PLAB 2 COMMUNICATION SKILLS COURSE
how you are expected to communicate with patients in the UK
- Ramesh Mehay
- 14th May 2024 3:48 am
- No Comments
IMPORTANT OTHER WEBPAGES TO HELP YOU…
- Scripts and Phrases for Consultations
- Consultation Models & Frameworks
- Practising Holistically – expoloring ICE & PSO
- The Narrative – understanding the patient’s story
- Showing empathy & compassion
- When talking about sex and sexuality
- Medical Explanations – the theory
- Medical Explanations – video clip demonstrations
- Medical Analogies to explain things
- Safety Netting
- RCA marking sheet
ASSESSMENT
WANT TO PASS THE PLAB 2?
THE BRADFORD VTS PLAB2 & RCA ONLINE COURSE
Want to increase your chance of passing the PLAB2 exam?
This course was designed for the specialist RCA exam for GP Trainees. However, many doctors from overseas have said it is highly relevant for the PLAB 2 exam too.
No other RCA or PLAB2 course does what this one does.
Top Tips after discussion with LOTS of examiners
PLUS video demonstrations of Consulting Skills
The most reasonably priced PLAB 2 course on the web – because we want YOU to PASS!!!
Working in the UK
The PLAB 2 exam covers everything a UK trained doctor might expect to see on the first day of Foundation Year Two (F2). It tests your ability to APPLY your knowledge to the care of patients in the UK. Of course, you need to know some good medical knowledge, but this exam is not how well you can remember and recite facts but rather about
- the language and phrases you use to communicate that with the patient (to ensure they properly understand you)
- how well you work with the patient and collaborate with them
- to form a mutally acceptable or a shared management plan.
In terms of clinical knowledge, you should know the clinical evidence in relation to published UK guidelines and NOT necessarily what happens in your country. PLAB 2 tests clinical topics, clinical skills and clinical procedures that a doctor who passes the test would need to know and be able to do when working in the UK. It also provides details of the professional qualities and attitude expected of a doctor working in the UK. In many countries, the doctor is seen as the superior person who the patient should feel honoured to meet. In such countries, the patient is expected to speak when spoken to and at other times shut up, listen to the doctor, and obey their commands. This IS NOT how doctors work in the UK. You are expected to behave in a way that suggests you and the patient are equal – which of course you are – because both of you are simply fellow human beings. Therefore, in the UK, you are expected to have a CONVERSATION with patients rather than telling or commanding them what to do. Patients in other countries are expected to listen to the doctor’s thoughts and suggestions – in the UK we do this too BUT IN ADDITION the doctor is expected to also listen to the patients thoughts, worries, and expectations (we often call this ICE – ideas, concerns, expectations).
The videos in the course below were originally developed for the RCA (Recorded Consultation Assessment) exam for GP trainees. But 90% of the principles apply to PLAB 2. Dr Mehay demonstrates words and phrases to use and HOW to say them. If you’re not born in the UK but want to work over here, you should watch these. For those who want to know what the RCA exam was all about – in a nutshell, GP trainees had to submit real life consultations with patients with complex problems to an exam board who assessed each consultation against a marking sheet which explored three areas – Data Gathering, Clinical Management and InterPersonal Skills. These are the SAME domains which you will be assessed in PLAB 2.
What is PLAB 2?
The PLAB 2 examination is the final part of the PLAB (Professional and Linguistics Assessment Board) evaluation, administered by the General Medical Council (GMC) within the United Kingdom. You can only do PLAB 2 if you have successfully done the PLAB 1. You need PLAB 1 and PLAB 2 to be able to practise as a doctor in the UK if you graduated abroad.
In PLAB 2…
- There are a total of 16 stations
- Each station allotted an 8-minute duration
- A 90-second interval between stations
- Inclusion of 2 rest stations
- The whole exam will take around 3 hours
What's the difference between PLAB1 and PLAB2
PLAB 1 tests your foundation medical knowledge. You will navigate scenarios similar to those encountered by a UK-trained doctor entering their Foundation Year 2 program. You needd to have some good clinical knowledge to pass this exam. The PLAB 1 exam is a written multiple choice test. This contains 180 questions, which you have 3 hours to complete the exam. You can take the PLAB 1 exam in multiple countries at approved test centres.
