can struggle with this station. 

Build neurology cases into your video revision early and return to them regularly. It's one of the few areas where screen time genuinely compensates for limited ward exposure.

Practising communication skills scenarios

You can't revise for communication skills stations through watching videos alone; you need to be in the scenario to develop the fluency the station requires. That means speaking, reading the patient, and managing time. 

The PACES Communication Skills Course addresses this directly, but between formal sessions, use the downloadable roleplay activities within the Pastest PACES platform to run through scenarios with a colleague. Rotate who plays the patient—being on the other side of a consultation is its own form of preparation.

PACES teaching sessions and in-person courses

Most hospitals with active medical training programmes run PACES teaching sessions. Dr Al Dean recommends finding yours and attending as often as you can. 

Teaching groups give you something ward practice alone doesn't: an audience. Being observed by peers and a senior who can critique you is a closer simulation of exam conditions than anything you'll replicate alone. If no formal group exists at your trust, organise one. Even two or three colleagues committing to a regular session with a registrar or consultant will make a difference.

In-person courses can also be invaluable PACES preparation resources for anyone seeking more face-to-face practice. The Pastest PACES In-Person Course in the North West is designed to give candidates a true exam-day experience, replicating conditions as closely as possible.

PACES preparation: frequently asked questions

How long does PACES preparation take?

Most candidates take between 3 and 6 months to adequately prepare for the PACES exam. The right window depends on your weekly hours available, your clinical workload, and your access to suitable patients. Don't measure your preparation in hours alone, but look at patients examined and scenarios practised.

How do I prepare for PACES while working full-time?

Integrate preparation into your clinical work instead of treating it as a separate task. Examine patients on the ward as you would in the exam, follow the same structure and timing every time. Use commutes for podcast revision. Reserve weekends for observed practice with colleagues or formal teaching. An hour of intentional ward practice daily will outperform three hours of passive reading.

How should international graduates approach MRCP PACES preparation?

Allow more time than the average UK trainee; not because the clinical knowledge requirements are different, but because access to PACES teaching groups, familiar ward environments, and observed practice tends to be more limited. Communication skills and ethics stations are the most common failure point for international graduates. Prioritise roleplay practice for these from early in your preparation. The PACES Communication Skills Course is worth considering specifically for this.

What is the pass mark for MRCP PACES?

To pass, you need an overall score of at least 126 out of 168, and you must meet the minimum pass mark in each of the seven assessed clinical skills. Failing a single station does not automatically mean failing the exam, but failing any individual clinical skill does.

Can I prepare for MRCP PACES online?

Online revision is a valuable part of MRCP PACES preparation—particularly for neurology, Station 5 cases, and communication skills scenarios that are hard to access on the ward. Use it to build case familiarity and examiner awareness, then apply that knowledge to real patients.

Ready to start revising? Explore the Pastest MRCP PACES online revision course, with over 130 high-resolution patient examination videos, roleplay scenarios and spot diagnosis exercises written by expert clinicians.