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MRCP PACES Course Introduction.

The MRCP PACES Password course is the best choice for those who want to start preparing for the MRCP PACES exam.

The website teaches you how to take a structured history and provides practical advice on examining patients in the exam room. It helps you build confidence, communicate effectively with patients during the exam, answer examiners’ questions, and avoid common mistakes.

It is beneficial for candidates who do not have enough time to study all aspects of the MRCP PACES in detail.

The website includes:

Stations 2 and 5: Consultation and common cases
Stations 1 and 4: Communication skills, respiratory, and abdominal cases
Station 3: Cardiovascular and neurology

MRCP 2023 changes

Stations 2 , 4, and 5 were removed. The station's history-taking can be artificial, with structured history-taking skills being tested in isolation. The 20-minute single communication and ethics encounter at station 4 is felt to be rather long, and in particular, the five-minute examiner candidate interaction adds little value to the candidate's overall assessment. At station five, candidates and examiners undergo significant time pressure, undertaking two brief clinical consultations, testing all seven skills in an integrated manner. However, it is very much like real life, but it feels too pressured in just 10 minutes.

Therefore, to introduce two new encounters in the PACES 2023, a sale will be held to continue testing all seven skills, but in a more effective manner. The new carousel for PACES 2023 as shown here, demonstrates the encounter introduced in 2023.

Now there are 2 10-minute communication encounters assessing candidates on their communication skills. These encounters will no longer include a question-and-answer section with the examiners. The encounter is being judged on observation alone.

These two counters have become station 1 before the respiratory examination and station 4 before the abdominal examination. Five minutes of reading time is provided before entering your communication encounter, which will always precede the clinical examination of either the respiratory or abdominal examination.

Stations 2 and 5 have become 20-minute clinical consultations, which will assess candidates across all seven skills in a realistic and integrated manner.

Candidates have 15 minutes to take a structured history, examine the patient, explain the likely diagnosis and management, and address any questions and concerns the patient raises.

The patients may give the history themselves, or a surrogate may provide it on their behalf. After 15 minutes, there is a 5-minute question-and-answer period between the examiner and the candidate.

Station 3, involving examination of cardiovascular and neurological systems, remained unchanged.

Stations 2 and 5 Example

This station consists of a 20-minute consultation, which will assess the candidate's performance across the 7 PACES skills in a realistic and integrated manner.

Stations 2 and 5 may involve candidates assessing patients in an acute setting, such as a medical assessment unit (AMU), or in a less acute setting, such as an outpatient clinic.

The history is delivered by the patient or a surrogate giving the patient's history.

Only one examiner will lead the questions, but both will mark independently.

Introduction

The MRCP diploma aims to qualify doctors who are interning training scheme to be qualified in terms of knowledge, clinical skills, and patient approach in general.

To pass the MRCP PACES, you must be systematic and organized. To achieve that, you need to follow the classical approach to the patient.

This approach should include:

Clinical communication: History

You must analyse the patient's complaint properly. In daily practice, many cases are missed due to inadequate history-taking. According to The Journal of the American Board of Family Medicine (1998), physicians asked about 59% of essential history items. They frequently obtained appropriate information about presenting symptoms and medications, but they often missed important information about related symptoms and medical history.

To complete the picture of history taking, it is essential to ask about all systems (Systematic Review) to find linked symptoms or symptoms related to the vague presenting complaint.

Example:
An asthmatic patient presented with an acute flare-up. In the setting of the AMU or the Emergency department, some doctors may focus solely on respiratory symptoms. Upon a systemic review of this patient, he reported a new onset of numbness. On questioning the patient about this numbness, he mentions there is a distal asymmetric numbness (sensory neuropathy) with weakness.
At the end of the complete examination and investigation, he turned out to have Churg-Strauss syndrome.

Physical examination

You must practice doing professional clinical examinations daily in your practice rather than mastering them only during clinical courses.

It is important to practice a complete neurological examination on any patient you see, for TIA, as an example. It is also important to perform a systemic respiratory examination. Always listen to the heart. Aortic stenosis murmurs are common in admitted elderly patients due to sclerosis. It is also expected to see many patients with valve replacements, so practice daily. Compare your findings with the patient's echocardiogram result. If you did not pick up the correct murmur, go and listen to the patient's heart again.

COPD and lung fibrosis patients are common among admitted patients, so practice with your colleague or discuss physical examination with a senior doctor.

Identifying physical signs

From your daily practice, you should be able to identify physical findings and avoid inviting false findings.

Differential diagnosis

The examiner would not expect you to pick the exact diagnosis at the end of the scenario, but it is essential to include it in the differential diagnosis. They will ask you about the most likely diagnosis, and you must support your diagnosis.

