Demystifying PACES - How the exam is organised (15 Dec 2023)

SPEAKER_02 0:00

Hello, I'm Dr. Matt Thomas, Dean of Examination at the Royal College Physicians of Edinburgh. When I was chatting to successful candidates recently when they were receiving their diploma, I was pleased to hear about how they valued Edinburgh and the education that it provides from evening medical updates through to the PACES podcast. And that was one of the reasons that they chose Edinburgh as their college of entry. Add to this the expert team in the examinations department who will try and help smooth your way through your PACES application, along with the fact that we provide PACES centers throughout the UK. I would encourage you to think of Edinburgh as your college of entry when doing PACES.

SPEAKER_01 0:45

Hello, my name is Kat Ralston and I'm a member of the Training and Members Committee as well as a medicine of the Elderly Registrar in Edinburgh. I'm delighted to introduce this new podcast series called Demystifying PACES. In this series, we will discuss each station in detail with an experienced PACES examiner to share top tips for success, common challenges, insights, and advice. We will also have episodes exploring the exam from the candidate perspective. This series focuses on candidates sitting in the UK, and while the principles will be the same for those sitting internationally, local variation will of course be present. We hope that this will be helpful in both your preparation for PACE and your experience on the exam day itself. I'm delighted to be joined by Dr. Matt Thomas, who's recently taken over as Dean of Examinations at the RCPE. Matt has nearly 20 years' experience in examining PACE locally, nationally, and internationally. And he's also a consultant geriatrician at Poole Hospital in Dorset. Welcome, Matt.

SPEAKER_03 2:18

Thanks very much, Matt. Really nice to have the opportunity to hear this. And I think you're absolutely right. I think the more people understand about the exam, the less scary it becomes.

SPEAKER_01 2:26

Yeah, absolutely. So I thought it might be good to start the podcast with talking about what happens leading up to the exam. So, first of all, can we talk a little bit about the application process? What does that look like?

SPEAKER_03 2:38

The first thing I need to say is that a lot of the information that I'm going to give you is on the MRCP UK website. And please check that for latest facts and advice. But in general, the first thing you need to do is make sure that you are eligible to enter the exam and the eligibility criteria are there. You know, you've spent the requisite amount of time entering past the right bits of the exam prior to this. It's then a question of registering for a federation royal college positions, the joint body number, and then applying for the exam, which all happens online.

SPEAKER_01 3:14

Absolutely. And about how far in advance do applicants need to apply before their PACES diet?

SPEAKER_03 3:20

The applications open about two to three months before the diet. So we're looking at applications opening in November for a diet that will start in late January. So you need to be looking about that far ahead. But again, the whole year's timetable will be on the website, giving you the exact dates so that you can be ready.

SPEAKER_01 3:38

And you've talked about the fact that there is an exam diet that spans a couple of months usually. How are applicants actually allocated an exam date? How is that chosen?

SPEAKER_03 3:47

Well, currently that's random. And so the diet runs three times a year, and as you say, runs throughout the dates that are there. And that means that you could be allocated something in a weekday or something in a weekend because depending on the center and how they are organized, depends on whether it runs during the week or the weekend. So people need to be aware and flexible to be able to match that.

SPEAKER_01 4:11

Yeah, absolutely. Because I guess your revision time can be significantly lengthened or shortened just by where you are in that, you know, exam diet.

SPEAKER_03 4:17

You're absolutely right. There can be a good few weeks between a colleague taking it and you taking it. And that's just unfortunately luck of the draw. I think that there are thoughts in the future about being able to allocate yourself places, but at the moment it's all random.

SPEAKER_01 4:31

At the minute it sounds like it's random. So candidates don't have a choice on a date or an exam center. Is that right?

SPEAKER_03 4:37

No, unfortunately not. And I say random, but of course, we must bear in mind that we don't send people to be examined at places where they've worked or where they may have been examined previously in the last year or so. So I think that we have to take those things into practice, and then it's random. Yeah, that's helpful to know.

SPEAKER_01 4:53

And do you have any prioritization of candidates in terms of who gets those exam slots? Is there a waiting list?

