Unfortunately I see many doctors struggle with PLAB 2 and it is often for a few easily rectified reasons. Having been a PLAB 2 examiner I have seen many areas where doctors fail to demonstrate their obvious talent because of the impact of nerves, scripted-approaches and rumours that have completely changed their natural ability to consult.
Below are eleven important, but often less discussed tips for this exam – both for preparation, as well as for the day itself – things that we focus heavily on during our Immersion PLAB 2 Day Course as well as PLAB 2 audiobook courses.
For full details of what PLAB 2 exam entails, as well as how to prepare, click here.
1) Trust the doctor that you already are
Too many times I role-play with doctors who are trying to be someone else – too many pre-rehearsed lines, adjusting to too many rumours about the exam (see point 9 below) and too many robotic reactions to natural situations. I ask why this happens and I’m almost always faced with the answer – “I thought this is what they were looking for”. You have reached the point of PLAB 2 by being the doctor that you are – you need to trust this background. You have seen hundreds of patients in your life, dealt with hundreds of different situations and have by now developed your own, competent style. Whilst of course like for any exam you may need to make some adjustments or include or exclude certain things, please don’t feel that you need to start from scratch and become a completely different doctor. Trusting your natural ability and skills is an important starting point – 80% is already there – don’t start from zero and ‘learn’ what you already know how to do.
2) Don’t become ‘scripted’
There are many role-play ‘scripts’ available for people preparing for this exam. They claim to represent ‘what comes up in the exam’ but please don’t rely on them as at best, they lead to a formulaic and robotic approach and at worst, to blinding you from key issues in a case. When an exam is testing your ability to hold an 8-minute consultation there is no way that trying to memorise the whole thing will work. Whilst it is of course helpful to review potential patient presentations, scenarios and situations – and then thinking about possible approaches, key questions and management options – try and keep these as loose frameworks, as opposed to rigid pathways. Relying on scripts leads to panic when a new situation arises that hasn’t been ‘learned’, as well as you not listening to patients as we think we know where we’re going. Focusing more on key issues that present themselves and trusting your ability to adapt is a must.
3) Always show RELEVANCE
Data gathering is not done just for the sake of getting data. It is not only important what you ask (most doctors will end up asking similar core questions in the end) – it is important how you ask them.
Two people can ask the same question – for example about smoking – but one will look forced and the other natural. The key difference is relevance. Linking questions to the symptom or condition can help show that everything you ask is for a reason. For example, “Slightly odd question Mrs. X – sometimes indigestion can be made worse by habits such as smoking – can I check if you do this by any chance?” is much better than “can I ask if you smoke Mrs. X?”. Bring the symptom or condition back as many times as you can in data gathering to show continual relevance for everything that you’re doing. Examples of relevance in Psychosocial are discussed in our short video: How to Signpost your Psychosocial History
4) Don’t forget the medicine
One of the most frequent PLAB 2 rumours that I hear is that ‘it is a just a communication exam’ and that ‘its all about language and how nice you are’. Of course these things are important and can help give a better overall mark. Remember however, primarily this is a test of your clinical skills and safely managing a situation. Don’t focus so much on how you’re doing things that you forget to do the correct thing in the first place!
After this exam you will be closer to working in the NHS, perhaps at times on your own – making sure your clinical judgement and abilities are sound has to be a priority for assessment – don’t neglect what you’ve been learning for 5+ years due for the sake of ‘trying to be nice’. Know your guidelines, know your red flags, know your treatments.
5) Reflect and acknowledge
Often when practicing with doctors preparing for PLAB 2 I see a clear lack of reflection and acknowledgement of cues, emotion and patient reactions. Whilst this does not necessarily mean that they have missed these key aspects of the consultation, it is impossible for anyone watching to assume that they have been picked up. Reflection and acknowledgment, for example “I can see how you may be worried about that” or “I can see that you look very embarrassed” not only makes it clear that you have picked up the potential cue, it allows rapport to be built. If a patient tells you something important to them – eg their worry about a cancer, or difficulties with their boss at work or that this situation really frightens them, and you DON’T reflect or acknowledge that, a large hole may appear in the consultation – also appearing very doctor-centered. Get into the habit of reflecting things back there and then – and watch how your consultations flow more smoothly. I discuss this more in our short video: Reflection of ICE – how it helps.
6) Organise EARLY in management
The first minute of management often signals the shift from patient-time to doctor-time. The first minute can eloquently set up the remainder of the case – make it work hard for you. As you sit down from examination, think clearly – what do I need to demonstrate in this next two, three or four remaining minutes. What are the key points that I need to cover? Find a way to demonstrate your understanding of the case early in management – show that you understand the issues going on in this SITUATION as opposed to the CONDITION. Management needs to highlight that everything that you did in data gathering was important and understood – getting the first minute of management right can go a long way to achieving this. More details on this in our video: Manage the Situation, not the Condition.
