PACES communication and consultation in one paragraph
PACES has five stations and eight encounters, and four of those eight are about talking: two 10-minute communication encounters at stations 1 and 4, and two 20-minute consultations at stations 2 and 5. Per the Federation of the Royal Colleges of Physicians' PACES format page (read on 21 October 2026), the communication encounters are marked on four skills, C (Clinical Communication), E (Clinical Judgement), F (Managing Patients' Concerns) and G (Maintaining Patient Welfare), and the consultations on all seven, A to G. Two independent examiners watch each encounter and grade every skill Satisfactory (2 marks), Borderline (1) or Unsatisfactory (0). Skills C and F are earned only in these four encounters, so they decide whether your communication passes. A costly mistake is to treat the communication encounter as a short consultation and spend it taking a history, when the official example cards say in capitals "DO NOT TAKE A HISTORY". The job is to explain, negotiate and support, then agree a plan before the bell.
- 5 stations, 8 encounters, 125 minutes including 5 minutes between stations. You start at any station and move round the carousel every 20 minutes.
- Communication encounter: 10 minutes, written instructions given in the 5-minute interval before it, no examiner-candidate interaction, marked on C, E, F and G.
- Consultation: 20 minutes, of which 15 are with the patient (history, relevant examination, discussion) and 5 are questions from the lead examiner. Marked on A to G.
- Two examiners per station, ten in all. Each grades each skill 2, 1 or 0.
- Latest published pass standard (2024/01): 126 out of 168, and every one of the seven skills passed.
- You must have passed MRCP(UK) Part 1 before you apply. Part 2 Written and PACES can be taken in either order.
The PACES23 station table
This is the table from the Federation format page, with the skills column filled in from the same page. Total time is 125 minutes, including 5 minutes between each station. The September 2026 regulations add that each station is assessed by two independent examiners and that candidates "move round the carousel of stations at 20-minute intervals".
| Station | Encounter | Minutes | Skills marked | What you do |
|---|---|---|---|---|
| 1 | Communication | 10 | C, E, F, G | Talk with a patient, relative or surrogate. No history, no examination. |
| 1 | Respiratory examination | 10 | A, B, D, E, G | Examine, then discuss findings. |
| 2 | Consultation | 20 | A to G | History, focused examination, explanation and plan, then examiner questions. |
| 3 | Cardiovascular examination | 10 | A, B, D, E, G | Examine, then discuss findings. |
| 3 | Nervous system examination | 10 | A, B, D, E, G | Examine, then discuss findings. |
| 4 | Communication | 10 | C, E, F, G | Talk with a patient, relative or surrogate. No history, no examination. |
| 4 | Abdominal examination | 10 | A, B, D, E, G | Examine, then discuss findings. |
| 5 | Consultation | 20 | A to G | History, focused examination, explanation and plan, then examiner questions. |
Do the arithmetic once and the priorities become clear. Each skill in each encounter can earn 4 marks (2 from each examiner). A communication encounter is therefore worth 16 marks, a consultation 28 and a physical examination encounter 20. That puts 88 of the 168 marks in the four encounters where you talk (our calculation from the published station table and the 2024/01 pass standard). TalkDrill helps with the talking: the explaining, the listening, the plain English and the pace. The examination technique in stations 1, 3 and 4 needs real patients and a clinical teacher, and we do not pretend otherwise.
