PLAB 2 Guide

By DR. Irfan

INTRODUCTION

If you are reading this, then with the fair assumption of you having cleared PLAB 1, I first of all congratulate and welcome you to the second half of your UK journey – the PLAB 2. This exam is probably the exact opposite of PLAB 1. That’s right! No pen, paper or even a book for this one. It relies wholly and solely on your clinical skills and approach. So hang tight and start getting enlightened.

PREREQUISITES

There are certain things that need to be taken care of before you get on board with this exam.

1. Make sure you visit the GMC website and go through what you need for your PLAB 2 exam and very importantly, your GMC registration. Those who have done their house jobs / internships, please visit: http://www.gmc-uk.org/doctors/registration_applications/routeG.asp and http://www.gmc-uk.org/doctors/registration_applications/img_plab_p1.asp . There are 9 pages in the second link. Please go through them thoroughly as they contain information about what internship rotations you need for GMC registration along with other needs and exemptions. Those who have not done their house jobs / internships, please visit:  http://www.gmc-uk.org/doctors/registration_applications/img_pr_p1.asp
2. Work on your CV and tidy it up before coming to the UK. Visit http://www.get-uk-jobs.com/sample-medical-cv.html for a sample medical CV.
3. Try to attend the ATLS workshop before coming. It really adds to your CV remarkably.
4. If possible, try to have a paper publication in your name. The UK system has also started to have a liking for research publications.
5. Your visit will probably be for around 5-6 months. So if you are interested in doing attachments, apply for them while you are still in your home country. Some institutions ask for a fee and some may let you do it for free. You may also ask for an attachment through consultants by searching for their email contacts on google and sending them your CV along with a request. The HR department would probably run a criminal check (CRB) before they allow you to join in and may ask for a police certificate from your hometown. The whole process may take up to 1-2 months to finalize properly, and that’s why I recommend you to apply for it while you’re still in your home country to save time rather than applying later on after your PLAB 2 exam.

IF YOU HAVE TIME:

1. Search for past PLAB 2 questions and topics available on forums and start reading about them through information pamphlets on www.patient.co.uk
2. Also visit http://www.gmc-uk.org/guidance/case_studies.asp to understand good medical practice in the UK.
3. If you want to read a book, the one I would recommend is “London PLAB”, but that is only if you want to.

THE EXAM – PLAB 2

This exam comprises of 16 stations along with 1 rest station. In each station, you will need to perform a specific task in 5 minutes. You will have a 1 minute interval between every station to read the task, enter the station and perform the task in 5 minutes, and the cycle continues until you have completed all your stations. One thing is for sure: This will be the fastest 100 minutes of your life.

There are basically 5 types of tasks that you are asked to perform in this exam. They are:

• History taking: You will be given a scenario stating a certain complaint, and you will need to take a history. You may also be asked to come up with a diagnosis or differential diagnosis and discuss it with the examiner at the end.
• Counselling: You will be asked to talk to a patient who may have some concerns or problems that he wants to discuss OR you may need to explain and take consent for a procedure OR you may need to break bad news.
• Examination: You will be asked to perform a clinical examination which may be from medicine, surgery, orthopedics, psychiatry, ophthalmology, ENT or gynecology and obstetrics.
• Skill: You will be asked to perform a clinical procedure on a mannequin
• Miscellaneous: You may be asked to perform dose calculation / give a viva to an examiner on a certain medical emergency. These types of stations do not come very often.

There is always a good mix of all stations and there is no set pattern or number, which means that you need to be ready for all of them! Result comes in 2 weeks time.

THE PREPARATION

As I mentioned before, you don’t need a lot of books to study for this exam. Your knowledge has already been tested and now is the time to show how you interact with the patient. So just as soon as you have booked your place for the exam, start working on your approach to the patient. Be kind, gentle and courteous to your patients wherever you are working. Try to use phrases like “thank you”, “please”, “sorry” when you interact with your patients (sounds difficult!!!).

Lower your voice but keep your tone confident. Inquire and try to address your patient’s queries and be comfortable saying “I don’t know” if you don’t know the answer. Try explaining your prescribed treatments to your patients; it will help you develop patience towards their questions. These practices may not seem of much value right now, but trust me you will thank me after the exam.

You basically need a month’s time to get set for this exam. So, how to start up for the real deal? You will need to attend a training course conducted here in the UK as it will give you a good orientation of how to plan, manage, train and prepare for this exam. The good courses are “PLAB Right” in Liverpool and “Swamy” in London.

