Dr Tanzeem H Raza FRCPSenior RCP London PACES examiner

PACES 2020 Update16 October 2019

Overview

• Brief history of PACES

• Why change PACES

• Development of PACES 2020

• Agreed changes

• Next steps

PACES history

• PACES replaced old clinical exam in 2001

• 5 stations – 2 examiners at each station

• 4 scale marking system with overall judgement at each station

• All marks added together – good performance could compensate for overall result

Old [original] PACES (oPACES) 2001-9

PACES history

• nPACES introduced 2010(3)

• New assessment methodology

• Introduction of 7 clinical skills for testing

• Non compensated skills based marking scheme

• Amended clinical encounters in station 5

The seven skills in nPACES

• Proposed as a solution to the problem of compensation

• Submission to PMETB, 2008

The current PACES carousel

Overview

• Brief history of PACES

• Why change PACES

• Development of PACES 2020

• Agreed changes

• Next steps

Why PACES 2020?

• Ensure PACES remains relevant, fair and up to date

• Reflect changes in postgraduate medical education, training and assessment

• Reflect changes in the workplace

• Mixed feedback re current station 5

• Its 10 years since we last did it!

Shape of Training

Overview

• Brief history of PACES

• Why change PACES

• Development of PACES 2020

• Agreed changes

• Next steps

PACES 2020

• Need to ensure that the MRCP(UK) Part 2 Clinical Examination remains:

– Relevant

– fair to candidates

– fit for purpose

– and of the highest quality

• PACES 2020 Short Life Working Group

– First meeting on 25 August 2016

Assessment of a competent physician

• Ability to perform the professional activity of a competent physician

• Rebalance the large number of individually identifiable competencies

• Mechanism to translate competency into practice

TORs PACES 2020

• Consider all aspects structure and content

• Achieve the balance between academic and operational ideals

• Recommendations should reflect changes in postgraduate medical education and training

• Consider impact on international candidates

• Relevant, fair and fit for purpose

• Academic validity

• Reliability

• Deliverability

• International partners

• Business model

Five tests for any PACES changes

Aims• An assessment that:

– Ensures physicians continue to deliver the best possible care for patients – right knowledge, skills, attitudes

– Remains the best possible assessment of clinical skills

– Reflects changes in postgraduate medical education and training

– Remains relevant assessment for physicians in training

PACES 2020 Methodology

• Literature review

• Short life working group convened (Aug 2016)

• 4 days of meetings

• 2 proof of concept studies

• Engagement with key stakeholders (MSARG)

• Engagement with psychometricians/JRCPTB

• Engagement with international stakeholders

Current PACES Strengths• Importance of clinical examination with real patients

and real physical signs

• Direct observation of encounters including communication and professionalism

• Infrastructure supporting the written material

• Two independent assessors at each encounter

• Calibration

• Non compensated skills based assessment methodology

Current PACES Opportunities

• ? Testing history taking skills in isolation

• ? 20 minutes in communication and ethics with 5 minute examiner/candidate interaction

• ? Time pressure in brief clinical consultations

Overview

• Brief history of PACES

• Why change PACES

• Development of PACES 2020

• Agreed changes

• Next steps

Recommendations

• Retain non-compensated skills based marking scheme (seven skills)

• Retain 5 station carousel with 8 clinical encounters (125 minutes)

• Retain 2 independent assessors at each clinical encounter

• Retain 4 system based physical examination encounters

Proposed new encounters

• 20 minute ‘clinical consultations’

• 10 minute communication encounters

• Proof of concept study (CSAC Feb 2017)

Recommendations

• Introduce 2 x 10 minute communication encounters

• Remove the examiner/candidate interaction from communication encounters

• Assessment of skill E by observation only

• Align each communication encounter with a physical examination encounter

Recommendations

• New clinical encounters well received

• Introduce two new 20 minute clinical consultation encounters

• 15 minutes for interaction with patient and 5 minutes with examiners

• All seven skills assessed

• Suggest one acute and one non acute scenario

• Content to reflect new IM curriculum

Overview

• Brief history of PACES

• Why change PACES

• Development of PACES 2020

• Agreed changes

• Next steps

PACES 2020 Timeline

• 2015 – Clinical Exam Board asked to review PACES

• Aug 2016/7 – short life working group convened and met x4

• November 2017 – Proposal to AQMRC

• Proof of concept studies – Edinburgh Feb 2017 & Hull July 2017

• Pilot of exam – London & Edinburgh (July/Aug 2018)

• GMC submission: December 2018

• Training and communication 2019-2020

Goes live in the third diet of 2020

• Principle: Candidates should not be disadvantaged by new exam

• Release of results

• Higher Specialty recruitment

PACES 2020

Implications for trainees

3 attempts max rather than 4 before Aug 2021

Historically 60-75 ST3 job offers go to trainees without full MRCP

~35%will be for group 2 specialities or legacy group 1 posts.

20-25 trainees may have job offers but not have full MRCP

The MRCP(UK) is part of the Federation of theRoyal Colleges of Physicians of the United Kingdom

Any Questions?