SPEAKER_03 4:59

We try not to let there be a waiting list. We try and make sure that we've got as many slots as possible to get through as many people. And of course, COVID brought about a need to prioritize people because of the reduced number of spaces that there were. But I think the backlog is pretty much gone now. And so I think for the next diet on, that probably won't be an issue.

SPEAKER_01 5:19

That's good to know. Because I think a lot of anxiety about getting that exam done before your next job. So yeah, that's great to know. So just thinking a little bit about exam centers next. So I'm interested to know how the patients are selected, what that process looks like.

SPEAKER_03 5:33

Well, it all vary in each center as to how they manage it, but essentially you're looking for a patient who has got relatively stable signs because you want to know exactly what you're examining, that they're well enough and able enough to come up and take part. It can be a bit of a long day. And if they are giving their history as well, that they're going to give a good and consistent history. So you've got to take that into account, as well as looking for patients across the whole breadth of medicine. So consultants who are hosts will be touting across all their colleagues for people with good signs, good stories that they can bring up. So it's very much the patients that are seen in the hospital day to day.

SPEAKER_01 6:15

That's helpful. People who are stable enough that they could be there for the whole exam and have sort of stable clinical science. So it's useful to think about when you think about what type of conditions might come up as well. And thinking about those conditions, I was just wondering whether you could see the same condition in different stations in an exam carousel. So say there's a patient with COPD in the respiratory station and the consultation station, is that something we try and avoid or is that a possibility?

SPEAKER_03 6:38

I'd never say never in medicine. And it may be that for whatever reason that that happens, but that's something we certainly try to avoid. We want to examine the breadth of people's skills. So giving them a similar scenario in one of the physical examination encounters as well as the consultation encounter, or talking about the same issue in one of the communication stations. We try and avoid that.

SPEAKER_01 7:00

Yeah, so perhaps alarm bells should be ringing if you think something's coming up twice in your in your station.

SPEAKER_03 7:05

Possibly though, one of the things that has to happen is that patients who have volunteered for this may get unwell, and at short notice, somebody else needs to be drafted in. And so it's not impossible, but we try not to do it.

SPEAKER_01 7:18

Yeah, absolutely. And we just talked about what if a patient can, so you've just mentioned that slightly. So what happens in that situation if you have a last-minute gap?

SPEAKER_03 7:27

There are lots of different things that you can think about doing. You can look on the wards to see if there's somebody who's an inpatient, perhaps, if this is happening on an acute hospital side. You may have, and some posts do this, will bring back up patients in, and then when they know that everybody's arrived, they'll say to somebody, thank you very much, but we don't need you today. And patients are very good and accepting of that. And you can, in extremes, have somebody with normal examination. You should be aware that normal examination is part of the findings that could be there. So in a consultation where most of the history is going to be the important thing and the lack of abnormality, you might find that there's somebody with no signs. And of course, then actually that opens up who you could get to slot into that. But in the main, we really like to have patients who've got signs.

SPEAKER_01 8:15

Yes, most patients in the exam will have genuine pathology to find, but it might be that someone has a normal examination, normal findings, and don't be put off by that, just mindful of what the situation is.

SPEAKER_03 8:25

Part of the skills is finding physical signs, but also not inventing physical signs that aren't there.

SPEAKER_01 8:30

That's really helpful. And do you reuse scenarios, say for the communication stations?

SPEAKER_03 8:36

There is a large bank of scenarios, and I can't remember the exact number, but it runs into the hundreds. So things do get reused, they get reviewed after reach use with feedback from the examiners who have used it and look at how discriminatory they are in producing a differentiation between candidates who pass as well to see whether they're still valid. And we have meetings three times a year to look at the scenarios for the coming diets, tweak the match required. So some will get reused over a period of time, they will get subtly changed. So don't assume that because somebody said they once did a scenario with X and Y in it, that when you see X and Y, it's going to be exactly the same scenario. The focus may have changed.