PLAB 2 is an OSCE exam. It tests you ability to communicate with patients not only in the history taking (or data gathering) phase but also in the decision-making/management-plan-making stages. For example, you may feel a patient is depressed and that antidepressants might be a good for them clinically. But what if the patient doesn’t want to take them because they have fears about them. What do you do then? What if a patient has back pain for 4 weeks, and wants an orthopaedic referral. Let’s say you think it is muscular and they don’t need an orthopaedic referral but instead some pain killers and back exercises should make things better. How do you get them on board? This is the reality in the UK. Whilst in other countries, where the patient is expected to shut up and listen to and do what the “expert” doctor says, UK patients have moved away from this. In the 1970s and 80s, yes, patients in the UK used to be like this too – they would shut up, listen to what the doctor’s advise was and then to adopt it without question. But since 1990, the culture of UK patients have changed. UK patients have their own ideas, concerns and expectations. Every patient is different in this regard and many patients want to be able to share their ideas, concerns and expectations so that the management plan can be altered accordingly (we call this a SHARED management plan = a balance of what the doctor suggests and what a patients wants and doesn’t want).
So, unlike PLAB 1, PLAB 2 moves away from rote memorization and factual recall. It’s more about your flexibility in the way you handle different patients. PLAB 2 adopts the format of an OSCE (Objective Structured Clinical Examination). Comprising up to 16 evaluated mock scenarios, this examination replicates authentic clinical settings, including a hospital ward and consultation room. So, PLAB1 is about the depth and breadth of your actual medical knowledge but PLAB 2 is about the APPLICATION of that knowledge – because it will vary from patient to patient – even with those patients with the same medical condition! (In the depression example above, some patients will be happy to take antidepressants, others wont. Some will be happy to see a CBT counsellor, others wont.)
You must also remember that PLAB 2 benchmarks your performance against the UK’s prevailing optimal practices. So, if you’re from Nigeria, India or Pakistan, PLAB 2 does not mark you against what is considered good practice in those countries. You are marked against what is considered good practice in the UK – because YOU have decided YOU want to work in the UK! And – you will be working with UK patients, not patients in Nigeria, India or Pakistan. So, it is only right to test you on what is considered good practice in the UK. UK patients expect a certain type of behaviour from their doctors which is not the norm in other countries – like developing a mangement plan WITH them (unless of course it is a medical emergency). This aspect should guide your preparation endeavors and role-play simulations.
Isn't the RCA course designed for the GP Trainees? Will it really help me with PLAB 2?
The simple answer is YES. Why do we say this? Because the assessment areas (called domains) are the same. In the PLAB2 exam, you are assessed on 3 domains – (1) Data Gathering, (2) Clinical Management and (3) InterPersonal Skills. And guess what? GP Trainees who do the RCA exam are tested on 3 domains too – the exact same three – (1) Data Gathering, (2) Clinical Management and (3) InterPersonal Skills. This is why we strongly feel (and have had feedback from other overseas doctors) that our RCA course will help you with the PLAB2 exam. In fact, our RCA course goes into greater depth than what is required in places for the PLAB2, but this is a GOOD thing because
- You will look impressive and should pass the PLAB2 easier
- All the skills will help you converse with British patients when you come over to the UK
- The skills will also make you a better suited doctor for UK practice.
What is so good about the RCA course for PLAB2?
Bradford VTS presents…
THE KEY BENEFITS OF OUR RCA-PLAB2 COURSE
- Effortlessly learn from over 150 video clips which demonstrate skills and techniques to help you pass.
- Lots of top-tips and tricks.
- Clear non-conflicting advice.
- When practising with others or by yourself: learn how to mark your own performance with greater accuracy and confidence.
- Understand the marking scheme completely.
- Learn how to tackle common areas where trainees struggle.
- Time Management advice and how to handle the patient with multiple complaints.
- Many videos have annotated notes to emphasise key points.
- Videos range from 5-15 min clips to aid your retention.
- Developed after discussions with lots of RCA examiners.
- Videos are categorised and themed to help you truly understand what the examiners are looking for.
- Videos include demonstration of skills PLUS interaction with lots of trainees.
- A lot of online RCA & PLAB2 courses only TELL you what you need to do. This course TELLS and DEMONSTRATES exactly what to do. Using a technique called dual-character role-play (using myself as doctor AND patient). This ensures simulations are kept as close to real-life General Practice as possible. Also enables replay of the same scenario in several different ways.
