The Pastest Guide to the MRCP PACES Exam

The complete guide to taking and passing the MRCP PACES exam, including online resources and format.

What is the PACES exam?

The Practical Assessment of Clinical Examination Skills (PACES) is a postgraduate medical examination designed to test the clinical knowledge and skills of trainee doctors who hope to enter higher specialist training. Passing the PACES exam is a mandatory step in qualifying for Membership of the Royal College of Physicians (MRCP) in the United Kingdom.

The MRCP PACES examination is divided into five stations, each designed to test a different set of clinical skills. These skills include history-taking, communication, clinical examination, diagnosis and management. The exam sets rigorous standards to confirm that trainee doctors possess the competence necessary to provide a high standard of care to patients.

Who can apply for PACES?

To sit the PACES exam, you must hold a GMC-recognised primary medical qualification, have completed at least 12 months' experience after graduation, and have passed the MRCP Part 1 written exam within the last seven years. You don't need to have completed MRCP Part 2 before sitting PACES, but MRCP(UK) strongly recommends doing so—you'll need both to gain your diploma either way.

Timing is important: it’s worth gaining clinical experience before sitting the PACES examination. MRCP(UK) data shows that candidates sitting PACES 24–36 months after graduation pass at around 50%, while those who wait until 36–48 months post-graduation pass at roughly 77%.

How is the PACES exam structured?

The PACES exam takes place over half a day in a clinical setting, usually a hospital or clinical skills centre. You move through a carousel of five PACES stations containing eight encounters in total, with two independent examiners at each. Every station lasts 20 minutes, with a five-minute break in between.

The five PACES stations are:

• Station 1: Communication (10 minutes), then Respiratory (10 minutes)

• Station 2: Clinical Consultation (20 minutes)

• Station 3: Cardiovascular (10 minutes), then Neurological (10 minutes)

• Station 4: Communication Skills (10 minutes) and Abdominal (10 minutes)

• Station 5: Consultation (20 minutes)

At Stations 2 and 5, you have 15 minutes to take a structured history, examine the patient, and explain the likely diagnosis and management. This is followed by a five-minute question-and-answer session with the examiners. The communication encounters at Stations 1 and 4 are judged on observation alone, with no examiner Q&A. The remaining 4 cases (Respiratory, Cardio, Neurology & Abdominal) are broken down into a 6 minute examination followed by 4 minute Q&A with the examiner.

The carousel structure means that examiners at each station contribute more judgements per skill per candidate, improving the overall reliability of the exam. The format introduced in 2023 (previously referred to as PACES23) is now the standard across all PACES centres.

When does the PACES exam take place?

The PACES exam runs three times a year across three diets:

• January to March

• June to August

• September to December

Exams take place at clinical centres in the UK and at a growing number of international centres. For confirmed 2026 diet dates and centre locations, check the MRCP(UK) website directly. Slots fill quickly and early registration is advisable, particularly for UK candidates given the current waiting list.

How much does the MRCP PACES exam cost?

PACES is among the more expensive components of the MRCP(UK). Fees for UK and international candidates differ significantly, and both have risen in recent years. Below are the current fees, but always check on the official MRCP(UK) website before applying.

What's changed for MRCP written exams in 2026?

If you're still working through the written components before sitting PACES, there's an important update to be aware of. 

Following significant disruption to the 2025/2 diet of the MRCP(UK) Part 2 examination and the 2025/1 Rheumatology SCE, The Federation of the Royal Colleges of Physicians of the UK has moved all MRCP(UK) written papers and Specialty Certificate Examinations (SCEs) away from remote online proctoring. From 2026, written exams return to test centres using a computer-based testing (CBT) format.

The change is designed to protect the reliability, fairness, and security of the examinations.

How is the PACES exam marked?

