Part 2 Guidance

How to apply

1. Where

You can only take Part 2 at the GMC Clinical Assessment Centre in London, UK.

2. When

Part 2 is held on the basis of demand. Forthcoming exam dates are shown on our Test dates page and available places are shown in MyGMC.

3. To book online

You must apply online if you are able to do so. If you have a disability which prevents you from doing so, or if you are a refugee who does not possess a credit or debit card, please contact us.

To book online you must login to MyGMC. To do this you will need your GMC reference number, and your MyGMC PIN and password. You were given these when you booked PLAB Part 1.

Log in to MyGMC (opens in a new window).

If you have forgotten your GMC reference number, or if you were never issued a PIN and password, please contact us.

The availability of place 2 places are outlined in the My PLAB section of MyGMC. Places occasionally become available in a previously full exam when someone cancels a place. When this occurs it is clearly shown and you may want to check the My PLAB section of MyGMC regularly in case a place becomes available in an earlier exam.

To complete your booking you will need to choose a test date and proceed to the payment section and enter the details of your valid credit or debit card (VISA, MasterCard, VISA Delta or Maestro).

Once you have entered all the information required and paid your fee, you will receive an immediate confirmation of your booking. You must bring a copy of this email to your examination.

4. If you cannot book online

You should contact us and we will send an application form to you.

5. Fees

The booking fee for Part 2 is £430.

6. If you are a refugee doctor

If you are a refugee doctor living in the UK, you can claim a reduced fee. But you must pay the full amount, and then claim the refund. See Refugee doctors living in the UK.

7. If you have a disability

If you have a disability, we may be able to make reasonable adjustments to the examination. We will not make adjustments to the standard of the examination but may be able to make adjustments to the arrangements if you have mobility difficulties or visual impairment for example. If you would like us to consider making reasonable adjustments, please let us know as soon as possible. If you delay in telling us we may not be able to make the reasonable adjustments in time for the date of your examination. Please contact us.

You can find details about the process for reasonable adjustments in the Examination Regulations.

You may find it helpful to contact the Equality and Human Rights Commission (external website).

Temporary circumstances that might affect your performance in the test, such as illness, pregnancy or bereavement, will not be taken into account. This is because examinations are held frequently and we would expect you to cancel and book a later place. Under these circumstances, you may be entitled to a refund.

8. How to cancel

You can cancel your place online by logging in to MyGMC with your GMC reference number, PIN and password. You will automatically be charged the relevant cancellation fee. The remainder of your fee will be credited to the credit or debit card you used when booking your place or a cheque will be sent to your address if you did not pay by credit or debit card.

If you cannot use the online system, you can download a cancellation form (189kb, pdf).

If you want to change the date of your examination you must first cancel your place, pay the cancellation fee and book again. The following cancellation fees apply:

Period of notice	Cancellation Fee
Four months or more	£258
Between 21 days and four months	£301
Less than 21 days	£430

 

If you cannot attend the examination because of serious illness or another overwhelming problem, you must provide the following evidence:

• Illness – medical certificate or letter on appropriate headed paper covering the day of the examination
• Death or serious injury of family member – death/medical certificate
• Immigration difficulties, such as refusal of visa – a letter from the Home Office
• Any other difficulty you could not have foreseen – a letter of explanation (for example, from an employer)

Every document must be an original. We cannot accept photocopies.

What is involved

9. Format

Part 2 is an Objective Structured Clinical Examination (OSCE). It takes the form of 14 clinical scenarios or ‘stations' as well as a rest station and one or more pilot stations. A pilot station is one where we are checking whether the station can be used in future examinations. Your mark for this station will not count towards your result. It is important, however, that all candidates complete the station because without the information gained from this we cannot evaluate the station properly. For this reason we do not reveal which is the pilot station.

Each station lasts five minutes.

10. Level

The PLAB test is designed to test your ability to practise safely as a junior doctor (former senior house officer (SHO)) in a first appointment in a UK hospital. It is set at the level expected at the end of Foundation Year One. You can find out more about the Foundation Programme on the NHS Modernising Medical Careers website. Setting the standard at this point means that in the OSCE you must show that you are capable of performing the clinical and communication skills expected of a doctor who has had one year of clinical experience following graduation. The examiners will assess whether you are able to use your knowledge and skills appropriately.