SPEAKER_01 9:18

Yeah, that's helpful to know. And I think it's also reassuring to know that there is a feedback process after scenarios and they're constantly getting reviewed and updated. So there's not ones that are out of date, you know, that have been made years ago. So that's reassuring to me as a person who sat there exam. That's a really good point.

SPEAKER_03 9:33

We look at the scenarios and both the story may be the right thing, the treatments that are mentioned need updating, or actually it may be that it's time expired and that it's no longer a big issue that we want to examine people on, and then it will just be gently retired into the background.

SPEAKER_01 9:48

Yeah, it's good to know. And moving on, I think a part that I was always really interested in when I was setting paces was who are the examiners? So can you talk to us a little bit about who they are, what that process is?

SPEAKER_03 10:01

Yeah, so they're people who are interested. That's the first and foremost thing. So there'll be consultants from any of the three colleges: Edinburgh, Glasgow, London, but we share examiners who have expressed an interest in examining. They will come from a medical specialty. We do want people to be actively engaged with trainees. So they have to have been engaged with trainees. They have to have done a specific quality and diversity training that is done for pedicists, and they will come forward to have a training session. So they will shadow examiners for an exam, shadow marking and comparing their marks with the examiners. And as long as they go through with that okay, then the next diet they would be expected to be examiner. So there's a whole range of people. It's one of the great pleasures of going and doing the exam is meeting a variety of people from a variety of specialties around the country and talking about their bit of the country. So it's actually good TPD for me as well, hearing and talking to people. But they're just normal people like me.

SPEAKER_01 11:01

Yeah, that's good to know, isn't it? And I guess people often get a bit worried when they think about specific stations, so say the cardiology examination station, and worry that the examiner is going to be, you know, some professor in cardiology who's going to be looking for the minutiae. Is that something we should be worried about? Who's examining each station and how's that decided?

SPEAKER_03 11:19

Who's examining each station is decided centrally by the college to make sure that there's a balance of stations examined by that examiner over a year or two so that people rewrang the stations, they're not always examining Cardi Basquel, they're not always doing a consultation, but they vary where they're doing. The important thing to remember is the level at which we are expecting people to perform. And that is, according to the IMT curriculum, being able to operate independently with remote supervision. So that's what we're looking at. So we want people who are sensible. So things that we're looking for are not to trick people on the minutiae. I think people think we're there to look for a reason where we can fail something. We are there to pass people. There is no bigger sigh that goes round the room than hearing that somebody has failed after the exam. We're there to try and pass people. It's probably worth talking about calibration at this point because it fits into what you asked. Calibration is where before the exam has formally started, the examiners will go to the station that they're due to be at and will examine the patient or take the history from the patient and examine them or do the communication scenario without knowing what's wrong with the patient. So they'll know that it's a cardiovascular station, but they will examine the patient without knowing what's going on. It's then up to them to agree that, yes, I did hear an aortic murmur, I think it was an ejection systolic murmur. Yes, we agree that's there. One of them may say, I thought I heard the early diastolic murmur of aortic incompetence. And though it may be there, if both examiners don't agree that that is an easy thing to hear and that actually they can both agree about it, then we would say, yes, it's there. And if somebody mentions it, fine. But actually, if they miss it, we're not going to fail them because we don't think it's that easy. I always think about it that if actually I was in that position and we were having a discussion about a murmur, I wouldn't ask the cardiologist to come and listen and referee voice. I'd get the gastroenterologist. This is about general medical skills, not being an expert in my new shine. Somebody may be a professor, but they will be taking this idea of you being remote supervision and having a general knowledge, not looking to emulate them.

SPEAKER_01 13:37

Yeah, I think that's really helpful to hear coming at it with your general medicine hat on, not a specialty hat. And also, I think reassuring to hear that thought about try and get people to pass instead of looking for why they might fail. And I think that's a nice way to think about it.

