PLAB2 - LAST BIG TEST

Hey Everyone! It’s Reetu here, and I just want to say CONGRATS!! YAY! You're almost there! This is your last hurdle to overcome before you become a GMC licensed doctor(: One thing that you must know is that THERE IS NO ONE FORMULA OR SECRET RECIPE YOU CAN FOLLOW to pass this exam. If there was we would all be doing that, but many people pass doing different things and pass. So don't worry! It's very SUBJECTIVE you will be analysed from the moment you enter the room.

I'll be writing about my experience and how I passed 12/15 stations this September POST- COVID19.

PLAB 2 is an OSCE exam. It is held only in Manchester.

I know people who have passed the exam with only 2 weeks of prep and people who have failed with 3 months of prep. So timing doesn't matter for this exam, its confidence and technique.

Please DON'T MEMORIZE THE SCRIPTS that is the WORST thing you can do. You would have heard from you friends about one case of ectopic pregnancy and go inside and expect the same case, yet it'll be slightly different for you. But because you have your friend's case in your mind you'll miss the fact that the ectopic patient you had was also having NAI (non accidental injury) and was being abused. The main ideas of the case are the same but dont miss other important details just because you memorized what cases came previously.

Please go with the flow, don't be RIGID. Don't go with a present mind of "oh I know this case" or "I've heard of this new case it must be this --- " because that will make you think in a very narrow minded way. Be open and see what happens.

This exam does test medical knowledge, but it also tests your character and how you deal with situations. You need to be able to handle every case and situation given to you, with poise and grace. It is not about the diagnosis alone. It's about the questions you ask, picking up on the small social cues the patient gives you and treating them with empathy and respect. I know people who have failed stations even though they have gotten the diagnosis right and contrastingly people passed stations without even giving a diagnosis.

Unfortunately I can't tell you what is right and wrong, it's not that simple. It depends what the examiner thinks of you and what the patient thinks of you.

There is one thing I noticed on my exam mark sheet, as well as 5+ of my friends’ exam sheets (all of us had taken the exams in September). If we had scored a 3 or 4 in our IPS (Interpersonal Skills) we NEVER FAILED that station. If we scored 2 the chance of failing that station increased significantly and if our IPS was a 1 then we definitely failed the station. I don't know how GMC grades, but I do think this pattern exists. If you're a safe doctor, with good IPS you won't fail. You already have the medical knowledge as you have been learning about/ treating patients for 4+ years. Remember you are tested as an FY-2. You DO NOT NEED to KNOW EVERY POSSIBLE TREATMENT! That is not your job! Your job is to take history, initial labs, examination, basic treatment and MAKE THE PATIENT COMFORTABLE! If you are explaining all the tertiary treatments for every complicated case there's nothing left for the consultant to do.

NEW FORMAT:

Now post COVID-19 there are only 15 cases. There are 5 telephone cases, 2-3 mannequins and 1 simman case. I’ll explain all these in detail in PLAB2 - PART 2 blog

ATTENDING A CLASS:

Choosing a class is entirely up to you. See what is close to you, what is in your budget, where your PLAB 1 friends are going and book it! All courses are more or less the same. They won't teach you everything and not everything they teach will be applicable in every scenario, but these academies will give you a good overview . The most important thing about the class is meeting some people to study with. Even if you don’t attend any class, please practice with the mannequins and SIMMAN.

DISCLAIMER: I did not attend any academy, I tried but it wasn't for me. However I had taken previous similar OSCE tests, which is why I opted out of classes. If you are not used to OSCE format please do attend a class.

FINDING A STUDY BUDDY:

Please find a study buddy as soon as possible, someone with a similar date as you. You will need a partner to study with. Find someone who is motivated, because you will need someone to keep pushing you when you're down and vice versa. I owe a lot to my first PLAB 2 study buddy! Find one in your class or on facebook! Try practicing with them for a few days if it doesnt work,dont feel bad and kindly let them know. Find someone you gel well with because you will be spending a lot of time with them for a few weeks. So keep one stable partner (whom you do 5 cases with) and have multiple short term partners (to do 1-2 cases) to practice with during your free time. Vaanathi formed a study group with 3 other people and as she preferred having 3 constant people to study with.

