Tips for PLAB 2 Preparation

How to best prepare for it and what to expect on exam day.

Photo by National Cancer Institute on Unsplash

If you are reading this article, chances are you are done with PLAB 1 and are about to prepare for PLAB 2. Congratulations! If you are looking to gain an overview of PLAB 2 and high-yield resources to supplement your future revision, this article will also be useful for you.

As recommended by trusty seniors, I joined the Aspire Academy (not sponsored) and mainly used their study materials for the bulk of my preparation. Other sources that aided my revision included: Dr. Mo Shoby’s notes (shared by other candidates), Youtube videos and the NHS website.

What is PLAB 2?

It is a practical exam, which is usually undertaken after completing PLAB 1. PLAB 2 is essentially an OSCE (objective structured clinical exam), consisting of different scenarios to simulate cases and consultations that candidates might face at the level of a FY2 doctor when working in the NHS. The exam aims to test the candidate’s ability to apply their clinical knowledge and skills in terms of facilitating patient care according to existing NHS guidelines.

Please be informed that unlike PLAB 1, there are only two exam centers as of date, where both are located in Manchester, United Kingdom.

What to expect on exam day?

Since COVID, the number of test stations have decreased from 18 to 16 stations (two rest stations included), bringing the exam duration of 3 hours and 10 minutes down to 2 hours and 50 minutes. Each candidate is expected to spend 1.5 minutes outside each cubicle to read the task and case notes, followed by 8 minutes inside the cubicle to complete the station. Throughout the exam, a bell is played over a sound system that indicates when the candidate should enter the cubicle, are at the 6-minute mark of their consultation, and when the station has ended.

Please be aware that there are no breaks in between each station, however, there are two rest stations where candidates are allowed to use the loo and help themselves to some water and snacks.

Official PLAB 2 video from GMC

The Grading Criteria

Each station is graded according to three broad components: data gathering, management and interpersonal skills. A maximum of 4 marks is given to each component, adding up to 12 marks per station, and 192 marks in total (16 stations).

Candidates need to pass at least 10 out of 16 stations, and score a total of at least 100 marks to pass PLAB 2. The passing mark for every exam differs (as it is determined based on all of the candidates’ performance on exam day), but it is usually an average of 100 marks, with ± 2 margin.

Preparation strategies, tips and useful links

Before diving into the resources I have used and some personal strategies and notes to aid your PLAB 2 preparation, I think it is only fair to provide you with a general idea of my clinical background and a summary of my PLAB 2 preparation.

My Background & PLAB 2 Story

For some context, I completed PLAB 2 in May 2022, after months of exam cancellations and booking delays due to various travel restrictions in 2021 when the pandemic was at its peak. This means I have been preparing (albeit inconsistently) throughout 2021, during which I was also studying for the MRCS Part A , but that too was delayed (let’s save that story for another time 😉).

As recommended by trusty seniors, I joined Aspire Academy and mainly used their study materials for the bulk of my preparation. Watching videos on Youtube also aided my revision.

I finished going through Aspire’s PLAB 2 book in 2021 (and attended their teaching sessions online). However, serious preparation only began when I attended the academy in-person, where I practiced cases with fellow doctors, and even developed personal strategies to approach different consultation scenarios. This took place in late March 2022, for a duration of around 2 months.

With regards to my clinical experience: I was a fresh graduate when I undertook my PLAB journey, with merely 12 months of pre-graduate internship, did some extra shadowing here and there throughout the clinical years of medical school, and had an expired BLS certificate.😂 In short, my clinical skills were average at best. Still, with the right strategies, I was able to pass the exam comfortably on my first attempt.

Did I doubt my clinical skills? Maybe, as my skills became a little rusty during the pandemic. Was I scared of failing the exam? No. Intimidated? Slightly. After all, it is best not to underestimate any exam.