SPEAKER_03 13:51

I can just mention about that because one of the things that I see in the feedback and the appeals that happens is that candidates will often say, the examiner kept interrupting me, and they felt that that was them having a go at them. No, it won't have been that. It will have been that we agreed that we wanted to get certain information out to be able to test knowledge, and that we're asking to try and get you to say that so that we can then pass you, not to trick you. So don't be put off if the examiner cuts you off and then asks you something else because they're probably satisfied with what you've said and they're looking for you to score points somewhere else.

SPEAKER_01 14:28

Yeah, I think that's so helpful. Just because I think if someone interrupts you, that can feel quite stressful at the time. So knowing what's behind that is incredibly important. And the fact that that's the examiner trying to get you to get marks, which makes it feel a lot nicer than feeling like you've been interrupted because you've said the wrong thing. So I think that's so important for people to know. And just thinking about those questions, is it similar to the identifying signs part where the examiners have to agree on what they want to ask? Is that something that the examiners on the day do, or is that pre-allocated?

SPEAKER_03 14:55

Though there may be with the scenarios that come from the bank, some suggestions about what should be looked for. With all stations, calibration happens on the day, and there's agreement between the examiners on the day about what makes a pass and what makes it fail, and what possibly would make a borderline. Though we we try to mark at the extremes and not go to borderline because it makes it much easier to clearly see what's happening with candidates doing that. But no, it's all decided on the day that yes, they must identify the age of the relation. Yes, they must talk about the investigations and include these investigations and include this treatment. So not only the physical signs will agree, but there's calibration about the rest of the station as well.

SPEAKER_01 15:39

Yeah, that's good to know. And I think the other thing that I like and I didn't realize was that examiners are going into the station blinded as well in that calibration process. So they don't know what they're going to find. So they're in the same situation as the candidate.

SPEAKER_03 15:52

That's really important because we want it to be real, we want it to be fair on people. And to go in knowing the echocardigan result would obviously influence what you thought you might be healing. To go in knowing the CT result would influence what you might be feeling in the absence. No, we go in blinded. So that nervousness that people felt about being in front of Professor So-and-so, I feel this as well when I go and examine what we all feel it.

SPEAKER_01 16:18

Yeah. And I've heard something about who the examiners are in each station. And I just want to double check that with you that like a respiratory physician wouldn't be allowed to examine in the respiratory examination station. Is that true or is that a rumor?

SPEAKER_03 16:32

Again, never say never, but people try not to examine in their base specialty. So obviously, if they examine a sickness or something like that, that means that people need to be moved around, uh, then that might happen. But we tend not to, again, for this reasoning that we want this to be a general thing, not you being tested by a specialist.

SPEAKER_01 16:50

Yeah, absolutely. I think hopefully that'll allay some people's concerns about that. And just the final thought about examiners what happens if you know your examiner, you walk into the station and realize, oh, I've met you before. Is that a problem?

SPEAKER_03 17:00

Really interesting question because as of this diet, we no longer are given the names of the candidates before they come in. It's just the candidate numbers or the paperwork. And so we equally might be slightly perturbed at seeing somebody we know. The ideal scenario is that we may have had some idea we have seen that somebody was coming up, and we would not be the person leading that exam. It might hand it over to the other. At each station, one examiner leads and the other is is observing, both are scoring. And it may be that we leave it to the person who doesn't know the candidate to examine. But all examiners are pretty professional and actually could manage that situation if they had to deal with somebody they knew. But I think we all probably would rather give the candidate a bit of breathing space and not be the one asking them the question.

SPEAKER_01 17:49

Yeah, absolutely. Try not to be put off by it. So I guess just moving on, thinking about the exam day itself. So just sort of practical points around what that looks like. I guess starting with a general question about just what to expect on exam day, is there a lot of waiting around? What kind of happens when you turn up?

