PACES
PACES is at the heart of the MRCP(UK) exam. It stands for the ‘Practical Assessment of Clinical Skills'. The exam assesses important skills that junior physicians should have prior to completion of the Core Medical Training, such as communication skills, law and ethics.
This brief MRCP guide to PACES provides an overview of stations 2 (history taking), station 4 (communication skills and ethics), and 5 (focused clinical problem/integrated clinical assessment).
Station 2
The history-taking skills station aims to assess the candidate's ability to gather data from the patient in a methodological manner, to construct a differential diagnosis, to deal with concerns the patient may have (listening attentively and responding to cues), to summarise the information with the patient, to construct a comprehensive, sensible and appropriate management plan (including the key steps of management) that is explained to the patient clearly, and to treat the patient with comfort, dignity and respect ensuring patient welfare.
When reading the referral letter, it is useful if you should have at the front of your mind the key elements of the history which you feel are going to be relevant,
While taking the actual history, you should ensure that you also ‘tick off' the following aspects, in that you:
• Introduce yourself appropriately to the surrogate/patient
• Use open questions initially
• Complete the history in the allotted time
• Avoid the use of jargon
• Do not impart wrong information
Video tutorials
For further help, please see the Law and Medicine tutorial on basic communication skills as part of the ‘core medical training' programme
http://www.lawandmedicine.org.uk/ExaminationFiles/1T.swf (comm. Skills)
http://www.lawandmedicine.org.uk/ExaminationFiles/3T.swf (breaking bad news)
Tutorial on Station 2 of PACES
http://www.lawandmedicine.org.uk/ExaminationFiles/Station%202.pdf
Station 4
The communication skills and ethics station aims to assess the candidate's ability to guide and organise the interview with the subject (who may be a patient, relative, or surrogate, such as a health care worker), explain appropriate clinical information, apply clinical knowledge, including knowledge of ethics, to the management of the case or situation, demonstrate clinical judgment in managing (and responding to) patient concerns, provide emotional support and treat the patient respectfully, ensuring always comfort, dignity and respect.
Video tutorials
For further help, please see the Law and Medicine tutorial on basic communication skills as part of the ‘core medical training' programme
http://www.lawandmedicine.org.uk/ExaminationFiles/1T.swf (comm. Skills)
http://www.lawandmedicine.org.uk/ExaminationFiles/3T.swf (breaking bad news) Tutorial on Station 4 of PACES
http://www.lawandmedicine.org.uk/ExaminationFiles/Station%204.pdf
Station 5
The integrated clinical assessment/focused clinical problem station aims to assess the way in which the candidate approaches a clinical problem in an integrated manner, using a satisfactory history taking (this history must be relevant to the complaint), essential clinical examination which is correct, appropriate, practiced and professional providing all the clinical signs (i.e. no incorrect ones, identification of all signs available), and communication with a patient or a surrogate patient in a focused, fluent and professional manner.
The candidate must consider all relevant diagnoses within the correct differential diagnosis (including the actual correct diagnosis), demonstrate sound clinical judgment in formulating a sensible management plan, not missing out any key steps, including the inclusion of all relevant investigations, and, finally, the candidate has to address the patient's concerns to pass this Station. For this final part, the candidate must demonstrate that (s) he can listen to the patient and demonstrate empathy. Above all, the patient must be treated respectfully to ensure maximum comfort, safety, and dignity.
For further help, please see the Law and Medicine tutorial on basic communication skills as part of the ‘core medical training' programme
http://www.lawandmedicine.org.uk/ExaminationFiles/1T.swf (comm. Skills)
http://www.lawandmedicine.org.uk/ExaminationFiles/3T.swf (breaking bad news) Tutorial on Station 5 of PACES
http://www.lawandmedicine.org.uk/ExaminationFiles/Station%205.pdf