What should you do if you fail PACES?

Failing the MRCP PACES exam can feel discouraging, particularly after months of preparation and clinical practice. However, it’s far from uncommon. The PACES exam is designed to assess a wide range of clinical and communication skills under pressure, and many strong candidates do not pass on their first attempt.

The most important thing after receiving an unsuccessful result is understanding why you failed, what the marksheet is actually telling you, and how to approach your next sitting more strategically.

In this guide we explain what happens if you fail PACES, including pass rates, retake limits, common reasons candidates struggle, and how to improve your chances at the next attempt.

How hard is the PACES exam?

The PACES exam is widely regarded as one of the most demanding postgraduate medical examinations in the UK.

Unlike written papers, PACES assesses your ability to apply knowledge in real clinical encounters. You are expected to:

• Examine patients accurately under strict time limits

• Identify and interpret clinical signs

• Communicate clearly with patients and relatives

• Formulate sensible differentials and management plans

• Demonstrate professionalism throughout the encounter

The pressure of performing these skills in front of examiners is one reason many candidates find PACES significantly harder than MRCP Part 1 or Part 2 written exams.

Is PACES the hardest medical exam?

Whether PACES is the “hardest” medical exam is subjective, but it’s certainly one of the most challenging clinical examinations undertaken during postgraduate training.

What makes PACES difficult is not just the knowledge required, but the combination of:

• Clinical reasoning

• Communication skills

• Time management

• Examination technique

• Performance under pressure

Even experienced trainees can struggle if preparation focuses too heavily on theory without enough bedside practice.

What is the PACES exam pass rate?

The PACES exam pass rate generally sits at around 55–60% overall, although this varies slightly between diets and candidate groups.

First-attempt pass rates tend to be higher among candidates with more clinical experience, particularly those sitting the exam later in training. MRCP(UK) data has consistently shown that candidates with stronger exposure to acute and general medical practice perform better overall.

Given the pass rate, failing PACES does not necessarily indicate a lack of clinical ability. In many cases, candidates narrowly miss the required standard in one or two specific skills.

Can you fail PACES by one mark?

Yes. Candidates occasionally fail PACES by one mark or by narrowly missing the required threshold in an individual skill domain. This is because PACES is not simply pass-or-fail based on a total score. You must also meet the minimum standard across each of the seven assessed skills.

That means a strong overall performance cannot fully compensate for significant weakness in areas such as:

• Physical examination

• Clinical communication

• Differential diagnosis

• Patient management

It is possible to perform well across most stations and still not achieve an overall pass.

How many stations can you fail in PACES?

There is no fixed number of stations you can fail in PACES and still pass overall. The exam is scored across seven core clinical skills rather than individual stations alone. Because of this, outcomes depend on:

• The severity of underperformance

• Which skills are affected

• Whether the minimum standard is reached across all domains

A borderline performance across multiple encounters may still lead to failure, even if several stations felt subjectively “good” on the day. For this reason, reviewing your marksheet carefully is essential after an unsuccessful attempt.

Why do candidates fail PACES?

Most candidates who fail PACES do not fail because of lack of medical knowledge alone. More commonly, issues arise from:

Examination technique

Candidates may:

• Miss important examination steps

• Examine inconsistently under pressure

• Struggle to complete examinations within time limits

Identifying physical signs

This remains one of the most difficult aspects of PACES. Common problems include:

• Missing clinical signs

• Overcalling signs that are not present

• Presenting findings unclearly to examiners

Communication under pressure

Some candidates struggle to:

• Explain information clearly to patients

• Manage patient concerns effectively

• Avoid overly technical language

This becomes particularly important in the communication stations.

Poor exam strategy

Candidates sometimes:

• Spend too long on one part of the encounter

• Rush examiner discussions

• Fail to adapt to the station scenario

Strong clinical knowledge alone rarely compensates for weak exam technique.

What should you do immediately after failing PACES?

The first step is to review your marksheet objectively. The PACES marksheet provides detailed breakdowns across the seven skills and often identifies patterns in performance. Rather than focusing purely on the overall result, look for recurring weaknesses.

Questions worth asking include:

• Were the same skills weak across multiple stations?

• Was time management an issue?

• Did communication scores consistently fall below standard?

• Were physical signs being missed repeatedly?

This analysis should guide your next phase of preparation.

Should you resit PACES immediately?

Not always. Some candidates benefit from sitting the next available diet while the exam experience is still fresh. Others may need additional clinical exposure before attempting again.

In general:

• Candidates who narrowly failed often benefit from targeted revision and an earlier resit

• Candidates with broader weaknesses may benefit from allowing more preparation time

The decision should be based on the quality of preparation possible before the next sitting, not simply urgency to rebook.

How many times can you take the PACES exam?

MRCP(UK) allows candidates a maximum of six attempts at the PACES exam.

If you have failed PACES multiple times, it becomes increasingly important to identify exactly what is limiting performance rather than simply repeating the same revision strategy.

Candidates approaching later attempts often benefit from:

• Structured bedside teaching

• Examiner-led feedback

• Focused communication practice

• Supervised mock PACES sessions

What if you failed PACES on your third attempt?

Failing PACES multiple times can understandably affect confidence, particularly after a third attempt. However, repeated failure does not necessarily mean you are incapable of passing. More often, it suggests there are persistent issues in preparation or exam technique that have not yet been addressed directly. 

At this stage, revision should become highly targeted. That may include:

• Recording yourself presenting cases

• Working regularly with PACES tutors or consultants

• Increasing exposure to real bedside examination

• Focusing heavily on communication and patient interaction

Many successful candidates pass after several attempts once preparation becomes more structured and feedback-driven.

How to improve your chances of passing next time

The most effective PACES preparation usually combines three elements:

1. Regular bedside practice

Nothing replaces examining real patients repeatedly under timed conditions.

2. High-quality feedback

Generic revision is rarely enough after a failed attempt. Direct feedback from experienced clinicians is essential.

3. Structured revision resources

Using focused PACES revision resources can help improve consistency across all seven assessed skills. 

This includes:

• Video demonstrations of examinations

• Communication practice scenarios

• Mock stations and examiner-style questioning

• Structured revision guides

How Pastest can support your PACES resit

Pastest provides several resources specifically designed to support candidates preparing to resit PACES.

These include:

• The Pastest MRCP PACES Online Revision Course

• The PACES In-Person Course

• The PACES Revision Guide

These resources focus not only on knowledge, but on the practical communication, examination and presentation skills that PACES specifically assesses.

For a full breakdown of the exam format, stations and marking system, check out The Pastest Guide to the MRCP PACES Exam.