Example:
Right iliac fossa mass with multiple scars in the abdomen. The patient is slightly cachexic and has a healed non-functioning small fistula in her right hand. The differential diagnosis should include a transplanted kidney, a colonic mass, and the terminal ileum. If you didn’t mention a transplanted kidney, you will fail because you didn’t examine the patient systematically to see both hands’ skin where there is a healed old fistula.

A broad differential diagnosis is acceptable—for example, a young man with paraplegia with upper motor neuron signs. You can say the diagnosis could be: demyelinating disease, cord compression, stroke in young, or vitamin B12 deficiency.

Clinical judgement

In the exam setting, it means your diagnosis, selecting relevant investigations, and management plan.

Managing Patients’ Concerns

You must address patient concerns clearly in simple language without using jargon. You must clearly communicate your diagnosis and advice to the patient.

Maintaining patient welfare

Treat the patient with dignity, ask for permission to expose the patient, and cover them after examination. Avoid examining sensitive areas in the exam setting. When performing percussion, be gentle; never press an area where the patient reports pain.

Example of how to approach the patient systematically to find the differential diagnosis and manage the patient properly:

A 42-year-old woman presents with fatigue.

"Hello, Mrs. Ann, my name is Dr. Scot, one of the doctors in the Acute Medical Unit. Your GP asked me to see you regarding your fatigue. Can you please tell me more about that?"

Patient:
"Yes, doctor. I have been experiencing fatigue for 3 months. It is getting worse over time; now I can’t even do my daily activities."

Candidate:
Do you feel fatigued all day, or are there times when you feel better and worse

The patient mentions all day.

Q: "Have you lost any weight?"
A: "No."

Q: "Any high temperature?"
A: "No."

Q: "What about your appetite?"
A: "It is OK."

Q: "Any headaches?"
A: "No."

Systems review

Respiratory tract:
"Any cough, shortness of breath, or wheezing?"
"Sometimes there is a dry cough, but no SOB or wheezing."

Cardiovascular:
"Do you feel your heartbeat? Any shortness of breath at night? Any chest pain?"
"No."

Musculoskeletal:
"Any muscle pain? Any joint pain?"
"I have on-and-off joint pain sometimes; I receive painkillers."

Skin:
"Any skin rash?"
"No."

Gastrointestinal system:
"Any mouth sores?"
"No mouth sores, but I feel dry mouth."

"How long have you been feeling dry mouth?"
"3 months."

"How does it affect you?"
"Sometimes, making chewing and swallowing difficult."

"How can you cope with that?"
"I carry water with me almost 24 hours."

"Any vomiting, heartburn, tummy pain, or diarrhoea?"
"No."

"Any ulcers in your back passage?"
"No."

Eye:
"Any pain in your eye?"
"It is like a sensation of sand in my eye."

"Any blurred vision?"
"No."

CNS:
"Any weakness, numbness, unsteadiness?"
"No."

Genitourinary system:
"Do you pass urine normally?"
"No problems."

Physical examination

Hands: No clubbing signs or signs of chronic liver disease or thyroid disorder.
Face and eyes: Slight redness and dryness.
Mouth: Dry mouth, no ulcers.
Neck: No masses or lymphadenopathy.
Chest: Normal heart sounds, no crackles.
Abdomen: Normal palpation.
Lower limbs: No rash or swelling.

Diagnosis & Management

Based on the information you provided, and after my examination, I suspect a condition called Sjögren syndrome.

Probable diagnosis:
Sjögren's Syndrome

Differential diagnosis:
Medication side effects, mouth breathing, thyroid ophthalmopathy.

Investigations:
FBC, ESR, RF, ANAs, Schirmer test, serum protein electrophoresis, lupus anticoagulant, anticardiolipin antibodies.

Management:
Artificial lubricants, referral to rheumatologist and ophthalmologist.

Other systems affected:
Musculoskeletal, nervous system, respiratory, kidneys, vascular, lymphatic, skin.

This is a real patient. She has been instructed to volunteer information about fatigue, and the candidate will ask her about mouth and eye symptoms. You should take a structured history by asking the relevant questions to reach the diagnosis.

Start Your Free Sample

Before committing to a full course, explore our free sample module to experience the structure, teaching style, and exam-focused approach used throughout MRCP Paces.

This sample gives you access to selected cases, examiner-style questions, and structured answers designed to reflect real exam scenarios. It allows you to familiarise yourself with how cases are presented, how answers are structured, and the level of detail expected in the MRCP PACES examination.

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