SPEAKER_03 18:07

There is a bit of waiting around. We try to minimize it as much as possible, but it's a necessity for a number of reasons. If there are a number of cycles going on during the day, then because patients may not change between the cycles, we need to isolate candidates who are just leaving from the ones who are just arriving from an exam security point of view. So there can be a little bit of waiting around, but some of that is filled up with filling in forms. So you need to make sure that you've got your application form with you and printed out. You need to make sure you've got some ID. You'll be given your march sheets to carry around with you, and they will need to be filled in with your candidate number, your RCP number, and the center number. So there's about 16 forms to fill in. So there's quite a bit of pencil work beforehand. So that tends to go. There'll be a track, usually from the host or from the chair of the examiners, who will come in and offer some calming words. And I know it's very difficult to palm people in this sort of situation. They'll be very anxious. And while all that's going on, we're doing our calibration. Now, if there is a patient who's become unwell, or if there is an issue with calibration, that can see that time go on a bit. But it is not common for it to be more than five to ten minutes delay from the normal start time, and many places start back on time.

SPEAKER_01 19:24

And just sort of a general question about what to wear, because I think that at the minute or in the last few years, we are now wearing scrubs to work. And that's pretty much what most people are wearing at work, although some people have gone back to normal clothes. And is that acceptable in PCs? What would you recommend?

SPEAKER_03 19:40

Indeed, it's acceptable. My preference, and this is a personal preference, is people should be smart and professional. And I'm sure, chat, from your dealing with older people, they quite like to see people dressed as what they think the doctor should look like. So I think professional hair care, you should be aware of the infection prevention rules in the truss that you're being examined in, and they'll tell you that. So bear below the elbows would be typical. But beyond that, it's just being professional and neatly turned out. I wouldn't wear anything that was too billowy to catch on things, or anything that was too tight to be able to mean that you couldn't easily maneuver around doing a neurological examination or whatever. So it's being sensible. Personally, I'm not a big fan of scrubs. I would like to see people professionally dressed. Again, there's really good advice on the website.

SPEAKER_01 20:28

Yeah, that's helpful to know. And just I guess a brief overview of the PACE's carousel, because that can seem quite confusing and complicated when you read about it or you first experience it. Can you give us an overview of what that looks like?

SPEAKER_03 20:42

I absolutely agree. So during your time in the exam, you will go through five different stations. Station one is a communication scenario, and that is always the first bit in station one and is 10 minutes, and you will have had some pre-reading outside, and you will have had five minutes to read the communication scenario. That will finish, and then you'll move on to a respiratory examination. That respiratory examination is unrelated to the communication. So don't go in expecting it to be the same. But we put the communication first so that you don't have to examine a patient with possibly something completely different and then try to be remembering what you've read outside the station. Always the communication becomes before the physical examination. That physical examination lasts 10 minutes. It's six minutes examining the patient. You'll notice at one minute that you've got a minute left, and then you'll have four minutes chatting to the examiner. If you finish early, the conversation can start early. Once that 10 minutes is up, so 20 minutes in total for that station, as it is for every station, you'll move on to the next station, station two is a consultation station. And this is where you have a scenario and a patient, and you've got 15 minutes to talk to the patient. So unlike the physical examination where there's no history taking, this you're taking a history and examination. At the same time. So it's much more real life. And then you've got five minutes with the examiners discussing your findings and what you plan to do for that patient. Again, you'll have had five minutes of reading outside for the referral letter that introduces the patient and the issue. Once that one's gone, you're on to station three, which is a cardiovascular examination for 10 minutes, and then neurological examination for 10 minutes. And it's exactly the same as the respiratory examination, six minutes examining, four minutes questioning, and swapping over it ten minutes. And then on to station four, which is back to a communication for 10 minutes. You'll add five minutes reading it outside. And then the abdominal examination for 10 minutes after that. Again, six minutes examining, four minutes questioning. And then finally, station five, another consultation, same idea, something to read outside, and then 15 minutes examining, taking a history from the patient, then five minutes with the examiners afterwards. Things to say about it are that you could start at that carousel at any point. So you may go five, one, two, three, four, you may go three, four, five, one, two. It's just randomly allocated. Things to note that in the consultation scenario, in order to make sure that patients are giving consistent stories, we sometimes use a surrogate to give the story, and then the patient is there to be examined. So it may be somebody acting as a relative, the son or daughter of the patient giving the story for the patient. And that allows us to have good, consistent, and fair history giving prior to the examination. So it's just to be aware that that might happen. That's something that's happened abroad for many, many years in the exams and is well tried and works well. So it's new to this country. Yeah, that's useful to know.

