5 Tips for PACES in Practice

09 Jul 2015
MRCP

How should you prepare for the ever-difficult PACES exam? Dr Jez Hunter passed PACES only a few weeks ago - here are his top 5 tips for exam success.

One of my PACES buddies described the exam akin to running down a wet track trying to avoid puddles, only the puddles are those of your own making. My PACES experience was stressful, uncomfortable but ultimately successful. I hope the following tips help to keep your own track a little drier!

1. Pick your core texts

Whoever you speak to will have their favourite. I lost count of the amount of times I was told “all you need to do is learn the green book!”

In truth, most of the popular PACES texts these days are really high quality. There is a tendency to throw serious money into PACES thinking it will offset the need to work quite so hard. In this case, the reverse is true. I had about 3 texts on the go at any one time, until I realised that this was both confusing and inefficient.

Have a look at the core texts early, decide which you want to use for each type of station and stick to it.

2. Exploit your downtime

I commute an hour each way to work. I was able to fill this time with PACES podcasts which made me feel better when working 13-hour days with no time, energy, or inclination to revise at the end of each shift. I found them especially useful for the communications and ethics stations. Many of the nuanced questions I remembered to ask my patients were not down to my mental dexterity but simply because I’d heard a similar consultation on a podcast a few weeks before. Counselling a patient’s relatives on brain stem death does not feature heavily in core medical training, so I found this experience by proxy invaluable.

3. Station 5 prep is crucial

With over 1/3 of the whole exam’s marks crammed into a single station, it makes sense to practise this and yet it’s the most difficult to prepare for. One colleague of mine suggested that you have to think like a GP to get through this station, and there is much truth in this.

This is where I found the Pastest videos so useful. They provided both aural and visual prompts on how to deal with “typical“ Station 5 problems. Whilst this structure seems obvious in the comfort of routine clinical practice, this common sense approach seems to implode when under a ticking 8 minute clock and hawkish examiners. The videos spiced up the dullness of book work, enabling me to switch between learning mediums when interest was flagging.

4. Invest in a course

I cannot recommend this highly enough. It is incredibly inefficient to stalk the wards looking for typical PACES patients. When you find the perfect fit they are either sleeping, unwilling or too ill to examine. When you find one, these “untrained” PACES patients often tell you their diagnosis mid-flight, or the tight timings that are crucial in order to replicate the real thing go out the window. Seeing up to 30 typical patients with rare chronic stable conditions per day under near exam conditions is revision rocket fuel.

I know a few who have passed without the hint of structured PACES training; however I know far more who have struggled with multiple exam retakes until they did a course.

5. Prepare to be disappointed

On the day you will only remember the things you missed or the mistakes you made. You are not a good judge of performance at this stage so don’t torture yourself unpicking each thread of the experience. I do not know many who left the exam feeling it had been positive career highpoint. That is to come. The real gem from PACES is it refines the way you think. It teaches you the value of being really present during clinical encounters. It trains a higher level of cognitive athleticism. It makes you a better doctor.

Good luck.

09 Jul 2015
MRCP