MRCP PACES marking scheme: how PACES is scored

You search for how PACES is marked and the top result is a 2015 marking guide, written before PACES23 arrived in the 2023/03 diet. Most blog explainers below it talk in generalities, then stop short of giving the actual numbers you need.

Here is the MRCP PACES marking scheme in plain numbers. We’ll set out the seven skills A to G, what each one has to clear, the three point grading used at every encounter, and the overall bar that sits above the skill minima.

Last reviewed: 14 August 2026.

How the MRCP PACES marking scheme works

PACES is marked on seven skills labelled A to G. At every encounter each skill is graded as satisfactory 2, borderline 1 or unsatisfactory 0. To pass you must meet a minimum standard in every one of the seven skills, and also reach a minimum total score across the whole assessment.

This is where candidates talk past each other. It is not one hurdle. It is the seven separate skill floors, plus the overall total. A strong performance in one domain does not rescue a skill that sits below its own floor, which matches domain marking in any OSCE.

The seven skills are A Physical examination, B Identifying physical signs, C Clinical communication, D Differential diagnosis, E Clinical judgement, F Managing patient concerns, and G Maintaining patient welfare.

The shape of the exam matters to how this feels on the day. There are 5 clinical stations, each 20 minutes, with 2 independent examiners per station. You will generate 16 marksheets across the circuit, so a rough patch at one encounter can be absorbed by solid work elsewhere, as long as each skill clears its own floor.

The seven skills, and what each one has to clear

Here is the MRCP PACES marking scheme by skill, exactly how it is scored at the stations.

• A Physical examination What it covers: How you examine the patient · Pass mark: 16
• B Identifying physical signs What it covers: Spot and describe physical signs · Pass mark: 14
• C Clinical communication What it covers: Explain and discuss with patients · Pass mark: 11
• D Differential diagnosis What it covers: Weighs different possible diagnoses · Pass mark: 15
• E Clinical judgement What it covers: Make sense of findings · Pass mark: 20
• F Managing patient concerns What it covers: Listen and address patient concerns · Pass mark: 10
• G Maintaining patient welfare What it covers: Keep patient safe and comfortable · Pass mark: 28

G, maintaining patient welfare, carries the highest floor at 28, and F, managing patient concerns, the lowest at 10.

The floors are not equal across skills, so "I need to be uniformly good" is the wrong model for how you think about risk across the grid.

The Federation sets these pass marks in the published skills breakdown.

Why 126 is not the sum of the seven floors

Add the seven skill minima: 16 plus 14 plus 11 plus 15 plus 20 plus 10 plus 28, which totals 114. The overall pass mark is 126. That means the overall bar sits 12 marks above the combined floors for the seven skills.

Scraping every skill at exactly its own minimum is a fail. You need to be above the floor somewhere, by 12 in total, as well as clearing all seven floors individually. The floors keep you from passing with a major gap, they don’t describe a passing performance.

Both conditions apply at once, and that’s where people get tied in knots. If you fall short on a skill, that skill fails regardless of how strong your other skills were. At the same time, the marks you earn in stronger skills still count toward the overall total.

So a strong E Clinical judgement score does not save a shortfall in C Clinical communication from failing the skill requirement. It does, however, push your overall total up. The reverse is also true, a near miss on the total is not rescued by having cleared every floor by a whisker.

The practical reading during the circuit is simple enough. Guard each floor, and try to build a buffer where you’re strongest. Not perfect, and stressful under the clock, but it matches how PACES is actually scored.

Practise against the rubric Speak to an AI patient by voice or text and get scored after every case. Run a case free

Why the guidance you found is probably out of date

PACES23 arrived in the 2023/03 diet, so anything written before 2023 is describing an earlier version of the exam. Some of that older advice still reads sensibly, but it isn’t aligned to the format you’ll actually sit.

The current pass standard was set by the MRCP(UK) Clinical Examining Board on 28 May 2024 to take forward from the 2024/02 diet. The Federation of the Royal Colleges of Physicians of the UK publishes the pass standard as a per assessment period notice on its site, so a number copied into a blog post two years ago may now be wrong.

