skip to main content
study systems

PACES23 Consultation Stations: Execution Under the Clock

A 20-minute consultation blueprint: how to run focused history + exam + explanation + plan, with scoring behaviours baked in.

Review date
Feb 2026
Reading time
15 min read
Author
Dr. Kola Tytler MBBS CertHE MBA MSt MRCGP
On this page

Key points

  • Consultation stations reward <strong>clinical realism</strong>: focused history, targeted exam, clear synthesis, safe plan.
  • Your biggest enemy is time drift—use <strong>time boxes</strong> and move on deliberately.
  • Every consultation must end with: <strong>summary → differential → initial plan → safety net</strong>.
PACES23 consultation encounters are designed to mirror real clinical consultations: a clinical problem, a patient, and your ability to combine history, examination and communication safely. Your edge is to treat it like a structured clinic, not like a traditional OSCE checklist marathon.

The 20-minute blueprint

<strong>0:00–2:00</strong> Opening + agenda + clarify task <strong>2:00–8:00</strong> Focused history (problem-led) <strong>8:00–12:00</strong> Targeted exam (verbalise + interpret) <strong>12:00–15:00</strong> Synthesis (summary + top differentials) <strong>15:00–18:30</strong> Initial plan (tests + management) <strong>18:30–20:00</strong> Safety net + close
1

Step 1 — Start with a ‘one-line’ problem statement

Within 30 seconds, state the one-liner: age, key symptom, timeframe, severity, and key comorbidity. This signals control and helps you stay focused.
2

Step 2 — Use a ‘hypothesis-led’ history

Ask questions that discriminate between your top 3 possibilities. Avoid exhaustive ROS. A good consultation history is <strong>selective</strong> and <strong>purposeful</strong>.
3

Step 3 — Examine what changes management

In PACES23 consultation, examination is not theatre. Do the bits that confirm/refute the hypotheses and change your plan. Verbalise what you are looking for and what you found.
4

Step 4 — Synthesis is where marks are won

Give a concise summary, then: “My top differentials are A, B, C because…” and name one discriminating feature for each. Then propose immediate next steps.
5

Step 5 — Say the safe plan out loud

Even if you don’t have every detail, you must communicate a safe plan: what you would do now, what tests you would order, and what you would do if results change. Demonstrate managing uncertainty rather than pretending certainty.
6

Step 6 — Close like a real clinician

Finish with a patient-facing plan, confirm understanding, and safety net. “If X happens, seek urgent help. Otherwise we’ll review in Y.”

Common failure modes (and how to prevent them)

  • Time drift in history → fix with time box: stop at 6 minutes and move to exam.
  • Examination too broad → do a targeted exam and interpret findings.
  • No clear synthesis → force yourself to say top 3 differentials + why.
  • No safety net → treat safety netting as mandatory, not optional.
SourceMRCP(UK): PACES format (official Federation page)
Open Link
SourcePACES23: Consultation scenario guidance (official PDF hosted by Federation site)
Open Link
Your learning path

Save your place and choose what comes next

sign in to save your learning
Work through this guide (10 steps)

Use the actions from this article to track what you have worked through.

Sign in using the reading controls above to save your steps.

  • Within 30 seconds, state the one-liner: age, key symptom, timeframe, severity, and key comorbidity. This signals control and helps you stay focused.

    Return to this section

  • Ask questions that discriminate between your top 3 possibilities. Avoid exhaustive ROS. A good consultation history is selective and purposeful.

    Return to this section

  • In PACES23 consultation, examination is not theatre. Do the bits that confirm/refute the hypotheses and change your plan. Verbalise what you are looking for and what you found.

    Return to this section

  • Give a concise summary, then: “My top differentials are A, B, C because…” and name one discriminating feature for each. Then propose immediate next steps.

    Return to this section

  • Even if you don’t have every detail, you must communicate a safe plan: what you would do now, what tests you would order, and what you would do if results change. Demonstrate managing uncertainty rather than pretending certainty.

    Return to this section

  • Finish with a patient-facing plan, confirm understanding, and safety net. “If X happens, seek urgent help. Otherwise we’ll review in Y.”

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

Study planning · Article 18 of 32