11. Content

The PLAB test is designed to test the knowledge, skills and behaviour relating to conditions commonly seen by trainees entering the second year of the Foundation Programme (former first year SHOs), the management of life-threatening situations and rarer, but important, medical problems. Any advice you give during the examination must be accurate but you should remember that the OSCE is a test of skill rather than of knowledge.

You will not be expected to be familiar with NHS procedures or British culture other than in the way it might affect how you treat patients. You should be familiar with the GMC publication Good Medical Practice, and the supporting guidance as you will be expected to respond to situations in line with the advice they give. You should also make sure you are familiar with how people in the UK might behave: you should not make assumptions about a patient on the basis of gender or ethnic origin – for example, women may smoke and drink.

The skills assessed are:

• Clinical examination
• Practical skills
• Communication skills
• History taking

You will be assessed on managing chronic and acute conditions and patients in peri-operative and emergency situations, as well as palliative and terminal care.

In most stations you will be awarded marks for being systematic and well organised, confident and competent.

Some of the areas on which you might be tested are listed below. Please bear in mind this is intended as a guide only: it does not tell you precisely what to expect on the day.

Clinical examination

You will be assessed on your ability to conduct a physical examination of a simulated patient. This will be an actor who has been trained to display signs as and when required.

Uncomfortable or intimate examinations will be carried out on an anatomical model. You are not required to speak to the model and will not gain any marks for doing so. You should address any comments to the examiner if the instructions require you to do so. However, you must make sure that you do not perform any actions on an anatomical model that would be unsafe or painful to a real person.

You are expected to be competent to carry out any basic physical examination, such as examination of the abdomen, breast, chest, hand, heart, and joints. You must be able to perform a rectal or bimanual vaginal examination. You must also be able to use the appropriate equipment in carrying out an examination of the ear, eye or nervous system.

Examination of someone's mental state is a form of clinical examination for the purpose of the test.

In stations involving a simulated patient, you will be marked on your ability to respect their privacy and dignity, and to attend to their comfort during the examination. You will need to take this into account, while bearing in mind that you have only five minutes for each station.

Practical skills

You will be assessed on your ability to perform common practical procedures. Again, you may be asked to deal with a simulated patient or an anatomical model. You are not required to speak to the model and will not gain any marks for doing so. You should address any comments to the examiner if the instructions require you to do so.

The practical skills may include:

Checking blood pressure
Performing venepuncture
Inserting a cannula into a peripheral vein 
Giving intravenous injections 
Mixing and injecting drugs into an intravenous bag 
Giving intramuscular and subcutaneous injections 

Basic cardio-pulmonary resuscitation (adult and child)
Suturing 
Interpreting an electrocardiogram (ECG), X-rays or results of other investigations 
Interpreting basic respiratory function tests 
Performing urinary catheterisation 
Taking a cervical smear 
Safe disposal of sharps

Communication skills

Communication skills are tested by observing the interaction between the candidate and another person, usually a simulated patient or the examiner. Your approach to the patient will be assessed all through the examination, but in some stations communication will be the main skill for which you will be awarded marks. This may include

Explaining diagnosis, investigation and treatment 
Involving the patient in the decision-making 
Communicating with relatives
Communicating with health care professionals 
Breaking bad news 
Seeking informed consent/clarification for an invasive procedure or obtaining consent for a post-mortem
Dealing with anxious patients or relatives
Giving instructions on discharge
Giving advice on lifestyle, health promotion or risk factors

While all stations last five minutes and you are assessed on your interaction with simulated patients, we do not suggest that tasks such as breaking bad news would be completed within five minutes in the clinical environment. You will be marked on what you complete within the five minutes.

