PACES communication encounters (Stations 1 and 4): structure and common scenarios
How the 10-minute PACES communication encounters are run and marked, a structure that works, and the scenarios that come up most: bad news, DNACPR, capacity, errors, non-adherence and more.
The short answer
- Stations 1 and 4 each open with a 10-minute communication encounter with a patient, relative or surrogate. There are no examiner questions: you are marked purely on what the two examiners observe.
- Four skills are marked: C (clinical communication), E (clinical judgement), F (managing patients’ concerns) and G (patient welfare).
- A structure that works: plan in the 5-minute interval, find out what they know and what worries them, share information in small chunks, address concerns as soon as they come up, then summarise and agree a way forward before time runs out (you get a warning at 8 minutes).
How the encounter is run
- You read the written scenario during the 5-minute interval before the station, and you can take notes on blank paper into the room.
- You then have 10 minutes with a patient, relative or surrogate (an actor). The two examiners watch but do not speak to you.
- You get a warning at 8 minutes. If you finish early, the surrogate stays in the room until the 10 minutes are up.
- The Federation describes the aims as guiding the interview, explaining clinical information, applying ethical and legal knowledge, giving emotional support, and showing dignity and respect.
Using the 5-minute interval
Read the scenario twice and jot down:
- The task: what must be achieved (explain a diagnosis, discuss resuscitation, obtain agreement, respond to a complaint).
- The key facts you must convey, in plain language.
- The likely concerns the person will raise, and how you'll respond.
- Any ethical or legal framework involved: capacity, consent, confidentiality, candour.
- Your opening line and your closing summary.
A 10-minute structure
| Time | What to do |
|---|---|
| 0–1 min | Introduce yourself and your role, check who you're speaking to and their relationship to the patient, and agree the purpose of the conversation. |
| 1–3 min | Find out what they already know and what they're worried about. If you're giving bad news, give a warning shot first. |
| 3–7 min | Share information in small chunks, without jargon, pausing to check understanding. Respond to emotion. Address concerns the moment they're raised. Discuss options and decide together. |
| 7–9 min | Agree the plan and next steps, offer support and written information, and safety-net. |
| 9–10 min | Summarise what you've agreed, check for final questions, and close. Start closing when you hear the 8-minute warning. |
Common scenarios and what they test
| Scenario | What examiners are looking for |
|---|---|
| Breaking bad news (for example a new cancer diagnosis) | A warning shot, information at the person's pace, comfortable silence, honesty about uncertainty, and clear next steps and support. |
| Explaining a new diagnosis or test result | Plain language, chunking and checking, and a plan the person understands. |
| Resuscitation (DNACPR) and treatment escalation discussions | Explaining what CPR involves and its likely outcome honestly, exploring the patient's wishes, and making clear what care will continue. |
| Capacity and refusal of treatment | Applying the capacity test correctly, respecting a capacitous refusal even if it seems unwise, and keeping the door open. |
| Medication error or adverse event | Openness and an apology (the duty of candour), a clear explanation, what is being done, and how it will be reported and learned from. |
| Confidentiality (for example a relative asking for information, or a patient who should not drive) | Protecting confidentiality, knowing when disclosure is justified, and explaining the patient's own responsibilities. |
| Angry relative or complaint | Listening without becoming defensive, acknowledging feelings, explaining honestly, and signposting the complaints process. |
| Self-discharge against medical advice | Assessing capacity, explaining risks and alternatives, safety-netting, and making it easy to come back. |
| Consent for a procedure | Purpose, benefits, material risks, alternatives (including doing nothing), and checking understanding. |
| Not taking prescribed treatment | Exploring the reasons without judgement (side effects are common and sometimes embarrassing to mention), explaining the risks of untreated disease, and agreeing a plan the patient will follow. |
| Artificial feeding in advanced dementia | Explaining a best-interests decision to a relative, what a feeding tube can and can't achieve, and the plan for comfort and careful hand feeding. |
| A relative asking about a diagnosis when the patient lacks capacity | What can and can't be shared, and supporting the relative with their own worries, such as whether they need testing themselves. |
| Possible domestic abuse | Speaking to the patient privately, asking directly but sensitively, assessing immediate safety (including any children), and offering support without forcing disclosure. |
The law and guidance to know (UK)
- Mental capacity (Mental Capacity Act 2005 in England and Wales): assume capacity; capacity is decision-specific; the person must be able to understand, retain, use and weigh the information, and communicate a decision. An unwise decision is not proof of incapacity. Decisions for people who lack capacity are made in their best interests.
- Consent: since the Montgomery ruling (2015), you must discuss the risks that matter to this particular patient, along with reasonable alternatives. The GMC's guidance on decision making and consent sets out the same principles.
- Confidentiality and driving: patients must be told if they have a condition that may affect their driving and that they have a legal duty to inform the DVLA. The GMC's guidance explains when you may disclose to the DVLA if a patient continues to drive against advice.
- Duty of candour: be open and honest with patients when something has gone wrong with their care, apologise, and explain what happens next.
Common pitfalls
- Delivering a prepared speech instead of a conversation.
- Jargon, and long monologues without checking understanding.
- Postponing the patient's concern ("we'll come to that later").
- False reassurance, or avoiding a direct question.
- Arguing with an angry relative instead of acknowledging their feelings.
- Running out of time without summarising or agreeing a plan.
Sources
Frequently asked questions
How long is the PACES communication station?
Each communication encounter lasts 10 minutes, with a warning at 8 minutes. There are two, at Stations 1 and 4, each followed by a 10-minute examination encounter.
Do examiners ask questions in the PACES communication station?
No. There is no examiner–candidate interaction in the communication encounters. You are marked on the examiners’ observation of your conversation alone.
What skills are marked in the PACES communication station?
Skills C (clinical communication), E (clinical judgement), F (managing patients’ concerns) and G (maintaining patient welfare).
What scenarios come up in PACES communication?
Common scenarios include breaking bad news, explaining a diagnosis, resuscitation and treatment escalation discussions, capacity and refusal of treatment, medication errors, confidentiality (including fitness to drive), complaints, non-adherence to treatment, artificial feeding decisions, possible domestic abuse, self-discharge and consent.
What if I finish the communication station early?
The surrogate stays in the room until the 10 minutes are up. Use any spare time to check understanding, invite further questions and summarise again; don’t introduce new topics.
Written by The Ace PACES team. Exam facts are taken from the Federation of the Royal Colleges of Physicians’ published PACES guidance, linked in the sources above. This guide supports exam preparation and is not a clinical guideline.
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