SPEAKER_01 23:46

And sometimes there can be a rest station. What do people do there? Why would that be in?

SPEAKER_03 23:51

So the rest station has now gone. That was a COVID way of increasing the numbers of candidates that we could get through. So rather than five candidates coming for one carousel each person in the station, we had six, and one would be in a rest station. So the day went on slightly longer for everybody, but it allowed us to give more places to people during COVID in the catch-up after COVID. Now that, as I said, we've got to a position where we're not having to do that, we've gone back to the agreed method of by stations with no rest station.

SPEAKER_01 24:22

I think knowing in advance what to expect is so important. So that's helpful to know that's no longer needed. And I just wondered, you know, if you were mid-carousel and really needed to go to the bathroom or something, is there any way out of that? Or once you're in it, you're kind of trapped and there's no way out.

SPEAKER_03 24:36

Obviously, we hope that this sort of thing doesn't happen, but people get unwell, feel unwell, feel faints, happened before. What we would do is that the other stations wouldn't realize what was happening. It would only be happening in the one station that it was going on in. The examiners would likely, if somebody felt unwell, give them a minute or two, a glass of water, a sit down, and a chance to collect themselves, and then restart the clock at the time that they stopped it to give them that break. What they will have done is told everybody outside that something was going on so that when the carousel finishes for the other people, it doesn't go immediately into the five-minute reading. There's a pause so that the other person can catch up and rejoin the carousel. So there are ways of us managing the situation. It's very uncommon where we are used to minor interruptions.

SPEAKER_01 25:23

Yeah, it's good to know that there is an option to deal with that that wouldn't just completely disqualify you from the exams. And I think that's reassuring. What if, you know, you were a candidate and actually you felt like there was a problem on the day, perhaps the way the exam's been organized, so you haven't had a warning bell or something in your station, you feel like something's happened that might have affected your performance. Who do you speak to? When do you speak to them? What's the best process for that?

SPEAKER_03 25:44

So speak to the host or to the chair immediately after the exam. You will find that they will probably all be gathered into the room after the exam. Somebody will pop in and say, I'd like to raise an issue. Because at the end of the exam, the chair and hostwriter report about any significant issues that have happened. And examiners are encouraged to note anything that has gone on, excessive noise or anything during the exam, that nobody has any. As you say, it's the sort of thing that people find upsetting and tend to comment on. There's also obviously the option to then lodge an appeal. I would suggest waiting until you had your exam marks and requested your sheets because appeals can only be for, as you said, procedural issues. You can't appeal against the marks as such, but you can tell that the procedures weren't following. And one thing just to point out, Kat, you mentioned about the one-minute warning in the political examination to in the consultation, they're advisory, not compulsory. Most people do them, and we noted we didn't do them, but I don't think I've seen anybody who struggled just because they didn't get the warning.

SPEAKER_01 26:45

Ah, that's really interesting. So if an exam center wasn't doing a warning, would they tell candidates before that happened?

SPEAKER_03 26:52

The lack of a warning would be an examiner saying, I forgot to give the warning. And that would be noted on the form, but it would be unlikely to influence things because people usually practice enough that they're coming to the end of their consultation or examination.

SPEAKER_01 27:05

Yep, so we're definitely giving warnings. Sometimes examiners can forget, but that wouldn't really affect the performance in that station. Helpful to know. And what happens if you're sort of ill before the exam or unable to attend on short notice, or you have to just exit the exam because you're too unwell? Who do you get in touch with and what happens?

SPEAKER_03 27:22

If you can't make the exam and you know beforehand, then please get in touch with the college that you registered through and let them know. And I think they do like to have some evidence about the illness or sickness or something. And then I believe it's a 90% refund for pulling out beforehand with a 10% administrative charge. Because actually, behind the scenes, there's a lot of people juggling examiners, juggling candidates, juggling paperwork. So there is a knock-on effect. And obviously, the sooner we know, the better if you're not going to be able to undertake the exam because we could offer it to somebody else. If you're deciding not to do the exam because you don't you're you're ready for it, then that's a slightly different thing. And I think depends on how soon before you decide not to do it, as to how much percentage of the fee is docked. But again, that's on the website. But if you're sick and you're unwell, don't worry, get a form in, tell us, and we'll sort it out. Yeah, that's good to know.

