The most popular way for International Medical Graduates to show they have the necessary knowledge and skills for UK practice, is to take the Professional and Linguistic Assessments Board (PLAB) test.
The test consists of a medical knowledge exam (Part 1) and a practical clinical exam (Part 2). Before a doctor can book onto the PLAB test, they need to have an acceptable primary medical qualification and meet the standard for English language.
Dr George Kurian is a retired GP, palliative care specialist and medical professionals’ examiner. Here, George tells us about his experience as a Part 2 examiner and shares his top tips for candidates.
I was a GP for 35 years and retired about 3 years ago, but I still work one day a week in a palliative care setting so that I have regular contact with patients. As much as I enjoy working as an examiner, and as a performance assessor for palliative care fitness to practice cases, I became a doctor to help people and I find working at a hospice in North Wales incredibly rewarding. I’ve been there for about 15 years. Not many doctors specialise in palliative medicine, so I find I can put my knowledge and skills to good use.
What advice do you have for candidates about to take Part 2 of the PLAB test?
1. Be yourself – just be a doctor, try not to think of this as an exam, but a busy clinic day.
You have 18 consultations on your clinic list, you have time to have a look over the patient’s notes before each one, and there may be some test results to check too.
You could be seeing a patient or perhaps a relative – this could be the first time they have come in. You may be asked to provide advice for an ongoing condition or you could be asked to speak to a relative about a patient’s care.
Whatever you are faced with, you have eight minutes to complete the task and you will be marked on three areas:
- Domain 1 – Data gathering, technical and assessment skills: covers history taking, physical examination, practical procedures, investigations leading to a diagnosis.
- Domain 2 – Clinical management skills: covers diagnosis, explaining something to the patient, formulating a management plan.
- Domain 3 – Interpersonal skills: covers how the candidate approaches the station – whether they establish a rapport with the patient, how they use open and closed questions, involving the patient in their care and how they demonstrate their professionalism and understanding of ethical principles.
Find out more about how your skills will be tested in the Part 2 exam. This video will give you a good overview of Part 2 of the test and will help you to prepare.
2. Communication is key
In my experience, one of the biggest factors to a candidate’s ability to perform well in the test is their communication skills. This typically comes down to verbal English language skills. There is a requirement to demonstrate English language skills before applying to take the PLAB test. However, some candidates struggle to communicate clearly in the test environment.
If you are struggling to gather information from a patient about their medical history to make a diagnosis or to establish if they understand a particular course of treatment because of your verbal communication skills, this will affect your performance in the practical test.
The role player needs to be able to understand what you are asking of them or telling them. As in a real life situation, the examiners will expect you to make sure the patient understands what you have told them and they know what to expect next.
Sometimes candidates appear to be using stock phrases, which they may have learnt on courses and are just copying, such as ‘everything you tell me will be kept confidential’ or ‘can I ask you a personal question?’
These can sound out of place, insincere and odd if they are just repeated. If the examiner thinks you are using such learned behaviour without interacting with the patient in front of you, you could lose marks.
You need to show that you understand the needs of the patient, relative or colleague and understand their concerns, particularly if you are faced with an emotionally difficult situation, such as a bereaved relative. You need to be able to show compassion and that caring for the person as an individual is of the utmost importance. I think this can be quite difficult for some candidates in the test environment.
This is why I recommend that you practise your English language skills outside of a classroom setting.
You can access sample station scenarios on the GMC’s website to practise your skills before taking the test, and I would advise you find a way to practise your consultation techniques, using your English language skills.
3. Take the time to read the task
It’s really important to take the time to read the task and understand what is expected of you. Make sure you think of how to approach the scenario in terms of the three domains you will be marked on and make sure you cover all three elements for each station.
Read the scenario carefully, including who you are and where you are working, along with the patient, relative or colleague’s details. If the examiner thinks you have misunderstood the task, they will prompt you to refer back to it. If this happens – don’t panic, just take the time to look again and then carry on.
When candidates are given the name of the patient, it’s surprising how many candidates either use the wrong name when they greet the patient or they waste time establishing the patient’s name. Although it seems small, in a real consultation, calling a patient by the wrong name can make them question your professionalism and create an unnecessary barrier. It can also have a similar effect on the role players, causing unnecessary distraction and having the potential to impact on your ability to complete the task in the time allowed.
4. Keep up to date with any changes to the PLAB test
In September 2016, there were a number of changes to Part 2. For example, we extended the number of scenarios (from 14 to 18) and the time for each scenario (from five to eight minutes). The scenarios are more reflective of a patient consultation, rather than just asking a doctor to carry out a procedure. We also now have a stronger focus on the professional values and behaviours expected of doctors working in the UK, across both parts of the PLAB test.
We are also bringing in new time limits. From September 2017, candidates must pass Part 2 within two years of passing Part 1. After passing both parts of PLAB, doctors must have their application for registration with a licence to practise approved within two years.
Also from September 2017, candidates will have a maximum of four attempts at each part of the PLAB test.
The GMC has also launched a consultation with a view to introducing a standard entry test for those wishing to practise medicine in the UK; this test is called The Medical Licensing Assessment (MLA).
The MLA would create a single objective demonstration that doctors entering UK practice have met a common threshold for safe practice. It would give everyone, particularly patients and the public, confidence that doctors – wherever they’ve qualified – have met the same threshold of competence.
What do you like about being a PLAB examiner?
I find it very interesting. I get to meet a diverse range of doctors from all over the world and with that, I get to see varying standards of medical practice. Some are of an exceptionally high quality and others can be poor, with the majority in between. I feel that I am doing a duty to my profession, by assessing the standards of doctors coming to practice in the UK.