MAKE A SCHEDULE:

If you have X number of cases how many do you want to do a day? Divide that number by the number of days you have to study, then leave another 10-12 days for reviewing the whole thing again. In the beginning my study buddy and I would do 3-4 cases each and towards the end of our prep we had increased it to 8-10 cases each(which yes takes 6 hours- that's the max I can study in 1 day). So the first time you’re doing less number of cases, take this extra time to re-read cases slowly and watch videos! The second time around when you’re doing 8-10 cases each day, you’ll need less time to read.

DOING IT TIMED:

I can't tell you how important this is! First time I went through the cases timed at 8 mins, just like the GMC timer where they give you 1 min to prepare before starting and a warning at the 6 min mark! https://www.youtube.com/watch?v=sg00Kb_WhTk - this is the timer I used.

Second time around I did the same thing but using a 7 min timer. I had heard from many plabbers that even though they give you 8 mins in the exam it goes a lot faster. I also figured you need to have some time to account for any errors that may occur on exam day due to jitters or external factors.

I know this sounds silly, but I used to say my full name and GMC number before starting every practice case- because this is how it will be for you in the real exam.

HOW TO STUDY GENERAL OVERVIEW:

After you attend the classes, or even during the classes if you have time/ energy you can start studying.

The first revision we went systematically. Quickly review the section and all the DDs before practicing the cases. For example- if we were to do chest pain, we went through all the questions we would ask if someone came with chest pain, all the DDs (differential diagnosis), all the labs and possible Rx for each scenario- this would take just 15-20 mins before we started the actual cases.

We used to send each other the case scenario on whatsapp- but remove the diagnosis at the top. We never told each other about what dx of the case was beforehand. Then if I did pericarditis and MI, he would do pneumonia and musculoskeletal pain. We did opposite cases, so as to not repeat everything that day itself. Then I kept a log of all the cases he did and he kept a log of the cases I did, so we did not repeat any cases or miss any.

I would take notes during each station in my notebook/laptop about the questions he forgot to ask, or things I thought sounded odd/not as nice, etc. I would also take notes about good things he said, nice things and important things. Then after each case I would tell him about everything I wrote down regarding his case. We could not finish the cases by 8 mins in the first few days, but eventually, we were able to do so. It is important to take quick notes, because you may forget all the points you want to tell your partner by the time the case is over. Please take all criticism as constructive and just take it as a learning experience. Don't feel down about it, just learn from it and keep improving everyday (:

One thing which Vaanathi found a bit challenging was the counseling stations. These scenarios are handled a lot differently in our home country. But don’t worry. If you don't feel confident, just try and see how other people approach the station and keep practicing. YOU WILL GET THE HANG OF IT. We even heard advice to stand in front of a mirror to practice expressions.

Show and verbalise your sympathy and empathy to the patient's condition.

MOCKS:

I attended 4 SWAMY mocks, despite not attending the classes. I also spent the last 7 days doing 7 cases in a row with my partner, no breaks in between. So before we started she would whatsapp me the pictures of all 7 cases, I wouldn't open the first one until she played the GMC timer. Then I had 1 min to read and 7 mins to do the case. Then after I finished being the doctor for 7 cases she would give me the feedback for all of them. She used to write down the feedback during each case or else you’ll end up forgetting it. Then we had a 1 hour break and then she would do a set of 7. This was SO helpful because on the real exam I had 11 cases in a row! You need to keep doing cases at a stretch, because you progress you do get tired and you’ll feel yourself rushing. I personally felt my IPS (interpersonal skills) decrease as each case progressed, therefore I had to make a conscious effort to keep my IPS skills on the same level all throughout.

MANNEQUINS/SIMMAN:

These are some easy ways to get points in the exam. Due to COVID-19 we were not allowed to touch any patients, any examination we had to do was on the mannequin. Please go to the academys and try the cases on the mannequins. The first day I went and just walked through the mannequins and cases. The second time I went I did case scenarios with the mannequin like a real exam. So my partner gave me a case of a breast lump and started the timer. I took history from her just like I would normally and proceed to examine the mannequin. I suggest you do this so in the real exam you wont get freaked out by seeing the mannequin.

If you want specific advices of what phrases to use for each scenario, how to show empathy, sympathy and how to deal with an angry patient then please comment below and we will make another post (: