The Bottom Line
- Consultation stations reward <strong>clinical realism</strong>: focused history, targeted exam, clear synthesis, safe plan.
- Your biggest enemy is time drift—use <strong>time boxes</strong> and move on deliberately.
- Every consultation must end with: <strong>summary → differential → initial plan → safety net</strong>.
PACES23 consultation encounters are designed to mirror real clinical consultations: a clinical problem, a patient, and your ability to combine history, examination and communication safely. Your edge is to treat it like a structured clinic, not like a traditional OSCE checklist marathon.
The 20-minute blueprint
<strong>0:00–2:00</strong> Opening + agenda + clarify task
<strong>2:00–8:00</strong> Focused history (problem-led)
<strong>8:00–12:00</strong> Targeted exam (verbalise + interpret)
<strong>12:00–15:00</strong> Synthesis (summary + top differentials)
<strong>15:00–18:30</strong> Initial plan (tests + management)
<strong>18:30–20:00</strong> Safety net + close
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Step 1 — Start with a ‘one-line’ problem statement
Within 30 seconds, state the one-liner: age, key symptom, timeframe, severity, and key comorbidity. This signals control and helps you stay focused.
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Step 2 — Use a ‘hypothesis-led’ history
Ask questions that discriminate between your top 3 possibilities. Avoid exhaustive ROS. A good consultation history is <strong>selective</strong> and <strong>purposeful</strong>.
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Step 3 — Examine what changes management
In PACES23 consultation, examination is not theatre. Do the bits that confirm/refute the hypotheses and change your plan. Verbalise what you are looking for and what you found.
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Step 4 — Synthesis is where marks are won
Give a concise summary, then: “My top differentials are A, B, C because…” and name one discriminating feature for each. Then propose immediate next steps.
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Step 5 — Say the safe plan out loud
Even if you don’t have every detail, you must communicate a safe plan: what you would do now, what tests you would order, and what you would do if results change. Demonstrate managing uncertainty rather than pretending certainty.
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Step 6 — Close like a real clinician
Finish with a patient-facing plan, confirm understanding, and safety net. “If X happens, seek urgent help. Otherwise we’ll review in Y.”
Common failure modes (and how to prevent them)
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SourceMRCP(UK): PACES format (official Federation page)
Open Link SourcePACES23: Consultation scenario guidance (official PDF hosted by Federation site)
Open Link