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MRCP PACES (PACES23+): The Carousel Practice Protocol

A PACES plan mapped to the carousel: 5 stations, 20-minute moves, and a practice structure that builds clinical signs + communication under pressure.

Review date
Feb 2026
Reading time
12 min read
Author
Dr. Kola Tytler MBBS CertHE MBA MSt MRCGP
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Key points

  • 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.
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.
3

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.
4

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.
  • Each system exam has a ‘sign script’ you can run without thinking.
  • Summaries are 60–90 seconds, not 5 minutes.
  • Weekly timed carousel simulation in the final month.
  • Communication structure is rehearsed until reflexive.
SourceMRCP(UK) — PACES format (official carousel description)
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SourceMRCP(UK) — PACES examiners guide (timing and station conduct)
Open Link
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  • 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.

    Return to this section

  • 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.

    Return to this section

  • 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.

    Return to this section

  • Use a universal structure: agenda → empathy → explain → options → shared plan → safety net. The words change; the structure stays.

    Return to this section
  • Return to this section
  • Return to this section
  • Return to this section
  • Return to this section

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