The examiners will be considering

Approach to the patient

You should:

• Introduce yourself and explain or clarify the purpose of the consultation
• Be polite, respectful, non-judgemental and maintain the patient’s dignity
• Be empathic and acknowledge the patient's emotions or concerns and show sensitivity to potential pain

Listening and questioning

You should:

• Listen attentively to the patient's symptoms and concerns, use clear language and question at a comfortable pace, refraining from interrogative questioning
• Take any necessary steps to clarify or check information and summarise understanding

Explaining and advising

You should:

• Check what the patient already knows and wants to know
• Explain clearly at a level of detail and pace that the patient can follow, checking at intervals if the patient is understanding or has any questions
• Offer appropriate reassurance and handle any uncertainty well, whilst refraining from false or premature reassurance
• Not alarm the patient unnecessarily and be able to explain clearly the need for urgent action when indicated
• Demonstrate attempts to check the patient has understood

Involving patient in management

You should:

• Respect patient autonomy and help the patient to make a decision based on available information and advice. This includes explaining skills as above
• Explain information and its implications clearly including benefits, risks and options such that the patient is in a position to make informed decisions
• Avoid coercing the patient or showing irritation
• Check the patient’s understanding and feelings about the information
• Summarise any decision

History taking

You should be able to take an accurate history from the patient, and make a reasoned diagnosis if required. In any case, you will be expected to assess the patient's problem concisely and reasonably. The following are examples of symptoms with which patients may present:

Diarrhoea 
Wheezing 
Vaginal bleeding 
Palpitations 
Abdominal pain 
Headache 
Anxiety 
Weight loss 
Joint pain 
Difficulty in swallowing 
Episodes of loss of consciousness

12. How to prepare

The OSCE is assessing your skills rather than your knowledge. You have demonstrated that you know how to apply your clinical knowledge by passing Part 1 of the test. In the OSCE, you must show the examiner that you could perform the tasks competently in practice in an NHS hospital. Although you will be marked down for communicating incorrect facts and advice, you should concentrate on showing the examiner how you perform clinical tasks and interact with patients.

Remember that you are being tested at the level of a doctor who has qualified and completed one year of clinical practice.

Websites

Please use the GMC's own website. We update it regularly and it is a reliable source of information. We strongly recommend that you study with care Good Medical Practice and the supporting guidance.

Good Medical Practice sets out what we expect in terms of standards of care and interaction with patients and colleagues. In particular, the sections on Good clinical care, Relationships with patientsand Working with colleagueswill be helpful in the actual examination, as will the supplementary booklets, Confidentiality, Consent and the special notice about Serious communicable diseases. You may wish to try the series of ethical case studies in the interactive version of Good Medical Practice

Textbooks and handbooks

We cannot recommend specific textbooks and handbooks in preparation for the OSCE. This is because you are being assessed on your clinical and communication skills, rather than on your ability to remember and recite facts.

Journals can be a useful way to keep up-to-date.

We do not authorise or endorse any books specifically about passing the PLAB test.

Courses

We are unable to monitor the quality of courses and, therefore, do not endorse any. If you decide a course would be a useful preparation, we recommend that you research its quality before you enrol.

Equipment

You should be aware of the range of equipment routinely available in UK hospitals.

13. Common mistakes

Examiners have noted a number of mistakes that candidates make frequently and for which they are marked down. You should study the list below carefully and make sure you do not fall into these traps.

• Candidates do not always read the station instructions. We have a number of different variations on particular topics. You should not assume you know what the station is about. You should read the instructions carefully and respond appropriately. For example, if you are asked to suggest a likely diagnosis to the examiner, do not direct these comments to the patient. Give the examiner the reasons for your conclusion.
• Candidates do not always act naturally. For example, you will not gain marks by pretending to draw a curtain around the patient – the booth is already private. You can assume the examiner is the patient's chaperone. Nor will you gain marks for handing a tissue to someone who is not showing signs of tears just because you are conveying bad news. Remember that the examiner is assessing how you would deal with the situation in real life.
• Candidates sometimes talk at the patient and do not allow them to discuss their concerns. Sometimes candidates talk so much that the simulated patient hardly has the opportunity to talk. We have assessed your knowledge in the Part 1 exam and you will not gain marks for telling the simulated patient all you know about a specific symptom or illness. You should concentrate on showing the examiners how you interact with patients.
• Candidates do not always listen to the patient's response. They sometimes concentrate on asking a series of questions rather than really listening to what the patient has to say and responding appropriately. Examiners are aware of set phrases that are used by many candidates, sometimes in the wrong context. You will gain more marks if you listen carefully to what the patient is saying and react accordingly.
• Candidates sometimes produce set phrases intended to show empathy and understanding but do not actually demonstrate these qualities by their responses and behaviour. It is important to help patients to express what they want to say.
• Candidates have particular difficulty with psychiatric stations. Being able to assess suicide risk, for example, is a very important skill in the UK.
• In clinical examination stations, it is obvious that some candidates have learned the sequence of actions by rote and do not really understand why they are performing a particular action. Make sure you are clear about how to examine a patient and why you are undertaking each action.
• In the practical stations, candidates do not always consider preparation and the safety of the patient and others. It is important to cover these as well as the correct technique. Do not waste time telling the examiner what you would say to the patient or by repeatedly cleaning the model. You are being marked on the practical skill. Some candidates do not give themselves enough time to complete the task because they have spent time telling the examiner what they would say to the patient (for which they do not gain marks).
• In emergency management situations, candidates do not always know the correct protocols. It is necessary not only to be familiar with these to pass these stations but also to know how to apply them effectively.