7) Don’t worry about the small stuff
Please don’t worry about things that don’t deserve your worry. Too often I’m asked things like “what is the right amount of eye contact?” or “how do I stop moving my hands so much?”. There are far too many myths about things like this and unless you are doing something at an extreme (eg NEVER look at a patient or NEVER STOP looking at a patient), they are usually of little relevance. You have been seeing patients for years and have developed a natural consultation style – and if it was that extreme you would have been told by now (or it would have been obvious from patients’ reactions to you!). Trying to significantly change things like eye contact, body posture and whether you shake hands or not just a few weeks before an exam will be counterproductive for two reasons – 1) you aren’t focusing on the RIGHT things enough as you are pre-occupied on these too much and 2) you will appear robotic as you’re trying to be a different doctor. Remember the key thing is to have a consultation where you listen, understand key issues and manage the situation effectively – most of these little things have no impact on this end-point whatsoever.
8) Don’t put everything on finishing the case
Please don’t aim to finish every single case. Your ability to score well does not rely on you shaking hands and ending a case by minute 7:59. In fact, if you have finished every single scenario before the bell goes you have likely missed out on a lot of potential issues that could have helped boost your score. Remember your aim – by the end of this case I need to have a) understood all key issues going on (medical, psychosocial, fears, ethical etc) and b) demonstrated that I am able to manage the whole situation and take it forward appropriately – not necessarily have COMPLETELY managed everything.
9) Let the role-player help if they can
Often role-players can be seen solely as the route to the examiner. We are ‘talking’ to the patient but what is being said seems clearly for the examiner’s benefit. Remember the role-player often knows all the key points of the case themself – what the key issues are, which areas need discussing and which don’t, which cues are important etc. If cues are picked up and acted on appropriately, they can help guide you down paths that need expanding on or can try and divert you away from paths that are not being assessed. Often we can be so sure of what we think the right path is, the subtle hints and cues fall on deaf ears. The role-player will help you, but only if you listen and let them.
10) Challenge each other
I have watched many PLAB 2 practice role-plays taking place amongst friends – often a very relaxed environment, food and chat, mixed with a few cases. Even the role-plays themselves were friendly – information given too easily, breaking into laughter when trying to play an angry patient, overly-positive feedback etc. Make sure you act well (this is key to our Immersion PLAB 2 Courses) – put a little emotion into the case, add in a little challenge. Too often people come out of the exam thinking that it was a ‘step-up’ from what they were used to. Aim to make it feel like a ‘step-down’ instead – make the precious time spent practicing really worth it.
11) Know you’re going to pass
So often I hear people say ‘I’ll never pass PLAB 2’ or ‘I’ll never cover all of this’. Whilst wishing to pass won’t automatically make it happen, there is definitely something in favour of self-belief. Confidence is a key part of passing any exam – regularly telling yourself that you won’t pass, that you can’t pass, but somehow hoping that you will, just makes your preparation that much harder. Regular pep-talks, reminding yourself that you actually know a huge amount and convincing yourself that you will easily pass, will push you that bit harder. Yes PLAB 2 is a challenging exam, but it is one that you have been gearing up for a long time. All the time spent preparing will pay off – you just need to believe it for it to show on the day. Focus on the positive end-point and you’ll reach it much more easily.
How we can help you Pass PLAB 2
I am passionate about guiding you through the PLAB process in the method that suits you best. We provide a number of methods to help you prepare for your exam.
1) Flagship Immersion PLAB 2 Communication Skills Course: Held in London, Manchester, Birmingham. An intense 1-day course focused on maximising your interpersonal skills and effective use of 8 minutes for PLAB 2. These are areas that many struggle with and the whole day is focused on intensive role-play and direct feedback. I cover a range of scenario types such as patient emotion, counselling, ethics, and patient-centred care. Click here for details and dates.
2) PLAB 2 Communication Skills On-the-Go Audiobook Course: 25 Common PLAB 2 communication and consultation scenario type challenges. I break these down through audio and teach through a variety of tips and suggestions for how to deal with these. It is designed to listen to again and again and in a variety of situations e.g. travelling, at the gym etc. No expiry. Click here for details.
3) Medical ‘How to Explain’ On-the-Go Audiobook Course: 220+ medical conditions, diagnoses, tests and investigations explained in simple terms. Improve the quality of your scenarios by breaking down explanations into patient-friendly language. Also designed to listen to again and again and in a variety of situations e.g. travelling, at the gym etc. No expiry. Click here for details.
4) Dr. Aman’s free daily teaching emails: Join #aroradaily for Dr. Aman’s daily teaching email – a quick clinical scenario with teaching video straight to you email inbox. Also keep up-to-date with our special PLAB 2 offers. Join here: http://eepurl.com/duAwXr
5) Our various Social Media streams: Dr. Aman’s PLAB Support Group provides daily teaching to help you with PLAB 2. We also provide daily PLAB 2 teaching on Dr. Aman’s YouTube channel, Instagram feed (@dr_aman_arora) and Twitter feed (@aman999arora).
And on a Final Note…
PLAB 2 preparation is important. It is not just about doing multiple practice role-plays and reading multiple scripts for months on end.
Figuring out your strengths and weaknesses early, understanding what is being assessed and tackling your preparation in an organised way are keys to success.
I look forward to meeting you soon and good luck with preparation!