Practical Tips & Tricks for Paces ❗

(1st Edition)

Copyright ©2018 Dr Abdul Rashid (MRCP UK, MRCPI). All rights

reserved. No part of this document maybe copied or altered

This document will be part of my upcoming Paces book (I will try my

best to keep its online version free)

♦ 2 Golden rules for success in paces :

Practice, practice, practice
Make sure you are practising with correct approach.
Practising blindly with incorrect approach can result in making
same mistakes in exam !

♦ Tips for station 1,3,5

✅ Make a habit of scanning the patient in just 10 seconds. Quickly
observe :

Face for any spot diagnosis

Hands for any obvious deformity
Stature - short/long
✅ You can utilize the time while you are applying hand gel &
greeting the patient
♦ Tips for stations 2,4,5
Use layman language with patient/surrogate
Use technical language with examiner
e.g. to patient you can say I would refer you to joint specialist ;
but to examiner you would say I would refer this patient to a
Rheumatologist

♦ Tips for final preparation of paces

You should be speaking a lot & not just reading (for all
stations)
speaking will help you in achieving fluency
Examiners like fluency. Some minor deficiencies may be
ignored if candidate is fluent
Avoid doing exam discussion with study partners in your
local language. Please make sure you are speaking English all
the time

♦ Tips for clinical stations 1 & 3

Try to have as many mocks with experienced trainers & also
with recently passed candidates !
Mocks put you under pressure and will bring out mistakes
Mocks will help you to identify mistakes and you can prevent
them in real exam
Mocks help you to get used to pressure you will face in real
exam
♦ Tips for stations 1 & 3 for final revision
during last few days before exam continue the good old
technique of presenting common cases in front of mirror or to your
study partner
present findings, differentials investigations & treatment in 4
minutes as in real examiner viva
pay special attention to common cases e.g. renal transplant, ILD,
Prosthetic valves, Stroke etc

♦ Advice for those who were unfortunately not successful in

recent paces exam :
Please don't start from scratch. Don't change your study
resources dramatically
try to identify weak areas & work on them
maintain your strong areas
official feedback from Royal college is useful to identify strong &
weak areas

♦ Tips for clinical stations 1,3 (also applicable to station 5 to some

extent)
✅ Improve inspection. It will save you. Do active inspection i.e. you
should be knowing what you are looking for. E.g. only if you know u
have to look for palmer erythema in hands, you will identify it.
Otherwise you overlook it in the pressure of exam. Similarly, you
should have an idea of which scars to actively look for
♦ Tips for station 2
✅ Try to complete main history in about 10 minutes
✅ In rest of about 4 minutes :

Summarize & ask patient whether he would like to add anything

missed
ask & address all concerns
give important advice e.g. quit smoking, stop driving etc
according to relevance in the scenario.
convey to patient the possible diagnosis/differentials & outline
how you plan to proceed with investigations & Rx
Make sure patient agrees to your further management plan
(shared decision making)

♦ Tips for station 2

✅ History station is much more than just making a diagnosis !
Always make problem list relevant to a particular scenario e.g.
advice to quit smoking, cutting down alcohol, stopping an offending
medicine, driving/DVLA, Impact on activities of daily life, social
issues, Occupational therapy/physiotherapy referrals,
admission/outpatient, safety netting, referrals to relevant specialty
You will need to discuss this problem list with both the patient &
the examiner
♦ Key strategy to improve chance of success in paces :
have at least one "regular & serious study partner" till your
exam.
And in between keep interacting with other advance candidates

♦ Tips for station 5

try to keep history short
don't waste time in asking questions that will not help in
diagnosis or management plan

♦ Station 5 : Time management tips

examine at same time as taking history for features you can
inspect
e.g. if you are suspecting acromegaly & asking about change in
size in hands ➡ have a look at hands at the same time as taking
history
similarly for patients presenting with joints pains or rash, inspect
joints & skin rashes at same time as asking questions about them
mostly endocrine, rheumatological & dermatology cases are easy
to examine at the same time as taking history
♦ Tips for knowledge base required for paces
You don't need great depth of knowledge but should be at least
aware of initial investigations protocols & management steps of
conditions commonly encountered in Paces
for reference try to use easy to use British resources rather than
extensive resources like UpToDate !

✅ recommended reference resources :

oxford handbook of medicine & specialties
Patient UK website
GP notebook website
CKS website which has summary of nice guidelines

♦ Tips for station 2 & 5

Always pay special attention to past medical hx, drug hx & family
hx. There will always be vital information there

♦ Tips for station 1 & 3

✅ Always remember to do 3 things
1) use hand gel (frequently forgotten & important for welfare skill +
initial impression for examiner)
2) quick general look at patient - you might find a spot diagnosis e.g.
myotonic dystrophy, systemic sclerosis etc
3) quick inspection around patient - you might find important clues
e.g. inhalers, insulin pen, walking aids etc
♦ Station 4 tips
✅ A lot depends on how surrogate reacts. Be prepared to modify
approach accordingly. So that your consultation looks natural. E.g. if
surrogate gets angry don't move to next step before giving him
chance to express his anger & calming him down

♦ By Dr Teoh (MRCP UK) who passed paces in 2018

✅ " Before my exam I received a message of advice from one of my
consultants :
Have full confidence but not being cocky. Be humble with full
respect to patients and examiners. But do not be too humble.
Majority of the examiners do not know you. During that few
minutes, you must let them feel that you are at the level of their
peers. Then, you shall pass ❗ "

♦ Advice by Dr Chin (MRCP UK) who passed paces in 2018

✅ Study common cases (Those in OST book: volume 1)
Practice those cases with your colleagues (If can, those common
cases practice repeatedly for few time - either with real Patient or
with your colleagues or with yourself and the wall)
✅ Don't panic...
✅ Looking at the break down of the marking now - I just realise
they are not looking at perfection (some minor mistakes are
acceptable
✅ The advice is - keep cool, keep calm, say whatever u think is right
(as long as not too bizarre), positive thinking, work hard for it... and
lastly - pray for success!

Keep practising with with focussed & correct

approach . Good luck to all future Paces candidates !
(I am a professional trainer for MRCP UK and MRCPI Ireland clinical
examinations. For details you may visit my facebook page
https://www.facebook.com/PacesMocks )