MRCP PACES station 4
The Membership of the Royal Colleges of Physicians is postgraduate examination and diploma awarded to physicians training in the United Kingdom. In the final clinical exam (called PACES - Practical Assessment of Clinical Examination Skills), the fourth station assesses Ethics and Communication Skills. This is done in a 20-minute station, of which 14 minutes is a simulated clinical encounter with a patient, relative or colleague.
This website was designed to help candidates prepare for this part of their clinical exam, and also to provide useful information for any junior doctor on various ethical or legal issues. It is still a work in progress and any feedback or tips or information on scenarios would be very welcome.
Good luck to all those taking the exam!
Scoring breakdown
The PACES mark scheme was changed in 2009-2010 and is now quite complicated. For up-to-date information, visit the MRCP PACES homepage. Also you can download a sample PACES marksheet for station 4.
Essentially there are 16 points available at this station, out of 172, or 9% of all marks (the lowest of any of the stations!). If you had to pick any one station to have a 'brain freeze', station 4 would be it. But this is not the whole story - see the following table for the marks available and the marks required:
| 'Skill' | Pass mark | Total | Pass % | Station 1 | Station 2 | Station 3 | Station 4 | Station 5 |
|---|---|---|---|---|---|---|---|---|
| A: Physical examination | 14 | 24 | 58.3 | 8 | 0 | 8 | 0 | 8 |
| B: Identifying physical signs | 14 | 24 | 58.3 | 8 | 0 | 8 | 0 | 8 |
| C: Clinical communication | 10 | 16 | 62.5 | 0 | 4 | 0 | 4 | 8 |
| D: Differential diagnosis | 16 | 28 | 57.1 | 8 | 4 | 8 | 0 | 8 |
| E: Clinical judgement | 18 | 32 | 56.3 | 8 | 4 | 8 | 4 | 8 |
| F: Managing patient concerns | 10 | 16 | 62.5 | 0 | 4 | 0 | 4 | 8 |
| G: Managing patient welfare | 28 | 32 | 87.5 | 8 | 4 | 8 | 4 | 8 |
| All | 130 | 172 | 75.6 | 40 | 20 | 40 | 16 | 56 |
Each examiner will mark each relevant 'skill' out of 2 and because they work in pairs, each skill will be out of 4. Note that Stations 1, 3, and 5 comprise 2 clinical encounters and therefore the marks available are twice as many as the other stations.
Station 4 is important for skills 'C' and 'F' - there are only 16 marks available for these - and for 'G'. Skill 'G' has a very high pass mark and you should always remember the importance of patient welfare in all of the stations.
Marksheet guidance
For all of the skills, the sample marksheets provide useful guidance on what to do to pass. Also of interest is the calibration sheet, which has a few more pointers. However you don't have to download them as they are summarised here:
| 'Skill' | Satisfactory | Unsatisfactory | Calibration sheet |
|---|---|---|---|
| A: Physical exam | Correct Thorough Fluent Systematic Professional technique |
Incorrect technique Omits significant or important tests Unsystematic Hesitant and lacking in confidence Unprofessional |
|
| B: Identify signs | Identifies correct signs Does not find signs that are not there |
Misses important physical signs Finds signs that are not present |
|
| C: Comm skills | Explains relevant clinical information in an: Accurate Clear Structured Comprehensive Fluent and Professional manner |
Omits important information Gives inaccurate or unclear information Poorly structured Uses jargon Appears unpractised Unprofessional |
Defines purpose of interview Avoids jargon Uses open questions Summarises Confirms understanding |
| D: DDx | Sensible differential diagnosis that includes the correct diagnosis |
Poor differential diagnosis Fails to consider correct diagnosis |
|
| E: Clinical Judgement | Selects or negotiates a sensible and appropriate management plan for this patient, relative or clinical situation Can apply clinical knowledge, including knowledge of law and ethics, to this case |
Selects or negotiates an inappropriate, incomplete or incorrect management plan Cannot apply knowledge to this case |
Negotiates Respects the patient as a person (their medical best interests and their wishes) Uses professional judgement (in face of uncertainty and to communicate honestly and accurately) Tries to do more good than harm Shows awareness of the principles of justice and equity |
| F: Patient Concerns | Seeks, detects, acknowledges and attempts to address patient's or relative's concerns Listens Confirms patient's or relative's knowledge or understanding Empathic |
Overlooks patient's or relative's concerns Poor listening Not empathic Does not check knowledge or understanding |
Listens attentively Reacts to cues Empathises |
| G: Welfare | Treats patient respectfully and sensitively and ensures comfort, safety and dignity |
Causes patient physical or emotional discomfort Jeopardises patient safety |