I prefer PLAB Right because it has a good teaching faculty which involves consultants rather than PLAB students. Its accommodation is very good and their administration is very helpful. Since I didn’t attend Swamy course, therefore I can’t say how good it is. So visit their websites, do your homework on this and decide on one keeping in mind your financials, accommodation facilities etc.

It’s usually a 10 day course with a mock at the end. It’s preferable if you take a course that gives you a month for preparation for your exam. There is usually a mock at the end of the course. DON’T TAKE IT THEN!! First prepare and practice and when you are 10 days or so away from your exam, then appear for the mock.

It’s simply a self-assessment tool for you to know whether you’ve prepared correctly or not and also how the exam is going to be like, therefore one mock exam is sufficient. Also remember, take the mock from where you did your course. There’s no point if you go to PLAB Right for your course and appear in Swamy’s mock, simply because you will FAIL!!!

If there is one tip I want you to take from me it’s this…. PRACTICE!! You can forget this whole note I have written, take nothing from it but just remember the word “PRACTICE”. It is the key to passing this exam. Find yourself a partner and start talking and acting.

Ideally, a group of three works great; 1 actor, 1 performer and 1 examiner. But even if you are just 2, its equally good. If you think about it, the exam is virtually known.

You can download the list of stations from www.aippg.com or www.rxpgonline.com which will be around 250-300 stations. The GMC just puts in twists and turns in these stations every now and then. So why is it that people still fail? It’s probably because THEY DON’T PRACTICE ENOUGH or are just too STEREOTYPED.

One more thing: people who may have given Step 2 C/S might think this exam is easy. It’s very different from what you might have practiced and you seriously would need to tune up before you sit for this exam.

So let’s briefly go through the preparation of the different stations one by one:

In general: Your approach, your communication, your mannerism holds true for all stations – PROFESSIONAL AND NATURAL. Try to practice one or two liner introductions. Do it in front of a mirror, but keep repeating it so that it becomes spontaneous for you. Try to use “Hello” rather than “Good morning / evening”. You may be asked to tell someone he has terminal cancer and if you start your station saying “Good morning”, it won’t leave a very nice impression. Similarly practice nice conclusions of your meetings.

Try to keep your eyes and ears open. Be receptive and act natural. If you see that someone is in pain, at least be bothered enough to inquire how bad the pain is, and if he requires pain meds before he can talk to you. Similarly, if someone mentions a loss of a loved one or a tragic incident, be polite and give a simple acknowledgment by saying “im sorry to hear that”. Maintain good eye contact throughout the station.

Try to stay balanced; not so much caring and humane that you forget to perform the task, and not so ignorant that you simply don’t care for the patient at all. Try to start ending your stations smoothly at the 4 minute 30 second mark.

History Taking: Nothing new, you have done it hundreds of times before and the same practice applies. There are two things you need to work on; differential diagnosis and a patterned detailed history format. As soon as you read your tasks, start thinking about differentials.

For e.g. your task could be to take a history of a 25 year old female who has come with tummy ache. Gather all the differentials in your head for tummy ache in young females. Start your history with an open question: “Can you tell me more about your problem?”

Although differentials are very important, but sticking to a pattern is equally important. You can’t start asking about vomiting or burning urine without inquiring about PAIN itself. Remember: YOU NEED TO PROBE INTO THE PRIMARY COMPLAINT THOROUGHLY BEFORE YOU CAN JUMP TO OTHER LINKED QUESTIONS TO RULE OUT YOUR DIFFERENTIALS.

If you get a positive response to an answer, probe into it. For e.g. you ask about travel history and the patient replies yes, then you need to ask where he went, for how long, did he seek GP advice, did he take any vaccinations or medications. Don’t be hasty with asking questions and remember to stick to your practiced pattern. If you find yourself lost, then briefly recheck a summary of what you have gathered so far with the patient, so as to buy time to think over your next questions. BUT don’t do this too often.

Counseling: This task is actually meant to see your communication skills. People who have good English language skills often do well in these stations. You need some background knowledge on certain topics so that you can speak on them. You will be provided that material in the course you take. BUT the catch is that you don’t have to say it all. The simulator patient in front of you will be given a set of questions to ask you.

