How I passed my PACES Exam first time with 168/172
Planning and Preperation
PACES is so much more than the 3-hour exam action on the D-Day. The process starts many months before with the first step being deciding when to take the damn thing.
When to do the PACES exam?
The short and simple answer is – when you feel ready!
The official MRCP website advises to delay taking the Clinical Examination until 36 months after graduating. I am the sort of person who just wanted to get it over and done with as soon as I felt it was right. I did my exam as an IMT1 in June 2022- I went straight into IMT from F2 so this was the 35th month of me being a doctor so it’s just about the time limit they recommend. However, I do believe this is a VERY personal decision and would vary greatly from people. The top things to consider are the following:
At the time on my PACES exam, I was on my geriatric placement and had completed the following prior to this:
- 2 acute medicine rotations
- 1 Gastroenterology
- 1 Emergency medicine
- 1 Respiratory
- 1 Haematology
- 1 Orthogeries placement ongoing
The other big factor to consider: Will you have enough time to revise?
I took my exam in Orthogeries placement which was relatively relaxed, and the workload was manageable. As a stroke of luck, my consultant was the hospital lead who organised PACES teaching sessions and encouraged me to attend those. I also had the most fab team of ward juniors who supported me going off ward in the afternoons to do some PACES prep. For the weeks leading up the exam, I routinely stayed late or came in early for either PACES prep itself or used the extra hour to organise urgent and important ward jobs so I could attend PACES teaching in my scheduled working hours. I also requested study leave to attend my tertiary centre sister site to examine cases not found in my hospital like renal and neurology and attend an all-day medical ophthalmology clinic.
I know when working in the NHS, it is very difficult to do get the ‘ideal’ placement for the exam and you just have to me make do sometimes. At the end of the day, it’s about being organised. Before booking PACES in a given rotation, speak to the junior currently on it to see what their day-to-day workload is like. Whilst having a busy job is not a deal breaker and you can still go ahead with PACES then, it is good to know what you are signing up to so you can forward plan how much time you would need for revision. You can’t really revise PACES solely at home and you need exposure to patients with interesting clinical signs ath the hospital so it helps having a relatively quiet rotation where you can spare and hour or two in the afternoons for revision.
The Application Process
As for Part I and Part II Written exams, you apply through the MyMRCP portal. They confirm that your application is received, and you should be hearing more from the college you applied through in 3 working days. Realistically, for my diet anyway, it was around 10 days until any of us heard anything. When I did hear, they told me my application was accepted and they had transferred me from the Edinburg College even though I applied through to the London college to even out the spaces. Some of my other colleagues who applied got put on the waiting list until a space was available. I applied on the 14th April and got my examination centre and date for my PACES examination confirmed on the 29thApril.
Preparation
I had approximately 7 weeks between getting my PACES date on the 29th of April to my actual examination on the 18th of June. All in-all, I personally spent around 8-9 weeks preparing for the exam and in my opinion, this was enough. At first, I freaked out thinking I didn’t have enough time, but towards the end of my prep I wanted the exam to come sooner. It’s all-consuming having PACES looming over you and I wanted to just get the exam over and done with and was glad mine was in June rather than August like some of my other peers. By the 8th week, I didn’t feel I was adding significantly to my knowledge and skill base for the exam, so I guess that was enough time for me. I know this is very personal, and it depends on what medical placements you have completed and how much prior knowledge and clinical experience you have.
Exam Prep Resources: Online Subscriptions, Books and Courses!
Online Subscriptions:
- PasTest online video bank for MRCP is an absolute must have. It has a wide range of clinical cases with signs and you get a wide range of sample cases of what a good history/examination, presentation and viva should sound like.
- Clinical Skills Pro – I wouldn’t have bought this but one of my colleagues doing the exam with me bought Clinical Skills Pro as opposed to Pastest. We exchanged passwords for the respective online banks so we could have access to both. I didn’t think the videos and vivas in this were as helpful and pretty much everything and more was covered by PasTest.