Before the exam begins, examiners calibrate all cases at each station and agree on the specific areas a candidate must cover to receive a satisfactory mark. The criteria are drawn from the guidance on the marksheet and the expected performance of a competent trainee entering higher specialist training (ST3 in the UK). Grading runs on a 0–1–2 scale: 0 is unsatisfactory, 1 is borderline, 2 is satisfactory.

The PACES mark scheme assesses seven skills, labelled A to G:

• Skill A: Physical Examination Skills

• Skill B: Identifying Physical Signs

• Skill C: Clinical Communication Skills

• Skill D: Differential Diagnosis

• Skill E: Clinical Judgement

• Skill F: Managing Patients' Concerns

• Skill G: Maintaining Patient Welfare

The overall PACES pass mark is 126 out of 168. Each skill carries its own threshold, and you must meet the pass mark in every skill. A strong performance in one cannot compensate for a weak one in another.

Skill A: Physical Examination

Skill A tests your technique when examining the respiratory, abdominal, cardiovascular, and neurological systems. Examiners are looking for a systematic approach, correct technique, and no significant omissions; failing any of these can fail the skill.

The most common reasons for being marked down are:

• Hesitancy or lack of confidence

• Unprofessional examination conduct

• Examining through a patient's clothing

To build your technique, practise on as many patients as possible, including those without clinical abnormalities, so you're equally comfortable reporting a normal examination as an abnormal one. Ask your clinical supervisor or a senior colleague to observe you and give direct, critical feedback on both technique and findings. 

Practising with a timer is also worth doing. You have no more than six minutes to complete your examination at Stations 1 and 3, and at Station 5 you'll be expected to perform a focused examination based on the scenario and patient history.

Skill B: Identifying Physical Signs

Skill B is widely considered the most challenging to pass in the PACES exam. You're assessed on your ability to identify physical signs and present them logically and clearly to the examiners during discussion. The ability to recognise signs at the bedside remains a core physician skill—even with easy access to investigations—and confidence in it comes only with practice.

The two most common reasons for failing are missing signs agreed upon during calibration and reporting signs that are not present. To improve:

• Examine patients systematically across a broad range of specialties, including those without abnormal clinical signs, so you're comfortable identifying and reporting when nothing is there

• Ask colleagues from different specialties to observe you examining consenting patients, and discuss both your technique and your findings with them afterwards

• Ask your clinical supervisor and senior colleagues to watch you work through patients with clinical signs across all the relevant systems, and invite direct challenge on what you've found and why

Skill C: Clinical Communication Skills

Communication is an essential skill for physicians and is assessed throughout the PACES examination at various stations.

At Stations 1 and 4, you'll take a thorough and systematic history, identify the patient's concerns, and agree on a management plan in no more than 10 minutes. These encounters are judged on observation alone; there is no question-and-answer section with the examiners. At Stations 2 and 5, the 20-minute clinical consultation gives you 15 minutes to take a structured history, examine the patient, explain the likely diagnosis and management and address any questions or concerns raised, followed by a five-minute examiner Q&A.

Candidates who struggle with Skill C typically fail to explain relevant clinical information accurately or clearly, leave out essential information, provide inaccurate detail, or use specialist language that patients don't understand. 

To improve, review your marksheets carefully and discuss the feedback with your educational supervisor or a senior colleague. Practice information gathering and giving as often as possible, and work on presenting clinical information in plain, accessible language. Ask senior colleagues to observe you taking a history or communicating with patients or surrogates and to provide honest feedback on what they see.

Sample scenarios within the Pastest PACES online revision course are a strong source of practice material, and the dedicated PACES Communication Skills Course gives focused preparation for these stations. 

Skill D: Differential Diagnosis

Skill D is directly linked to Skill B. If you can't accurately identify physical signs, your differential will suffer too. You're expected to give the correct diagnosis and offer an appropriate differential, with the most likely diagnosis first. A textbook list that doesn't reflect the actual patient in front of you won't pass. Examiners are assessing whether your reasoning fits the clinical picture, not whether you can recite a list.

