PACES stands for Practical Assessment of Clinical Examination Skills. It is the final clinical exam that trainee doctors in the United Kingdom must pass before they can enter higher specialist training as physicians. Run by the Federation of the Royal Colleges of Physicians, PACES tests whether a doctor can competently examine patients, communicate clearly, and apply clinical knowledge in real time, not just on paper.
PACES is the third and last part of the MRCP(UK) diploma, following a Part 1 written exam and a Part 2 written exam. You must pass Part 1 before sitting PACES. Once all three parts are complete, you receive the MRCP(UK) diploma, the official qualification required to begin specialist physician training (known as ST3) in the UK.
What the Exam Looks Like
PACES is a face-to-face clinical exam lasting 125 minutes. You rotate through five stations, spending 20 minutes at each with a 5-minute break in between. Two independent examiners mark you at every station. You can start at any station and work through them in sequence until the full cycle is complete.
Three of the five stations are split into two separate 10-minute encounters, while the other two are single 20-minute encounters. That gives you eight clinical encounters in total across the exam:
- Station 1: A communication exercise (10 minutes) and a respiratory system examination (10 minutes)
- Station 2: A full consultation with a patient (20 minutes)
- Station 3: A cardiovascular examination (10 minutes) and a neurological examination (10 minutes)
- Station 4: A communication exercise (10 minutes) and an abdominal examination (10 minutes)
- Station 5: A full consultation with a patient (20 minutes)
The physical examination stations use real patients with genuine clinical findings. You examine them while the examiners observe, then answer questions about your findings, likely diagnoses, and what you would do next. The consultation stations require you to take a history, explain a diagnosis or management plan, and handle the conversation with empathy and clarity.
Skills Being Assessed
PACES evaluates seven core skills across all eight encounters. These cover clinical examination technique, identifying physical signs, forming a differential diagnosis, managing patients, communicating with patients and relatives, and maintaining a professional approach. Rather than simply tallying right and wrong answers, the examiners score how well you perform in each skill area independently.
To pass, you need a minimum score in every one of the seven individual skills and a minimum total score across the whole assessment. The overall pass mark is 126 points. Falling short in even one skill domain can fail you, regardless of how well you perform overall. This structure is deliberate: the exam is designed to confirm that a doctor is consistently competent, not just strong in one area.
Pass Rates
PACES is a genuinely difficult exam. According to the 2025 annual performance report from the Royal Colleges, UK resident doctors pass at a rate of 56.6% on their first attempt. For candidates based outside the UK, the first-attempt pass rate drops to 43.0%. Looking at all attempts combined (not just first sits), the overall pass rate is 54.2% for UK residents and 44.1% for other candidates.
These numbers mean that roughly half of all candidates fail on any given attempt, which is why most trainees spend months preparing with structured revision courses, practice examinations with colleagues, and repeated clinical exposure before sitting the exam.
Eligibility and Cost
You must hold a recognized medical qualification and have already passed MRCP(UK) Part 1 before you can register for PACES. Most candidates also complete the Part 2 written exam before or around the same time, though the requirement is only that Part 1 is done first.
Exam fees for 2026 sittings are £502 for UK-based centres and £672 for international centres, with a slight increase to £520 (UK) and £696 (international) for the third sitting of the year. PACES is offered at centres across the UK and at selected international locations, so candidates outside Britain can sit it without travelling to the UK.
Why PACES Matters for Medical Careers
Without PACES, a doctor in the UK cannot progress beyond core medical training into a specialty. It is the gateway to cardiology, gastroenterology, respiratory medicine, neurology, and every other physician specialty. Many international doctors also take it to demonstrate clinical competence when applying for positions in the UK or in countries that recognize the MRCP diploma.
The exam’s emphasis on real patient encounters, rather than written scenarios, is what sets it apart from the earlier parts of the MRCP. A doctor who passes PACES has demonstrated, in front of experienced examiners, that they can examine a patient systematically, pick up clinical signs, communicate findings clearly, and handle sensitive conversations. It is one of the few high-stakes medical exams anywhere in the world that relies entirely on live clinical assessment.