Skills A to G in plain words
The Federation's wording for each skill is short and dense. The table gives the official name, a short quote from the format page, what it means in a real encounter, where it is marked and how many marks it carries across the whole exam (our arithmetic: encounters marked on that skill, times two examiners, times two marks). The pass marks are from the Federation's 2024/01 pass standard.
| Skill | Federation wording (short quote) | In plain words | Marked in | Marks (2024/01 pass mark) |
|---|---|---|---|---|
| A Physical Examination | "correct, thorough, systematic" technique | You examine properly and in a sensible order. | 4 examination encounters and 2 consultations | 24 (16) |
| B Identifying Physical Signs | "Identify physical signs correctly, and not find physical signs that are not present" | You find what is there and do not invent what is not. | Same six encounters | 24 (14) |
| C Clinical Communication | "Elicit a clinical history ... Explain relevant clinical information in an accurate, clear, structured, comprehensive, fluent and professional manner" | You ask well and you explain well. In a communication encounter it is mostly the explaining: in order, in plain English, with checks. | 2 communication encounters and 2 consultations | 16 (11) |
| D Differential Diagnosis | "Create a sensible differential diagnosis" | You know what it could be, most likely first. | 4 examination encounters and 2 consultations | 24 (15) |
| E Clinical Judgement | "Select or negotiate a sensible and appropriate management plan ... Apply clinical knowledge, including knowledge of law and ethics, to the case" | You reach a safe plan with the person, and you get the ethics right: consent, capacity, confidentiality, honesty, knowing when to ask a senior. | All 8 encounters | 32 (20) |
| F Managing Patients' Concerns | "Seek, detect, acknowledge and address patients' or relatives' concerns. Listen ... confirm their understanding ... and demonstrate empathy" | You find out what the person is really worried about, say it back, and deal with it. | 2 communication encounters and 2 consultations | 16 (10) |
| G Maintaining Patient Welfare | "Treat a patient or relative respectfully and sensitively and in a manner that ensures their comfort, safety and dignity" | Respect, safety and dignity, every minute, including how you leave the room. | All 8 encounters | 32 (28) |
Three of these deserve a closer look for a doctor whose first language is not English.
C is about structure as much as vocabulary
The word that carries the most weight in the Skill C wording is "structured". A candidate who says what they are going to cover, covers it in that order, and checks understanding after each piece will sound structured even with a strong accent. A candidate with polished English who answers the relative's questions in whatever order they come will not. Signposting is a learnable habit: "I'd like to explain what the scan showed, then talk about what happens next. Is that all right?"
F is detected, not asked once
The Skill F wording begins "Seek, detect". Asking "Do you have any concerns?" at minute nine is seeking. Detecting is noticing that the daughter said "she's always been so independent" twice, and saying: "You've mentioned her independence a couple of times. Is that what's worrying you most?" The actors in PACES are briefed with attitudes and emotions as well as facts, as the surrogate briefs in the official examples show, and those emotions are where Skill F marks sit.
G is the skill that can fail you in one moment
Skill G is marked in every encounter and has the highest pass threshold: 28 of 32 in the 2024/01 standard, so you can lose at most four marks across sixteen examiner judgements. In a communication encounter, G is lost by talking over someone, by an unkind or dismissive phrase, by standing over a seated relative, or by leaving a distressed person without a plan. Regulation 4.7(d) of the September 2026 regulations covers the case where a candidate scores exactly 28 on G because both examiners marked G Unsatisfactory in a single encounter: even with 126 overall and every skill passed, the candidate is discussed at the post-cycle briefing and the board decides pass or fail.
The 10-minute encounter and the 20-minute consultation compared
The two talking formats look similar and are not. The left column is the communication encounter at stations 1 and 4; the right is the consultation at stations 2 and 5. Every row comes from the format page or from the official example PDFs on the sample scenarios page, except the last two, which are our arithmetic and our suggested timing.
