Lesson 1.1: The Station Types and the UK Consultation Standard
PLAB 2 is a performance-based OSCE. Nobody cares what you know in your head — they care what you can demonstrate in a room, in front of a patient, in eight minutes. It is formally aligned with the UKMLA Clinical and Professional Skills Assessment (CPSA) framework, and it tests one thing: whether you can behave like a safe, communicative FY2 doctor.
The Ten Station Types
PLAB 2 is not one exam — it is ten types of challenge, each requiring a different approach. Before anything else, know what you are walking into.
| Station Type | What You Do | The Critical Skill |
|---|---|---|
| History Taking | Focused history from a patient presenting with a complaint. | Structure, red flags, ICE |
| Counselling / Explanation | Explain a diagnosis, result, or medication to a patient who already has the information. | Plain language, chunk and check, ICE |
| Combined Station | History + examination + management all in 8 minutes. | Time discipline — the 4-minute rule |
| Breaking Bad News | Deliver serious news using the SPIKES framework. | Respond to emotion before moving to strategy |
| Ethics / Professionalism | Consent, capacity, confidentiality, safeguarding, DNAR, colleague problems. | Balanced reasoning, patient autonomy, GMC principles |
| Angry Patient / Relative | De-escalate and address concerns. | Acknowledge first — never defend while the emotion is still rising |
| Clinical Examination | Systematic examination on a healthy actor (findings are given to you on a card). SimMan stations use a programmable manikin that can display clinical signs. | Systematic technique, running commentary, say what you're examining |
| Practical Procedure | Venepuncture, cannulation, catheterisation, BLS. | Aseptic technique, sharps safety, communicate throughout |
| Emergency / SimMan | Assess and manage an acutely unwell patient (manikin) using ABCDE. | Escalate early via SBAR — rewarded, not penalised |
| Prescribing / Data Interpretation | Interpret an ECG, blood result, or ABG — then communicate or prescribe. | Systematic reading, plain language, allergy check |
The UK Consultation Culture Shift
Most candidates who fail PLAB 2 do not fail because they got the diagnosis wrong. They fail because they consulted in a way that does not meet the UK standard. This is a culture shift — not a knowledge gap.
Patient-centred care
In many healthcare systems, the doctor decides and the patient complies. In UK medicine, the patient is a partner. They have a right to understand what is happening to them, be involved in decisions about their care, and make choices — including choices you personally disagree with.
Telling a patient what to do will lose you marks in every station — even when the clinical decision is correct.
Shared decision-making
Present options. Explain the benefits and risks of each. Find out what matters most to the patient. Decide together.
I'm going to prescribe you ramipril. Take it once a day.
Your blood pressure is higher than we'd like. There are a few options — I'd like to explain them and then we can decide together what feels right for you.
Patient autonomy
A competent adult has the right to refuse any treatment — including life-saving treatment. Your role is to ensure they understand the consequences, check the decision is voluntary, document the conversation, and respect their choice. You do not override it.
ICE — Ideas, Concerns, Expectations
ICE is the most important consultation framework in PLAB 2. Every examiner looks for it. The presenting complaint and the real concern are often completely different things — you will never know unless you ask. ICE should be woven naturally throughout the consultation, not added as a box-ticking exercise at the end.
| Element | What You Are Asking | Why It Matters |
|---|---|---|
| Ideas | What the patient thinks is causing this. | "What do you think might be going on?" — Their theory shapes how you explain. |
| Concerns | What specifically worries them. | "Is there anything in particular you're worried this might be?" — A patient with a cough may be terrified about cancer because their father died of it. You will miss this if you do not ask. |
| Expectations | What they are hoping for today. | "Was there anything you were hoping we could do today?" — Some want a diagnosis; some want reassurance; some want a specific test. |
Common IMG pitfalls
| Pitfall | What to Do Instead |
|---|---|
| Rapid-fire closed questions with no pause | Start open. Let the patient speak for 30–60 seconds. Then narrow down. |
| Paternalistic advice — telling rather than offering | Present options and ask what the patient prefers. |
| Medical jargon throughout | Every clinical term must be translated: 'high blood pressure' not 'hypertension'; 'tests' not 'investigations'. |
| Ignoring emotional cues | When the patient says something emotionally significant — stop, acknowledge it, then continue. |
| ICE bolted on as a checklist at the end | Introduce each element naturally at the moment it fits. |