The Strategy

On exam day, you are expected to face four main types of test stations: History-taking, Examination / Procedure (mannequin), Medical ethics / Counseling and Prescription writing. As PLAB 2 is used to assess the application of your clinical knowledge in different scenarios where you might face them during your practice in the UK, history-taking stations will make up the bulk of your exam; there will be a couple of examination / procedure stations where you are expected to conduct physical examinations or interventions on mannequins; one SimMan station to test your management skills on an acutely ill patient (which is not an actual patient, but a talking mannequin with vitals, palpable pulses, breath and heart sounds); a couple of medical ethics / counseling stations, and one prescription writing station. Please also note that ever since the pandemic, some of these stations might be held over telephone and video-call (i.e., telephonic consultations).

Now that you are aware of the different types of test stations, recognize the need to approach these stations differently. Yes, a structured consultation is still expected, but do not attempt them by blindly following scripts given by academies (a common pitfall observed among candidates who are keen on memorizing and regurgitating questions). The most appropriate approach to PLAB 2 stations is to handle them as though you are seeing a patient at work: calm, professional, empathetic and ensuring the consultation is patient-centered. For that, you are strongly encouraged to develop different structures tailored to each station, and make notes (ideally, if time permits).

For instance, in a station where the patient presents with signs of depression, you would not ask whether they have leg pain, as that is irrelevant to their history. Likewise, if a patient presents with excruciating abdominal pain, you would not offer them lifestyle advice to manage their condition, as that management plan is irrelevant to their presenting complaint (i.e., neither does it resolve the pain nor find out what is the cause). Additionally, in a medical ethics station where a patient refuses a certain medication or procedure, it is not appropriate to approach as though you are taking history from a patient coming in with urinary issues (i.e., a presenting complaint). As you can see, the main aim of developing specific structures to tailor to different stations is to ensure that you are asking relevant questions within a short span of time, as per exam condition. However, as important as it is to have a structured consultation, please be aware that the patient (a trained actor) might interject with their concerns. Depending on the urgency and relevance to their condition, you may either address them directly or mention that you would address them after gathering more information related to their condition.

Although time management is not heavily emphasized, you are strongly encouraged to complete every station within 8 minutes where possible, with examination stations being the exception (since you are expected to take a short history before examining the mannequin). As a rule of thumb, for history-taking stations, try to allocate around 3 to 4 minutes to order relevant tests, carry out management plans and address the patient’s concerns. It is important to ensure that some time is spent on management, as it is part of the grading criteria. For examination stations, try to spend 2 minutes on history-taking (or lesser, depending on the question, such as a teaching scenario), 4 minutes on conducting the physical exam, and 2 minutes on management. Please be informed that some questions might contain specific instructions such as, “spend 2 minutes to talk to the examiner about your differential diagnoses”, hence, ensure your consultation is wrapped up by then.

Personal tips and useful links

Now here’s the juicy bit. 😝 Under this section, you will find useful links and notes that aided my exam preparation, and hopefully yours:

• Academy attended: Aspire Academy, based in Oldham, Manchester, UK.
• Youtube videos for physical examinations and procedure stations: Ankur Garg (one of the lecturers from Aspire Academy), Geeky Medics, OSCE Data-base (PR exam and primary survey), University of Sunderland GP Team (testicular exam) and Nabil Ebraheim (orthopedic exams).
• Youtube videos that enhanced my communication skills and approach to medical ethics and counseling stations: Quesmed, Dr. Aman Arora — Arora Medical Education (e.g., breaking bad news, sign-posting, test result discussion, etc.), FrontLine Communication and Dr Erwin Kwun.
• Resources to determine management and treatment: NHS website — it also contains the conditions’ signs and symptoms, risk factors and possible red flags that hint at a more insidious underlying pathology.
• Youtube videos to refresh my medical knowledge: Osmosis, Zero To Finals, Medicosis Perfectionalis and Dirty Medicine.
• Link to my notes, containing trial and tested approaches and structures tailored to different test stations and presenting complaints, which are ideally used to supplement study materials from Aspire Academy. ⭐️
  I have received feedback that the notes were really helpful to recent candidates’ PLAB 2 prep! 😄