| Feature | Communication encounter (stations 1 and 4) | Consultation (stations 2 and 5) |
|---|---|---|
| Time | 10 minutes with the subject | 20 minutes: 15 with the patient, then a 5-minute question and answer with the lead examiner |
| Who you talk to | "a patient, relative, or surrogate, such as a healthcare worker" | A patient or a surrogate |
| What you are given | Written instructions in the 5-minute interval: your role, the problem, the people, a scenario and "your task" | A referral letter with observations, and a task list: assess with a history and relevant examination, advise the probable diagnosis and plan, agree how to proceed |
| History and examination | The example cards say "DO NOT EXAMINE THE PATIENT" and "DO NOT TAKE A HISTORY" | Expected. The example says you do not need to finish the history before examining |
| Examiner talks to you | No. "Marks will be based on examiner observation alone" | Yes, in the last 5 minutes: abnormal findings, preferred diagnosis, differentials, remaining questions about the plan |
| Time warning (example examiner notes) | Two minutes remaining, after 8 minutes | Two minutes remaining with the patient, after 13 minutes |
| How it should end (example examiner notes) | "A good candidate would be expected to have agreed a summary plan of action with the subject before closure" | Solutions discussed and a chance for the patient to ask questions; "It is not necessary for candidates to agree a summary with the patient" |
| Skills marked | C, E, F, G | A, B, C, D, E, F, G |
| Marks available (our arithmetic) | 16 | 28 |
| Suggested minute plan (TalkDrill, not official) | 0 to 1 introduce, purpose, permission. 1 to 3 what they know and what worries them. 3 to 7 explain in pieces, respond, negotiate. 8 warning. 8 to 10 summary plan, safety net, questions. | 0 to 1 introduce and agenda. 1 to 7 history with ideas, concerns and expectations. 7 to 11 focused examination. 11 to 15 explain, plan, address the concern, check understanding. 15 to 20 examiner questions. |
Two language points follow from this table. First, in the communication encounter nobody will rescue you with a question, so silence after the eight-minute warning is expensive: have your summary sentence ready. Second, the consultation asks you to switch register at minute 15. With the patient you say "a camera test to look inside the bowel". With the examiner you say "colonoscopy". Candidates who keep the patient register with the examiner sound vague; candidates who use the examiner register with the patient lose Skill C. Practise the switch out loud.
Two examiners, 2, 1 or 0, and the pass standard
Per the format page, each skill in each encounter is "graded Satisfactory (2 marks), Borderline (1 mark) or Unsatisfactory (0 marks)" by each of the two examiners, independently. The official example PDFs describe how examiners prepare: during calibration they rehearse the surrogate, then "agree the issues that a candidate should address to achieve a Satisfactory award for each skill" and the criteria for Unsatisfactory, and record them on a calibration sheet. So for every scenario there is a short private list, agreed in advance, of what a Satisfactory candidate does. You cannot see the list, but the "areas of potential interest" in the official examples show its shape: for the dementia feeding scenario, under Skill F, "Listens sensitively to the daughter's concerns relating to her fear that her mother will die".
| What the regulations and pass standard say | What it means for you |
|---|---|
| Overall pass mark 126 of 168 and every skill passed (2024/01 standard; the September 2026 regulations still cite 126) | A strong overall score does not rescue a failed skill. C (11 of 16) and F (10 of 16) are decided entirely by your four talking encounters. |
| Skill G pass mark 28 of 32 | At most four marks lost on G across the whole exam. One encounter where both examiners mark G Unsatisfactory uses all four and triggers a board discussion (regulation 4.7(d)). |
| If only nine examiners are present, one examiner assesses a station alone and their marks are doubled (regulations 4.7(c)) | Rare, and not grounds for appeal. Perform for whoever is in the room. |
| Results are confirmed at the post-cycle discussion on the day and cannot be reviewed (regulations 5.1) | There is no re-mark route. Preparation is the only lever. |
| Six attempts at each part of the diploma, then an application for an exceptional additional attempt (regulations 3.3) | Treat each sitting as expensive. Do not sit to "see what it is like". |
The marksheets page carries the eight PACES23 marksheets, one per encounter, including the two communication and two consultation sheets. Print the communication sheet and use it when a partner watches you. Our practice bank has a self-marking sheet with the PACES skills and the PLAB 2 domains.