Tell me more about the Marking Schedule for PLAB 2?
You are assessed on 3 domains. You get a score for each domain. Here is a list of what each area means so you have a good understanding of it. You will have a better understanding of the three areas and how to pass if you decide to sign up to our RCA course.
- Data Gathering – In essence, this domain gauges your capability to collect pertinent data for formulating potential diagnoses and addressing specific situations.
- Thorough history taking (esp red flags)
- Aptitude in conducting examinations – using real-life actors, anatomical models, or electronic simulations. It covers routine examinations (e.g., cardiovascular, respiratory, abdominal, and joint examinations) as well as specialized assessments (e.g., breast, eye, and rectal examinations).
- Execution of practical procedures – skills relevant to a typical UK ward setting. For example: measuring blood pressure, venipuncture, urinary catheterization, cannula insertion, suturing, calculating drug dosages, and more.
- Competence in considering and implementing investigative measures
- Clinical Management Skills – Demonstrating sound clinical decision-making It encompasses your ability to navigate and manage complex medical situations.
- Managing clinical scenarios
- Devising effective treatment plans
- Interpersonal Skills – the critical human interactions intrinsic to medical practice.
- Establishing rapport with patients
- Seeing the patient’s point of view and their preconcieved ideas (ICE – ideas, concerns, expectations)
- Understanding the effect of the illness on the patient’s life (PSO – psycho, social, occupational effects)
- Effectively communicating and empathizing
- Developing shared-management plans
- Displaying professionalism and patient-centered care
ASSESSMENT
PLAB 2 is changing to CPSA in 2024
The UKMLA (UK Medical Licensing Assessment) will replace PLAB 1 and PLAB 2 in 2024. All doctors (both UK medical students and International Medical Graduate (IMG) doctors) will be exp[ected to take this exam in 2024/2025 onwards.
Why the change? The GMC’s adoption of the UKMLA underscores its commitment to equitable evaluation for candidates worldwide, irrespective of their medical degree origin. While these transformative changes may prompt concern, they need not disrupt your plans.
The UKMLA will be made up of two parts – the AKT (applied knowledge test) and the CPSA (clinical professional and skills assessment).
- The AKT replaces PLAB 1.
- The CPSA replaces PLAB 2. Depending on your medical school this may be called an OSCE (objective structured clinical examination) exam or OSLER (objective structured long examination record) exam. For IMG doctors this will replace the PLAB 2 assessment and will continue to take place at the GMC assessment centre in Manchester.
What is this Bradford VTS website all about?
Bradford VTS is the currently the most popular and number 1 GP Training website currently in the UK. It is mainly designed for qualified doctors wishing to become General Practitioners (GPs for short) primarily in the UK. General Practitioners are known as Family Physicians in other countries, like the United States. Bradford VTS provides an enormous wealth of free resources for doctors, trainees and educators and has been well established for nearly 20 years. The resources are also useful for those in health-care outside the UK. Useful for doctors, medical students, nurses, nurse students, associate physicians, advanced practitioners, pharmacists. But it is also useful for anyone into education and training – there is plenty of generic material free for you to use.
If you have any suggestions, please contact the founder: rameshmehay@googlemail.com (Dr Ramesh Mehay, an experienced GP and GP educator)
Bradford VTS website
UK’s number ONE free GP training website
WANT TO PASS THE RCA?
THE BRADFORD VTS PLAB2 ONLINE COURSE
Want to increase your chance of passing the PLAB2 exam?
No other PLAB 2course does what this one does.
Top Tips after discussion with LOTS of examiners
PLUS video demonstrations of Consulting Skills
The most reasonably priced RCA course on the web – because we want YOU to PASS!!!
THE BRADFORD VTS PLAB2 ONLINE COURSE
What people are saying
Preparing for Clinical Stuff
These red flags will tell you when you need to worry for things like cancer.
In the UK, most doctors use CKS (Clinical Knowledge Summaries) or GP Notebook for looking up clinical information and guidelines. So, study these.
If you are a working doctor, write down the conditions your patients come and see you about in your country (except for specific infectious diseases for your country). Then look up those things each day on either GP Notebook or CKS. Ask yourself – what do we do in the UK that you don’t in your country. Learn the differences.
