Get ready for PACES 2020

Introducing PACES 2020

Postgraduate medical education has undergone significant changes in the ten years since the current MRCP(UK) Part 2 Clinical Examination (Practical Assessment of Clinical Examination Skills), commonly known as PACES, was introduced.  The new Internal Medicine Curriculum, Shape of Training and other reviews have helped the Federation of the Royal Colleges of Physicians ("the Federation") to better understand the competences required of doctors in the 21st century.

How PACES is changing

The changes to PACES are the product of a 12 month review of the examination by MRCP(UK) to ensure that it remains fair, relevant and fit for purpose. The changes build on the current format but develop some elements to make them more realistic for examiners and trainees.  It now better reflects the new Internal Medicine stage 1 curriculum, developed by the JRCPTB on behalf of the Federation. The curriculum, implemented in August 2019, is designed to produce doctors with the generic professional and clinical capabilities needed to manage patients presenting with a wide range of general medical symptoms and conditions and holistic decisions on progress will be made for high level capabilities in practice.

Dr Mike Jones, RCPE Director of Training and medical director for training & development for the Federation said:

These changes reflect much of the ambition of the new Internal Medicine training programme in promoting capability in practice that is relevant to the everyday experience of the physician. Success in the exam will demonstrate that trainee physicians have acquired the necessary experience and skills to provide a very solid basis for expert patient care.   

Dr Nicola Robinson, specialty registrar in respiratory and general internal medicine, SE Scotland and member of the clinical examining board, added:

It [the PACES 2020 exam] will allow additional skills testing by more examiners so is a better judge of each candidate and gives you more opportunities to display your ability. It feels more realistic than previous versions of the exam, and is reflective of what physicians do on a daily basis.

Dr Towhid Imam, specialty registrar in geriatric and general internal medicine, London and member of the clinical examining board, also said:

I have had a unique opportunity to contribute to how the exam is shaped and improved as well as observe and feedback on the new format and advise on the scenarios used. The changes are more reflective of clinical practice, allowing candidates to demonstrate their clinical skills. 

When is it happening?

The new clinical examination will be introduced for the 2020/3 diet in September 2020.

The Federation will be providing a comprehensive range of resources for candidates and examiners to ensure that they are prepared for the new format of PACES. These will include informative videos of the new encounters, an examiner webinar, written guidance and attendance at events and training days. Please look out for these on the MRCP(UK) website, Facebook and Twitter, as well as the Federation's newsletters and emails in the coming months.

UK trainees should now start discussing with their educational supervisors when they plan to sit PACES.

What’s being removed?

• Station 2: The history-taking station was considered to be artificial with structured history-taking skills being tested in isolation and not representative of modern practice.
• Station 4: 20 minutes for a single communication and ethics encounter was felt to be rather long and in particular, the five-minute examiner/candidate interaction added little value to the overall assessment.
• Station 5: Testing all seven skills in an integrated manner was very like real life but was very pressured in 10 minutes

What’s being introduced?

• Communication: Two 10-minute communication encounters. These will no longer include a question and answer section with the examiners. Instead, the encounter will be judged on observation alone.
• Consultations: Two 20-minute clinical consultations will assess candidates across all seven skills in a realistic and integrated manner. Candidates will have 15 minutes to take a structured history, examine the patient, explain the likely diagnosis and management and address any questions or concerns raised. There will then be a five minute question and answer section with the examiners. 
• Encounter sequencing across the carousel: The new carousel will alter the sequencing of the encounters through the carousel. Some stations will include physical examination and communication encounters. This will ensure that examiners at each station contribute more judgements in each of the skills for each candidate, improving the reliability of the exam.