Books:
- The PocketBook for PACES by Rupa Bessant: The most useful book in my opinion for PACES prep. It’s small, it’s portable and is written in a question answer viva format so you can easily pass the book to your colleague on a quiet on-call and ask them to quiz you. I also felt the information was pitched at the right level – not too much, not too little. It also has helpful sections such as “An approach to peripheral nerves” and groups differentials based on the constellation of clinical signs you would find in the examination – e.g. pure motor proximal pattern of weakness and a list of things which can cause this. This helps cut down the thinking time in the actual exam and you are more likely to have a pre-prepared list of differentials
- An Aid to the MRCP PACES (Volumes: 2 and 3). The Consultants kept calling it The Ryder Book! after the author. I was sceptical of using it at first. It is last published in 2014 and I thought the clinical information might be outdated. I found this book super useful for Station 2 (History), Station 4 (Communications) and Station 5 (Brief Clinical Consultation). It has both the candidate information, patient briefs and goes through what a good candidate should be able to elicit for pretty much every possible PACES scenario that can turn up. I went through cases in these books with my peers also sitting the exam through zoom sessions primarily (as time in hospitals l was precious and sign hunting a priority). It’s a good resource to understand the wide spectrum of scenarios which may come up, and as long as you double check the clinical info on management is still in date.
- Clinical Medicine for the MRCP (by Guatam Mehta and Bilal Iqbal): This is HEFTY. The clinical information very dense and you definitely do not need to the vast knowledge the book covers for the exam. The most helpful part about this books were its sample presentations of clinical cases like cirrhosis, Parkinson’s, bronchiectasis etc. Between this and the Pastest videos I was able to polish up the presentation skills – you don’t just need to be competent for PACES, you need to appear competent too! This book is also written in a viva format but you need to pick and choose the relevant things, its improssible to get through all the knowledge in the book.
- Cases for PACES (Stephen Hoole, Andrew Fry and Rachel Davies). The little blue book of the PACES. I know some of my colleagues swear by this book, saying that they only read this cover to cover and got through. I felt this book was good for consolidating rather than learning. It is written in bullet points and this book did a lot of stating rather explaining and I found it a bit limited for the learning process. However. it was useful for station 5 cases a where you needed to know little bits about a lot of different topics. I could have done without it but did use it on occasion for last minute glances at topics or to tidy up/consolidate a topic. If you are very tight on time this should be your go to book. However, if you have around two months, I thought the pocketbook of paces was better in gearing you for the thinking process as well as the knowledge behind paces stations as it went through approach to clinical examinations.
Courses:
- PassPACES: I did the PassPACES course run by Dr Rupa Bessant around 10 days before my exam. I didn’t plan it that way but if I could, I wouldn’t have planned it any other way. By the time I got to the course, it was the final hurrah, the last bit of revision I did before the real deal. I had already done the bulk of my prep before the course so I felt I could focus on learning the bits from the course that I couldn’t from books/online materials. The mock exam at the end of the course was more reflective of how I would be like in the real thing a week later which could be a blessing or curse depending on how it goes so soon before the exam – in my case the mock went a lot better than what I was expecting so it was a good confidence boost. Overall, it doesn’t really matter when you do the course but doing one is definitely helpful particularly if you are in district general hospital and don’t see a wide variety of cases.
- PACESAhead: I didn’t do this course so cannot comment but my colleagues who did also passed and the quality is similar. I chose my course based on which dates worked for me rather than who it was run by.
PodCasts:
- PrePACES Podcast: If you are like me whose commuting time could easily reach an hour in rush hour traffic – using this times with PodCasts is super helpful. My favourite was the PrePACES Podcast hosted by Dr San Williams where he invites Consultant and Registrars to talk about their specialist subject in a format relevant to PACES. They go through how each topic sleek myasthenia gravis, IBD or bronchiectasis can come up in the exam, how to examine, signs to looks out for and the potential viva questions.
The most useful advice given to me going into the exam:
You don’t have time to think during the exam. So prepare your differentials before hand – for example, compile a list of conditions causing bilateral upper motor neurone patterns of weakness or unilateral pure motor weakness. Having a list of reasons for each surgical scar or what are the MS mimics are. This really helped me to remains structured under pressure.