In any PLAB 2 station, we often tend to focus on the data gathering domain more than management, therefore reducing the time we have for speaking about the management. It is important to remember that there are only 8 minutes for every station and 3-4 minutes must be spent on every station exclusively talking about management. In this blog I am going to talk about how I improved my management skills which helped me pass the exam.
History Taking Stations:
These are the ones which take up a lot of time in data gathering, and rightly so as we need to be sure of the diagnosis before going ahead. I prioritised the following things in these stations:
Explaining my diagnosis in layman terms
Spending 1 minute in giving an overview of the entire plan of action including baseline investigations, symptomatic and definitive treatment
Always asking their concerns by following the chunk and check method and answering them by providing solutions or explanations. This is really important as it upgrades you from a 1 to a 3 in management and it also might fetch you marks in the IPS domain
Talk about lifestyle modifications, non pharmacological treatment and safety netting. This can take upto a minute if done right. Another way of talking about lifestyle modifications is by signposting it during history taking
Ethical Stations:
The most important thing to remember in an ethical station is that to the point history matters more. Rambling on asking all differentials, past history, socioeconomic history is often irrelevant here. These stations test you if you know the principles of autonomy, beneficience, non- maleficience and justice.
It would definitely help if you go through the GMC ethical guidelines to understand what the expectations are out of you. The commonly tested scenarios are breaking a bad news to the patient or relative, confidentiality, medical errors, angry patients, abuse and culturally competent communication.
To manage breaking bad news stations effectively, establish rapport, assess patient preferences, use clear language, validate emotions, and offer support resources. Maintain professionalism, respect autonomy, and ensure a follow-up plan. Demonstrate empathy, provide information in digestible chunks, and involve family if desired, prioritizing patient well-being and dignity.
In handling treatment refusal stations, begin by understanding the patient's concerns and reasons for refusal. Discuss potential consequences respectfully and offer alternative options, involving family or support services if necessary. Emphasize the importance of informed decision-making and ensure the patient's autonomy while addressing potential risks and benefits.
When managing medical error stations, follow a structured approach. Begin by ensuring patient stability and conducting a system review. If no harm occurred, apologize, reassure, and examine for rectification. If any medical harm has occurred, investigate, treat, and discuss prevention strategies for the condition. Maintain transparency, apologize without blaming the patient, and prioritize patient safety and well-being throughout.
Counselling Stations:
Use the ARMMS approach for counseling in management-focused stations involves providing General Advice, addressing specific Risk Factors, discussing Management options (including Investigations and Medications), considering Multi-disciplinary Team involvement or referrals, and ensuring Safety Netting for the patient.
It emphasizes patient-centred care, structured communication, and empowerment through lifestyle modifications and treatment options. This approach aims to comprehensively address the patient's concerns while promoting collaboration between healthcare providers and the patient for effective management of their condition.
For any station, to be able to score good marks in management the key is to be able to find out key concerns of the patient and address them. Often these are brought by the simulators themselves and we have to focus on what they are saying to understand them.
Have the same calm and composed attitude that you have at the start of the station, and avoid rushing the patients through the management. Having good time management is half the battle won. So keep practicing by timing yourself and good luck!
Need More Help?
If you have any questions related to the exam, I would be happy to answer them at trewlink.com. Find me as an ambassador there.
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