Table of Contents
- What is the OSCE for Doctors?
- PLAB 2 Station Types
- History Taking Stations
- Examination Stations
- Communication & Counselling
- Practical Procedure Stations
- Emergency Management
- Prescribing & Data Interpretation
- Ethics & Professionalism
- How OSCE Stations Are Marked
- How to Practise Effectively
- Essential Frameworks
- Common Errors to Avoid
- AI-Powered OSCE Practice
- Frequently Asked Questions
What is the OSCE for Doctors?
The Objective Structured Clinical Examination (OSCE) is a practical assessment used to evaluate a doctor's clinical skills, communication ability, and professionalism. Unlike written exams that test your theoretical knowledge, the OSCE tests how you apply that knowledge in realistic clinical scenarios with simulated patients.
For international doctors, the OSCE is most commonly encountered in PLAB 2, the second part of the Professional and Linguistic Assessments Board exam required for GMC registration. PLAB 2 consists of a 16-station circuit, of which 14 are scored and 2 are rest stations. Each station lasts 8 minutes with 2 minutes of reading time beforehand.
Other OSCE formats that doctors may encounter include:
- MRCP PACES - Part of the Membership of the Royal Colleges of Physicians examination
- MRCOG Part 2 - For obstetrics and gynaecology trainees
- MRCS OSCE - For surgical trainees
- Medical School Finals - UK medical students must pass OSCEs to graduate
- GP Specialty Training CSA/RCA - Applied Knowledge Test for GP trainees
The principles of OSCE preparation apply across all these examinations. The stations in this guide are designed primarily for PLAB 2 but are also valuable for other medical OSCEs.
PLAB 2 Station Types
PLAB 2 stations are carefully designed to simulate the situations an FY1 doctor would encounter on a typical day in the NHS. Understanding the different station types helps you prepare systematically:
| Station Type | Approximate Number | Key Skills Tested |
|---|---|---|
| History Taking | 3-4 stations | Communication, clinical reasoning, systematic questioning |
| Physical Examination | 2-3 stations | Clinical technique, systematic approach, patient comfort |
| Communication / Counselling | 3-4 stations | Empathy, explaining information, shared decision-making |
| Practical Procedures | 1-2 stations | Technical skill, asepsis, patient safety |
| Prescribing / Data Interpretation | 1-2 stations | Clinical knowledge, safe prescribing, result interpretation |
| Emergency Management | 1 station | Rapid assessment, prioritisation, protocol knowledge |
| Ethics / Professionalism | 1 station | GMC guidance, ethical reasoning, professional judgement |
History Taking Stations
History taking is the most common station type in PLAB 2. These stations assess your ability to gather relevant clinical information from a patient while building rapport and showing empathy.
Scenario 1: Chest Pain History
Patient: Mr John Williams, 62-year-old man
Presenting Complaint: Chest pain for the past 2 hours
Task: Take a focused history to determine the likely cause of his chest pain. You do NOT need to examine the patient or discuss management.
Key Points to Cover (Simplified)
- Onset - when did it start? What were they doing?
- Character - crushing, stabbing, burning, tightness?
- Radiation - jaw, arm, back?
- Associated symptoms - sweating, nausea, breathlessness?
- Risk factors - smoking, hypertension, diabetes, family history
- Previous cardiac history or similar episodes
- Current medications
Communication Marks
- Introduce yourself and clarify role
- ICE - explore Ideas, Concerns, Expectations
- Empathetic response to patient anxiety
- Summarise and confirm understanding
- Systematic, logical approach
Scenario 2: Abdominal Pain History
Patient: Miss Sarah Chen, 28-year-old woman
Presenting Complaint: Right lower quadrant abdominal pain for 24 hours
Task: Take a focused history including relevant gynaecological history. You do NOT need to examine the patient.
Key Points to Cover
- SOCRATES - Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/Relieving factors, Severity
- Gynaecological - LMP, menstrual history, possibility of pregnancy
- GI symptoms - nausea, vomiting, bowel changes
- Urinary symptoms
- Past surgical history (appendix?)
Safety-Critical Considerations
- Always consider ectopic pregnancy in women of childbearing age
- Ask about pregnancy sensitively
- Explore red flag symptoms (peritonism, fever, rigors)
History Taking Framework for PLAB 2
The Perfect PLAB 2 History Structure:
- Introduction - Name, role, confirm identity, explain purpose, gain consent
- Presenting Complaint - Open question first, then focused questions
- History of Presenting Complaint - SOCRATES for pain, detailed symptom timeline
- Relevant Systems Review - Focused on differential diagnoses
- Past Medical History - Significant conditions, surgeries, hospitalisations
- Drug History - All medications, allergies (including reaction type)
- Family History - Relevant to presenting complaint
- Social History - Smoking, alcohol, occupation, living situation
- ICE - "What do you think might be causing this?" "Is there anything you're particularly worried about?"