Worked encounter 1: a patient who wants to leave (ethics and consent, 10 minutes)
Candidate card (written by TalkDrill, PACES23 communication style)
Your role: You are the doctor on the acute medical unit. Problem: A patient who wants to leave before his assessment is complete. Patient: Mr Rajan Pillai, a 58-year-old bus driver. Scenario: Mr Pillai was admitted last night with central chest pain, which has settled. His first heart tracing and first blood test did not show a heart attack. The team needs a second blood test this afternoon before a heart attack can be ruled out, and has asked that he stays until then. He has told the nurse he is going home now. Your task: Speak to Mr Pillai about his wish to leave and address any concerns he raises. Do not examine the patient. Do not take a history.
What the actor knows (our surrogate brief): he cares alone for his wife, who has dementia. A neighbour has sat with her overnight but must leave at two o'clock. He feels well. His brother went into hospital last year and died there, and he does not like hospitals. He must ask: "I feel fine. Why can't I just go?"
The transcript (written by TalkDrill)
[0:00] Doctor: Good morning, Mr Pillai. I'm Dr Meera Nair, one of the doctors on this unit. The nurse tells me you're thinking of going home. Is it all right if I sit down and we talk about it for a few minutes?
Mr Pillai: There's nothing to talk about. I feel fine. Why can't I just go?
Doctor: I'm glad the pain has settled. I will explain why we asked you to stay. Before I do, can I ask what's making you want to leave this morning?
Mr Pillai: My wife. She has dementia. The neighbour has been with her all night and she has to go at two.
Doctor: That's a real worry. You've been lying here all night thinking about her. Who usually helps when you're not at home?
Mr Pillai: Nobody. It's just me.
[2:00] Doctor: Thank you for telling me. Let me check I've understood. You feel better, and the main thing pulling you home is your wife, who can't be left alone after two o'clock. Is there anything else on your mind?
Mr Pillai: I don't like hospitals. My brother went into one last year and never came out.
Doctor: I'm very sorry about your brother. After that, I can understand why you'd want to be out of here. Thank you for telling me.
[3:30] Doctor: Can I tell you where things stand, and then we'll look at what we can do about your wife? What have you been told about the tests so far?
Mr Pillai: That the first one was clear.
Doctor: That's right, and it's good news. The difficulty is that one blood test isn't enough with chest pain like yours. Damage to the heart can take some hours to show in the blood. So we need the second test this afternoon to be sure. Does that make sense so far?
Mr Pillai: So you think it's my heart?
Doctor: I don't know yet, and that's honestly why we want the second test. It may well be clear. What I can't do is tell you it's safe until we have it. If something is happening with your heart and you're at home, perhaps on your own with your wife, or driving, it could become dangerous before anyone could help.
[6:00] Doctor: I want to be sure I've explained it properly. Could you tell me in your own words what the risk is if you go home now?
Mr Pillai: If it is my heart, it could get worse, and I wouldn't be in the right place.
Doctor: Exactly right. Now, about your wife. Would it help if I asked our social work team, right now, whether someone can be with her this afternoon? I can also ask for your blood test to be taken as early as it safely can be. If she were safe, would you be willing to stay until the result?
Mr Pillai: If someone's with her, yes. If not, I'm going.
Doctor: That's fair, and it is your decision. If you do decide to go, I'll still help you. You'd leave with a letter, a clear list of the symptoms that mean calling 999 straight away, and a plan to come back for the test. You won't be in any trouble for leaving. I'll also let my consultant know we've talked.
[8:00, the examiner: "Two minutes left."]
Doctor: Let me sum up what we've agreed. I'll ring social work as soon as we finish about someone sitting with your wife. I'll ask for your blood test to be done as early as possible. If both of those happen, you'll stay until the result. If they don't, I'll come back and we'll talk again before you go, and you'll leave with a plan and a letter. Is that how you understand it? Is there anything else you'd like to ask me?
