During the grueling process of registering with the UK’s General Medical Council, the step which I feared the most was the PLAB 2 exam. You must be aware that it is an OSCE-style exam that consists of stations (including 2 rest stations) in which you have 1 minute 30 seconds to read a task outside the cubicle and the rest of 8 minutes for your patient consultation. Please bear in mind that the timer goes off when you’re outside the cubicle, so every second really does count.
When preparing for PLAB 2 exam, I had tons of questions running through my mind such as “How will I complete a physical examination or a practical procedure in just 8 minutes?”. But now, looking back after that I’ve successfully passed the exam with flying colors I can tell you that, yes 8 minutes is enough and yes you will be able to interact with the simulator as if it is just another patient.
In this blog post, I am going to share with you a general consultation structure/template containing PLAB 2 mnemonics with their questions which you can use for practice purposes. You may tweak this depending on the type of specialty you are dealing with.
Good luck! 🙂
Here’s the Google Drive link for this template/structure: Click here.
|INTRODUCTION||Hello I am Aurang Zaib. I am one of the junior doctors working at this hospital. Could you please confirm your name and date of birth?|
|Alright, Mr. Jacob, what brings you to the hospital today?
*Do not interrupt the patient while they speak, take as much detail as you can*
|COMPLAIN||Could you please tell me more about it?|
|ODIPARA: (SOB, Cough, Dizziness & Vertigo)
· Onset: When did it start? What were you doing when it started? Did it start gradually or suddenly?
· Duration: For how long has it been occurring?
· Intensity: How bad is it? On a scale of 1-10, how severe would you rate your pain?
· Progression: Is it getting better or worse with the passage of time?
· Aggravating and reliving factors: Is there anything that makes your pain better or worse?
· Association: Is there anything other than the pain?
· Site: “Where exactly is the pain?”
· Onset: “When did it start? What were you doing when it started? Did it start gradually or suddenly? / Is it continuous or intermittent?”
· Character: “What kind of pain are you experiencing?” (e.g. sharp, dull, crushing)
· Radiation: “Does the pain move anywhere else?”
· Associated symptoms: “Have you developed any other symptoms?” (e.g. shortness of breath, cough, loss of consciousness)
· Timing: “How long has the chest pain been present?” / Does it occur at any specific time?
· Exacerbating and relieving factors: “Does anything make the pain worse?” “Does anything reduce the pain?”
· Severity: “On a scale of 1-10, how severe would you rate your pain?” (this can be useful later when assessing the impact of treatment)
· Have you taken any medications for it? How much and when? Have they made your pain any better?
|If there is a second complain, explore it similarly|
|DDs (exclude your differentials using relevant questions)||CHEST PAIN
· Fever (Pneumonia/Pericarditis)
· SOB (MI/PE/Asthma/Pneumonia/Pericarditis)
· Chest Pain (ACS/PE/Pneumonia)
· Cough (Pneumonia/TB/PCP)
· Sickness/Vomiting (Gastric problems/Indigestion)
· Any calf pain/Redness/Swelling (Pulmonary Embolism)
· Any rashes (Shingles)
· Any injury (Sports/Exercise/Fall/Musculoskeletal)
|P-2||A: Past Hx. of present complain
B: Associated Risk Factors, Any other past medical history
Have you had any surgeries in the past? If yes, what type of surgery you had? How did it go? Did you have any complications?
|P-3||DESA: (Personal Habits)
· Diet: Could you please quickly walk me through your daily diet?
· Exercise: Do you exercise? If yes, appreciate.
· Smoking (Since when/how much/do you plan on quitting)
· Alcohol (Since when/how much/do you plan on quitting)
· Sexual History (only if relevant): Signpost first: Mr. Jacob, I am going to ask you a few questions which might seem intrusive but they are part of our routine consultation. Are you sexually active? Do you have a stable partner?
· Family History
· Travel History
· Social History (psychosocial) Living alone or with family
· Anything else at all which you would like to mention
· Observation (B.P, PR, RR, Temp, Blood Oxygen Levels)
· Head-to-toe examination (GPE)
· Systemic Examination
|INVESTIGATION||In order to better assess your condition, I would like to order some investigations which include:
· Inflammatory markers (ESR, CRP)
· Blood Electrolytes
· Urine Dipstick
· ECG > tracing of your heart
|Give a summary of your history to your patient
**IPS: Would you like to add anything that I could have missed?
· Do you have any ideas as to what is going on at the moment?
· What’s your biggest worry at the moment regarding what this might be?
· Are you worried about anything in particular? ✔
IPS: Your concern is valid / Why do you think so?
· What do you think might be the best plan of action?
· Is there anything else you were hoping I can do for you?
|PROVISIONAL DIAGNOSIS||State your provisional diagnosis and explain in simple terms:
Thank you Mr. Jacob for being so patient… I can understand that answering so many questions can be overwhelming.
So Mr. Jacob, when I connect the dots from your history, examination, and lab investigations, you might be having a problem with your _________, called __________.
Ø It is a condition involving your ___________
Depending on the condition, any one of the following:
a. The good news is it is a self-limiting condition
b. Unfortunately, it is a long-term condition but don’t worry, we have good treatment options and with necessary lifestyle modifications, this condition can be treated/controlled. Our expert team of doctors would take good care of you.
c. Your condition can worsen / can be life-threatening / can deteriorate anytime. So, we need to admit you.
**IPS: Are you following me, Mr. Jacob?
Does that sound like a plan to you, Mr. Jacob?