- Summary & Next Steps - Recap key points, explain what will happen next
Examination Stations
Examination stations test your ability to perform systematic physical examinations correctly and efficiently within the 8-minute time limit. You will be examined on a simulated patient (actor) or manikin.
Scenario 3: Cardiovascular Examination
Task: Perform a cardiovascular examination on this patient. As you proceed, explain to the examiner what you are doing and what you are looking for.
Cardiovascular Examination Checklist:
- Wash hands, introduce yourself, explain procedure, gain consent
- General inspection - colour, breathing, distress, oedema
- Inspect hands - clubbing, cyanosis, splinter haemorrhages, temperature
- Check radial pulse - rate, rhythm, character
- Check blood pressure (mention you would do this)
- Inspect face - eyes (anaemia, jaundice), xanthelasma, corneal arcus
- Inspect neck - JVP, carotid pulsation
- Precordial inspection - scars, deformity
- Palpation - apex beat location, heaves, thrills
- Auscultation - all four areas with diaphragm, ERB's point with bell
- Listen for radiation to carotids/mitral area
- Check for ankle/sacral oedema
- Auscultate lung bases (optional - for pulmonary oedema)
- Thank patient, help them redress, wash hands
- Present findings to examiner
Key Examination Tips
- Always wash your hands before and after the examination
- Expose appropriately - adequate exposure while maintaining dignity
- Inspect before you touch - visual inspection is the most overlooked step
- Commentate as you go - tell the examiner what you are doing and what you expect to find
- Look at the patient - not just at the body part you are examining
- Practice within 8 minutes - many candidates run out of time
Communication & Counselling Stations
Communication stations are where many international doctors struggle most. These stations test your ability to explain complex information clearly, break bad news, obtain informed consent, and handle difficult conversations.
Scenario 4: Explaining a New Diagnosis of Type 2 Diabetes
Patient: Mr David Brown, 55-year-old man, newly diagnosed with type 2 diabetes
Task: Explain the diagnosis to the patient, what it means for him, and the initial management plan. Check his understanding and address his concerns.
Key Skills to Demonstrate
- Establish rapport and check what the patient already knows
- Explain diagnosis in plain English (no jargon)
- Use the 'teach-back' method - ask patient to repeat understanding
- Discuss lifestyle modifications (diet, exercise, weight)
- Explain medication if relevant
- Mention follow-up and monitoring (HbA1c, eye screening, foot checks)
- Explore ICE - Ideas, Concerns, Expectations
Common Pitfalls
- Using medical jargon ("hyperglycaemia", "polyuria", "retinopathy")
- Information overload - giving too much at once
- Not checking patient understanding
- Being overly pessimistic or dismissive of concerns
- Forgetting to explore ICE
Scenario 5: Breaking Bad News
Patient: Mrs Patricia Green, 68-year-old woman
Scenario: Her recent CT scan has confirmed widespread metastatic disease. She has come to see you for the results.
Task: Break the bad news to the patient sensitively and discuss the next steps in her care.
Breaking Bad News - SPIKES Protocol:
- S - Setting - Ensure privacy, sit down, make eye contact
- P - Perception - "What do you understand about your condition so far?"
- I - Invitation - "Are you the kind of person who likes to know all the details?"
- K - Knowledge - Give a warning shot first: "I'm afraid the results are not what we hoped"
- E - Empathy - Acknowledge emotions: "I can see this is very difficult to hear"
- S - Strategy & Summary - Discuss next steps, offer support, arrange follow-up
Practical Procedure Stations
Practical procedure stations assess your technical skills in common procedures performed by FY1 doctors. These stations use manikins, models, or simulated patients.