Personal revision tips:

• Do not blindly follow any academy’s study material (i.e., role-play scripts). Develop your own consultation structures based on the test station type and patient’s presenting complaint, and include questions pertinent to the patient’s condition.
• Likewise, do not attempt any consultation without a structure, as you may end up repeating questions, missing out certain important ones and just miss the diagnosis and management completely. I distinctively remember going into one of the telephonic stations on exam day and winged it. Needless to say, that station was a gone case.
• Make notes wherever possible — especially for the management section. It is impossible to cover every single degree of management from acute ones to giving lifestyle advice. Hence, recognize the relevance of each and apply them according to your patient’s condition and needs.
• After creating your consultation structures, put them to the test — practice offline and online with other doctors who are preparing for the exam, ideally with a timer (the PLAB2App was commonly used among candidates at the academy), to mimic test day. If you have the luxury of time, I would advise practicing with doctors from different backgrounds. More often than not, they provide you with lots valuable feedback. Also, having new practice partners is a good way to overcome any form of anxiety or shyness. Constantly putting oneself in such uncomfortable situations makes the exam appear less daunting.
• As you practice with other doctors, pay attention to your tone of voice. It is one of the many forms of non-verbal communication (others include facial expression, gestures and postures) that most of my practice partners tend to overlook. An appropriate tone of voice is essential in establishing clarity and adds meaning to your words — it makes a difference in conveying empathy when you say, “I’m sorry for your loss,” rather than bluntly stating it for the sake of scoring interpersonal (IPS) points. 😅
• When I took the exam, COVID-19 restrictions were still in place, which meant that masks and social distancing were required. If possible, practice your consultations while wearing a mask and consider how you would introduce yourself without shaking the patient’s hand, as well as how you would carry yourself throughout the consultation in general.
• Refer to physical examination and procedure videos prior to practicing them on mannequins. Dedicate a few days (depending on how confident you are with your clinical skills) to familiarize with the equipment, techniques and timing. Have one or two practice partners to provide feedback where possible.
• Being nice is not enough. Being polite is not enough. And unfortunately, inflating your IPS to the moon is not enough to pass PLAB 2. Contrary to the widespread myth I had heard countless times over the course of my exam preparation, PLAB 2 does not test how nice you are to the patient, as this is baseline behavior — you are expected to treat your patients with courtesy and empathy. In reality, the exam is a tool to assess whether you are able to hold a decent consultation (i.e., data gathering during history-taking where appropriate) and whether you are a safe doctor (i.e., proper management plans).

Is it necessary to attend an academy?

I have seen this question making rounds on Facebook groups, and thought it would be a good idea to shed some light after going through the exam myself.

In short: Yes and No.

I have heard of success stories where some candidates were unable to join an academy in-person, but passed the PLAB 2 with flying colors. However, they have several years of clinical experience under their belt, while some of them attended preparatory courses online. A common denominator was these doctors regularly practiced PLAB 2 cases with other candidates (online and face-to-face). If you are a fresh graduate with minimal to 12 months of internship experience, or do not feel confident in your clinical skills, I highly recommend attending an academy in order to get hands-on experience in performing procedures and physical examinations on mannequins. Besides, practicing and learning from other doctors is a very rewarding experience. Some of my most useful revision strategies were developed after interacting with fellow doctors from different parts of the world. Additionally, some academies may provide mocks (with feedback) that simulate test day, for which I highly recommend.

Overall, the PLAB 2 is not a difficult exam. You just have to learn the rules of the game. 😉

Wishing all plabbers the best of luck! 🍀

Love,
Alice

P.S.:
I took PLAB 1 in November 2020. On hindsight, it might not be ideal to write about my preparation strategies (and the revision sources used) for this exam now, as it has been two years. 😅 However, if anyone wants some tips and advice, I am happy to write about my experience in a short blog. Just leave a comment!