MRCP PACES Station 5 Marking: The 2023 Mark Sheet
Last reviewed 14 August 2026.
What changed at Station 5 in 2023
Station 5 is now a single 20 minute Consultation station in PACES23, assessing all seven clinical skills. It replaced the old Brief Clinical Consultations format that used two 10 minute cases. Station 2 is the other 20 minute Consultation, and also assesses all seven skills.
Per the Federation's PACES format page, the new format will be introduced from the third Diet of 2023, with Stations 2 and 5 having one encounter each and Stations 1, 3 and 4 having two, giving eight encounters in total. It also sets Station 5 as a 20 minute Consultation assessing all seven skills, and says one consultation is likely acute while the other is likely less acute.
The exam runs as a five station carousel with two independent examiners at each station. Candidates move every 20 minutes with a 5 minute period between stations, total time 125 minutes including those gaps.
Before 2023, Station 5 was called Brief Clinical Consultations, with two 10 minute encounters, and it already tested all seven skills in an integrated fashion. The change, per MedCourse's 2023 format guide, happened because "it was felt that in each of the two encounters in this station, it was very difficult to complete in a relatively short time of 10 minutes".
Why most Station 5 mark sheets you find are out of date
Most Station 5 mark sheets you will find online describe a format that no longer exists. They are for the retired Brief Clinical Consultations station, so their timings and structure will not match what you face now.
Here is a concrete example. Clinical Skills Pro published a Station 5 Brief Clinical Consultations MRCP PACES Practice Mark Sheet in November 2018, five years before the format changed, and it describes multiple encounters of 10 minutes each. You can see it here, as an exhibit of the stale format, in a 2018 practice mark sheet.
Under the current format, Station 5 is one encounter of 20 minutes. So the tell is quick. If a sheet says Brief Clinical Consultations, or shows two encounters, or 10 minutes per encounter, it predates the third Diet of 2023.
Plenty of pre 2023 material still ranks, including academic book chapters for the Brief Clinical Consultations station and older college marking documents. Useful for history, misleading for timing or structure if you take them at face value.
The seven skills did not change, the shape of the encounter they are scored across did. If you want the mechanics, see how mark sheets are filled.
The seven skills scored at Station 5
Station 5 is the only encounter where all seven skills are scored at once, and two examiners grade your performance as Satisfactory, worth 2 marks, Borderline, worth 1, or Unsatisfactory, worth 0.
It feels busy, every decision judged in real time. In 20 minutes you take a focused history, examine appropriately, discuss investigations and management, respond to concerns, and protect welfare.
- A. Physical Examination What the examiner is judging: Use a correct, systematic technique, focused to the case, fluent and professional.
- B. Identifying Physical Signs What the examiner is judging: Detect genuine signs and avoid reporting findings that are not present.
- C. Clinical Communication What the examiner is judging: Take a relevant, structured history and explain information accurately and clearly.
- D. Differential Diagnosis What the examiner is judging: Offer a sensible differential built from your own assessment of this patient.
- E. Clinical Judgement What the examiner is judging: Select appropriate investigations or treatments and negotiate a sensible plan, applying law and ethics.
- F. Managing Patients' Concerns What the examiner is judging: Seek, acknowledge and address concerns, listen, check understanding, show empathy.
- G. Maintaining Patient Welfare What the examiner is judging: Behave respectfully and sensitively, protecting comfort, safety and dignity at all times.
Communication encounters at Stations 1 and 4 score C, E, F and G, and physical examination encounters score A, B, D, E and G. Station 5 is the only one that scores all seven.
D and E refer to "a patient that the candidate has personally clinically assessed". Your differential and plan must come from what you found. Ten examiners see you, two at every station, with grading agreed in advance at calibration, as set out in the published skill descriptors.
Station 5 scores seven skills; Diagnosica can drill the consultation and reasoning half, skills C, D, E and part of F, but not physical examination or identification of physical signs. Run a case free on the free tier, one case a week.
How the 20 minutes is actually split
The clock is tight. Twenty minutes sounds generous and it is not, because a full examiner Q&A sits inside it.
- Pre-brief, 5 minutes. Before you enter, you get written instructions for the case, usually a short note or a referral letter. This is outside the 20 minutes.
- Patient-facing, minutes 0 to 13. You are with the patient, with 15 minutes total to, in the Federation's words, "take a detailed history, carry out a relevant examination, and respond to the patient's concerns." Examiners give a 2-minute warning when 13 minutes have elapsed, per MedCourse's timing breakdown.
- Patient-facing, minutes 13 to 15. Use the final 2 of the 15 to give a clear explanation of the likely diagnosis and next steps, and to explore any concerns. A focused examination with correct identification of signs is expected in the same 15-minute block, as MedCourse describes.
- Examiner-facing, minutes 15 to 20. A 5-minute question and answer period with a lead examiner. No patient interaction here.
History might come directly from the patient, or on some occasions from a surrogate speaking on their behalf. Stations 2 and 5 together carry over a third of the marks in the whole examination, MedCourse's figure, which is why the 13-minute warning matters.
