MRCP PACES — How It Is Marked

The carousel

PACES runs as five stations and eight encounters in a 125-minute cycle. Two examiners sit at each station and mark independently.

Station	Encounter	With the patient	Examiner questions	Time warning
1 and 4	Communication (1a, 4a)	10 min	None	At 8 min
1 and 4	Physical examination (1b, 4b)	6 min	4 min	At 5 min
3	Cardiovascular, then neurological	6 min each	4 min each	At 5 min
2 and 5	Consultation (one acute, one non-acute)	15 min	5 min	At 13 min

There are five minutes before Stations 1, 2, 4 and 5 to move and read the scenario. A time warning is information, not a penalty: use it to move to your summary, not to rush.

MRCP(UK) / the Federation, Examiners’ Guide to PACES23 (version 3 February 2025).

How each judgement is scored

Every skill at every encounter gets one of three grades from each examiner:

Satisfactory = 2 · Borderline = 1 · Unsatisfactory = 0

Across the cycle there are 16 marksheets and 84 judgements, so the maximum total is 168.
Not every skill is tested at every encounter, so the maximum for each skill differs (see the table below).
A skill that should have been tested but was not counts as Unsatisfactory (0).
Each examiner marks alone, and examiners do not see your marks from other stations. A bad encounter does not follow you into the next room.

MRCP(UK) / the Federation, Examiners’ Guide to PACES23 (version 3 February 2025).

The seven skills

Skill	Tested at	What earns Satisfactory	Common reasons for Unsatisfactory
A Physical examination	Physical examination and Consultation	Correct, thorough, systematic, fluent and professional technique (focused at Consultation)	Unsystematic or incorrect technique; missing significant parts. Examining through clothing usually earns Unsatisfactory
B Identifying physical signs	Physical examination and Consultation	Finds the signs that are present, and does not report signs that are absent	Missing agreed signs, or reporting signs that are not there. One of the commonest reasons for not passing PACES
C Clinical communication	Communication and Consultation	A relevant, systematic history; information and options explained clearly, with empathy	Inaccurate, unclear or missing information; jargon the patient does not follow
D Differential diagnosis	Physical examination and Consultation	A sensible differential for this patient, including the correct diagnosis	Missing the correct diagnosis; a generic textbook list not tailored to the patient
E Clinical judgement	All encounters	Selects or negotiates a sensible plan, with a timescale	Unfamiliar or inappropriate management; a good plan for the wrong diagnosis
F Managing patients’ concerns	Communication and Consultation	Seeks, detects, acknowledges and addresses concerns; listens; checks understanding	Not exploring concerns; interrupting; not checking understanding; running out of time for questions
G Maintaining patient welfare	All encounters	Treats the patient or relative with respect and sensitivity; protects comfort, safety and dignity	Insufficient respect or sensitivity; causing discomfort; jeopardising safety

So a Communication encounter marks C, E, F and G; a physical examination encounter marks A, B, D, E and G; a Consultation marks all seven. Across two examiners and eight encounters that gives the 84 judgements above, and works out as a maximum of 24 marks each for A, B and D, 16 each for C and F, and 32 each for E and G.

The marksheet wording is guidance. You do not have to meet every criterion to be Satisfactory, and the examiner pair sets the exact standard for each case before the exam.

MRCP(UK) / the Federation, Examiners’ Guide to PACES23 (skill descriptors); the Federation, PACES preparation page (reasons for not passing each skill).

Passing, and the Skill G rule

To pass PACES you must meet the minimum mark in every one of the seven skills and reach a minimum total score of 126 out of 168. Meeting the skill minimums alone is not enough: they add up to only 114.

Skill	Minimum to pass	Maximum
A Physical examination	16	24
B Identifying physical signs	14	24
C Clinical communication	11	16
D Differential diagnosis	15	24
E Clinical judgement	20	32
F Managing patients’ concerns	10	16
G Maintaining patient welfare	28	32
Total	126	168

These pass marks were set in May 2024 and apply from the 2024/02 diet; they can change, so check the Federation’s current figures before you sit. The maximum for each skill is worked out from how often it is tested. The Federation says examiners are “not looking for perfection.” Marks do not transfer between skills: a strong differential cannot make up for missed signs.

Skill G works differently. Its minimum is 28 out of 32, far closer to the maximum than any other skill. A candidate with 29 or more for Skill G is not discussed. A candidate with 28 or less is discussed by the examiner group after the cycle, which recommends whether the candidate should fail on Skill G alone. The Clinical Examining Board makes the final decision.

So Skill G is not just added to a total. A low Skill G can decide the result on its own.

The Federation, Pass marks explained (overall and skill pass marks, standard set 28 May 2024); MRCP(UK) / the Federation, Examiners’ Guide to PACES23 (Skill G post-cycle review).

What “Borderline” means

There is no separate written descriptor for Borderline. Before the exam, each examiner pair calibrates every case: they examine the patient, agree which signs are present and absent, and agree what a Satisfactory candidate must cover. The standard is an Internal Medicine trainee at Level 3, entrusted to act with indirect supervision. Borderline is the examiners’ judgement of a performance that falls between that standard and Unsatisfactory.

MRCP(UK) / the Federation, Examiners’ Guide to PACES23 (calibration); the Federation, PACES preparation page.

Five things the guidance says plainly

Signs are agreed in advance. You are only expected to find signs that both examiners independently agreed are present, and “such signs are usually clear cut.”
Do not invent signs. Reporting signs you cannot find “simply to fit a presumptive diagnosis” is described as unprofessional, and usually earns Unsatisfactory for Skill B.
Confident absence counts. Examiners are as interested in your confidence over the absence of a finding as in your ability to detect one.
Address concerns when they are raised. Deal with a patient’s concern as soon as it comes up, however disruptive to your plan. Not doing so is called disrespectful, and affects Skill F.
Close the consultation. Sum up what you have agreed with the patient and agree a way forward.

The Federation, Preparatory advice and information to candidates, PACES examination (May 2026).

What this changes about practice

Practise skills, not just cases. After each practice encounter, grade yourself 2, 1 or 0 on every skill tested there, not one overall mark.
Report what you found. Say “I did not detect a murmur” rather than adding a sign your diagnosis predicts. Your differential and plan are only as good as the signs they rest on.
Put a timescale on every plan. It is in the Skill E descriptor, and it is easy to leave out.
Leave time for the patient’s question. Build it into your structure from the start, at every Communication and Consultation encounter.
Treat Skill G as continuous. Exposure, positioning, draping and how you finish under time pressure all count. If time is short, protect the patient’s dignity before your checklist.

Sources

MRCP(UK) / the Federation, Examiners’ Guide to PACES23, version 3 February 2025 — carousel and timings, 2-1-0 scale, marksheet totals, skill descriptors, calibration, Skill G post-cycle review.
The Federation, PACES preparation — skills by station, reasons for not passing each skill.
The Federation, Pass marks explained — overall pass mark 126 and the minimum for each skill (standard set 28 May 2024, from the 2024/02 diet).
The Federation, Preparatory advice and information to candidates, PACES examination, May 2026.

PACES is run by MRCP(UK) through the Federation of the Royal Colleges of Physicians. This page summarises their published material; it is not theirs and is not endorsed by them. Rules can change between diets, so check the current candidate guidance before you sit.