QBank for the PLAB Part 2 of the United Kingdom

The CanadaQBank.com QBank for the PLAB Part 2 contains 171 classic simulated cases inspired from the recent PLAB 2 exams.

The QBank follows a similar pattern like this in starting cases. In PLAB 2, you are preparing for an exam that will give you a training position in the UK as an FY2. So, the cases will start by saying that you are an FY2 because you are being tested if you are qualified to work in a such position. Then the case will state the problem you have to solve. It could be taking history, doing physical exam, or interpreting work up studies. Since in this case we have been given the ultrasound results and the consultant surgeon’s recommendation, the FY2 job is simply to counsel the patient about both.

In this second picture of a case, you will see that we are given a detailed story of the patient’s case. It will include things that are on the examiner’s checklist that you will have to address to be able to pass this case. You could use these to grade yourself during practice. We know the ultrasound results and the recommendations of the surgeon, but how did this problem start? What did the patient try and failed? What kind of symptoms did she have? Which doctors did she see? Data gathering has 4 points in PLAB 2. Diagnosis and management will have 4 points. Interpersonal skills in how you show empathy and care to the patient will also have 4 points. So, from where you stand at the door before you enter the room, you have to create a mental strategy how you will maximize your marks on each of these based on what you are reading.

The QBank will teach you the time-tested approaches to the cases that have been tried by thousands of candidates in the past and successfully passed the PLAB 2. The first one is introduction. You always have to say your name and role as you enter the room. This will give you your first interpersonal skills marks. You also need to find out the name of the patient, how he or she prefers to be called, and the age of the patient. The confirmation of the age of the patient is usually for the purpose of clarification that you are in the room you should be.

In PLAB 2, there are 2 ways you can open up a conversation with a patient. In the first one, you can just say “How can I help you”—you will do this with new patients who are being seen for the first time and you don’t know what the problem is. In the second one, you will try to find out what has been done for the patients and what they understand about their medical condition. Whatever they answer, you have to acknowledge, clarify, or try to explain. You also have to give yourself an opportunity for data gathering, because you need that to score high on history taking. So, after finding out what this patient understood about her case, the doctor proceeded to taking history of how this problem came about.

In the above conversation, a standard history taking follows. You see that even though this is a case of dermoid cyst, the initial presentation could have been just abdominal pain. In such a situation, you can expect that the standard abdominal pain history taking with SOCRATES strategy will be on the examiner’s checklist. Though your primary task in this case will be counseling the patient on the management of the case, including ultrasound results and what the surgeon has recommended, it won’t give you data gathering marks. It won’t give you interpersonal skills marks. You could end up with just 3/12 or 4/12 score on this case if you ignore taking history and showing empathetic listening to the patient.

Even though abdominal pain might have been the chief complaint in this patient, an obstetric and gynecological history is usually important in female patients, especially those of child-bearing age. A candidate who takes abdominal pain history alone, while ignoring the ObGyn part, stands to lose scores, when compared to the candidates who will be doing data gathering that takes into consideration the gynecological history of the patient.

In taking history, remember to cover past medical history. Be brief, 8-minutes for these cases goes pretty fast.

Remember, if a case says, “assess”—then physical examination is part of that, unless said otherwise. Don’t miss physical examination when cases say assess, because you will be losing some of the data gathering marks. As the counseling of the patient begin in management, you see that the doctor will give the name of the diagnosis. You can’t just say “you have a cyst.” You must give the medical terminology of the name of that cyst. You also must explain the management based on the NICE UK Guidelines or other acceptable standard management procedures that NHS and GMC recognize. A dermoid cyst < 5 cm would be managed surgically by laparoscopy while a dermoid cyst > 5 cm would be managed surgically with open laparotomy. Candidates can’t just say “you will have surgery” in the exam because that’s already been given to you in opening stem. Some who do this are still able to pass if they can at least communicate clearly, but the reason of doing this QBank is not to give you a bare minimum of what you need to pass, rather the standard performance that is expected from someone with clinical experience.

If you are counseling a patient, it should not be a one-way street, in which you give a lecture and the patient marvels at your medical knowledge. This is a clinical skills exam, not a medical knowledge memory exam. Can you help the patient understand the process? Can you alleviate concerns of surgery? The examiners are looking for this. Later, the GMC will analyze the video from your encounter to re-assess if the scores that the examiners have given you actually fit what you have done. While standard medical guidelines are important in counseling, empathetic listening, checking for understanding, and helping the patient see what you know in lay terms is part of your test.

Any treatment, whether surgical or medications, will likely have some adverse effects. Counseling must include that. If a patient is going to have surgery, they need to know how long they will be in pain, if some pain relief will be provided, how soon they can resume regular activities, all these should be part of your counseling session. Answer any questions the patient rises. Don’t ignore the questions, even if you don’t have a standard answer, acknowledge it and say you will research or talk to the seniors about it—or simply state what you know. It’s better to tell the patient that you don’t know the answer than pretend that the patient has not asked you an important question. But it’s even better to know the correct answers. Never give false information to patients.

Counseling will also include any further tests that may be ordered. If a patient has a dermoid cyst and has done an ultrasound, it’s likely that there are biochemical tests that will need to be ordered as well. Ovarian cancer is part of the differential diagnosis and the biomarkers for cancer should be part of the laboratory tests ordered. While an FY2 doctor may not be able to decide ordering these tests without the input of the consultant, they should at least be able to say what the specialist would order based on the findings available so far.

In addition to showing candidates how to solve problems of PLAB 2, going from introduction, history taking, physical examination, and management plan; the QBank also attempts to show what is likely to be the examiners final grading objective for each case. There are mistakes you could make and lose points and there are mistakes you could make and lose the whole station, no matter what else you did right. It may sound harsh or unfair, and certainly some exams, like the USMLE step 2 Clinical Skills and the MCCQE Part 2 of Canada took into account all candidates’ efforts. Generally speaking, not so much in countries where the concept of critical error exists. So, make sure that when you are practicing with your friends or the day before the actual exam, you come back to these critical errors as the succinct summaries of what you will be expected to do in each case.

The PLAB Part 2 is the second part of the PLAB (Professional Linguistics Assessment Board) that evaluates your capability to work as a doctor in the United Kingdom. It is generally taken by medical graduates that didn't finish in the UK.

For you to successfully pass the PLAB Part 2, you should know that the exam is not a test of your ability to regurgitate theoretical medical principles. Instead, it is a test of your practical application of said knowledge in the management of patients.