Most popular explainers correctly cover the seven skills A to G and the three point grading, then stop without giving you the overall pass mark or the individual skill floors. From what I can tell, they focus on technique and skip the arithmetic. A lot of trainees share around one popular passing-criteria guide, which is helpful on skills and grading but doesn’t include those thresholds.

Check the date on anything you read about PACES scoring, this page included. Anchor your numbers to the Federation’s current notice, and treat older summaries as context rather than gospel.

What the skill floors tell you to practise

G, maintaining patient welfare, has the highest floor at 28, so bake it into every move. Prioritise comfort, dignity and consent, avoid causing pain, and never leave someone exposed or confused while you press on.

E, clinical judgement, sits next at 20. That rewards committing to the diagnosis and plan you think is right, and defending it with evidence, instead of spraying a list and hoping the examiner picks the one you meant.

C at 11 and F at 10 are the lowest floors, but they are scored at every encounter, so they keep feeding your overall total. These are the cheap marks that help close the 12 mark gap between 114 across the seven floors and the 126 overall pass mark.

Turn that into practice by making welfare visible in your language throughout. Ask permission before you continue, explain what you are doing in plain words, check understanding, and stop or adjust if the person looks uncomfortable.

The skills you can rehearse alone are the conversational and reasoning ones, and they work best if you run a complete encounter, not a pile of disconnected facts, which is the point of the patterns in solo station drills.

If you need a simple way to stack volume at home without a partner, follow the framework in building PACES reps at home.

The two skills you cannot rehearse without a patient

Skill A is physical examination and skill B is identifying physical signs. Between them they carry minimum floors of 16 and 14, and you cannot rehearse either by talking to anyone, in person or otherwise. You need to put your hands on real patients with real signs, supervised.

There is no replica. Bedside time with a supervisor is the only practice that moves these skills.

Our cases present signs as history facts. That trains how you reason from described signs, not how you find them.

In our own case library a 34 year old man volunteers straight away that he has lost weight over a few months despite eating well, and that his heart races and pounds.

If you ask, he mentions a fine tremor in his hands.

Only if you probe specifically does he tell you his partner has noticed his eyes look more prominent and staring, and that he has a smooth, diffusely enlarged swelling in his neck.

The signs sit in the case, but he is telling you about them. You are reasoning from signs you have been told about. You are not eliciting them, and that is a different skill with a different letter on the marksheet.

That frame sits behind what the PACES tools cover, so you can decide where tools help and where they cannot.

Diagnosica gives rubric scoring calibrated to the published mark sheet, and it does not and cannot cover skills A and B.

Questions people keep asking

What is the pass mark for MRCP PACES?

126 overall, and a separate minimum in each skill: A 16, B 14, C 11, D 15, E 20, F 10, G 28. Both conditions must be met. Hitting every floor exactly totals 114, which is 12 short of 126, so you need extra marks from somewhere.

Can one bad station fail me?

It depends which skill fell and by how much. A skill below its own floor is a fail on that condition regardless of the total, since the seven minima are checked separately from the overall score. Every encounter hits several skills, so damage is rarely confined to one station. If Station 5 worries you, read how Station 5 is marked.

Which skill carries the most weight?

G, maintaining patient welfare, has the highest published floor at 28. E, clinical judgement, is next at 20. This describes the published floors, not a ranking of what examiners care about. A strong G or E helps your total, but it cannot offset dipping below any other skill's floor.

This page explains how PACES is scored, not how you will score. It lays out the seven skills, their minima, and the aggregate rule, but it doesn't predict performance and nothing can. It doesn't give advice about real patients, and it's not a diagnostic system. Treat every output as educational.

Diagnosica lets you speak to an AI patient by voice or text, order investigations, commit to a diagnosis and a management plan, and get scored after every case, with rubrics calibrated to the published mark sheet. One free case a week. 74 cases across 14 specialties in three difficulty bands, every one written and signed off by a doctor.

Educational use only. Not medical advice. AI-generated; verify clinically against primary sources.

Clinical review pending.

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