Introduction

PACES stands for Practical Assessment of Clinical Examination Skills

Before candidates can enter the MRCP(UK) Part 2 Clinical Examination (PACES), they must have fullfilled the following criteria:

General Tips About MRCP PACES

MRCP Station 1

Examination of the respiratory system

-insufficient time spent on inpection,missing scar and abnormalities of shape and movement of chest wall.
- failing to percuss and auscultate over the apices and /or right down to the lung bases.
-not knowing normal leves of diapragm anteriorly and posteriorly.
-failing to assess tracheal position.
-failing to test vocal resonance.
-failing to consider non-respiratory disease (eg cardiac failure,nephroyic syndrome) in the differential diagnosis.
-inventing signs to fit a diagnosis.

Examination of the abdomen

-being too rough and causing the patient discomfort.
-not performing light palpation first.
-not ensuring patients breathe through their mouth when testing for downward organ movement
-failing to palpate for kidneys.
-failing to examine correctly for th presence of ascites.
-inventing signs.

MRCP Station 3

Examination of Cardiovascular system

-insufficient time spent on inspection, missing scars and abdominal pulsations.
-not adequately assessing character of heart sounds as well as murmurs.
- failing to turn patient to left lateral position and localize apex beat before listening to apex for MDM.
-failing to position patient correctly to examine for an EDM at the lower left sternal edge.
-FAILING TO ANALYSE MURMURS IN CONJUCTION WITH THE OTHER FINDINGS EG PULSE,POSITION OF APEX BEAT, ABNORMAL HEAVES AND HEART SOUNDS.
-not assesing JVP correctly, most commonly due to poor positioning of patient.
-inventing murmurs.

Examination of the CNS

-being too rough and causing patient discomfort.
-failing to instruct patient adequately, leading to wrong interpreattion of signs, especially when testing power, sensation and co-ordination.
-not taking into account patient's mental state and alertness.
-failing to assess gait, where approriate.
-failing to assess limb posture and muscle wasting/tone.
-failing to assess visual acuity and fields.
-performing an unstructured examination, especially when testing sensation.
-misinterpreting weakness as a cerebellar deficit when testing for co-ordination.
-poor and unpractised tendon hammer technique.
-failing to identify and intepret patterns of abnormalities.
-failing to recognise that not all neurological pathologies always present with absolutely typical features (eg UMN lesions may sometimes not be accompanied by increased tone and hyper-reflexia.)
-inventing signs.

MRCP Station 5

Examination of fundi

-insufficient practice with opthalmoscope.
-failing to assess for presence of cataracts.
-not describing what you actually see.
-inventing findings to fit pre-conceived diagnosis.

Examination of skin

-not describing what actually you see.
-guessing when you do not know the diagnosis.

Examination of Locomotor

-failing to establish whether the patient has active arthritis, with painful joints.
-being too rough and causing patient discomfort.
-poor assessment of joint movement, especially the spine.
-poor assessment of functional limitation, especially when examining the hands.
-inadequate knowledge of the differentiating feature between common arthropathies.

Examination of the Endocrine

-poor understanding of the patho-physiology of the common endocrine conditions.
-inadequate assessment of thyroid status and expecting patient to have active thyrotoxicosis if they have other features of Grave disease.
-poor assessment of dysthyroid eye disease

The Marking Of The MRCP(UK) Part 2 Clinical Examination(PACES)

The overall PACES score:

Fourteen mark-sheets in total are completed by the Examiners: two by each examiner at Stations 1 and 3; one by each Examiner at Stations 2,4 and 5. The Station Mark awarded on all fourteen mark-sheets determines the candidate’s overall PACES score.

All marks are recorded using a four-point grading system. These are

PACES is marked out of a total of 56 marks ( being the maximum available from the fourteen mark-sheets). A candidate will not pass if awarded three or more ‘clear fail’ grades regardless of the PACES score achieved. The nominal Pass Mark for PACES is 42. However, the MRCP(UK) Clinical Board has the authority to vary the Pass Mark.

How Do They Mark You?