For a few reasons, I think my PLAB2 journey was kind of unique. To start with it took me two visits to the UK, two visas, and three attempts. I also attended two academies.
The first time I took the exam was in September 2018. Before that, I attended Swamy, which was about 4 weeks before the exam date, and reluctantly practiced the stations. At that time there were about 150/180 stations and the infamous new PLAB2 assessment method was being slowly introduced. I failed to pass the exam and my mind was a bit unsettled. The next thing I did was promptly booked another date within a month without a second thought, which was indeed a wrong decision, and that attempt also yielded the same result with almost similar scores. After that, I was unnerved and was thinking about whether to give up on PLAB or not. It will be a bit difficult but I will try to sum up the reasons which contributed to my failure.
Reasons for Failure
🍁 My reluctance towards the exam would be the first thing. I had a preset idea about exams in general that if I do what most people around me are doing, I will be fine. But this particular exam is a very subjective one and the method they use to determine who passes who fails warrants one to excel above other candidates appearing on the same date rather than performing about the same.
🍁 I did not have a very clear idea about the exam. By this, I am not saying that I didn’t know how many stations would there be and how they determine the pass mark. I think, in this OSCE exam they expect the candidates to demonstrate certain attributes, and they also have certain things which they consider as a critical error. For all these, maybe, they have a kind of a tick-box chart, based on which they mark a candidate. It is not merely about taking a clinical history, vocalizing certain phrases, and uttering the treatment. Perhaps, later I will try listing the things I think they expect from a candidate and what are the possible critical errors.
🍁 Practicing inefficiently was another thing. I was practicing in the same manner without any attempts to bring in improvements. I feel that one needs to come out of their comfort-zone during practicing so that they can perform under exam conditions.
🍁 Sticking to the scripts given by the academy. The last thing one would want to do is appear scripted in the exam. The simulators turn very frigid and hostile if they feel that the candidate is vocalizing from scripts. I saw it right in their eyes.
🍁 I failed to demonstrate confidence and was not calm. This was due to my lack of idea of their expectation, fear about the exam, and lastly insufficient knowledge.
After that, I had another go at it in June 2019. This time I made sure that I have a fairly clear idea about the exam and tried to bring in necessary changes in my approach. I did attend Samson this time, which was recommended by a few of my course mates from Swamy, which I have found helpful in several ways. This time I had about 3 weeks after my course and the number of total stations has risen to about 250/260. As I have mentioned before, this is a very subjective exam and the result depends on the candidate’s performance on that very day. Although this time around, my exam didn’t go as I would hope it did but I managed to pass. I will try to list the things I feel have helped me pass this time.
Reasons for Success
🎯 A very clear idea about the exam and the expectations of GMC.
🎯 A general change in my approach during my regular patient consultation.
🎯 My understanding that I need to perform better than my peers while practicing.
🎯 Not following any particular scripts, and practicing using my own words and language.
🎯 Finally, a boosted confidence level which was largely developed during the mocks at Samson.
After saying all these I would like to mention that even on my last attempt I was not that much serious and had a bit of a laid-back approach towards this exam. But my improved interpersonal skills saved me big time. Regarding the academies I’ve attended, each of them has its own pros and cons, discussing which is beyond the scope of this post. Listening to Aman Arora audiobook on PLAB2 communications helped me greatly to understand this exam. Even though I have had a hard time with this exam but I would like to mention that this is a fairly easy exam to pass. With the right understanding of the expectations of GMC and how the NHS works, if a candidate can perform in most stations in the warranted approach, I think, this extensively subjective exam will not be that difficult to pass.
Things that are expected by the GMC from a PLAB2 candidate in my opinion are-
📚 Purpose of the consultation:
- Confidence throughout the consultation.
- Appropriate greetings in the beginning.
- Starting the consultation with an open-ended question and following it up with close-ended questions during history taking.
- The doctor can pick up cues (verbal and non-verbal) and follows it up with a response.
- Active listening.
- Have a very good structure for the consultation.
- The doctor encourages the patient to open up, talk more about his idea of the condition.
- The doctor acknowledges the patient’s worries, emotions, and shows appropriate emotion (sympathy/empathy).
- Asks about psycho-social situation in-depth.
10) Asks about the patient’s Expectations/Concerns and acknowledges them as valid.
📚 Defining the Clinical Condition:
- Can explore the clinical situation (Presenting complaint, Life-style, etc.) to identify the provisional and differential diagnosis.
- Asks red flag questions and calls for interventions if acute help is warranted.
- Asks relevant questions and perform/ mentions relevant physical/ mental examinations, investigations.
- Can formulate a workable diagnosis.
📚 Overall Management:
- Explains the diagnosis and give the reasoning for the presenting complaints to the patient in plain language.
- Checks Patients understanding
- Addresses the presenting complaint and also performs other medical management (hospital admission/ referral/ prescription/ medication/ supportive helps/ investigations etc).
- Involves the patient in the planning of the management and seeks the patient’s permission/opinion on the management.
- Safety nets
- Gives a Follow-up date in an appropriate interval.
📚 Possible Critical Errors:
- Offending the Simulator.
- Doing something or mentioning something that might cause physical/ mental harm to the patient.
- Coming up as an unsafe doctor. It could be forgetting to ask red-flag questions where it was necessary, Missing out NAI cases, handling instruments in an unsafe manner, etc.
During the whole consultation, the doctor should use non-judgemental words, postures, expressions, and give appropriate buffering before bringing up something that might come up as out of the context/ embarrassing/ bad news to the patient. In almost all stations the doctor should remain energetic, not depressed/ worried/ sad. I know it could be very difficult to show that you are not worried. But no patient wants a worried doctor. The doctor should always reassure the patient (reasonable reassurance) and look forward to solving the problem.
These are all the points that I can sum up. And no, I wasn’t able to execute all of these in most of the stations. But I think keeping these points in the back of the mind, while practicing, will definitely help greatly in the actual exam.
Dr. Zubair Islam Shovon