The examiners are basically after a (i) Safe (ii) Structured and (iii) Comprehensive clinical assessment. They are more interested in this than you covering every single minute detail.
So, skim-read things like
- Differentials or Clinical Systems to explore
- Essential Hx for above
- Red flags not to miss
But remember – the aim is to to fill in your gaps, not to review what you already know!
LINKS
You may find it helpful to make notes before you call the patient after you have looked at their medical records and reviewed the clinical topic on something like CKS or GP Notebook. Things you may wish to make a note of are things like
- Clinical Systems or Differentials to Explore, e.g. for SOB “explore heart, lungs, anxiety”
- Clinical History bits not to forget, e.g. for SOB “don’t forget PE/DVT”, for depression/anxiety: “don’t forget suicidal risk assessment”
- Red flags not to miss, e.g. “Don’t forget meningitis”
- The latest Clinical Management advice.
The whole point of jotting things on an A4 was alluded to earlier in point 1 above:
- To help organise your mind OR
- To help you remember things you might forget.
Remember, you are not making notes on things YOU ALREADY KNOW, but rather to make notes on areas you might forget about or simply to provide a structure for your mind. The key is NOT to make your notes too wordy or list’y. Keep very brief – one or two words is best. Not sentences. Otherwise, you will focus on your notes sheet rather than the consultation, and your consultation flow will be ruined, and you will miss essential bits of the talk as the patient speaks (i.e. you will miss verbal and non-verbal cues). And use a new sheet of A4 for each patient.
I repeat – PLEASE PLEASE PLEASE remember to keep these notes brief. If you make them detailed, you will be more concerned with your notes sheet than the patient and you will miss what they say and the consultation will lose its natural flow. So, in order to prevent this…
- Write 1-2-3 word things down.
- DO NOT write down everything you need to cover. It will confuse you and you mind will become distracted and lose focus in the “here and now”
- Just jot down things that you might forget or things to help organise your mind.
- Perhaps a maximum of about 5 items.
- Space them out over the whole of the blank A4 sheet.
- Use a brand new blank A4 sheet for the next patient. You don’t want to clutter the next patient with the previous patient’s notes do you!
DOWNLOADS
- The last 3 consultations
- DH
- PMH
- Letters
- Blood/Test Results
Tips for Beginning a Consultation
Here are some examples. Try and see if you can make one of your own that fits in with your personality.
- A good example:
- “Hello my name is Dr XXXX. I am one of the GP trainees nearly at the end of my training. I want to thank you for agreeing to this recording which is for my final assessment. I will check again at the end of the consultation to see if you are still happy for me to use it. Is that okay?”
- If you have a speech impediment:
“Hello my name is Dr XXXX. I am one of the GP trainees nearly at the end of my training. I want to thank you for agreeing to this recording which is for my final assessment. I will check again at the end of the consultation to see if you are still happy for me to use it. Before we start, I just want to let you know that I have a bit of a speech problem – I stammer, so please bear with me. Is that okay?” - If you have a strong accent:
“Hello my name is Dr XXXX. I am one of the GP trainees nearly at the end of my training. I want to thank you for agreeing to this recording which is for my final assessment. I will check again at the end of the consultation to see if you are still happy for me to use it. Before we start, I just want to let you know that I know I have a very strong accent. So if there is anything you do not understand or if I confuse you, please stop me and let me know – I will not be offended. Is that okay?”
Try and use 14Fish to do the recording – because their consent process is really easy, smooth and comprehensive. It means you don’t have to do much other than the “opening statements” listed in the point above. If you are using iConnect, then you will have to do the consent process in full. And if you show the consent process on your recording, it has to be done properly or there is a risk that your consultation recording can be rejected and you get no marks no matter how good that consultation is! So, if you talk about consent – make sure you do it properly on iConnect. Don’t worry about time running out – your 10 minutes only starts after the consent process at the point at which you say “How can I help you” or “What would you like to talk about today?”
DOWNLOADS
Tips for the Middle & End of the Consultation
PLAB 2 is a practical objective structured clinical exam (OSCE). Exam duration: Each scenario lasts 8 minutes. The total time, accounting for the time between the scenarios, isn’t specified by the GMC. Number of stations: 16 scenarios.