14. How to approach the OSCE

An actor, who has been provided with a detailed script beforehand, plays the patient. The examiner will observe you and will not intervene, except in very limited circumstances.

You have one minute before entering the station to read the instructions. You must clean your hands thoroughly using the alcohol gel outside the station at this point. Hygiene is an extremely important issue in NHS hospitals. You may be asked to examine a patient, take a history and give a diagnosis, or to carry out a practical procedure. The instructions also give basic information about the patient, such as name, age and major symptoms.

You will be given full and clear directions on the day about what you have to do.

Each station lasts five minutes, and there will be one minute between stations. The stations will be numbered clearly and staff will be there to help you move from station to station.

The Chief Invigilator (the senior examiner on the day) will observe the exam remotely through a camera system. Each station has two cameras installed to allow observation, reducing the need for observers to enter and sit in stations. The cameras do not record the exam and therefore cannot be used to review the exam afterwards.

15. Marking scheme and standard setting

Each station has a number of objectives, such as past history, technique, and diagnosis. You will not see what the objectives are, but they will be on the examiner's marksheet. The examiner awards a grade between A and E for each objective.

Each objective is weighted, with the total weightings for each station adding up to 100%. The examiner is not aware of the weightings for the station. An overall grade is calculated for each station. You must obtain a grade C or above in 10 or more stations to pass Part 2 of the test. You cannot pass if you obtain grade E for more than one station even if you obtain grade C or above in all other stations.

From May 2008 the Part 2 exam will be standard set using the Borderline Group Scoring method. This is an internationally recognised method of standard setting and it ensures that exams are of a consistent standard over time. Examiners will award a grade between A and E for each objective and an overall judgement of pass, fail or borderline performance. A score is calculated for each station.

Standard setting

The passing score for each station and for the exam is set using the Borderline Group Scoring method, where we identify the mean score for each station from a number of previous candidates who have been given an overall judgement of borderline. We add the scores for each station plus one standard error of measurement to determine the total score. To meet the minimum standard required in each exam, candidates must meet or exceed the total score and achieve the passing score in a minimum of nine stations. Candidates must meet both criteria to be successful.

You may wish to look at Frequently Asked Questions about the borderline group scoring method

We have made a short OSCE briefing video that shows you what you can expect on the day.

16. Sample OSCE Station

Set out below is a sample OSCE station, which contains:

1. Examiner schedule to assist in marking the station
2. Instructions to candidates
3. Instructions to simulated patients

In the actual examination you will only see the instructions to candidates.

17. Examiner schedule to assist in marking the station

STATION TITLE: JOINT PAINS

CONSTRUCT:

The candidate demonstrates the ability to take a history and suggest a diagnosis in a case of joint pain.

NB TO EXAMINER: At the 30 second announcement, ask the candidate for a differential diagnosis.

OBJECTIVES

1. Presenting complaint
   Elicits a history of acute mono-arthritis.
   Checks is recurrent.
   Checks is of sudden onset.
   Checks is responsive to Indometacin.
   
   
2. Other history
   Social.
   Sexual (absence of STI).
   Alcohol.
   Diet.
   Excludes symptoms of other joint diseases.
   
