The management trap
In the PLAB2 exam, or any clinical assessment we more often than not find ourselves in a precarious situation, thanks to our own working. That is, rushing to management, and then unloading all the knowledge of the condition on the patient
And feel we did a good job
Sadly, that is the worst way we can approach the management of a clinical station. It’s a lot more than just naming a disease and enumerating the treatment methods, or the drugs and the doses to an already overwhelmed patient. I call it “going on autopilot”. For some unfortunate examinees, they realize this on the day of the results; and that, truly, is a horrible horrible feeling.
So here I am again, with a few points on the management of a history station. Again, needless to say, but no, I will not be discussing any exam content.
1.Make the management tailored to that patient, specifically. Use what you learnt about the patient in the history/data gathering portion of the station. This is an amazing boost for your management and your interpersonal skills. It shows you have been listening to the answers of the role-player and also remembered to come back to their complaints with solutions. Don’t give a generic management to the patient. And if you must, mention how each aspect of the management addresses an issue they have raised or is present. Generic management just shows you memorized a page from the oxford handbook and now unloading on autopilot,
2.Resist the urge to divulge everything about the condition. You just won’t have the time. This would be the next issue. If we look at the PLAB2 assessment as only an exam, we misguide ourselves that our job is to show we know everything about the condition. But your patient doesn’t understand that, neither do they care. And the examiner doesn’t want to see that. They want to see how you treat the patient and not the condition, That means that you tell what is relevant. Not too much. Else again, the need to get all that knowledge out there means you’d be on autopilot in management. And that is not good.
3.Listen Listen Listen!! I cannot emphasize this too much! Most of the important concerns of the patient emerge during management. Because they want to see you manage the concerns! Don’t just do a two way conversation for the sake of having a two way conversation! You should actually listen! They have separate marking criteria for listening to the patient! You cannot succeed in deploying good management without having that information.
4.Watch watch watch! A major portion of the cues given by the roleplayer will not even be verbal. They will be changes in tone, expression or posture. We always understand those, however, we fail to address them. It’s a habit of many of us to ignore them. Do not fall do that mistake! Keep those wonderful eye open!
5.Verbalize findings/verbal and non verbal cues; as the previous two points that I just mentioned, it is not sufficient to just know that there are these cues. You must show to the role-player and the examiner that you can identify them and address them. The first step to that is to verbalize them in some way or another. Make sure you do that!
6.Break the management into segments; It’s not about mentioning all the drugs. You won’t even remember all of them! But protect your management skills by breaking the management into segments. Make a framework around it. Then fill it up with particulars of that patient and the condition. Feel free to make your own framework. Here is an example of one
Diagnosis & Pathophysiology
Findings that led to this diagnosis
Medical treatment for the patient
Any issues with the treatment
Involving senior if necessary
Follow up and safety netting
Close the station.
Please bear in mind this is a broad overlay. It will not work with all stations nor all conditions. What it does show is if you just remember this framework, then even if you forget everything from medical management, you have enough material to talk about to make your patient feel cared for. And the structure helps you remember all the points that you must touch. There are better structures. Try to build your own one.
7.Chuck and check. This is a beautiful technique that my colleagues taught me. After every segment, just check in with your patient if they are clearly understanding you, or if they need anything to be repeated or clarified. Stay in touch with you patient. It prevents you flying off on autopilot, scores you well on interpersonal, and most importantly, allows the patient to voice concerns.
8.Never forget Follow up and safety netting. Just don’t. Ever.
9.Do not rush, do not use medical jargon. Complex terms and rushed consultation feels impersonal and very uncaring. Would you ever take your non-medical friend to a doctor like that? Nope. So keep it simple. Easy terms. And take your time.
10.Wrap it up, in time, with a smile (if appropriate). Express a sense of warmth and compassion through your consultation. Cut it short to the main points if you feel like you’re going to run out of time. Mention the key points and wrap up. Close with a warm note, the way you would say goodbye to a friend.
Notice how I don’t mention diagnosis as one of the key points, because even though it is extremely important to reach a proper working diagnosis and base treatment on it, it is in some cases still possible to pass without reaching one. In many stations, it is good enough to actually reach a set of differential diagnoses and discuss from there. Don’t get me wrong; I am not saying it is not important, but that we should give the aforementioned factors much more importance than we are giving them now.
To improve your management skills and marks, you really need to practise as much as you can. Make your own notes from these points and then begin practising with different people. If anyone wants to practise with me, please feel free to message me for sorting out a time to try a few sessions. And no, I am not charging for these lol. As I keep saying, this is me giving back to the people who helped me!
Just keep your head clear on exam day! As they say; Imagine it’s a busy day at the clinic!
YOU WILL MAKE IT.