Why this would score well (TalkDrill's commentary)
| Skill | What the examiners can see | What would lose it |
|---|---|---|
| C | A signpost ("where things stand, and then ... your wife"), a check of what he already knew, one idea per sentence, no jargon, a teach-back at minute six. | "Your troponin needs repeating to exclude ACS." Correct, and meaningless to a bus driver. |
| E | Capacity presumed, then quietly checked by asking him to explain the risk back. Autonomy respected ("it is your decision"). A negotiated plan, a safer alternative, and the senior informed. | Telling him he "can't" leave, or that he must "sign a form and then we can't help you". That is a threat, and it is wrong. |
| F | Both concerns found before any information was given: the wife, and the brother. Each acknowledged in words, and the practical one acted on. | Explaining the test first and asking about concerns at minute nine. |
| G | Sat down, asked permission, no blame, an explicit promise that leaving would not be punished. | Standing over the bed, or a cold "that's your choice then". |
The legal frame the examiners expect you to know in outline: in England and Wales, the Mental Capacity Act 2005 starts from a presumption that an adult has capacity. A person is unable to make a decision if they cannot understand the information, retain it, use or weigh it, or communicate the decision, and the Act links that inability to an impairment of the mind or brain. Scotland and Northern Ireland have their own legislation. The official example notes say "Candidates are not expected to have a detailed knowledge of medical law in the UK, but should be aware of general legal and ethical frameworks". That is the level to aim for: name the principle in plain words, do not recite the Act.
Worked encounter 2: a son who asks you not to tell his mother (relative, 10 minutes)
Candidate card (written by TalkDrill, PACES23 communication style)
Your role: You are the doctor on a medical ward. Problem: A relative asking you not to tell a patient her diagnosis. Patient: Mrs Kamala Rao, a 76-year-old retired teacher. Relative: Mr Suresh Rao, her son. Scenario: Mrs Rao was admitted with weight loss and tiredness. A scan has shown changes that are very likely to be bowel cancer that has spread to the liver. She is alert and has capacity. Your consultant plans to discuss the results with her this afternoon. Her son has heard there is a result and wants to speak to you first. Where relevant, assume you have the patient's consent to discuss her condition with her son. Your task: Speak to Mr Rao and address his concerns. Do not examine the patient. Do not take a history.
What the actor knows (our surrogate brief): his father died eight months ago and his mother has barely eaten since. In his family, elders are protected from bad news and the children decide. He is frightened she will "give up". He must ask: "Please promise me you won't tell her it's cancer." He may also ask "Can't you just say it's an infection?" and "How long has she got?"
The transcript (written by TalkDrill)
[0:00] Doctor: Mr Rao? I'm Dr Farah Ahmed, one of the doctors looking after your mother. I understand you wanted to talk before we see her this afternoon. Is here all right, or would you prefer somewhere quieter?
Mr Rao: Here's fine. I know you have the scan result. Please, promise me you won't tell her it's cancer.
Doctor: I can hear how much you want to protect her. Before I answer that, can you tell me what you're most afraid will happen if she hears it?
Mr Rao: Since my father died she hardly eats. If she hears the word cancer, she'll give up. In our family we don't tell elders things like this. We decide for them.
[2:00] Doctor: That makes sense to me. You lost your father eight months ago, and now you're scared of losing her too. You're trying to look after her the way your family always has.
Mr Rao: So you won't tell her?
Doctor: I'd like to be honest with you, because I think you'd want that from me. I can't promise not to tell her, and I won't lie to her if she asks. It's her body and her illness, and if she wants to know what's happening, she has the right to. But I can promise you something just as important. We won't force information on her. We'll start by asking her what she already thinks is going on, and how much she wants to know. Some people want every detail. Some say "talk to my son". Whatever she chooses, we'll respect it.
[4:30] Mr Rao: Can't you just say it's an infection?
Doctor: I understand why that feels kinder. The trouble is that she'll be asked to make decisions soon, about tests, about treatment, perhaps about where she wants to be. She can't make those choices well if she's been told something that isn't true. And people often sense when something is being kept from them, which can feel lonelier than the truth.
Mr Rao: How long has she got?
