The Bottom Line
- Train PACES as a *carousel*: time pressure + transitions are part of the exam.
- Build ‘sign scripts’ (what you look for, what you say, what you conclude).
- Rehearse summary and management in a tight, examiner-friendly format.
Official PACES carousel constraint
PACES is marked across five clinical stations with candidates moving to the next station every 20 minutes, with a short interval between stations. Your practice must include timed cycles, not just ad-hoc bedside teaching.
PACES failure is often a communication failure disguised as a knowledge failure: candidates see the sign but can’t present it cleanly; or they have the right differential but can’t justify it under questioning. The fix is a station-based protocol with tight, repeated reps.
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Step 1 — Build ‘sign scripts’ for core examinations
For each major system exam: (a) opening line + consent, (b) inspection/palpation/percussion/auscultation sequence, (c) the top 6 signs you actively hunt, (d) what each sign implies, (e) your one-sentence summary + top 3 differentials.
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Step 2 — Practise ‘presentation under fire’
After each exam, force yourself into a 60–90 second summary: findings → what they mean → most likely diagnosis → immediate management/next steps. Record yourself; most candidates are 2x too long.
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Step 3 — Run full carousel simulations weekly (timed)
Do a 5-station timed cycle weekly in the final month. The goal is not perfection; it’s consistency under fatigue. Capture recurring errors (missed signs, messy summaries, weak differentials) and drill them mid-week.
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Step 4 — Communication stations: memorise structure, not lines
Use a universal structure: agenda → empathy → explain → options → shared plan → safety net. The words change; the structure stays.
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SourceMRCP(UK) — PACES format (official carousel description)
Open Link SourceMRCP(UK) — PACES examiners guide (timing and station conduct)
Open Link