MY PLAB Part 2 Journey (EXAM day)

I travelled to Manchester, the day before the exam and stayed in a hotel that night. I tried to do some revision but was too nervous and stressed to study anything. The next morning was the day of the exam, and I was even more nervous. I wore a corporate pant suit, with sleeves rolled up according to GMC guidelines. I met some other doctor at the centre who had come from all over the world including Nigeria, Dubai, Saudi Arabia, India and Pakistan. I sat down with some of the doctors while waiting for the exam and most of them were just as nervous as me. We all knew we had tried our best in preparations but didn’t know what to expect with the exam.

We were finally called in to the waiting room where we were briefed by the supervisor who was also a consultant. Her words were very soothing. She encouraged us to be confident and put our best into every station. She also made us know that there was no fixed percentage on who would pass and that a 100% pass rate was possible if we all scored above the average point which is usually decided by a metric, the details of which I cannot remember now. She re-assured us that we should never feel that we’ve failed a station as many times people surprisingly do well on the stations, they think they’ve failed and sometimes the opposite happens. She encouraged us to not dwell on previous stations but treat every station as if it was brand new. I held to this advice firmly and shortly after, we were all arranged in front of our respective starting stations.

I didn’t realize we were supposed to start reading the cues and waited for the bell to ring first after which I saw everyone entering into the stations. I quickly took about 10 seconds to catch a glimpse of what was written on the cue card and realized it was station where I had to give advice to a parent whose child had been diagnosed with epilepsy. It was one of the stations I had practiced several times, so I had no difficulties with the station. I had very good rapport with the actress and even made her laugh a bit while counselling her. I forgot to add a few tips about avoiding bright lights and excessive screen time but everything else was covered for the most part (Score- 11/12).

I went on to the next station which was about a teenager who was having missed 2 months of missed menstruation. It was a teenage pregnancy scenario, and I did quite well on it although I forgot to suggest counselling/support for the patient possibly in conjunction with her parents as she was quite stressed about how her parents would react. (Score- 11/12).

The next station was to give advice to a mother who needed advice about her autistic child. I don’t know why I struggled a lot to create rapport in this station, but I know I could have done better in this regard. Perhaps this was because it was the first phone call station I had encountered (Score- 9/12). After that was a station with a patient who had a mole, with a positive family history of melanoma. I was biased due to the positive family history and quickly went along to counsel the patient on treatment options for melanoma although I did stress the fact that further investigation would be needed. I later found out it was actually a case of subacute keratosis which I would have known if I had taken my time to properly look at the image provided (Score- 3/12).

The fifth station was a Sim-man station which I did very badly in. I didn’t realize that the IV fluids and everything else I needed were in the drawer next to me. I could see the examiner, wanting to help me out but resisting as this wasn’t allowed. I gave the patient the Oxygen mask as he was de-saturating, did a general examination then went on to verbally state what I would have done if I knew where to get the IV fluids and other equipment (score- 4/12). Following that was a teaching station where I had to demonstrate testicular examination to a medical student, and I did quite well for the most part although I only asked the medical student if he had questions towards the end of the station and didn’t have enough time to provide answers to the questions he asked (Score- 8/12).

The seventh station was a sick note station for a woman who wasn’t sick. The whole essence of the station was not to give the sick note to this patient, and although I didn’t, it got really frustrating as the actress was very persistent and a bit annoying, talking a lot, and taking a lot of time from the 8 minutes I had but this was simply her doing her job (Score- 6/12) . The next station was a psychiatric station for a patient who was experiencing delusions of guilt. I did extremely well in this station, establishing rapport and calming the patient down while explaining his diagnosis to him, hence it was one station that I was pretty sure I would get a perfect 12 and I did.

The next station was about explaining palliative care to the daughter of a patient who had dementia. I didn’t do well in this station as I forgot to offer the patient the option of care homes or at home care with a live in/visiting carer. In fact, when the actress asked me if she could take the patient home, probably in an effort to nudge me in the right direction, I still didn’t get the hint and instead, I insisted that the patient had to remain in the hospital to receive palliative care so yes, I failed that station (score- 3/12). The 10th station was for a patient receiving pre-operative assessment. I went through all the motions, asking the right questions and giving proper advice but I couldn’t help but notice that the patient was very apathetic, I wondered if I had missed something in that station. Could I have asked about depressive symptoms? I asked other doctors after the exam, and they were just as perplexed as me claiming that the actor behaved the same way with them (Score- 8/12).

After that, there was a hypothyroidism (Score- 8/12) and a medical error (Score- 11/12) station which were quite basic and straight forward. The next station was for a patient whose blood results I had to review and give a diagnosis and management plan. He clearly had anaemia but for whatever reason, I forgot to check the MCV and just assumed that he had iron deficiency anaemia. I gave a general management plan for anaemia and counselled him on his drinking habits. I later found out that he’s MCV was about 107 so it was a case of Macrocytic Anaemia (I still scored 8/12 in this station though).

The 14th station was quite basic, it was a patient who had severe nausea and vomiting post-op. He didn’t have an IV cannula and needed anti-emetics. After getting this information from a very quick clerking session, I immediately proceeded to do the IV cannulation going straight for the large vein in the mannequin's cubital fossa. I requested a re-start of the patients IV fluids as well as IV metoclopramide. The examiner looked pleased. This was the second station I got a perfect 12 in. A lot of my colleagues struggled in this station as they spent an unnecessary amount of time clerking the patient's reasons for admission when this was irrelevant, and the purpose of the station was simple IV cannulation and management of emesis.

The last station threw me off quite significantly. The cue card stated that the patient had been on long term omeprazole, so I assumed this was probably gastric related. Hence, I went into this station looking more at GIT related symptoms. When the patient complained about shortness of breath, I thought about GI bleeding and Anaemia as opposed to several other respiratory and cardiac causes. I guess that was the purpose of the cue card, to throw us off. Fortunately, I requested a chest x-ray among my investigations and the patient handed over to me an x-ray which revealed cardiomegaly and very obvious signs of fluid overload. I screamed Congestive cardiac failure in my mind and quickly had to start scaling back on everything I had said previously. I gave her the management plan for Cardiac failure and asked if she had pedal oedema to which she said yes. I mentioned furosemide just before time was up (Score- 6/12). This was the very last station, and I was severely exhausted after the exam.

I was not confident about my performance at all and wondered when the next PLAB 2 seats would be coming out. One unique thing I observed was that there was no doctor I met who was confident about how the exam went. We all looked drained, exhausted and unsure of what the results would be. One thing I was sure of was that I had done my best. I went home that day and tried to forget about the exam and in the following weeks, I patiently and frightfully waited for the results. Throughout the 4 weeks of waiting, I would go over all the scenarios, scoring myself and guessing what my score would be and if it would be enough to pass.

Mid July, the results were out, and I kept procrastinating, as I was too terrified to check the results. My mom called me at about 11pm asking if I had seen the results and she pressured me to check. I reluctantly went to the website to check the results, and God had done it, not only did I pass but I scored a total of 119 when the passing mark required was a 96. I was so happy and relieved. I cried and laughed at the same time, sang and prayed, jumped and danced. This was the end of my PLAB journey, one I had planned before I went to medical school and started in January 2020.