PLAB 2 For Beginners: All-In-One Approach - [Updated] MLACases Consultation Checklist (Downloadable PDF)

MLACases

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PLAB 2 For Beginners:

All-In-One Approach - The 'Simple' Consultation

Consultation Checklist



MLACases - Consultation Checklist - Dr Hashim.pdf

Attached is the MLACases Consultation Checklist to help you with practising your ‘simple’ (as defined in this curriculum) medical consultations. Best used in groups of three where you take it in turns to be the doctor, patient and the examiner.

Caution: I have included all the details and permutations in the checklist - but you are not expected to, nor should you, include all points in your 8 minute consultation. At this stage in your training you are expected to be able to prioritise the most relevant parts in real-time, whilst simultaneously delivering a fluent consultation.

Consistent practise should be the cornerstone of your PLAB 2 preparations. You should be practising from day one, ideally under timed conditions with an 8-minute timer (and 6-minute bell) to make sure you develop good time management habits from the beginning.

This is the best way to build and strengthen those neural pathways - most of your weaknesses will autocorrect by themselves with consistent practise. It will also keep you on track to make sure that your reading is finely tuned to helping you with what matters the most - your performance during actual consultations.

I would recommend against leaving your practise sessions for the later stages of your preparations (for example because you think you might need to do more reading first) - This is a common pattern I've observed in people who fail the exam. By passing PLAB 1, you have already demonstrated that you have the baseline level of medical knowledge required to know what to do. Now you need demonstrate that you know how to do it. The best way to learn this is of course by 'doing'. Be aware of any rationalisations you might tell yourself to avoid active learning. I would encourage you to try practising first, making your mistakes early, and reading afterwards - not the other way around. This is what we've found to be the most efficient way to prepare for this exam. Generally, the earlier you start active learning, the better the final result.

Note on Time Management:

PLAB 2 is a time-pressured exam. You have 8 minutes to complete your data gathering, and to manage the issues that you've identified.

Successful time management often depends not on how fast you operate, but on how well you prioritise. The goal of course is not to rush or cram a rigid checklist into every station, but to ensure you allocate time and depth to different topics based on their relevance and importance for that particular task, and for the particular patient that is in front you.

Good time management starts with focused, efficient data gathering.

Ensuring your data gathering is focused and efficient is the only way to ensure you complete your history and examinations effectively within a sensible timeframe - and to leave you adequate time to collect your marks in management. This is a common sticking point I encounter when coaching PLAB 2 candidates - and of course it's usually those who haven't been practising under timed conditions.

That said, even if time is tight, for most cases, you can still deliver a solid management plan (in about 90 seconds) with a very simple exam technique:

1. Summarise the key points first.
2. Avoid getting stuck in one thing.
3. Then add extra details if time allows.

I would recommend practising giving an overview of your management plan within a 90 second timeframe. This is usually enough time to provide the examiner evidence that you have understood what all of the main issues are in a particular task, and what needs to be done to solve them. By 'planting the seed' for each key management point, the examiner can be more confident that you were headed in the right direction.

You can find me me demonstrating this simple technique here and here.

This approach is particularly useful in Combined stations (where you need to perform an examination as well) and Psychiatry stations (can be quite wordy) - these stations are typically where candidates find themselves with little time left in management.

Side note: The same concept can also be applied to the beginning of Teaching stations - by giving a brief overview of the topics you intend to discuss in your lesson. This way, you still show the examiner (and the student) how you planned on structuring your lesson if you were to run out of time later. Prescription stations are also very time-sensitive. Time management in these stations is addressed in the Prescription Tutorial.



Note on ICE:

ICE = most commonly misunderstood part of data gathering by PLAB 2 candidates.

3 “ICE” mistakes to avoid:

  1. Does not ask ICE when they should - You get a general sense when ICE is most important and this will improve with experience. But generally speaking, it should be a staple in any emotion-based stations (BBN, Medical error, Angry) or any counselling-type station (where they often present with a component of ICE).
  2. Asks ICE but asks it improperly (position, execution) - ICE is often used in a formulaic way that comes across as strange rather than integrating into the consultation in a natural way. One good way to minimise this is to use ICE flexibly in a position that feels most natural, which often is where you get a patient cue or where the patient already brings up one of the components of ICE. A nice trick is also to avoid using the exact terms “ideas”, “concerns” and “expectations” themselves and instead use alternatives like “thoughts”, “worries” and “hopes". Generally, the more natural & flexible you are and the more you are able to adapt to the patient, the more you are likely to impress the examiners.
  3. Asks ICE but does not use it - The third group are those who ask ICE to "tick a box" because they were advised to do so, but do not fully understand it’s relevance or importance (or forget it) and so do not later address it in their management. In some ways, this is worse than the first group because we are all human and forget things. But when a doctor is presented with a significant issue that needs managing but then doesn't address it, it can highlight an inability to manage patients holistically. This often arises as a result of coming from a disease-centred (or 'doctor-centred') mind frame, as opposed to a a patient-centred one that takes into account all components of the biopsychosocial model. For example, issuing a “one size fits all” template management plan for all patients with the same medical condition. One way to use ICE in your management is by utilising linking words such as “you mentioned that...”, “you pointed out that...”, "in terms of...", "regarding..." and then addressing them directly.


Take Dr Hashim's PLAB 2 Beginners Quiz


How Many Can You Get Right?


Lesson Summary

MLACases Consultation Checklist for 'Simple' Medical Consultations - Summary of Main Points:

Data Gathering:

  • GRIPS
    • Greet
    • Rapport
    • Introduce Self / Identity Check
    • Purpose
      • Blind (How can I help?)
      • Orientated (3P's)
    • Smile
  • Focused History Taking (BPS model)
    • P3MAF
      • Presenting Complaint (History of)
      • Personal History (+/-)
      • Past Medical History | Medication History | Allergic History | Family History
    • Social
      • Life Style (SADES)
      • Life Situation
      • Life Effects
    • ICE
      • Wherever is most natural to ask (respond to patient cues)
    • Summary
  • Physical Examination
    • Basic Observations
    • Specific Examinations
    • Bedside Tests


Clinical Management:

  • Impression / Provisional Diagnosis / Clinical Diagnosis
    • Gives Differential, Suspected or Confirmed Diagnosis
      • Checks Current Understanding
      • Offers Explanation
      • Gives Targeted Explanation
  • Patient-Centered Management Plan
    • Key Decisions
      • e.g. Admit, Refer, Treat, Reassure, Other Key Decisions
    • Investigations
      • Bloods, Specimens, Imaging, Invasive Procedures / Biopsies
    • Treatment & Advice
      • e.g. Conservative, Medical, Surgical (Explore Preferences)
      • General Self-Care Measures
    • Aftercare (FSL)
      • Follow up | Safety Netting | Leaflet
    • Re-Check Expectations
    • Manners

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