Ghafur Saira - The MRCP PACES Handbook

The MRCP PACES Handbook

Second Edition

The MRCP PACES Handbook

Second Edition

Saira Ghafur

CCT in Respiratory and General Internal Medicine and Harkness
Fellow in Health Care Policy and Practice

New York City, New York, USA

Parminder K Judge

ST6 in Nephrology

Oxford, England, UK

Richard Kitchen

Consultant in Palliative Medicine
Glasgow, Scotland, UK

and

Samuel Blows

Consultant Geriatrician and Acute Physician
Ipswich, England, UK

Foreword by

Dr Fiona Moss

Dean of the Royal Society of Medicine
London, England, UK

CRC Press

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Contents

Foreword

Postgraduate medical exams are significant both as career-defining milestones for the candidate and as one of the ways of ensuring that doctors who progress have all that it takes to provide excellent patient care. Exams focus the minds of candidates for whom exam content and exam approach define what examiners consider important and so perhaps mould approaches to practise. The Practical Assessment of Clinical Examination Skills (PACES), the final part of the Membership of the Royal Colleges of Physicians (MRCP) examination, is a pivotal step for all aspiring physicians, and this book will be an enormous support for them. But, the MRCP PACES Handbook is so much more than a book for passing exams. A comprehensive book, it succinctly covers much of the necessary content, and for that it will be useful to candidates. Responses and analyses to the questions posed are logical and practical and cleverly proceed from the likely and frequent to the rarefied. It is also very well organised, demonstrating not just how to pass an exam, but also the importance of an ordered approach to clinical reasoning. Lists of key points at the ends of chapters keep the reader on track, and the well-chosen lists of references really do encourage further reading. The real strength of this handbook is that it gets to the heart of the purpose of the PACES examination.

The PACES exam reflects the work done through MRCP UK to develop assessments of all the skills necessary for excellent clinical practice. Of course, this includes physical examination, recognition of clinical signs and differential diagnosis, the stuff of medical examinations for many years. Now, assessments have become more patient centred and more holistic and are designed to demonstrate explicitly the expectation of modern physicians and good medical practice. Clinical judgement, communication, managing patient concerns and maintaining patient welfare are four of the seven skills assessed through the PACES exam, and these skills are very well covered in this handbook.

Not only are technical points covered, but by including, for example, outlines of themes explored, suggestions for candidates and expectations for both candidates and patients, this handbook provides a succinct but in-depth outline of some of the difficult but crucial aspects of medical practice.

The simplicity of approach and the clear language throughout make it clear that this is not a book for the superficial learner wanting a quick fix for an impending exam, but one that encourages understanding and a mature approach to developing all the skills necessary for becoming a good physician.

PACES, the final part of the MRCP exam, is what is says: practical. And reflecting the essence of the PACES exam, this handbook is a supremely practical vade mecum . It is a handbook that not only will be essential for those approaching their PACES exam or those considering becoming a physician, but also will be a useful and continuing guide to practise after PACES for those entering higher training after PACES, and it will be useful for anyone who teaches postgraduate or undergraduate medicine.

This is a book that will be bought and used to help aspiring physicians through their PACES, will encourage development of a patient-centred approach to care and then, for many years after, will stay in easy reach.

Dr Fiona Moss, CBE, MD, FRC
Dean of the Royal Society of Medicine

Preface

Observe, record, tabulate, and communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become an expert.

Sir William Osler, FRS, FRCP

The Practical Assessment of Clinical Examination Skills (PACES) should be seen as the defining moment of your medical training when you have been accepted into the fold the final hurdle you need to jump over before gaining the elusive title of Medical Registrar . The wise words from Sir William Osler sum up the skills needed to achieve this goal.

This book is designed to be a comprehensive revision aid that will be invaluable to candidates studying for their PACES examination. The book is designed to be used at the patient s bedside to guide clinical examination, as well as having enough detail to cover pertinent points in the case in question.

Each of the chapters contains hints and tips on how to tackle each of the examinations and a summary at the end to consolidate key learning points. The cases represent a collection of those which are most frequently encountered in the PACES examination and are set out in a standardised format. Each chapter has been reviewed by senior clinicians within the specialty. The information within the handbook has been updated and is supported by evidence-based literature and supporting guidelines.

Passing PACES requires not only an in-depth knowledge of the subject of the case but also the fine art of being able to present in a concise and coherent manner. Each case contains a section on presentation which will aid the candidate in perfecting this skill.