Doctor: I know that's the question that matters most to you. I can't give you a reliable answer today. The scan tells us a lot, but the specialist team needs more information before anyone can talk honestly about time or treatment. When we know more, we'll discuss it with her, and with you if she wishes.
[7:00] Doctor: Would it help if you were with her when we talk this afternoon? I'd also like to ask our specialist nurse to join us, so that you both have someone to call afterwards.
Mr Rao: Yes. I want to be there.
[8:00, the examiner: "Two minutes left."]
Doctor: Then let me sum up. We'll see your mother together this afternoon, with the specialist nurse. We'll ask her first what she understands and how much she wants to know, and we'll follow her lead. We won't lie to her, and we won't push information on her that she doesn't want. Is there anything else worrying you that we haven't talked about?
Why this would score well (TalkDrill's commentary)
| Skill | What the examiners can see | What would lose it |
|---|---|---|
| C | The ethical position explained in everyday words ("her body and her illness"), in short sentences, with the reason given each time. | A lecture on autonomy and the law with no reason the son can feel. |
| E | No collusion and no lie, but no abandonment of the son either. A shared plan: ask her how much she wants to know, son present if she wishes, specialist nurse involved. No prognosis guessed. | Agreeing to say "infection". Or, at the other extreme, "It's illegal not to tell her", which is cold and overstates the law. |
| F | His fear explored before any answer, his grief named, his family's view acknowledged rather than dismissed. | "In the UK we always tell patients." True in spirit, and it shuts him out. |
| G | Offered a quieter place, did not argue, treated the family's culture with respect. | Talking over him when he became upset. |
Three phrases from this encounter transfer to almost any relative scenario: "I can hear how much you want to protect her", "I'd like to be honest with you, because I think you'd want that from me", and "we'll follow her lead". The first two are slow phrases. Say them slowly, with the stress on "protect" and "honest". Our plain English page has more of these, grouped by the moment they fit.
Worked encounter 3: a 20-minute consultation with a frightened patient
Referral letter and task (written by TalkDrill, PACES23 consultation style)
Your role: You are the doctor in the general medical clinic. Patient: Mrs Grace Okafor, a 61-year-old school cook. Letter: "Dear Doctor, I would be grateful if you would see Mrs Okafor, who has felt tired for three months. Her blood count shows anaemia and her iron levels are low. Please advise on further investigation and management." Your task: Assess the problem with a clinical history and relevant physical examination. Advise the patient of your probable diagnosis and your plan. Discuss the options with her, agree how to proceed, and answer her questions. You have 15 minutes with the patient, then 5 minutes with the examiners.
What the actor knows (our patient brief): she has taken ibuprofen most days for a year for knee pain. Her sister was diagnosed with bowel cancer last year. She has noticed no bleeding. She is frightened of "the camera test" because her sister found it unpleasant, and she is privately sure she has cancer. She wants to keep working.
Key moments from the 15 minutes (written by TalkDrill)
[0:00] Opening and agenda. Doctor: Good afternoon, Mrs Okafor. I'm Dr Arjun Iyer, one of the doctors in this clinic. Your GP has written to us about your tiredness and a blood test. Before we start, what would you most like to get out of today? Mrs Okafor: I want to know why I'm so tired. And whether it's something serious. Doctor: Then we'll make sure we answer both. I'll ask you some questions, then examine you, and then explain what I think and what happens next. Is that all right?
[1:00 to 7:00] History, three lines of it. After an open question about the tiredness and focused questions about breathlessness, bleeding, bowel habit, weight and diet: Doctor: You mentioned your knees. Do you take anything for them, including things you buy at the chemist? Mrs Okafor: Ibuprofen, most days, for about a year. Then, on family history: Mrs Okafor: My sister. Bowel cancer, last year. Doctor: I'm sorry. That must have been a hard year. Is that something that's been on your mind with all this? Mrs Okafor: Every day since the GP rang. Doctor: Thank you for telling me. I'll come back to that, I promise, because it matters. Let me finish a few questions so I can give you a proper answer.