The most common reasons for failing are:

• Giving an inadequate or inappropriate differential diagnosis

• Failing to consider the right diagnosis

To improve, formulate differential diagnoses for every patient you encounter clinically and seek feedback from colleagues on your reasoning. Look for opportunities to be observed while examining patients and generating a differential and make case-based discussions with your clinical or educational supervisor a regular part of your preparation.

Skill E: Clinical Judgement

Clinical judgement is assessed across all five stations and is closely dependent on the skills before it. Failing to identify physical signs accurately (Skill B), and particularly failing to consider the correct diagnosis (Skill D), will lead to a deduction in your Clinical Judgement score. You're expected to suggest appropriate investigations and outline a reasonable management plan for the patient you've examined. Managing the wrong condition, even if done correctly, will not be considered satisfactory.

The most common reasons for failing Skill E are:

• Lack of familiarity with the correct management plan

• Failing to arrive at the right diagnosis, leading to an incorrect management plan

• Proposing investigations or management that don't fit the patient

Review the feedback on your marksheets and discuss it with your clinical and educational supervisors. If the exam has identified knowledge gaps, go back to the areas covered in the written exams and revise them. Ask for structured feedback from senior colleagues across a diverse range of medical patients—covering differential diagnosis, appropriate investigations, and management—so that your clinical judgement is tested regularly before the exam itself.

Skill F: Managing Patient Concerns

A satisfactory consultation requires identifying the patient's main concerns, asking whether they have questions, answering them accurately and sympathetically, and confirming their understanding. The most common reasons for not passing are:

• Failing to explore concerns in enough depth

• Talking over the patient or not listening

• Not checking the patient's understanding

• Failing to build rapport

• Running out of time to address questions

To improve, review your marksheets for examiner comments and reflect on specific areas of weakness with your educational supervisor or a senior colleague. During clinical interactions, make a conscious habit of identifying patient concerns early and practising how to respond to them. Using a timer during preparation sessions ensures you leave enough time for this part of the encounter. If English is not your first language, targeted scenario practice is especially worth building into your preparation.

Skill G: Maintaining Patient Welfare

Skill G examines whether you treat the patient with appropriate dignity and sensitivity throughout the encounter. Failure here may indicate causing emotional or physical discomfort, making unsafe clinical decisions, or not taking adequate steps to ensure the patient's comfort and safety. Specific areas of concern will be flagged on your marksheet.

Reflect on the examiner comments and discuss them with your educational supervisor or a senior colleague. As a practical guide, consider how you would want your own relatives to be examined or cared for; it is a simple reference point, but a reliable one for calibrating your approach.

What is the PACES pass rate?

The overall PACES pass rate is approximately 55–60%. That means thorough preparation genuinely matters. UK trainees historically pass at higher rates on their first attempt than international candidates, and pass rates increase significantly with more clinical experience. MRCP(UK) publishes skill-by-skill breakdowns in its annual reports, which are worth reviewing as part of your preparation.

When will I receive my MRCP PACES results?

PACES results are released through the My MRCP(UK) portal. After each diet closes, the awarding body reviews the reliability of the examination—including GMC candidate safety requirements—before releasing final PACES exam results. This process typically takes several weeks. The precise release date varies by diet; check the MRCP(UK) results page for the expected timeline for your sitting.

If you believe there has been an error in your result, the MRCP(UK) has a formal appeals process. Details are available on the Federation's website.

How many attempts can you make at the PACES Exam?

All MRCP exams have a maximum of six attempts each. The marksheet feedback breaks performance down skill by skill and tells you precisely where to focus before resitting. If you don't pass the first time, review the marksheet feedback with your educational supervisor, address the specific gaps it identifies, and use targeted revision resources to work on the areas most linked to failing.

How to pass the MRCP PACES exam

Now that you know the seven skills assessed in the PACES examination, the preparation steps below will help you approach each station with confidence.