Many candidates start and finish the task with the objective of saying as much as they can, in the process not giving the opportunity to the patient to speak. So whatever knowledge base you have, try to break it up into 1 minute talks. Tailor your talks according to your patient’s needs, e.g an obese non-smoker who has suffered from MI would benefit from talk on exercise as a lifestyle modification rather than non-smoking. After small bits of information ask the patient if he was able to follow you, and if he wants to ask you something.

If the patient asks you something you don’t know, then simply say that you don’t know and you would ask you’re senior about it. Delivery of wrong information can get you failed here easily. Also remember not to prescribe or change any medication on your own, unless instructed in the task. If you feel that you need some information before you can start counseling, you can ask a couple of questions to clear your path. Keep in mind that it’s not a history taking station and the questions should be very precise and minimal.

Another important thing: be wary of different departments and specialties and know when to involve them. This is called team work, something GMC is eagerly looking for. For e.g. A Stroke patient needs follow up from a Neurologist, the Stroke Rehabilitation Unit, a Physiotherapist, a Swallowing Assessment Team (SAL) and maybe later on an Occupational Therapist. Some people may need adjustments in diet and would therefore need to see …………….  A DIETICIAN! It’s not that difficult, just needs your presence of mind.

Examination: Practice, practice, practice. Try to learn good, systematic examinations and how to ask your patient to perform different maneuvers for you. For e.g. if you want to check gait, you can either say “walk for me”, or “please walk for me” or “can you manage to walk for me?” The third one is the best because it is giving your patient an option to choose rather than an order to follow.

Before starting, ensure patient’s comfort and request for appropriate exposure. Avoid touching or handling the patient too much unless you are performing palpation. Be gentle, and let your patient know if you are going behind him / touching him at any point during the examination. Keep your eyes open, as patients may have findings in them. Try to do a running commentary of what you see and what you don’t. If you leave it for the end, it will be difficult to sum up your findings properly.

REMEMBER: the objective of this station is not how quickly you finish the exam, but how gentle you are with the patient, how important it is for you to look and focus on findings and how systematic and good you look while performing it. Don’t worry if you cannot finish the examination on time; just look professional and smart while you’re doing it.

1. Skill: These are simple procedures that you need to perform and can easily do after good practice on mannequins. It has some stereotyped precautions that you will be taught in the course e.g. sharps in the sharps bin, and sterile techniques etc.
2. Miscellaneous: If you get time, just go through the emergency pages on OHCM and some routine X-rays and ECG’s.

When you are done with your course and practicing on your own, try to make a schedule of when to cover what. Be honest to identify where you are good and where you need to work hard. Try to allocate time for history taking, counseling and examinations daily. How much time you need to give each – you decide, but do all three daily. Mannequins can be practiced once every alternate day or in 3 days.

EXAM DAY: A good night’s sleep and punctual arrival at GMC goes without saying. Don’t reach GMC at 8 o’clock if you have been asked to come at 10. You will tire for no reason. Dress smartly and feel positive. Once there, avoid talking too much to people around you, and if possible, avoid reading notes as well. Just stay focused and go through your stations in your head.

You can’t smoke once inside the building, so smokers need to be wary of that. Also avoid drinking coffee 30 minutes before the exam; it causes tremors. Once the exam starts, read the question properly and completely. Be ready for surprises and some twists.

Try to identify what you need to do and think how you will do it. Do they want you to talk to the examiner at the end or not? As soon as you open the station door, you will see two of the most pleasant faces on the planet: the examiner and the actor. They are very nice individuals, so don’t be afraid of them. Give a simple greeting to your examiner and let him check you’re ID. DON’T RUSH TO THE TASK. Take 10-15 seconds for yourself. Have a look inside the station, see where the question is and read it if you want to.

Look for any equipment or charts that they might have kept for you to use. Turn towards your patient and start off with your introduction. By using these 10-15 seconds for yourself, your nerves would have come in control by now and leave the rest to your reflexes. At the 4 minute 30 second mark, try to smoothly windup your station and thank your patient. Once you step outside the station, NO MATTER WHAT HAPPENS, don’t think about it. Go towards the next station and continue you’re routine. In your rest station, try and think about stations that you did well, so as to boost yourself and carry on with your momentum. Once you have finished, take a good sigh of relief and don’t forget to ENJOY UK!!

The above guide is not an exhaustive list of how to prepare. There are many more things you will need to polish up, but it’s just my way to show you how to start. Well that’s all I can think of at the moment. Feel free to share your experiences and fill in information about the exam if I have missed anything. And for those who are appearing – GOOD LUCK AND GODSPEED!!!!!!