[7:00 to 10:30] Examination with a running explanation. Doctor: I'd like to examine you now: your eyes and hands, your heart and chest, and your tummy. I'll tell you what I'm doing as I go. Please tell me if anything is uncomfortable.
[10:30 to 13:00] Explanation and the concern. Doctor: Let me tell you what I think. Your tiredness is very likely caused by the anaemia. Your blood is low in iron, so it carries less oxygen. The real question is why the iron is low. At your age, a common reason is slow bleeding from the stomach or bowel, which you wouldn't necessarily see. The ibuprofen you take can irritate the stomach and cause that kind of bleeding, so it's one possible reason. I know you're worried about bowel cancer, and I won't pretend it isn't possible. Because of your age, your low iron and your sister's illness, we need to check properly. That means looking inside the stomach and the bowel with camera tests. Many things other than cancer cause this, and the tests are how we find out which one it is. Mrs Okafor: My sister said the camera test was awful. Doctor: Thank you for telling me that. A lot of people feel nervous about it. The team will explain the preparation beforehand and talk with you about what can help you feel more comfortable. Would it help if I wrote down what happens on the day?
[13:00, the examiner: "Two minutes left with the patient."] Doctor: So the plan is: stop the ibuprofen, and we'll write to your GP about other options for your knees. Start iron tablets. One more blood test today. And a referral for the camera tests. If you notice black, sticky stools, vomit blood, or feel faint or very short of breath, please call 999 or go straight to A&E. Can I check I've explained that clearly? What will you tell your husband tonight about what happens next? ... What questions do you have for me?
The five minutes with the examiner (model answer, written by TalkDrill)
The official consultation example tells the examiner to ask you to describe any abnormal physical findings and give your preferred diagnosis and differentials, then use the remaining time on the plan. Change register now. This is doctor to doctor.
Examiner: Tell us your findings and what you think is going on. Candidate: Mrs Okafor is a 61-year-old woman with three months of fatigue and exertional breathlessness, referred with iron deficiency anaemia. She has taken ibuprofen daily for a year and her sister was diagnosed with colorectal cancer last year. She reports no overt bleeding and no change in bowel habit. On examination she was pale; I found no other abnormality. (For this written example, assume those were the findings.) My working diagnosis is iron deficiency anaemia from gastrointestinal blood loss. NSAID-related upper gastrointestinal bleeding is a strong possibility, but colorectal cancer must be excluded given her age and family history. Other causes include coeliac disease and poor intake. I would stop the NSAID, start oral iron, check coeliac serology, and arrange upper and lower gastrointestinal investigation in line with current national guidance and the local pathway. Her main concern is cancer. I have told her honestly that it is possible and that the tests are how we find out.
How the seven skills map onto this consultation (TalkDrill's commentary)
| Skill | Where it was earned in this example |
|---|---|
| A and B | The examination itself. Outside the scope of a language page; practise it on real patients. |
| C | The agenda at minute one, focused questions that explored the differential (bleeding, medicines, family history, diet), the explanation in pieces, the teach-back question at minute 13. |
| D | A ranked differential to the examiner, including the diagnosis that frightens the patient. |
| E | A plan that fits the history: stop the likely cause, treat, investigate, safety-net, and a clear presentation in examiner register. |
| F | The sister's illness spotted, acknowledged at once, promised a return, and then addressed honestly without false reassurance. The fear of the test drawn out and acted on. |
| G | Permission and commentary during the examination, dignity, a safety net before she left. |
The official consultation example 1, a haemoptysis referral, lists under Skill F that a good candidate "Sensitively explains to the patient that lung cancer is a possibility and does not offer false reassurance". The pattern is the same in our example: name the feared diagnosis yourself, honestly, before the patient has to.
