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PACES23 Communication Stations: Scripts That Score

A station-ready system for explaining diagnoses, discussing risk, shared decisions, consent/capacity and safety-netting—without sounding robotic.

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

  • PACES23 communication is scored through <strong>structure</strong>: agenda → ICE → explanation → options → risk → plan → safety net.
  • Use <strong>chunk-and-check</strong> to stay human and ensure understanding under time pressure.
  • Your goal is not eloquence—it’s <strong>safe, patient-centred decisions</strong> with explicit uncertainty handling.
PACES23 includes communication encounters designed to test real clinical practice: clarity, empathy, risk discussion, and safe next steps. Most candidates underperform because they improvise. The fix is to use a small number of reusable structures and phrases that keep you on rails while still sounding natural.

The 10-minute structure (memorise this)

<strong>0:00–1:00</strong> Agenda + rapport <strong>1:00–2:30</strong> ICE (ideas/concerns/expectations) <strong>2:30–5:30</strong> Explanation (chunk-and-check) <strong>5:30–8:30</strong> Options + shared decision + risk <strong>8:30–10:00</strong> Plan + safety net + close
1

Script 1 — Opening + agenda (20 seconds)

“Hello, I’m Dr Tytler. Thank you for coming in. I understand you’ve been asked to see me today about <strong>X</strong>. Before we start, what were you hoping we’d achieve by the end of this conversation?”
2

Script 2 — ICE that doesn’t feel forced (30 seconds)

“Just so I pitch this properly: what do you think might be going on? What’s worrying you most? And what were you expecting we might need to do next?”
3

Script 3 — Explanation using chunk-and-check (2–3 minutes)

Chunk: “From what you’ve told me, this fits with <strong>X</strong>…” Check: “Does that make sense so far?” Chunk: “The reason we think that is…” Check: “What questions do you have at this point?” This prevents monologues and scores well because it demonstrates patient-centred communication.
4

Script 4 — Risk discussion that is adult and clear (1–2 minutes)

“There are two risks to balance here: the risk of doing nothing, and the risk/downsides of treatment. In your situation, the main risk of waiting would be <strong>A</strong>. The main downsides of treatment are <strong>B</strong>. Based on that balance, my recommendation is <strong>C</strong>—but I want to check how that feels to you.”
5

Script 5 — Capacity/consent language (as needed)

“To make sure we’re making the right decision, can you tell me in your own words what you understand about the options, and what matters most to you here?” (If confusion persists) “Would it help if I summarised again and we take it step-by-step?”
6

Script 6 — Safety netting (mandatory, 20–30 seconds)

“If you develop <strong>red flag 1</strong>, <strong>red flag 2</strong>, or if things worsen despite the plan, you should seek urgent help. If you’re unsure, it’s safer to get checked. Let’s agree how you’ll access help if needed.”

Communication station “do not miss” behaviours

  • Explicit agenda-setting early (stops you being dragged).
  • Demonstrate empathy with specificity (“That sounds frightening / exhausting”), not vague reassurance.
  • Avoid jargon or translate it immediately (“a clot—basically a blockage”).
  • Offer options (even when one is recommended) and check preference/values.
  • Close with a summary and confirm understanding.
SourceMRCP(UK): PACES format (official Federation page)
Open Link
SourceGMC: MLA themes (patient-centred care, managing uncertainty) — useful behavioural alignment
Open Link
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  • “Hello, I’m Dr Tytler. Thank you for coming in. I understand you’ve been asked to see me today about X. Before we start, what were you hoping we’d achieve by the end of this conversation?”

    Return to this section

  • “Just so I pitch this properly: what do you think might be going on? What’s worrying you most? And what were you expecting we might need to do next?”

    Return to this section

  • Chunk: “From what you’ve told me, this fits with X…” Check: “Does that make sense so far?” Chunk: “The reason we think that is…” Check: “What questions do you have at this point?” This prevents monologues and scores well because it demonstrates patient-centred communication.

    Return to this section

  • “There are two risks to balance here: the risk of doing nothing, and the risk/downsides of treatment. In your situation, the main risk of waiting would be A. The main downsides of treatment are B. Based on that balance, my recommendation is C—but I want to check how that feels to you.”

    Return to this section

  • “To make sure we’re making the right decision, can you tell me in your own words what you understand about the options, and what matters most to you here?” (If confusion persists) “Would it help if I summarised again and we take it step-by-step?”

    Return to this section

  • “If you develop red flag 1, red flag 2, or if things worsen despite the plan, you should seek urgent help. If you’re unsure, it’s safer to get checked. Let’s agree how you’ll access help if needed.”

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

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