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PLAB- PART 1

How to approach the PLAB examination?

You will have two answer sheets on the day - a purple one for questions 1-100 and a pink one for questions 101-200.

Extended matching questions

Extended matching questions are grouped into themes. Each theme has a heading that tells you what the questions are about.

PLAB

Within each theme there are several numbered items, usually between three and six. These are the questions and the problems you have to solve. There are examples in the next section.
It is recommended that you begin by reading carefully the instruction that precedes the numbered items. The instruction is very similar throughout the paper and typically reads 'For each patient described choose the SINGLE mostappropriate managementfrom the list of options. Each option may

be used once, more than once or not at all. It is recommended that you consider each of the numbered items and decide what you think the answer is. You should then look for that answer in the list of options above the items (each of which is identified by a letter of the alphabet). If you cannot find the answer you have thought of, you should look for the option which, in your opinion, is the best answer to the problem posed.

For each numbered item, you must choose ONE, and only one, of the options. You may feel that there are several possible answers to an item, but you must choose the best one from the option list. If you enter more than one answer on the answer sheet you will gain no mark for the question even though you may have given the right answer along with one or more wrong ones. In each theme there are more options than items, so not all the options will be used as answers. This is why the instruction says that some options may not be used at all. Alternatively a given option may provide the answer to more than one item. For example, for two different patients the most likely diagnosis could be the same. In this case the option would be used more than once.

Single best answer questions

PLAB

We recommend that you consider the scenario and decide what you think the answer is to the PLAB question given at the end, which typically reads 'What is the SINGLE most likely diagnosis?'. You should then look for that answer in the list of options below (each of which is identified by a letter of the alphabet). If you cannot find the answer you have thought of, you should look for the option which, in your opinion, is the best answer to the problem posed. For each question, you must choose ONE, and only one, of the options. You may feel that there are several possible answers, but you must choose the best one from the option list.

If you enter more than one answer on the answer sheet you will gain no mark for the question even though you may have given the right answer along with one or more wrong ones.

PLAB- PART 1 Marking scheme

You will be awarded one mark for each correct answer. Marks are not deducted for incorrect answers nor for failure to answer. The total score on the paper is the number of correct answers given. You should, therefore, attempt all items.

PLAB - PART 2

Clinical examination

PLAB

You will be assessed on your ability to conduct a physical examination of a simulated patient. This will be an actor who has been trained to display signs as and when required. Uncomfortable or intimate examinations will be carried out on an anatomical model. You are not required to speak to the model and will not gain any marks for doing so. You should address any comments to the examiner if the instructions require you to do so. However, you must make sure that you do not perform any actions on an anatomical model that would be unsafe or painful to a real person.

You are expected to be competent to carry out any basic physical examination, such as examination of the abdomen, breast, chest, hand, heart, and joints. You must be able to perform a rectal or bimanual vaginal examination. You must also be able to use the appropriate equipment in carrying out an examination of the ear, eye or nervous system.

Examination of someone's mental state is a form of clinical examination for the purpose of the test. In stations involving a simulated patient, you will be marked on your ability to respect their privacy and dignity, and to attend to their comfort during the examination. You will need to take this into account, while bearing in mind that you have only five minutes for each station.

Practical skills

You will be assessed on your ability to perform common practical procedures. Again, you may be asked to deal with a simulated patient or an anatomical model. You are not required to speak to the model and will not gain any marks for doing so. You should address any comments to the examiner if the instructions require you to do so.

1.
Checking blood pressure Performing venepuncture Inserting a cannula into a peripheral vein Giving intravenous injections Mixing and injecting drugs into an intravenous bag Giving intramuscular and subcutaneous injections
2.
Basic cardio-pulmonary resuscitation (adult and child) Suturing Interpreting an electrocardiogram (ECG), X-rays or results of other investigations Interpreting basic respiratory function tests Performing urinary catheterisation Taking a cervical smear Safe disposal of sharps

Communication skills

Communication skills are tested by observing the interaction between the candidate and another person, usually a simulated patient or the examiner. Your approach to the patient will be assessed all through the examination, but in some stations communication will be the main skill for which you will be awarded marks. This may include

1.
Explaining diagnosis, investigation and treatment
2.
Involving the patient in the decision-making
3.
Communicating with relatives
4.
Communicating with health care professionals
5.
Breaking bad news
6.
Seeking informed consent/clarification for an invasive procedure or obtaining consent for a post-mortem
7.
Dealing with anxious patients or relatives
8.
Giving instructions on discharge
9.
Giving advice on lifestyle, health promotion or risk factors