   
3. Diagnosis
   Makes a reasoned assessment of the patient's problem.
   Suggests a diagnosis of gout.
   
   
4. Listening and questioning
   Listens attentively to the patient’s symptoms and concerns, uses clear language and questions at a comfortable pace, refraining from interrogative questioning.
   Takes any necessary steps to clarify or check information and summarises understanding.
   
   
5. Approach to the patient
   Introduces her/himself and explains or clarifies the purpose of the consultation.
   Is polite, respectful, non-judgemental and maintains patient’s dignity.
   Empathic and acknowledges the patient’s emotions or concerns and shows sensitivity to potential pain.
   
   
6. Fluency of performance
   Systematic and well organised.
   
   

18. Instructions to candidate – joint pains

This station tests your ability to take a history and reach a diagnosis.

• Mr Horton has been referred to you in the Rheumatology Clinic with pain in his right big toe joint and stiffness in his left knee.
• Take a relevant history and suggest a likely diagnosis to the examiner.

This station will last five minutes

19. Instructions to simulated patient – joint pains

You are Mr Horton, a married man in your early 40s. For the last six months some of your joints have been painful. Your general practitioner (GP) has sent you to see a rheumatologist.

The first time you had trouble was about six months ago when you returned from hospital after an operation to repair a hernia in your groin. That was around 48 hours after the operation. Your right big toe became excruciatingly painful and swollen. It was so bad you could not put any weight on it for two days. Your GP gave you some anti-inflammatory tablets and these helped. The skin around the foot was bright red for three or four days. Gradually the symptoms subsided and after about a week you were able to limp back to your job as a computer technician.

The toe was a lot better for some weeks. However, about three months ago the a similar thing happened suddenly to your left knee - intense pain and swelling, though there was no skin colour change this time. The pain subsided again with the help of anti-inflammatory tablets after a couple of weeks. It has remained slightly swollen and stiff.

Recently the toe pain has returned, though it is not swollen like before. The stiffness in both toe and knee joints appears to be worse first thing in the morning, and eases by the time you get to work.

You are married with two young children. You have not had extra-marital sexual intercourse. You work irregular hours with frequent night shifts. On weekdays you tend to drink three or four pints of beer with colleagues after work. At weekends you generally drink a couple of bottles of wine at mealtimes with your wife. You are generally fit and well and do not take any regular medications

 

On the day

20. Arrival

You must make your own arrangements for travel and accommodation. You must be sure you are not prevented from attending the examination by events you could have foreseen, for example, not being able to take time off from your job, transport problems, or problems with visa or immigration formalities. You should check all these are in order before you book. If you have to cancel a place you have already booked, you will have to pay a cancellation fee.

If you need accommodation, one source of information is the British Tourist Authority website.

Candidates have asked us about what they should wear to the examination. While you are not required to wear a formal suit, you should wear clothes which are appropriate for the clinical environment and remember that you will be seeing patients. Jeans and trainers should not be worn.

The examination will last about one hour and 40 minutes, although you will be in the centre for considerably longer than this. If you are taking the examination in the afternoon, be aware that it will not finish before 15.45.

We expect all examinations to start on time. Traffic and public transport can cause delays, so allow plenty of time for your journey.

When your place is confirmed you will be told what time to arrive at the assessment centre. It is important to arrive on time, because if you are late you might not be able to take the examination. You may be asked to arrive at the centre in the morning although your examination will be in the afternoon. This is because you are not permitted to meet the group of candidates that took the examination first thing in the morning. If this is the case, we will provide a vegetarian sandwich lunch for you.

Please note that smoking is now illegal in enclosed public spaces and workplaces. We know that some candidates would like to smoke whilst waiting to take the examination and would like to make you aware in advance that there is no opportunity for this once you are in the building.

21. Documents you must bring with you

Identification

We will check your identity at the examination. The following are the only forms of identification we will accept. Whichever you choose, it must be original, current and bear your photograph.

• Your passport 
• Your UK Immigration and Nationality Department identification document 
• Your Home Office travel document 
• Your UK driving licence
• Your EU identity card

If the name on your identification document is different from that on the confirmation from the GMC offering you a place in the examination, you must provide original evidence that you are the person named in that letter. We will accept

• Your marriage certificate or
• A declaration from the awarding body which granted your primary medical qualification, stating that both names relate to you

If GMC staff are in any doubt about your identity or the authenticity of your documents, the identity documents provided will be photocopied and you will be asked to sign and date them on the back to verify their authenticity. If you refuse to do this, you will not be allowed to take the examination. An investigation will take place. If it is decided that the person who sat the examination is not the person who is entitled to do so, the attempt will be invalid and the matter will be reported to the Registrar of the GMC.

