Ever wondered what’s involved in being a Professional and Linguistic Assessments Board (PLAB) examiner? Dr Anna-Maria Rollin shares her experience of the important role, based at the GMC’s Clinical Assessment Centre in Manchester.

The majority of graduate doctors with international medical qualifications who wish to register with the GMC take the PLAB test as part of their application. Making sure that those applying to join the medical register meet the high standards required in the UK is a vital and fundamental part of the GMC’s role.

Dr Anna-Maria Rollin
Dr Anna-Maria Rollin

Overseas doctors are really important to the NHS. I’ve spent my life working in a district general hospital and know they are the mainstay of many departments.

It’s vital to recognise and appreciate this contribution, but as a PLAB examiner, I have a responsibility to help make sure that those who go onto train and work in the UK meet the right standard.

Ultimately it’s about making sure patients are safe. Afterall, soon after a candidate has passed, they could be helping to look after someone’s granny.

Clinical Acumen

When a doctor arrives to take the PLAB part 2 OSCE (objective structural clinical examination) they already have a medical qualification and have passed a GMC clinical knowledge exam (PLAB part 1). They have also been tested on their English language. What we’re examining, in so far as possible, is their clinical acumen and patient communication skills.

This is done through clinical scenarios called stations. Each is laid out with a different clinical task and candidates rotate through them. There are 16 in total, and they each last five minutes. There are 14 stations that the candidates receive a score for and there are two stations we are piloting and testing out for future exams.

To make the stations realistic, actors come in to role-play a script at some and we use a patient simulator at others. Examiners have time to talk to the actors before the exam to help them be realistic and consistent in their responses and ensuring they understand the importance of explaining how much a gallstone would really hurt, for example, or where a something is located on the body.

The simulator is controlled remotely and can do things like have an asthma attack. I was the first examiner to run a station when we began piloting the patient simulator and the reaction from the candidates was interesting. Some approached him like a human, others didn’t know what to make of him.

Patient Simulator  in a PLAB exam
The clinical scenarios PLAB candidates face often involve a patient simulator. “Some approached him like a human, others didn’t know what to make of him.”


Making sure standards don’t slip

As an examiner, we aren’t out to fail people but we have to mark what we see as the doctor’s best shot at performing a task. Of course we are aware that some candidates are nervous or have travelled a long way but as a doctor you have to perform regardless of the circumstances.

Examiners have minimal communication with candidates, as you’d expect. I only speak to individuals during a task to direct them back to their instructions if they are way off target. You get different reactions to that. Some candidates re-read their instructions and correct themselves immediately, others still don’t grasp what is being asked of them.

That’s when you feel you are making a difference and helping to make sure standards don’t slip. The majority of doctors taking PLAB are just at the beginning of their careers but they must have the right knowledge base and alarm system. We look to see that they are competent, but also that they know when to call on a senior for help.

I’d encourage other doctors to consider becoming an examiner. We need younger doctors to be involved and more women too. Further to making a contribution to patient safety, being involved helps with CPD. Examining has required me to refresh my generalist skills, like correctly examining a knee. I’ve also gained insight into overseas medical convention and training and that’s interesting to me because I’ve always been involved in training in the UK.

An independently-led review, which was commissioned by the GMC as part of a longstanding and ongoing programme of review and evaluation of the Professional and Linguistic Assessments Board (PLAB) test, was published in September 2014 [PDF].

All of its recommendations were welcomed and accepted by the GMC, one of which suggested more female examiners should be recruited. A report on the progress of the recommendations will be published in 2016.
Doctors who are interested in becoming a PLAB examiner can register their interest by emailing associateservices@gmc-uk.org