The Professional and Linguistic Assessments Board (PLAB) test is the main route by which International Medical Graduates (IMGs) demonstrate that they have the necessary skills and knowledge to practice medicine in the UK.
The PLAB test can seem a daunting prospect for candidates, consisting of two parts: Part 1, which is a written examination and Part 2, which is an Objective Structured Clinical Examination (OSCE). The test is conducted by the General Medical Council (GMC) of the United Kingdom.
The PLAB test is set at a similar level to Medical School finals, and the depth and level of revision required to pass are enormous. Candidates are tested on far more than just factual recall and a good understanding of the GMCs ‘Good medical practice’ is also required. A successful candidate will need to demonstrate many attributes, including a commitment to caring for others, the ability to remain calm under pressure and the capacity to make important decisions with limited time available.
What does the PLAB Part 1 cover?
PLAB Part 1 is a computer-based exam that lasts three hours and ten minutes, with a total of 200 questions.
The GMC website gives the following information about what knowledge is required to take the PLAB Part 1 test:
- The exam tests your ability to apply knowledge to the care of patients rather than how well you can remember and recite facts.
- All questions relate to current best practice – answer them in relation to published evidence and not according to your local arrangements.
- Any drugs featured in the exam will be listed in the most recent edition of the British National Formulary (BNF).
- You should be aware of the range of equipment routinely available in UK hospitals.
PLAB Part 1 focuses on important or acute conditions (common in emergency departments) seen by trainees entering the second year of the Foundation Programme (F2), and the management of long-term conditions seen in primary care. It excludes the advanced duties of a general practitioner (GP).
The GMC have created a helpful blueprint for the PLAB test that helps to guide candidates through their revision. It is very important to familiarise yourself with this blueprint before embarking upon your exam preparation, and it can be viewed on the GMC website.
This blueprint sets out the scope and content of the test in terms of the topics, skills and procedures that a doctor who passes the test would need to know and be able to do, and the professional qualities expected of a doctor working in the UK.
For each exam, questions are selected on a wide range of topics from the PLAB blueprint, ensuring a consistent balance of questions in each area for every exam. The skill areas tested in Part 1 are grouped under three main headings:
- Good clinical care: assessment
- Good clinical care: management
- Applying knowledge and experience to clinical practice
The PLAB Part 1 Question Style
The questions in the PLAB Part 1 are single best answer questions (SBAs) in which there is one correct or best answer out of five choices.
Single best answer (SBA) questions require convergent thinking and the ability to come up with a single answer to a set problem. It is relatively easy for an examiner to test higher order thinking, such as application and evaluation of knowledge in this type of question.
Standard format SBA questions usually have three parts:
- A statement or a clinical scenario that the question will be asked about
- The question itself
- The answer options, which will include one single correct answer
The answer options in an SBA will contain one single correct answer and several other distracting options. The question commonly asks for the ‘single most likely diagnosis’ or the ‘most appropriate next management step’. In many SBA questions, several of the answer options are correct, but only one will be the ‘best’ answer.
Within the statement or clinical scenario, there will be many useful clues to point you towards the correct answer. It is worthwhile highlighting or underlining these clues while reading the scenario. Most clinical scenarios will include vital signs, history points, examination findings and/or results of investigations. Some of the questions will contain clinical images, ECGs, X-rays and CT scans.
If time allows, review the questions and answers again after finishing the test, as it is possible that you may have misread some questions on the first attempt. When you are unsure of the answer, it is usually best to stick to your first instinct and not be tempted to change the answer on re-reading.
Here is an example of the sort of SBA question that you might expect to encounter in the PLAB Part 1, with a model answer included:
A 37-year-old man presents with a 6-month history of general malaise and intermittent diarrhoea. His stools have varied between watery and occasionally more solid, but foul smelling and difficult to flush. He also frequently experiences abdominal distension and pain. He denies any history of rectal bleeding but has lost 3 kg in weight unintentionally over the past 6 months. He works as a business analyst and recently returned from a 3-month trip to Thailand. On examination his abdomen is soft, and he has a normal rectal examination. You note the presence of an itchy, vesicular rash on his elbows.
What is the SINGLE most likely diagnosis?
A. Tropical sprue
B. Coeliac disease
D. Ulcerative colitis
E. Crohn’s disease
Answer: B. Coeliac disease
This gentleman has symptoms and signs consistent with a diagnosis of a malabsorption syndrome and has dermatitis herpetiformis present on his elbows, making a diagnosis of coeliac disease most likely in this case.
A diagnosis of coeliac disease should be considered in any patient presenting with:
- Chronic or intermittent diarrhoea
- Sudden or unexpected weight loss
- Persistent or unexplained gastrointestinal symptoms including nausea and vomiting
- Prolonged fatigue (‘tired all the time’)
- Recurrent abdominal pain, cramping or distension
- Unexplained iron-deficiency anaemia
Coeliac disease has a recognised association with numerous conditions including:
- Autoimmune thyroid disease
- Dermatitis herpetiformis
- Type 1 diabetes mellitus
- Selective IgA deficiency
- Sjögren’s syndrome
- Lymphocytic gastritis
The first-choice serological test for coeliac disease is IgA tissue transglutaminase (tTGA), with IgA endomyseal antibodies currently used as a second-line test if the result of the tTGA test is equivocal. A positive serological test warrants a referral to a gastroenterologist for internal biopsy to confirm or exclude the presence of coeliac disease.
Dermatitis herpetiformis is an intensely itchy, vesicular rash, typically present on the extensor surfaces of shoulders, elbows, buttocks and knees. It spares the mucosa. 90% of patients with dermatitis herpetiformis will have celiac disease. Dermatitis herpetiformis is not associated with any other of the options listed above.
Patients with inflammatory bowel disease generally present with a history of diarrhoea mixed with blood and mucus.
Tropical sprue could present in a similar fashion to the history in this case; however the timing of his trip to Asia does not correlate well with the onset of clinical symptoms, and as already mentioned it is not associated with dermatitis herpetiformis.
Giardiasis can cause a chronic malabsorption syndrome; however, this is once again less likely to be the diagnosis in this case.
Preparing for the PLAB PART 1
To gain a full understanding of the topics within the PLAB blueprint takes a great deal of time and candidates should start preparing at least 6 months before the examination. A robust textbook covering each of the areas should be used, and this should form the basis of your initial revision.
Once you have started to get to grip with basics of each topic, it is a good idea to begin to supplement your learning with regular SBA practice using resources such as our website and any of the various SBA question books available.
Try to isolate areas of weakness and concentrate on these areas and spend less time on your areas of strength. It is a good idea to use your performance in SBAs as a benchmark of your knowledge base in each area of the curriculum and use this as a means to support your revision planning. By the time each of you has qualified as a doctor, you will already have sat many exams and developed your own methods for preparing. It is a good idea to keep using the revision methods that you are used to when preparing for this exam. It is crucial not to under-estimate the amount of work that is required and to spend plenty of time preparing!
Thank you to the joint editorial team of www.plabprep.co.uk for this ‘Exam Tips’ post.