SPEAKER_01 28:18

And I guess from the other side, what happens if the exam center cancels the exam?

SPEAKER_03 28:22

I'll confess to having had COVID and not being able to be replaced in an exam center having to go down. So I feel really bad about this because we knew that there were people who wanted to be examined. A further date was put in within a month's time. So people will be prioritized if they missed that opportunity. They will do everything they can to get an alternative date done in that diet. But if not, then I'm sure that we would look to prioritize those people in the future diet. But we do everything we can to reallocate those people if there have been others who've dropped out for other reasons and spaces appearing, or to rearrange something. And the exam centre that did go down a couple of years ago when both two examiners had COVID, happened to be me and my wife, and we reorganized it, and a month later we were out to do a good exam.

SPEAKER_01 29:04

That's good to hear. I think it can be extremely stressful, obviously, for candidates if something gets cancelled last minute. So knowing that you're trying to re-fit people in in that diet is useful and prioritise those candidates.

SPEAKER_03 29:14

There are protocols for examining with less than the required number of examiners. So we're meant to have 10 examiners, we will examine with nine, where when examiners' marks will be double counted. Candidates would be told if that was the case before they go in and offered the chance to step out without it figuring in their numbers and to be offered a refund. The calibration and the concordance between examiners means that just having one examiner's marks counting double would make very little difference. So I would always say to people, just crack on with the exam. If you're ready to do it, you're ready to do it. But yeah, so we can tolerate an examiner disappearing. We try our hardest. Edinburgh filled every slot, even with examiners dropping out at short notice in the last diet we were able to fill with other people coming to the rescue.

SPEAKER_01 30:01

Yeah, that's good to know. And I guess just the final few points to cover are just sort of general points that I think come up sometimes. So one is just thinking about if a candidate had a poor performance in the PACES exam, could that ever lead to the exam center reporting a concern about a candidate to where they work? If that happens, when would it happen? And what would that look like?

SPEAKER_03 30:22

There are, I suppose, two aspects to this. One, you can always ask for your marksheets and read what the examiner was saying and as to why they scored you as they did. And I would always encourage people who have not asked to get hold of their marksheets and go and talk to their educational supervisor and say, right, how do I address this? Was this just unlucky on the day and actually I'm in the right ballpark, or do I need to concentrate on something in particular and work with your educational supervisor? There will be occasions where we think somebody needs specific counseling, but we'll only recommend that if there is something specific and something smart, you know, is it simple, measurable, achievable, realistic, and timely. We will then offer feedback from a group of senior examiners who will write a letter saying, look, this is what we think you could think about. And again, our recommendation will be you take that to your educational supervisor. But us directly going to our educational supervisor, no, what happens in the exam is for you. But we would encourage where there's been a problem that you go and discuss it. It's easier to fix if you share it.

SPEAKER_01 31:26

Yeah. So feedback for learning and for improving. And the other thing that comes up, I think, from trainees is the fact that sitting this exam is incredibly expensive. I wonder whether you can expand, I guess, on how are the fees set and where does the money go that trainees are paying for these exams?

SPEAKER_02 31:41

Well, that's a really good question, Kat, one that's often asked. I think the bottom line is that there is no real surplus after the exam. The fees cover everything that you would expect them to cover. They cover the support that happens with the team in the college, allocating places, going through the applications, all the way through to the results being released into diplomas. There are things that need to be paid for: cost for centres, staffing in the centers, expenses, for people traveling to exams, particularly for the volunteer patients who come in and for the materials that are used in the exams. So all that gets consumed quite quickly from the fees that are there. So no real surplus to speak of.

