Some guidance that I can give to help people appearing for Plab 2 (sorry for the long post but it has some helpful points at the end) - Everyone experiences Plab 2 differently. With the right approach, it’s do-able. Whether that right approach is directed by an academy or someone willing to help you who is already working in the NHS, doesn’t matter as long as you get there in the end. Don’t get discouraged by what people are doing or who they are following. There’s no fixed formula to pass any exam. Different things work for different people. Don’t spend time worrying about new stations coming in the exam or how to acquire the scripts of various academies. Once you have a basic script of any academy, work on that, build on that. Join Facebook and WhatsApp groups. Keep yourself well connected to people from different academies, practice with them. Time yourself. Focus on holding a normal conversation. It’s slightly like IELTs. However you do have to manage the patient’s issues as well. The simulators are very helpful. They always point you in the right direction during the exam in subtle ways. Here are a few pointers that might help:
- Before entering the room, when you are forming your thoughts, make a list of differential diagnosis in your mind. Also, the red flags. ( I struggled with what to think about before going in) in case of ethical scenarios, think of the one liners you may have Practiced and the main points you have to cover, e.g what to ask in data gathering, how to empathetically address all those issues in your management part. Keeping the 1st part of your consultation short and precise helps you throughout the station. In most cases you will already know the diagnosis so this is essentially just a formality. However, don’t skip it and jump to the diagnosis as that may seem formulaic
- Always acknowledge the patient’s / relative’s / student/ nurse/ whoever-you-face’s emotions in each station. They will give you verbal and non-verbal cues. Respond accordingly. You can be given the opportunity to do this at the very beginning of the station as well. There’s no hard n fast rule about when you do it but you must! And the number of times you do it is also variable. You may have to acknowledge in different words each time in ethical scenarios. Always follow that up with what you can do for the patient. How to move forward from there. So that you control the direction of the conversation. E.g Mr. X I can see how emabrassed you are OR I can sense embarrassment OR obviously this must be a difficult situation for you to face your colleagues, however we have many treatment options that can help control your symptoms. (If you are in the middle of the consultantion keep going and say) … But before I discuss those options with you I need to ask you a few more questions to help me understand things better ( this way you have acknowledged without ruining your structure and kept the conversation going ) I was inspired by beej shah and Dr. Aman arora to come up with these one liners.
- Don’t spend more time on data gathering. Mostly you will not score more than a 3 in this section even if you ask all the questions. Ask short, precise questions to rule out the list of DDs you may have formed in your mind before entering the room. Rule out red flags. As long as you have ruled out the emergencies, you are fine. Ask ‘relevant questions’ in lifestyle (smoking and alcohol are not always linked to every case) and personal history section. Don’t signpost by saying I will now ask you questions about your lifestyle. You can say …’ personal questions’ before taking sexual history. But for lifestyle say something like “Mrs. X sometimes when people have these type of symptoms, they tend to get worse by or are triggered by smoking/ drinking alcohol. Is that something that you do?” “What do you do for a living? Do you get time to exercise?” Try your best not to sound judgmental! One wrong word or expression and you’ll throw your whole rapport out the door. “people who get tattoos and piercings are more prone to catching infections like hepatitis, do you have any of those?” For psychiatric stations: “sometimes when people feel low they tend to start smoking/drinking alcohol/using recreational drugs to cope with it, is that something thats happening with you?” “Generally the low mood can lead people to start having dark thoughts, that life is not worth living, is that something that crossed your mind?” “It’s a very tough situation that you are in and even more difficult if dealt with alone, do you live alone? Have you talked about it with someone?” Etc etc
- Be a good listener. Never interrupt the patient while they are speaking. They will never try to waste your time with mindless gibberish. Everything they say is relevant. Make a mental note of all the things you will have to address in management. For example, patient might tell you that his hip fracture has limited his mobility. Ask about living situation, friends and family who can help him. You can then address it by saying how difficult it must’ve been for him and that you can ask someone in occupation therapy to have a look in your house to make arrangements etc. There are volunteers who help in care centers with the groceries as well.
- Leaflets. It’s not possible to address all the medical and non-medical issues in each station in management. Never rush the patients. Give some info then offer leaflets so that even if you miss anything leaflet will cover it. Refer to specialized nurses or clinics for the same reason: Asthma nurse, diabetes clinic, Tia clinic etc etc. Don’t panic if you run out of time as long as you have addressed the main concerns and emergencies.
- Always try to keep more time for management. Again, don’t panic if it doesn’t happen. Practice “shared management” with the patient. Mr. X how about I prescribe these antibiotics to you and then see how you respond to the treatment. Why don’t you see me in a week’s time?! Mr. X I would suggest you see a specialist as you “may” need to be investigated further, how does that sound OR does that sound like a good plan?! Always always keep things vague. Use words like MAY. Never say CAN or WILL or SHOULD while referring. Don’t promise anything. You don’t know if the specialist will definitely do a CT scan for example. It depends on that specialist’s own opinion. Always say MAY do a CT scan. Further clarify if the patient nags with I’m not promising anything Mr. X because it depends on your consultation with that doctor, however I’ve mentioned some possibilities just to make things more clear for you.
- Symptom diary. For symptoms of asthma, IBS, autism,etc (any chronic illness with a chance of change in symptoms over time) ask the patient/ mother to keep a symptom diary.
- Read up on medicine and emergencies from NHS , patient.info, oxford handbook. Or a combination. Anything that works for you. Make notes.
- Look up ethical scenarios on GMC website. Also, read the good medical practice PDF they email when you book the exam. It explains in very simple words what they want from us, which is what some academies focus on. Practice those points. Don’t rote learn a specific pattern. Be flexible, listen and respond to the simulators according to each scenario and situation. Jot down your own one liners, in your own words. That comes with practice.
- Practice, practice, practice! Find online partners. Whoever you feel comfortable with. Two to three or more if you want. Preferably people from different academies so that you can compare notes and gain experience from one another. Keep an open mind and help each other as much as you can guys.
- New stations essentially have the same pattern that the old ones do. It does give you a peace of mind if you get hold of the new stations and the best way to stay updated is to join WhatsApp groups. Don’t panic if you get new stations in the exam. You probably have background knowledge on it. Just talk to the patient. Try to avoid the things you are unfamiliar with and say you will look up n get back to them or get seniors involved and offer leaflets. Don’t tell the patient to research it on the internet themselves, however if they already have then acknowledge that it’s good how they made an effort to keep themselves updated on their condition.
- Be confident. You are all doctors, who have studied, worked hard and have some clinical experience as well. This is what they will tell you at the beginning of the exam as well. And it’s true what they say. Goodluck everyone! Don’t be too hard on yourself if you don’t clear in your 1st attempt. You can do it!