Thread by @prachiiiiiik

Let’s talk a little bit about #PLAB2~

My take on the exam day itself,what I think they expect of us and scripts!
A thread 🧵 ~

1. Exam day will have you standing in a corridor with 18 rooms, two of which will be rest stations. Eat the cookies, relax your mind! Of the other 16, you get 1.5 mins to read, 8 mins to cover the station, rotate through the circuit and fair well in 10/16 to pass the exam.

Now the station could be history based, counselling, ethical issues, interacting with a colleague/teaching them, or doing basic procedures graduates are required to do. You’re graded on three domains: data gathering, management and interpersonal skills.

2. What do they expect of us? An examiner during the briefing said very simply on the exam day, “We don’t care how much you know, we’ve assessed that in PLAB1, what we are looking for is kind, compassionate, safe and competent doctors.”

Kindness and compassion: I think it’s the core of those much feared IPS. And this isn’t something you can fake and goes beyond the very frequently used, “I’m so sorry to hear that.” But it is something you can easily develop with practice, and put to use even ahead beyond PLAB2.

When you are practicing have an approach to think what concern could a patient have as an issue beyond medicine, and how can you help. A daily wage worker in pain, will be more worried about his job than the pain. Acknowledge that concern, provide possible solutions!

Try to modulate your tone and speed. If you have a patient with a grim prognosis/learning difficulty: don’t rush, give them time to absorb the news. If you have a patient responding to treatment, give them an assuring smile!

What’s a safe doctor? Simply, one who knows his/her limits and can rule out or diagnose critical conditions. In other words, as a junior doctor I don’t need to know how to do a spinal cord surgery, but I need to know how to detect Cauda Equina and refer the patient immediately.

Competent: this is where the medical knowledge you already have comes in, but along with it also the workings of the system. This is what is new to us. It takes some time to understand how social workers work here, the role of occupational therapists, etc.

You cannot pass the exam going on and on with just the medical management. A patient of post-op hip replacement along with pain meds requires a home visit by the OT to put things in place at the same level, physiotherapists, home-help if needed before discharge.

TIP: Doing my attachment has made me more aware of the system really. Always a detailed social history is checked for before admission. Every ward has an occupational therapist in charge, no discharges can be made go without checking if the patient is socially fit.

An odd advice that’s NOT AT ALL necessary but I think would’ve helped me better if I knew before would be: a couple weeks of practice to understand the basics, (without this you’ll be lost!) then the attachment sandwiched between a couple more weeks of practice before PLAB2.

IMP: Attachments are not at all necessary and people usually do it after PLAB because time issues. SO IF ONLY YOU HAVE PLENTY OF TIME I would suggest doing it before PLAB as it will give you a wonderful idea of the system, see how the doctors talk to the patient, clerking, etc.

That being said, I did not do my attachment before, but I was able to understand the system in a few weeks of practice too. This just helps a tad bit more, especially if you struggle with the social aspect of consultation.

3. Lastly, are scripts important? Yes, and No.
Scripts are there to give an idea of the structure you need to use initially, or to cross check on what important aspects you’ve missed out on in the later course of the practice.

Going on and on learning the scripts in my opinion does more harm than good in my opinion for the examiner listens to 30 students everyday, they are obviously going to figure out who is scripted. And secondly, everyone does the same thing, how do you plan to stand out?

What I used to do was practice and then read through them, but people read first and practice later and that works well too. So there’s no right or wrong way, you have to find your own. But definitely, you don’t have to mug it up. The exam isn’t difficult, it’s just different.

What’s more important is, add more of YOU to the script. Be yourself, be confident. As long as your patient and you feel satisfied after your 8 minutes, as long as you make a good impact, help the patient through, you should pass.

I cannot cover everything in this thread, because PLAB2 is an exam that was unlike anything I had taken before. It was wonderful. I feel like a much better doctor not just in knowledge but how to improve the overall quality of life not just the disease. All the best!

As long as you do the same, there’s no reason why you shouldn’t pass. Always remember It’s not about how much you know and how much you’ve told, it’s how well understood your patient feels after the consultation and how much he benefits from the same!

Patients don’t want the drug name, they should know how it works. Similarly, if you are counselling a patient for lifestyle changes, find out the reason for the lifestyle, ask them if they are willing to change, tell the pros and cons before enforcing it on them. More impact.

Interpersonal skills are all about how comfortable your patient feels towards you, approach them with a smile, ask them if they’re comfortable and try to make sure they’re concerns and expectations are met.