SPEAKER_03 32:23

And just so people are aware, in the interest of openness, my remuneration for being dean of examinations is zero.

SPEAKER_01 32:30

I think that's really interesting to know because I think I've always assumed that PACE's examiners are getting paid and that people in senior roles in the college are getting paid, but that's not necessarily the case, is that right?

SPEAKER_03 32:41

No, not at all. Many, many college roles are not remunerated. It's the trust, people's base trust that are supporting them doing it. Yes, I'll have expenses paid if I need to travel to Edinburgh to examine, etc. That doesn't come out of my own pocket. But do I get paid for doing the exam? No.

SPEAKER_01 32:57

I think that's useful to know. And I guess final point, really, before we sum up. So just a practical point about if you had a date of exam near the end of the diet and you were at a point where you needed to know whether you need to apply for the next diet or not, and you don't have results before that application window closes, I guess A, it feels odd that that could happen and can add a bit of extra stress on candidates. And if that's the case, what do you suggest people do if they don't know the results and they think if I fail, I really need to get in that next diet?

SPEAKER_03 33:28

Really difficult. So, in normal circumstances, I would say apply, and yes, it's going to cost, but if you find that you do not need that seat in the diet because you subsequently find out you've passed, you get 100% of the money back. So it's a safe investment. What I should say is that for the next three diets, with the introduction of this latest iteration of PACE, we are not taking money off people until they are allocated a space. So you can register for the exam, the following diet, and not have to pay until you know that you've got a space. The reason we're doing that is that there's been a significant change in the way that PACES is run. And in order to retain our approval from bodies such as the GMC who supervise all this, we have to make sure that the standards of the exam do not change. So that the exam doesn't get too easy or doesn't become too hard, that it remains at the level that it has been. Now, in order to do that, we have to wait to assess the marks of about 90% of the group that we're standardizing against, which happens to be UK trainees on their first attempt. And that won't happen till towards the end of the diet. So everybody's marks will be delayed this diet and for the next two diets of this new iteration. And hence we've not asked people for money, but we'll only ask them if they actually need to move on to have another attempt. So apologies if there's a delay in the marks coming out, but it's for good reason.

SPEAKER_01 35:00

Yeah, I think it's good to know that you have a contingency plan for that in terms of not having a financial hit for these ones where there is an extended results window. That's good to know. So I guess just to summarize the episode, do you have any top tips or top take-home messages you'd like the listener to take away from this episode?

SPEAKER_03 35:18

Well, your question, we could carry on as long as we can with the tips. First tip is look at the website and watch the videos of the carousel and the different stations. There's some excellent videos there showing you a demonstration of exactly how it's designed to go. So please watch that. Please make sure you practice. I think that looking at people who make it look like this is their day-to-day job are the people who impress the most. So lots of practice. And I know it's difficult to say this, but enjoy medicine. One of the reasons I do this is because I enjoy it so much, because I see keen young people at the start of their career. And I really enjoy seeing people do well and pass. And a lot of the people who do really well look like they do it every day and they enjoy it.

SPEAKER_01 36:07

Thank you so much. Really valuable top tips. And I guess that's the whole part of revising is the exam is supposed to emulate to a degree, particularly the new consultation station, what day-to-day practice might look like. So just work as normal for us on medicine. So I think that's a really useful way to think about it. And I think for me, the helpful bits, I guess, are also practical points as well. So the examiners want you to pass. I think that's useful to know, and particularly around that. If you're getting interrupted, it's because they're trying to help you, trying to get you to get the points. And thinking about stations from a general medicine hat. So there won't be someone looking for the specialty menu shot. It is just, you know, what a sensible general medic would do for that patient. And I think that's all quite useful.

SPEAKER_02 36:47

I'm glad it's been useful.

SPEAKER_01 36:49

So thanks so much, Matt. Really appreciate your time. And I hope to the listeners this has helped demystify some of the aspects of paces that you might not have been aware of. Certainly, I've learned things during this chat as well. And I hope it's helpful to you preparing for and sitting paces soon. Thanks for listening and hope to see you next time.

SPEAKER_00 37:23

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