While all stations last five minutes and you are assessed on your interaction with simulated patients, they do not suggest that tasks such as breaking bad news would be completed within five minutes in the clinical environment. You will be marked on what you complete within the five minutes. The examiners will be considering

Approach to the patient

You should:

1.
Introduce yourself and explain or clarify the purpose of the consultation
2.
Be polite, respectful, non-judgmental and maintain the patient's dignity
3.
Be empathic and acknowledge the patient's emotions or concerns and show sensitivity to potential pain

Listening and questioning

You should:

1.
Listen attentively to the patient's symptoms and concerns, use clear language and question at a comfortable pace, refraining from interrogative questioning
2.
Take any necessary steps to clarify or check information and summaries understanding

Explaining and advising

You should:

1.
Check what the patient already knows and wants to know
2.
Explain clearly at a level of detail and pace that the patient can follow, checking at intervals if the patient is understanding or has any questions
3.
Offer appropriate reassurance and handle any uncertainty well, whilst refraining from false or premature reassurance
4.
Not alarm the patient unnecessarily and be able to explain clearly the need for urgent action when indicated
5.
Demonstrate attempts to check the patient has understood

Involving patient in management

You should:

1.
Respect patient autonomy and help the patient to make a decision based on available information and advice. This includes explaining skills as above
2.
Explain information and its implications clearly including benefits, risks and options such that the patient is in a position to make informed decisions
3.
void coercing the patient or showing irritation
4.
Check the patient's understanding and feelings about the information
5.
Summarise any decision

History taking

You should be able to take an accurate history from the patient, and make a reasoned diagnosis if required. In any case, you will be expected to assess the patient's problem concisely and reasonably. The following are examples of symptoms with which patients may present: Diarrhoea, Wheezing, Vaginal bleeding, Palpitations, Abdominal pain, Headache, Anxiety Weight loss, Joint pain, Difficulty in swallowing, Episodes of loss of consciousness.

How to prepare?

The OSCE is assessing your skills rather than your knowledge. You have demonstrated that you know how to apply your clinical knowledge by passing Part 1 of the test. In the OSCE, you must show the examiner that you could perform the tasks competently in practice in an NHS hospital. Although you will be marked down for communicating incorrect facts and advice, you should concentrate on showing the examiner how you perform clinical tasks and interact with patients. Remember that you are being tested at the level of a doctor who has qualified and completed one year of clinical practice.

How to approach the OSCE?

PLAB

An actor, who has been provided with a detailed script beforehand, plays the patient. The examiner will observe you and will not intervene, except in very limited circumstances. You have one minute before entering the station to read the instructions. You must clean your hands thoroughly using the alcohol gel outside the station at this point. Hygiene is an extremely important

issue in NHS hospitals. You may be asked to examine a patient, take a history and give a diagnosis, or to carry out a practical procedure. The instructions also give basic information about the patient, such as name, age and major symptoms. You will be given full and clear directions on the day about what you have to do. Each station lasts five minutes, and there will be one minute between stations. The stations will be numbered clearly and staff will be there to help you move from station to station. The Chief Invigilator (the senior examiner on the day) will observe the exam remotely through a camera system. Each station has two cameras installed to allow observation, reducing the need for observers to enter and sit in stations. The cameras do not record the exam and therefore cannot be used to review the exam afterwards.

Marking scheme and standard setting

Each station has a number of objectives, such as past history, technique, and diagnosis. You will not see what the objectives are, but they will be on the examiner's mark sheet. The examiner awards a grade between A and E for each objective. The examiner also gives a judgment of each candidate's overall performance as Pass, Borderline or Fail. Each objective is weighted, with the total weightings for each station adding up to 100%. The examiner is not aware of the weightings for the station. An overall score is calculated for each station.

Standard setting

The passing score for each station and for the exam is set using the Borderline Group Scoring method, where they identify the mean score for each station from a number of previous candidates who have been given an overall judgement of borderline. They add the scores for each station plus one standard error of measurement to determine the total score. To meet the minimum standard required in each exam, candidates must meet or exceed the total score and achieve the passing score in a minimum of nine stations. Candidates must meet both criteria to be successful. The Borderline Group Scoring method is an internationally recognised method of standard setting and it ensures that exams are of a consistent standard over time

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