1. Fully understand the exam's scope

The MRCP PACES is designed to assess your clinical abilities through hands-on patient encounters. Understanding the five station types: their content, their timing and what examiners expect at each, is the foundation of good preparation. 

Mastering history-taking, physical examination, and clinical communication is vital; these skills assess your ability to interact with patients and arrive at accurate diagnoses in standard clinical scenarios.

2. Master the exam's pattern

Each station in the PACES exam follows a set structure. Practising these timeframes in a mock PACES environment will help you work within the limits without rushing and let you show your clinical skills at their best.

• Communication stations: You'll receive written guidelines and have five minutes to prepare before a 10-minute encounter with the patient or surrogate. There is no examiner Q&A.

• Clinical consultation stations (Stations 2 and 5): Five minutes to prepare, 15 minutes for the consultation, then five minutes of examiner Q&A.

• Remaining stations: Brief instructions, six minutes to assess the patient, four minutes to respond to examiner questions.

3. Practise articulation

Clear communication counts across the PACES exam. You need to collect your observations quickly and present findings concisely. Given the tight time constraints, excessive detail leaves less time to cover areas the examiners still need to cover, such as patient management, concerns, and welfare. 

Practise summarising important points efficiently and decide whether to lead with the diagnosis and expand on it, or to build toward it from the clinical picture.

4. Connect with a PACES Examiner, Consultant, or Mentor

Access to a consultant with experience as a PACES examiner can be a real advantage. They can offer valuable insights into the expectations of examiners and can guide you on typical mistakes to avoid, as well as help you refine your approach to presenting clinical findings. 

Discussing preparation with fellow candidates is also useful. Sharing experiences from different regions and centres helps you gain a better understanding of the health challenges prevalent in those areas and prepare for a wider range of scenarios.

What to expect on exam day

Preparation doesn't stop the night before the PACES exam. A few practical steps on the day itself make a difference.

Arrive at least one hour early. MRCP(UK) requires this, and late arrival risks being turned away. Bring your photo ID and admission document. You may be asked to store personal items, including your bag, away from the examination area. Wear comfortable, well-fitted clothing that won't restrict your movement during physical examinations.

Between stations, use the five-minute break to look forward rather than back. Read any scenario for the next station, settle your breathing, and reset. Examiners recognise that anxiety affects performance, and they know that practice, not nerves, is what your results should reflect.

What happens when you pass the MRCP PACES exam?

If you've passed, congratulations! Once you successfully complete all components of the MRCP(UK), you can submit your application for full GMC registration with a licence to practise. After the GMC reviews and approves your application, you'll be eligible to work as a doctor in the UK. From there, you can pursue specialist training and the path toward a consultant role.

How can Pastest help you pass PACES?

Are you preparing for the MRCP PACES exam and feeling overwhelmed with the amount of information you need to know? 

Pastest's MRCP PACES online revision course offers a range of features to support your PACES exam preparation, including over 130 hi-res, 'gold standard' PACES examination videos showing best practice from model exam candidates. 

You can view clear, close-up clinical signs and on-screen palpation findings—seeing patients through the eyes of an exam candidate. You’ll also have access to over 170 examples of spot diagnosis learning in the question bank, covering skin, fundoscopy, gait, neurology and more.

For the communication stations, downloadable role-play exercises let you work through immersive scenarios with colleagues. Your subscription dashboard tracks the cases you've worked through, broken down by station, so you always know where you stand.

Alongside the online platform, the PACES In-Person Course brings expert examiners to you in a clinical setting. The PACES Communication Skills Course gives dedicated practice on the stations that candidates most commonly find challenging. Add the MRCP PACES Strategy Guide for a station-by-station approach to the whole exam.

With top tips on each station provided by PACES experts, Pastest offers everything you need to pass your exam with flying colours. Get started today or contact us for more information.