Find out how Sarah Foot, a previous Pastest user, prepared for MRCP PACES during the pandemic.

PACES can feel like a dark cloud hanging over a medical trainee’s career. COVID-19 has meant that the PACES format has had to change, and that cloud can feel darker and gloomier than ever before. However, it’s not all bad news. It is possible to pass the exam, although you will need to modify your approach to increase your chances of success.

Impact of COVID-19

When revising for the 2020/3 exam I found patient perceptions had not significantly changed. Patients are still enthusiastic about being examined if we wear the correct PPE. Some patients, understandably, would decline examination due to fears around coronavirus, but given the high volume of inpatients this shouldn’t cause a problem.

New rules around maximum numbers for bedside teaching, not examining on the renal or COVID wards, and not visiting other hospitals within the trust on the same day, at first felt overwhelming. Again, these rules were understandable and with some planning could be worked around.

Finally, changing rotas, increased paperwork for the exam and slower responses from the exam offices due to limited staffing do add to the stress. Additionally, the concerns around exposure to COVID-19 pre-exam adds another level of uncertainty. Recognising these added stressors, and allowing extra time to focus on the exam, is crucial.

Adapting

A big adaptation is the use of PPE. In the exam you will wear a mask all the time, and disposable gloves and gown for each patient. The same is required to see patients on the ward, so you will inevitably get used to examining in gloves and changing PPE quickly. There is generous time given in the exam for donning and doffing between stations, so you don’t need to worry.

Another adaptation is needing to practice with minimal person-to-person contact. One way is video calling to practice the communication and ethics stations. This has the advantage of mimicking the exam and enables you to practice with colleagues at convenient times and in a socially distanced way. In my trust I was also fortunate enough to have some online lectures, including renal, to help with preparation when patient contact was minimised.

Something that hasn’t changed is that senior colleagues won’t have forgotten how hard PACES is. One consultant said to me today that you never forget the stations that come up in your exam! So, do tell them you’ve entered – whilst it isn’t a requirement for many training jobs, the exam still needs to be passed. Senior colleagues will support you!

How Pastest resources help

During preparation for PACES, it could sometimes be difficult to practice as much as you wanted. I found the Pastest PACES resource was great for helping create a “memory” of correct technique. Whilst it cannot substitute personal practice, it supplements it perfectly by repeatedly reminding you how to perform the examinations.

As I’ve said, sometimes exposure to patients could be limited by new rules, to keep patients safe. The Pastest cases are from across the spectrum of conditions you may see in the exam. Additionally, the rare cases, that even in “normal” times you don’t see in hospital yet appear in PACES with surprising frequency, form part of the case library.

A useful function of the Pastest resource is that there is a natural gap after the examination or history, before presenting to the examiner. This gives you an opportunity to practice presenting the findings, by recording yourself, before starting the video. A common concern among trainees is the ability to present your findings succinctly and recording yourself helps you practice your style and build confidence. It also helps you practice presenting findings when you don’t have a diagnosis. This can happen in the exam, yet you can pass a station if you present the findings and offer sensible differentials and investigations.

I hate reading books from cover to cover, and I found the Pastest resource great for structuring my revision time. You can either revise “blind”, choosing to revise a cardio or neuro station, for example, or you can revise specific conditions – whichever works for you.

Exam tips

Firstly, don’t be worried about how others are revising. To get to this point you’ve passed multiple medical exams. Do what works for you.

I did a course during my preparation. Naturally, it was great for seeing signs, however the main thing it gave me was confidence. I know I’m not the only doctor to suffer from “imposter syndrome”, and PACES is a huge mental challenge. After the course I knew I deserved to pass. I wrote down a list of why I should pass, and I’d read it before practicing and before the exam. Remember, the examiners want to help the next generation of medical registrars; it’s your opportunity to shine!

There are plenty of books, podcasts and online videos out there, you can’t use them all. I read one main book and used one additional book when required. I’m a big fan of podcasts as I can utilise my commute time to learn.

Work together. We had a WhatsApp group to arrange practice, share tips and where there are appropriate patients for revising. Your colleagues are one of your most powerful tools, help them, and create an ethos of collaboration.

You don’t need an expensive stethoscope! I seriously considered buying a cardiology stethoscope due to fear of missing heart sounds – my stethoscope doesn’t even have a bell. You don’t need to; practicing with your old faithful stethoscope is more important as you get used to hearing the different sounds.

Finally, don’t forget why you’re doing the exam. The stress can cause you to think of patients only as their “collapsing pulse” or “splenomegaly”. What can I get out of examining this patient? Remember: 30% of marks come from managing patient concerns and maintaining patient dignity. If this is a natural part of your practice it will come easily during the exam, giving you valuable easy marks.

PACES is a tough exam, requiring hard work and time, but it is possible, and you can do it!

Good luck!


Sarah Foot