What happens in the five minutes with the examiner
After the 20-minute consultation, there is a five-minute question and answer with the lead examiner. It exists to hear you justify what you thought and what you plan to do, not to re-take the history.
The communication encounters at Stations 1 and 4 do not have this. The Federation's wording is, "There will be no examiner-candidate interaction. Marks will be based on examiner observation alone." MedCourse notes those conversations lost their viva under the current format.
So the consultation stations are now the only places in the carousel where you defend your reasoning out loud, apart from the shorter discussion after each physical examination encounter.
Skill D asks for a sensible differential diagnosis for a patient you have personally assessed. Skill E asks you to select or negotiate a management plan, choose investigations, and apply clinical knowledge including law and ethics. Those five minutes are built to sample exactly those two skills.
Under the previous format, Station 5 had two ten-minute encounters and no separate questioning block of this length.
Prep on your side is about compressing your thinking aloud. Short, structured run-throughs help, including timed solo station drills.
What you can rehearse alone, and what you cannot
Station 5 scores seven skills. A simulator can drill three and part of a fourth; the other three need a real body in a room, and the two you cannot touch, A and B, are exactly the ones that make Station 5 hard.
Diagnosica is an AI clinical simulator you use on a phone or laptop, no hardware. You take a history by voice or text, order investigations, commit to a diagnosis and a management plan, defend it to an AI senior, then get a scorecard calibrated to published mark sheets. It doesn't give advice about real patients, and it's not a diagnostic system. Treat every output as educational.
- A, Physical Examination Can you rehearse it on your own?: NO · Why: No case carries an examination block. Nothing to examine.
- B, Identifying Physical Signs Can you rehearse it on your own?: NO · Why: A sign you are told about is not a sign you found.
- C, Clinical Communication Can you rehearse it on your own?: YES · Why: History taking and explaining your thinking are the whole interaction.
- D, Differential Diagnosis Can you rehearse it on your own?: YES · Why: Every case has named distractors, so wrong but plausible answers are real options.
- E, Clinical Judgement Can you rehearse it on your own?: YES · Why: You order investigations, commit to a plan, then defend it.
- F, Managing Patients' Concerns Can you rehearse it on your own?: PARTLY · Why: Cases carry ideas, concerns and expectations, with a phase for them. Whether you addressed them is harder to score than whether you asked.
- G, Maintaining Patient Welfare Can you rehearse it on your own?: NO · Why: Comfort, safety and dignity in a room cannot be assessed by a simulator.
In some cases a physical finding reaches you as something the patient or a relative reports, but most findings surface as ordinary history. Danny Ellison's partner has noticed his eyes look more prominent and staring. Stephen Marsh's wife has noticed a diffuse tan with dark palm creases and patches inside his mouth. A 72 year old man with excruciating abdominal pain tells you that pressing on his abdomen hurts surprisingly little. You can reason from a sign you are told about. You cannot elicit it.
For a home plan that respects those limits, see PACES revision at home.
A solo run at a Station 5 shaped case
A weeknight run looks like the consultation half, no examiner, no bedside. You open a one line referral, set a 15 minute timer, take a focussed history by voice, commit to a differential and plan, then defend it against an AI senior.
- Read a single sentence brief.
- Set 15 minutes. No pauses, no rewinds.
- Take the history by voice, the AI patient answers in real time. No physical examination block.
- Name a differential that actually engages the distractors, then commit to a plan and field questions.
For Endocrine, "Weight loss and palpitations, 34M" opens with weight loss and a racing heart, good appetite and loose stools if you look for them, stress on his mind, no thyroid link made. Distractors include toxic multinodular goitre, toxic adenoma, thyroiditis, anxiety disorder and phaeochromocytoma. For Rheumatology, "Back pain and stiffness, 28M" is nine months of low back and buttock pain with 30 to 60 minutes of morning stiffness, better with exercise, worse with rest, second half of the night waking, and he does not buy a strain story.
For Surgery, "Yellowing and weight loss, 70M" is new jaundice with weight loss, torn between gallbladder, a hepatitis he can get over, and worry it is something sinister. Distractors include cholangiocarcinoma and choledocholithiasis. "Painful swollen joint, 52M" wakes overnight with a hot big toe, with septic arthritis on the list beside pseudogout and cellulitis.
Nothing in that run touches skill A or skill B. The library has one dermatology case and no ophthalmology cases, two systems the old Station 5 leaned on are not covered. 73 of the 74 cases are male.
Diagnosica scores each run against a rubric on the paid tier, calibrated to the published mark sheet. If you want the wider context, see what PACES tools actually do.
Signs need a real body in a real room, and no simulator replaces a bedside teacher or a real patient. It doesn't give advice about real patients, and it's not a diagnostic system, so treat every output as educational. The library is 74 cases across 14 specialties, every case written and signed off by a doctor, with Standard at $29 a month or $249 a year, and UK cards at £22 a month or £189 a year; Start a case free.
Educational use only. Not medical advice. AI-generated; verify clinically against primary sources.
Clinical review pending.
