MLACases

[Simple > Intro]

PLAB 2 For Beginners:

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

Consultation Checklist

Attached is a PLAB2Cases Consultation checklist to help you with practising your ‘simple’ medical consultations. I would recommend printing off several copies double-sided and checking them off during your practise sessions. 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 possible permutations in the checklist - but you are not expected to, nor should you, include all of these points in your 8 minute consultation. At this stage in your training you will be expected to be able to handpick the relevant parts whilst simultaneously delivering a fluent consultation.

Regular, consistent practising of consultations should be the cornerstone of your PLAB 2 preparations. You should be practising from day one. This should be 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 only way to build and strengthen those neural pathways. Your weaknesses will autocorrect with consistent practise. This will also keep you on track to make sure that your reading is focused on helping you the most with your consultations.

Make sure you are not one of those people who leave their practise sessions for the later stages of their preparations because they think they need to do more reading first. Be self-aware and pay attention to any rationalisations you tell yourself to avoid active learning.

Practise first, make your mistakes and read afterwards - not the other way around. This is the most efficient “path of least resistance” way to prepare for PLAB 2.

Important 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 counselling stations. 
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 of people 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 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 more an inability to recognise the key themes of a task. This often arises as a result of coming from a disease-centred (or doctor-centred) mind frame as opposed to a patient-centred care mind frame. In other words, using the same “one size fits all” template management plan for all patients who have the same medical condition. The way to use ICE in your management is by utilising linking words such as “you mentioned that” or “you pointed out that” and then addressing them directly.

Lesson Summary

PLAB2Cases Consultation checklist is designed to help you with practising your simple consultations.

PLAB2Cases: Consultation Checklist - Summary of Main Points

GRIPS

• Greet
• Rapport
• Introduce self / Identity check
• Purpose - Blind (How can I help?) | Orientated (3P's).
• Smile

Focused History Taking

• P3MAFTOSA (PMAF) - Presenting complaint | Personal history | Past medical history | Medication history | Allergic history | Family history | Travel history | Occupational history | Social history | Anything else.
• ICE (throughout consultation, respond to cues)
• Effects (ADLs | Work/School | Relationships | Sleep | Mental health | Reading | Leisure activities)
• Summary

Examination

• Basic Observations
• Specific Examinations
• Bed-side tests

Provisional Diagnosis

• Gives suspected diagnosis
• Checks current understanding & Offers explanation
• Gives targeted explanation

Management Plan

• Key Decisions e.g. Admit, Refer, Treat, Reassure, Other Key Decisions.
• Investigations
• Treatment (patient-centered)
• Aftercare (FSL) - Follow up | Safety Netting | Leaflet.
• Anything else?
• Manners