How I passed the PACES exam first time with 168/172
The winning 8 week Revision Plan
How to pass the PACES Exam in 8 weeks!!
(+1 optional week to relax and unwind and consolidate at the end)
You absolutely DO NOT need tones and tonnes of time for PACES. If you are working doctor in medical specialties, a lot of your day to day life would prepare you fro the exam more than you think. I got my PACES exam date on the 29th April for an exam on the 18th June – that’s about 7 weeks and I only started focused revision when I applied for the exam 1-2 weeks before. I was holidaying in Pakistan before that so overall I had 8-9 weeks fro PACES prep.
Exam revisions structure will be very different from person to person depending on what the candidate wants to focus on, their strengths and weaknesses and their earning style. Here is the structure that worked for me:
1st to 3rd week:
I had very little idea of what the PACES Exam was about. For the first three week, the Pastest videos were my main focus of revision. It gave me a good overview of what the exam would be like, the range of common cases and the standards expected from a candidate. It also helped me understand how the exam was structured in terms of format and allocated time viable for each station. Watching the videos over and over helped me re-learn the 6-minute structured examination technique which I had forgotten since medical school. On the medical take it’s all about focussed examination which is different from PACES life where you need to be thorough and systematic. I also carried the pocketbook for paces with me to work in case I found time for reading (which I usually didn’t) but I felt like I was doing something taking it in. I did however read the Pocketbook chapters at home in the evenings and practiced talking out loud the sections I was reading. This helped me get used to idea of speaking and also coming up with model answers to questions like “What are the extra-articular manifestation of rheumatoid arthritis” or “What are the causes of exudative pleural effusions”. I listened the PrePACES on my way to and from work. For the first three weeks, there was a fair bit of spoon-feeding myself the knowledge for the exam through videos and books rather than active practice just because I didn’t have the background knowledge at this stage. I kept an eye our for patient with good clinical signs so I could hear and understand how they present but as I was still learning, I didn’t do these under timed exam conditions. It was only towards the third week I felt more confident going through wards with my senior or peers to exam clinical cases.
4th to 6th week:
PRACTICE, PRACTICE, PRACTICE. I let it be known amongst my peers, registrars, and consultants I was one the juniors taking the exam that diet and if there was a patient with interesting signs to let me know so I could examine them. We made a WhatsApp group chat of all those revising for PACES and we regular met up in small groups to examine patients with clinical signs and viva each other on the topic just examined. We used the pocketbook for paces book to help guide the viva for each other. You need to find the consultants and registrars who are happy to watch you examine – many of them are and its helpful to get senior feedback on examination technique. During this period, I spent majority of my revision time in hospital including staying behind after work if needed. We walked from the stroke ward to cardiology to respiratory to gastro asking the juniors/ consultants working there if they had patient with good signs. Sometimes one of us looked at the ward list/patient notes to see who may be suitable whilst the other one examined. I aimed to examine at least 2 patients a day for those three weeks under timed conditions with presentation and viva – that’s just over an hour of focussed revision a day at work which is manageable. Obviously, on some days you may be able to do more than an hour and other days you wouldn’t be even manage a minute but it’s a good average to aim for. A lot of PACES revision is opportunistic, so if there is a good case on Ward X, take time to go there as clinical case may not turn up again. Make the most of your working hours – for eample if you are doing a ward round or take, pretend each patient you see if a PACES patient and time yourself 6 minutes when you examine them. In the background of this, for about 1-2 evenings a week and the weekends, I aimed to do history, communication stations and station 5 prep either with my sister (who was a foundation doctor at the time) or my colleagues over zoom. An Aid to MRCP PACES (the Ryder book) was particularly useful during these sessions. I took a day of study leave to attend a medical retina clinic for ophthalmoscope practise.
7th week:
I spent my 7th week brushing up my presentation skills and doing more Station 5 cases. You have to come across as structured, systematic and confident not just in the examination but your presentation and viva too. You need to be able to the demonstrate to the examiner that if their granny got admitted to the hospital at 3am in the morning, you as the senior most doctor on site in the hospital, would be able to initiate the right management. Get them to trust you as a registrar and make them believe that their granny will be in safe hands. This comes from practising how you come across and I spent time talking and presenting to the mirror to get these skills polished. I also spend more time on Station 5 as it a large chunk of your marks (56/172) – about one third of the whole PACES marks come from just this one station. I also feel this is the station more reflective of clinical practice where you take a simultaneous focussed history and examination and you probably know it well already doing your day-to-day job but I went through more of the Station 5 example scenarios on the MRCP website and the Ryder book to work on Station 5 more.
8th week:
PACES Course. It’s a medical boot camp, it is intense, and you need to prepare for your stamina to be tested. The patients there are great, they know their condition so well and they teach you. The best person who taught me how to examine for a collapsing pulse was a patient with a collapsing pulse on the course and it was the first I could convincingly feel it. The course give you tips on examination techniques, such as the addition of “making a tight fist and opening it (to screen for myotonia) and inspecting the c-spine” for upper limb exam. They also help teach you how to logically think through signs – for example with a patient with a thoracotomy scar what could they potentially have (lobectomy, pneumonectomy, pleurectomy, single lung transplant or previous infections like TB). There is pretty much every clinical sign present there that you would examine with a fell mock exam.
9th week:
I was so shattered after the PACES course that the next two days I spend getting a full body massage and recovering. In the last week, I consolidated information I knew already, perfected my examination technique incorporating tips learnt from the course. I particularly spent time on the less performed examinations like cranial nerves by making family who I lived with my pretend patients. I leisurely practised some presentation skills to remove the guilt of not having done much this week and wentwent over the DVLA guidelines. It was a fairly relaxed week leading up to the exam, but I did want to conserve my brain power for the real thing.
Final thoughts tips, and advise:
Everyone’s revision technique is unique and this is something which worked for me so hopefully you find it useful.
I am kinaesthetic-type learner so I need to practise things to get it right. I probably did more practising in front of the mirror, or actively recalling presentations in my head in the “dead time” like walking down corridors to drop a lab sample or on my commutes to and from work compared to most other candidates.
I also like a spiral method of revision – where I continuously revisit topics at spaced intervals to help me remember. I find blocking revision like 1 week neuro, 1 week cardio is not very helpful for me You forget what your learnt in the first week by the time you get to the end. Also you don’t really know you blind sport – what if you realise there is a lot more to do in neuro than you realised and you have left it to the end spending more time on cardio then you should have and now you are suddenly tight for time.
Divide revision time based on marks allocated for each station. Station 5 is 56/172 marks which is nearly a third and this should take. good chunk of your revision time. Equally, this is the type of station you practise on a day-to-day basis at work with history and focussed exams on all your take shifts so you may already be very good at it. I would say really evaluate your strengths and weaknesses when planning revision and allocate time accordingly for each part.