Do you wanna build a Post-grad? Lessons from Building a PACES Course from Scratch

A while back, I found myself muttering the fateful words: “How hard can it be to run a local PACES course?”

Turns out — hard. But also oddly brilliant.

If you’ve ever considered designing a postgraduate course — or been dragged into it by your more enthusiastic colleagues — here’s a rough guide to what I learned.

PACES was our setting, but the principles run broader: design for humans, deliver with humility, and build something that outlives the course date.

Start with What’s Broken

The MRCP(UK) PACES exam is infamous: high cost, high stakes, low study leave. Courses can cost over £1,400, with travel and time off compounding the stress.

We asked: what if we built something local, practical, and not-for-profit?

Our goals were simple:

• Reduce the “fear factor”

• Offer real feedback, not platitudes

• Make the course feel worthwhile, even if you didn’t pass (yet)

Define What You’re Actually Teaching

It’s tempting to say “We’re running a revision course.” But what are you really doing?

For us, the content sat somewhere between revision and postgraduate diploma. The outcomes we aimed for:

• Specialist-level clinical and communication skills

• Safe, structured differential diagnosis

• Metacognition (whatever the fuck that means) and peer reflection

• A bit of emotional resilience, disguised as OSCE prep

We scaffolded around SCQF Level 11 learning, which aligns with postgraduate diploma-level complexity — even if no one said it out loud.

Use Learning Theory (But Don’t Drown in It)

We used Gagné’s Nine Events of Instruction as a flexible template. Why? It made sense. It gave flow to the weekend. And it meant our “teaching” had intent, not just instinct.

Examples:

• Pre-course material to stimulate recall

• Mock stations for eliciting performance

• Structured feedback for learner insight

• Post-course WhatsApp groups to reinforce learning

The best part? It helped our volunteer faculty stay consistent — and made it easier to brief them fast.

Plan for the Learner Spectrum

PACES candidates span wide: brand-new IMTs, ST3s staring down the retake abyss, and everyone in between.

That’s not just a logistics issue. It’s a psychological one.

We designed for adaptability:

• Novices revised theory and structure

• Veterans stress-tested performance and timing

• Peer feedback ran both ways, normalising vulnerability across experience levels

Engagement Needs More Than Coffee and Quizzes

We thought hard about engagement. Not just “did they turn up,” but how they turned up:

• Behavioural (they show up and participate)

• Emotional (they feel safe enough to ask dumb questions)

• Cognitive (they actually learn something)

Our tweaks:

• Low-stakes mocks, no scores

• Near-peer tutors who remembered the exam trauma

• Real patients, not scripts

All of it pointed towards building a psychologically safe space — one where failing was part of the learning loop, not the end of it.

Create a Feedback Culture, Not Just a Feedback Form

Every station gave structured peer and tutor feedback. More importantly, we trained learners in how to give — and receive — it.

Because PACES doesn’t give feedback. So we made sure our course did.

We also ran an open debrief at the end of each day.

Not everyone spoke — but many did. And their input made the next course better.

Simulate the Exam — Not the Trauma

Simulation has limits. Real kit, real patients, timed stations — yes. But also real support.

We told learners from the start: “This isn’t about passing. This is about calibration.”  That simple reframe changed the tone.

It made failure safe. It made reflection easier. And for some, it made the difference between fear and flow.

Acknowledge Inequity — Then Do Something

We can’t pretend PACES is a level playing field.

International Medical Graduates (IMGs) have lower pass rates — sometimes five times lower. That’s not just individual variability — it’s structural.

So we talked about it. Directly.

We included:

• Coaching on examiner psychology (“hawk vs dove”)

• Space to discuss unconscious bias

• Practical strategies for adapting without masking

We didn’t fix the system. But we made space to name it.

The Real Course Happens After the Course

We shared everything: mark sheets, structure guides, checklists. We encouraged learners to form peer groups. Past participants came back as mentors.

This wasn’t just about one course. It was about building a sustainable, low-cost model that local learners could own and grow.

And if people shared those resources on an ever expanding Google drive? No fire or fury. No litigation. Free advertising for the actual thing.

Things That Nearly Broke Us

• Getting enough clinicians to give up a weekend

• Sourcing real patients with consistent signs

• Learners not reading the pre-course packs

• Competing for venues with QI workshops and yoga retreats

Have backups. Have snacks. And assume that the projector will break at least once.

Final Word

Running this course was exhausting, slightly chaotic, and hands down one of the most fulfilling teaching experiences I’ve had.

We didn’t just help (some) people potentially pass PACES. We helped them see themselves differently — as learners, as clinicians, and as people still capable of growth under pressure.

If you’re building your own course? Keep it simple:

• Design for the learner you actually have

• Teach what the exam won’t

• Build a culture that outlasts the timetable

Because the goal isn’t just passing. It’s staying in the profession — skilled, supported, and still human.

Stay PACEd

— DW