Only look at the clock occasionally. I would suggest that in a consultation, you should only have to look at the timer 2-3 times. No more. The first thing you are looking for is the mid-point where you need to start moving from Data Gathering to Clinical Management (4th minute). After that, your are looking for the last minute mark where you need to wrap up, safety-net, follow-up and close.
Remember, you should be moving from Data Gathering (DG) to Clinical Management (CM) at the 4 min mark. HOWEVER, some stations wont be asking you to do all of Data Gathering, Clinical Management and InterPersonal Skills. Some may just provide you the Data Gathering but expect you to do the Clinical Management and show case your InterPersonal Communication Skills.
Follow a consultation structure because it will help provide a framework for your mind to loosely follow. Frameworks help you cover things…
- in a structure way.
- in a comprehensive way.
- in a safe way – making sure all generic areas of a clinical consultation are covered and nothing big is missed.
- in a time-efficient way.
Use whichever consultation model fits in with your personality. I’ve developed one specifically for the RCA – but feel free to ammend this to suit your personality or the way you think.
Ram’s PLAB2 Consultation Model
- ROLA: ROLA = Rapport (be nice, smile), warm Opening, Listen, (set the) Agenda
- The patient’s perspective – gather their story and try to understand it. Let them speak. ICE – ideas, concerns, expectations. PSO – pyscho, social, occupational impact of the problem.
- The doctor’s perspective – gather specific clinical information. ensure no red flags. Get enough info to get to a working diagnosis. Do an examination if necessary.
- Plan together. Verbalise diagnosis/differentials – give your professional clinical opinion. Suggest what you think needs to be done next – investigations, drugs, referrals etc. See what the patient thinks of what you have said. Is there anything they would like to add or question or change?
- Close the consultation with Follow UP & Safety Netting (use Ram’s EDF mode) – (i) explain what you EXPECT to happen, (ii) explain symptoms/signs indicating a DEVIATION from the norm, (iii) provide specific FOLLOW-UP advice.
Use phrases like…
- “Would you mind if I tell you what I’m thinking…..”
- “My recommendation is…”
e.g. ” Mrs. Smith, I have some good news for you. I know you were worried about your headaches being a brain cancer and you wondered whether you needed a scan. The good news is that I don’t think you do. People with brain cancers will get a change in vision or vomiting or fitting episodes and you’ve not had any of those, which is great. The other good thing is that on examining you, your brain and nerves seem to be working just fine. I do have a good idea what I think it may be and what we should do. Would you like to hear my thoughts?” (NB How can she say no? LOL).
DOWNLOADS
Get together with a doctor friend and assess each others consultations...
Please use a proper RCA marking sheet when assessing RCA consultations.
I see many people do this: They look at their consultation LOOSELY in terms of 3headings – DG, CM and IPS. In other words, they decide how good their consultation was in each domain by their rough gut instinct. This is NOT a good way to assess your consultations. This method produces high false passes that will not be mirrored by what the examiners give.
Instead, use a detailed marking crib sheet – see rca marking sheets on the right. In other words, YOU HAVE THE ANSWER SHEET provided for you. If you follow it, there should be little chance of going wrong.
So, in summary, always use a detailed RCA marking sheet and not just guestimate from your inner gut feeling. Look at the components of what makes a case pass and what makes a case fail for each domain area (DG, CM & IPS). If you do this, you are more likely to be in synchrony with the examiners.
Some RCA Posts
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A bit of fun...
Seriously, this is just for a bit of fun. I thought it was quite funny. But there are elements within this “doctor” that we see in trainees who submit for the exam. These things will result in a failure….
- Asking closed questions right from the start.
- Being too formulaic – following a “formula of questions” rather than trying to open up the story and understand the narrative.
- Not exploring deeper with the patient about their psycho-social circumstances.
- A lack of empathy or genuine interest in the patient.
Anyway, watch and enjoy.
WANT TO PASS THE PLAB 2?
THE BRADFORD VTS PLAB2 ONLINE COURSE
Want to increase your chance of passing the PLAB 2 exam?
No other PLAB2 course does what this one does.
Top Tips after discussion with LOTS of examiners
PLUS video demonstrations of Consulting Skills
The most reasonably priced PLAB2 course on the web – because we want YOU to PASS!!!