If you do not bring one of the documents listed above, or if the document does not bear your photograph, you will be required to bring the correct form of identification document or evidence of change of name to the Head of PLAB (or their nominee) at the GMC, Regent's Place, 350 Euston Road, London NW1 3JN. If it is decided that the person who sat the examination is not the person who is entitled to do so, the attempt will be invalid and the matter will be reported to the Registrar of the GMC.

Other documents

You should also bring:

• Your primary medical qualification certificate - If, when booking the PLAB test, you entered details of a primary medical qualification that we accept but you do not hold, you will not be allowed to take this exam.
• Your IELTS test report form
• Your certificate of good standing
• Evidence of your internship
• Your booking confirmation (which includes your GMC reference number)

Once all your documents have been checked, your photograph will be taken and stored on our database. A photo-card will be produced which shows the number of the station at which you will begin the examination. You must wear the photo-card at all times during the examination.

When you enter the assessment centre, you will be asked to store away all your belongings in a locker before moving to the candidate rooms. Before the examination you will be briefed on its format and will be shown the candidate briefing video.

22. Cheating and misconduct

You will be provided with all the materials you need during the examination. You must not use or refer to any other materials or try to communicate with other candidates during the examination. All books, pens, papers, mobile phones and other electronic equipment must be stored in your locker when you come into the centre. You must not take any examination materials out of the assessment centre, you must not write down the details of stations to take out and you must not obtain information about stations from any source including other candidates. If you do any of these things, you will be reported to the Professional and Linguistic Assessments (PLA) Board. If you are found to have given or received help your examination attempt may be declared invalid and your name reported to the Registrar of the GMC. Please refer to the Examination Regulations for further information.

23. Leaving the examination

At the end of the examination you should hand in your photo-card to a member of staff, collect your belongings from the lockers and leave quietly.

 

After the examination

24. Results

At the examination you will be given the dates of the release of results. They are published in MyGMC first and you will need your GMC reference number, PIN and password to access them. The results published in MyGMC will tell you if you have passed.  If you have failed, they will tell you the grades you obtained in each station. From May 2008, if you fail, you will see the total score required in the exam, the score that you achieved and a pass or fail result in each station. A letter will then be posted to the address you gave us at the examination. We cannot give you a detailed breakdown of your performance in each station. You may find it helpful to look at the 'common mistakes' section for general trends in candidates' performance.

To ensure your results remain confidential we will not give them out over the telephone, by email, by fax or at the GMC's reception.

25. Checking results

If you want your final mark to be checked you must request this in writing. Please note that a clerical check does not mean your examination will be remarked; it is a check to ensure that your marks have been transcribed correctly. If you would like us to undertake a clerical check, contact the PLAB Test Section, GMC, Regent's Place, 350 Euston Road, London NW1 3JN within 28 days of the results being posted. You must enclose a cheque for £40 made out to the General Medical Council, and we will respond within 10 working days of receiving your request.

26. Appeals and complaints

You cannot appeal against the result. The examiners' decisions are final.

If you want to complain about the examination, you should submit a detailed written report to registrationhelp@gmc-uk.org or to the GMC, Registration Enquiries and Support Section, St James's Buildings, 79 Oxford Street, Manchester M1 6FQ within 28 days of the date of the examination. Give your name, address, telephone number, email address and GMC reference number. We will investigate and aim to respond within 10 working days.

27. Next steps

If you pass, you can apply for registration.

For more information on applying for registration, please see our Registration Applications guidance.

You must pass Part 2 of the test within three years of the date you passed Part 1. You must be granted registration in the UK within three years of passing Part 2 of the test. Otherwise you will have to take Part 1 and Part 2 again.

If you fail you can book another place in MyGMC. You may not re-apply for Part 2 before the results have been issued. If you fail Part 2 four times, you will have to retake IELTS and both parts of the PLAB test.