Lesson 5.1: How Examination Stations Work — and How to Score in Them
What Actually Happens in a PLAB 2 Examination Station
- You examine a healthy actor. There are no real physical signs to detect.
- The examination is about demonstrating correct, systematic technique, not finding clinical signs.
- The examiner hands you a written card with findings only after you clearly verbalise each step.
- You then interpret those findings, present them to the examiner, and explain them to the patient.
- Marks come from: technique, running commentary, correct interpretation, plain-language explanation to the patient, and appropriate next steps.
If you are vague, 'I'd like to examine you', the examiner may not hand you any findings at all. You must say exactly what you are examining for each step.
The Universal Opening Sequence — Before Every Examination
- Wash or gel hands visibly: "I'm just going to clean my hands."
- Introduce: "I'm Dr [X], one of the junior doctors here today."
- Confirm identity: "Could I check your name and date of birth?"
- Explain and obtain consent: "I'd like to examine your [heart/chest/abdomen] — is that okay?"
- Offer a chaperone if intimate: "As this involves an intimate examination, I'll have a chaperone present — is that alright?" If declined: "That's absolutely fine. I'll note you're comfortable proceeding without one."
- Position and expose: 45 degrees for cardiac/respiratory; lying flat for abdomen. 'I'm going to need to expose your chest — I'll keep you covered as much as possible.'
- Ask about pain first: "Do you have any pain anywhere I should know about before I start?"
Say Exactly What You Are Examining
Use specific language for each step, this is what triggers the examiner to hand you findings.
| Symptom / Scenario | What to Say |
|---|---|
| Headache | "I'd like to check the nerves in your head and neck, and examine your eyes." |
| Chest pain / breathlessness | "I'd like to examine your chest and listen to your heart and lungs." |
| Abdominal pain | "I'd like to examine your abdomen." |
| Back pain or leg weakness | "I'd like to examine your lower back and legs." |
| Jaundice | "I'd like to examine your eyes and feel your abdomen, particularly your liver." |
| Palpitations / irregular pulse | "I'd like to listen to your heart and check your pulse." |
| Leg swelling | "I'd like to examine your legs for signs of swelling and check the circulation." |
| Joint pain | "I'd like to examine the affected joint and do a brief overall mobility check." |
Bedside Tests — Request These Out Loud During the Examination
These are part of the examination phase, not management. Say them aloud, the examiner will hand you the result. Do not request blood tests or imaging at this stage.
| Scenario | What to Say |
|---|---|
| Suspected UTI / renal symptoms | "I'd like to check your urine using a dipstick test." |
| Possible pregnancy (woman of reproductive age) | "I'd like to do a quick pregnancy test — is that alright?" |
| Chest pain or palpitations | "I'd like to perform an ECG — a heart tracing — to check your heart rhythm." |
| Suspected diabetes or hypoglycaemia | "I'd like to check your blood sugar with a small fingerprick test." |
| Breathlessness / asthma | "I'd like to measure your peak flow — your maximum breathing speed." |
| Any unwell patient | "I'd like to check your oxygen level with a probe on your finger — completely painless." |
When Findings Are Handed to You
The examiner will hand you a card with written findings after you have verbalised the relevant examination step. This is the moment to:
- Pause — take a moment to read the card carefully.
- Acknowledge it briefly to the patient: 'Let me just check what we've found.'
- Explain the findings to the patient in plain language. Do not read the clinical term back to them.
- Present the findings to the examiner with a brief differential and what you would like to do next.
| Finding on Card | What to Say to the Patient |
|---|---|
| High temperature | "You seem to have a raised temperature today." |
| Crackles in lungs | "There are some abnormal sounds in your chest when you breathe." |
| Wheeze | "I can hear a slight whistling sound when you breathe out." |
| Reduced breath sounds on one side | "The breath sounds are a little quieter on this side." |
| Dullness to percussion | "When I tap your chest, the sound is different on this side." |
| Displaced apex beat | "The main pumping point of your heart seems slightly further to the left than usual." |
| Elevated JVP | "One of the blood vessels in your neck appears more prominent than usual." |
| Pitting ankle oedema | "There is some fluid collecting in your ankles and lower legs." |
| Hepatomegaly | "Your liver seems slightly larger than usual." |
| Reduced power in a limb | "Your strength on this side is slightly less than the other side." |
| Lymphadenopathy | "Some of the glands in your [neck/armpit] are slightly enlarged." |
Never use clinical terms like 'crepitations', 'rhonchi', or 'hepatosplenomegaly' when speaking to the patient. If you say a clinical word, immediately follow it with a plain-language explanation.
Running Commentary — Getting the Balance Right
| What It Looks Like | Impact | |
|---|---|---|
| Too silent | No narration, examiner cannot follow the examination. | May receive no findings; loses Data Gathering marks |
| Too much | Narrating every minor step in full, sounds rehearsed, wastes time. | Runs over time |
| Just right | One sentence per manoeuvre: 'I'm palpating the abdomen in all four quadrants, starting away from the area of pain...' | Scores in both Data Gathering and IPS |
Presenting Your Findings to the Examiner
- State whether the examination was normal or abnormal overall.
- Lead with the most important positive finding.
- Add relevant negatives, not every negative, just clinically significant ones.
- State your differential: 'The findings are most consistent with...'
- State your next step: investigation or immediate management.
'On examination, the chest is clear on the right. On the left there is dullness to percussion and absent breath sounds at the base, with reduced vocal resonance. The trachea is central. This is consistent with a left pleural effusion. I would like to arrange a chest X-ray and refer for further assessment.'
Examiner Interaction and Telephone Stations
- Treat the examiner as invisible, do not look to them for approval or cues during the examination.
- If handed a findings card: take it, read it, then explain findings to the patient.
- Never ask 'Am I doing this right?' — stay in character throughout.
- Telephone stations, if you cannot examine: "If you were here with me, I would examine your chest and listen to your heart and lungs." Ask the patient to describe what they can observe about themselves.
Time Management
| Station Type | Time Split |
|---|---|
| History + examination + management | 3 min history → 2 min examination → 3 min management |
| Examination + management only | 4 min examination → 4 min management |
| Pure examination (present to examiner) | 6–7 min thorough examination → 1–2 min presentation |
| Examination + explain findings to patient | 5 min examination → 3 min explanation |