The official sample material, and the trap in it
Everything below is free on the Federation site and was available on 21 October 2026. Use it before any coaching centre's paraphrase.
| Material | What is in it | How to use it |
|---|---|---|
| PACES23 Communication encounter examples (PDF) | Four examples, each with the candidate card, the surrogate brief and the examiner notes: feeding and hydration in severe dementia with the patient's daughter; an antibiotic given to the wrong patient; explaining the importance of treatment to a young woman with newly diagnosed type 1 diabetes; explaining a diagnosis of multiple sclerosis. | Read the candidate card only, run it for 10 minutes with a partner reading the surrogate brief, then read the examiner notes and mark yourself. |
| PACES23 Consultation examples 1, 2 and 3 (PDFs, on the sample scenarios page) | Referral letter, patient brief and examiner notes for three 20-minute consultations. | Run them as 15 plus 5, with your partner switching from patient to examiner at minute 15. |
| PACES23 videos, with transcripts for each set (sample scenarios page) | Two introduction videos, then three sets: the communication encounter, the consultation, and a consultation with a surrogate. Each set follows a case from the examiners' preparation and calibration to the candidate's encounter and the marking. | Watch with the sound on once, then with the sound off to study pace, posture and pauses. |
| Station 4 Scenario Pack (PDF) | 24 sample communication skills and ethics scenarios from the earlier PACES format, including TIA, coeliac disease, a relative requesting information the patient has forbidden, Huntington's disease and a perceived drug error. | See the trap below. |
| Marksheets (eight PDFs, marksheets page) | One per encounter. | Give the communication marksheet to your partner. |
The trap. The Station 4 pack ranks at the top of search results for "PACES communication station scenarios", and its scenarios are excellent. But its cards were written for the older format, and they say "You have 14 minutes for your consultation with the patient/relative, 1 minute to collect your thoughts and 5 minutes for discussion". In PACES23 the communication encounter is 10 minutes and there is no discussion with the examiner. A candidate who rehearses the old clock arrives with a four-minute habit of explaining things to the examiners that nobody will ask for, and too little practice at closing with a summary plan by minute ten. Use the scenarios, re-time every one to 10 minutes, and finish with the summary plan of action that the PACES23 examiner notes ask for.
How to practise stations 1, 2, 4 and 5
- Learn the clock first. Run one official communication example with a phone timer: written instructions read in 5 minutes, 10 minutes of conversation, a partner saying "two minutes" at minute eight. Do this before any scenario bank.
- One scenario a day with the AI. Run the card as a spoken conversation in our role-play practice with a 10-minute hard stop, and repeat the hardest two minutes as often as you need. Mark yourself on C, E, F and G afterwards.
- Two partner sessions a week. A partner reading the surrogate brief and holding the marksheet is still the closest thing to the exam. Our practice bank gives each scenario with the candidate card and a brief for the person playing the patient or relative, so either of you can play either role. Its ten PACES communication cards include a DNACPR conversation with an upset son and a patient with epilepsy who will not stop driving; its ten consultations run 15 minutes plus 5.
- Fix the voice, not just the words. Bad news, apologies and refusals need slower speech and falling intonation. Ten minutes of read-aloud practice on your own key sentences does more than another list of phrases. If you are a Hindi, Urdu, Malayalam, Tamil, Telugu, Arabic or Yoruba speaker, the specific habits that cost Skill C and Skill G are on the mistakes by first language page.
- Plan backwards from your diet. The UK application window for diet 2027/01 runs from 08:00 GMT on 10 November to 08:00 GMT on 17 November 2026, per the Federation dates page; the full table and the international rows are on our PACES dates, fees and centres page. The 8-week roadmap fits the weeks before your allocated date.
If you are sitting PLAB 2 rather than PACES, the communication habits on this page carry over, but the clock and the marking do not: PLAB 2 has 16 scenarios of 8 minutes marked on three domains, per the GMC PLAB 2 guide. Our PLAB 2 station scripts are timed and marked for that exam.