Changes to MRCP (UK) PACES Examination
The RCP has announced changes to the MRCP PACES examination which are
scheduled to take place in October 2009 (diet 3 2009)
New Station 5
The most visible change
to candidates will be in the structure of the new Station 5.
There will now be two 10-minute encounters at this Station rather than the
current structure in which candidates see four patients for 5 minutes each.
The encounters will each
take the form of a “Brief Clinical Consultation” in which the patient presents
with a single clinical problem or symptom of the sort encountered in
day-to-day practice in the wards, receiving unit or outpatient clinic.
Candidates will be required to undertake a brief focussed history and brief
targeted examination in the 8 minutes available with the patient, before
discussing findings and diagnosis with the examiner for 2 minutes.
It is not necessary for
the candidate to undertake a full, comprehensive history (as required in
Station 2) or a thorough, systematic examination (as required in Stations 1
and 3) in these encounters but to demonstrate a focussed and integrated
clinical problem solving approach.
All the scenarios will
be structured to ensure that a capable candidate can undertake the task within
the time available. Real or simulated patients may appear in these encounters.
The four disciplines
currently represented at Station 5 will not now always be represented in the
examination, but clinical problems relating to those disciplines (dermatology,
ophthalmology, endocrinology, and rheumatology) will frequently appear at
Stations 2, 4 or 5, so candidates must continue to be prepared to assess
patients whose problems primarily relate to these systems. Patients with
problems relating to disciplines or areas less clearly represented in the
current examination, for example acute medicine and elderly medicine, may now
also be encountered.
The structure of all
other Stations, and the overall duration and timings of the examination remain
unchanged.
New Marking System
Pairs of examiners will
continue to assess each candidate at each encounter. They will now award marks
to candidates on the basis of their performance on each of seven clinical
skills. These skills are:
a) Physical examination
b) Identifying physical signs
c) Clinical communication skills
d) Differential diagnosis
e) Clinical judgement
f) Managing patients’ concerns
g) Maintaining patient welfare
Full descriptions of
these skills will be published for candidates in a future posting on this
site. Examiners will mark candidates on each relevant skill at each encounter
using a three point marking scale: Satisfactory, Borderline, and
Unsatisfactory. Marks received for all skills at all encounters will be
equally weighted and summed to produce an individual candidate mark.
The pass mark will be
defined by a formal standard setting process that will also take close account
of the current PACES pass standard. It is intended that the overall standard
of the examination will remain the same; that is, the examination overall will
be no harder or easier to pass.
Our interpretation of
these changes
·
More emphasis on
clinical skill
·
More difficult
for candidates to pass by memorising clinical signs and symptoms and using
pattern recognition.
Station 5
·
Standard cases
were encountered
·
Candidates could
easily memorise several likely cases and apply pattern recognition would now
no longer be possible.
·
Given the scope
of the station and likely scenarios it would be nearly impossible to memorise
all the likely scenarios.
Marking system changes
Emphasis on:
·
Demonstration of
clinical skills
·
Demonstration of
a satisfactory approach to investigation and management
·
Demonstration of
attention to the patient’s concerns and welfare paramount
·
Memorising
clinical cases, set questions and answer will not be useful in achieving
success.
How ACES for PACES will
help
·
Physical
examination
The detailed
explanations of technique in ACES for PACES will enable one to acquire these
skills
·
Identifying physical signs
The approach to
identifying and analysing physical signs will enable one to be proficient in
this
·
Clinical
communication skills
The detailed
explanations and methods of history taking and communication will enable one
to acquire these skills
·
Differential
diagnosis
The detailed lists of
likely conditions that may occur, the descriptions of physical signs and
symptoms and the extensive lists of causes will enable one to be proficient in
this
·
Clinical
judgement
The pragmatic approach
to diagnosis, investigations and management will help one be proficient at
this
·
Managing patients’ concerns
The systematic approach
to addressing patient’s anxieties and concerns will enable one to be
proficient at this
·
Maintaining
patient welfare
The pragmatic approach
to clinical skills, investigation and management will enable one to address
and maintain patient welfare
Link
to RCP Website
See
RCP website
Further Information
More information is now
available on the MRCP (UK) website regarding the changes to the PACES exam
We have included some
information here with our observations
New Station 5: Integrated clinical assessment
Total
Station Duration
20 Minutes
Number of Patient Encounters
2, Each of 10 Minutes
Focus
of Assessment
Focused History, Relevant Examination, Problem Solving and
Communication
System Content
Any System
Time
with Patient
8 Minutes per Encounter
Time
with Examiner
2 Minutes per Encounter
New Marking Scheme
Candidates are assessed
on their ability to demonstrate each of the seven clinical skills described
below. Each Station tests a fixed combination of these skills.
Physical Examination
Demonstrate correct,
thorough, systematic (or focused in Station 5 encounters), appropriate, fluent
and professional technique of physical examination
The methods of physical
examination in
ACES for PACES
will enable you to
fulfil this requirement. Read and practice extensively
Identifying the Physical
Signs
Identify physical signs
correctly and not find physical signs that are not present
The step by step
approach in
ACES for PACES
will enable you to pick
up the clinical signs and the extensive descriptions and causes of these
physical signs in
ACES for PACES
will enable you to identify them and list their causes
Clinical Communication
Elicit a clinical
history relevant to the patient's complaint in a systematic, thorough (or
focused in Station 5 encounters), fluent and professional manner. Explain
relevant clinical information in an accurate, clear, structured,
comprehensive, fluent and professional manner
The chapters on history
taking and communication skills in
ACES for PACES
will enable you to become competent in these tasks
Special attention should
be given to addressing the patient’s beliefs, expectations and anxieties or
concerns
Differential Diagnosis
Create a sensible
differential diagnosis for a patient that the candidate has personally
clinically assessed
The information on
clinical signs and symptoms and their causes will give you all the information
required to enable you to come to a diagnosis and the hypothetico-deductive
method of analysis described in
ACES for PACES
will make it easier to
analyse this information
Clinical Judgement
Select or negotiate a
sensible and appropriate management plan for a patient, relative or clinical
situation. Select appropriate investigations or treatments for a patient that
the candidate has personally clinically assessed. Apply clinical knowledge,
including knowledge of law and ethics, to the case
The chapter on
communication and ethics in
ACES for PACES
will enable you to approach this task with ease. Especially the sections on
planning investigation and management with special attention to risks and
benefits
Managing Patients'
Concerns
Seek, detect,
acknowledge and address patients' or relatives' concerns. Listen to a patient
or relative, confirm their understanding of the matter under discussion and
demonstrate empathy
The history taking and
communication sections in
ACES for PACES
will enable you to tackle these tasks with ease
The mnemonics and
acronyms will make it easier for you to remember all the categories of
information required to obtain and thus address the issues raised
Maintaining Patient
Welfare
Treat a patient or
relative respectfully and sensitively and in a manner that ensures their
comfort, safety and dignity
The section on
communication skill in
ACES for PACES
with emphasis on addressing risks and benefits and the sections on addressing
patient’s concerns will enable you to have a systematic approach to these
requirements