Venepuncture
- Introduce yourself, check identity, explain procedure, gain consent
- Wash hands, apply gloves
- Apply tourniquet, select vein
- Clean site with alcohol swab (30 seconds, allow to dry)
- Insert needle at 15-30 degrees
- Collect required samples, release tourniquet
- Withdraw needle, apply pressure, dispose of sharps safely
- Label samples at bedside, fill request form
Intravenous Cannulation
- Consent, identity check, explanation
- Wash hands, clean tray, prepare equipment
- Apply tourniquet, assess and select vein
- Clean site (30 seconds, allow to dry)
- Insert cannula with bevel up, observe for flashback
- Advance catheter, withdraw needle, release tourniquet
- Apply dressing securely, flush with saline
- Document size, site, date, time
Basic Life Support (Adult)
- Check for danger
- Check responsiveness - shake and shout
- Shout for help / call emergency team
- Open airway (head tilt, chin lift)
- Check breathing (look, listen, feel for 10 seconds)
- If not breathing: start CPR - 30 compressions : 2 breaths
- Compressions: 100-120/min, depth 5-6cm, full recoil
- Use AED as soon as available
Peak Expiratory Flow (PEF)
- Explain procedure to patient
- Ensure patient is standing (if able)
- Set meter to zero
- Patient takes deepest breath possible
- Seals lips tightly around mouthpiece
- Blows out as hard and fast as possible
- Record best of 3 attempts
- Compare to predicted value for height/age/sex
Emergency Management
Emergency stations test your ability to manage acute, life-threatening situations in a systematic and timely manner. These stations are often high-scoring for candidates who follow the correct protocols.
Scenario 6: Anaphylaxis
Patient: 34-year-old woman who has just been given IV antibiotics. She has developed widespread rash, swelling of the lips, and difficulty breathing.
Task: Manage this emergency. A nurse is available to assist you.
Anaphylaxis Management - ABCDE Approach:
- Call for help - emergency team, anaesthetist
- Remove trigger - stop the antibiotic infusion
- A - Airway - Assess, consider adjuncts if swelling
- B - Breathing - High-flow oxygen (15L/min via non-rebreathe), auscultate chest
- C - Circulation - IV access, IM Adrenaline 0.5mg (1:1000) into anterolateral thigh
- D - Disability - Conscious level (AVPU)
- E - Exposure - Full examination, check for rash progression
- Fluids - IV crystalloid if hypotensive
- Monitor - BP, HR, O2 sats, ECG
- Document - All medications given, times, response
- Consider - Repeat adrenaline at 5-minute intervals if no improvement
Prescribing & Data Interpretation
Prescribing stations test your ability to write safe prescriptions, identify prescribing errors, and interpret clinical data such as blood results, ECGs, and imaging.
Scenario 7: Writing a Drug Chart
Task: Write a prescription on the inpatient drug chart for a 70-year-old patient admitted with community-acquired pneumonia. The consultant has requested IV Co-amoxiclav and oral Clarithromycin.
Elements of a Correct Prescription
- Patient name, hospital number, date of birth
- Date of prescription
- Drug name (generic, not brand)
- Dose (e.g., 1.2g for IV Co-amoxiclav)
- Route (IV, oral, etc.)
- Frequency (e.g., TDS - three times daily)
- Signature and printed name
- Bleep/contact number
Safety Checks
- Check for allergies (penicillin?)
- Check renal function (dose adjustment?)
- Check for drug interactions
- Check weight for paediatric dosing
- Sign and date the prescription
Ethics & Professionalism
Ethics stations present scenarios involving difficult professional situations where you must demonstrate knowledge of GMC guidance and appropriate professional judgement.
Scenario 8: Confidentiality Dilemma
Scenario: A 16-year-old patient has confided in you that they are using recreational drugs. They have asked you not to tell their parents. Their parents have just called the ward asking about their child's condition.
Task: Discuss how you would handle this situation with the examiner.
Key GMC Principles to Reference:
- Young people aged 16+ are generally presumed to have capacity to consent
- Confidentiality is a core ethical duty but is not absolute
- Disclosure can be justified if there is risk of serious harm
- Encourage the young person to involve their parents
- Document all discussions and decisions thoroughly
- Seek advice from senior colleagues if unsure
- Consider safeguarding implications
How OSCE Stations Are Marked
Understanding the marking system helps you focus your preparation on the areas that will gain you the most marks. Each PLAB 2 station is marked against a structured checklist:
- Domain A: Data Gathering - History taking, examination technique, use of investigations
- Domain B: Clinical Management - Formulating diagnoses, management plans, prescribing
- Domain C: Communication Skills - Building rapport, explaining, shared decision-making, empathy
- Domain D: Professionalism - Consent, safety, ethics, GMC guidance, teamwork
Each domain carries equal weight. You cannot pass a station by excelling in one area while failing in another. A balanced performance across all four domains is required for each station.
The overall pass mark is set using the borderline regression method, which accounts for station difficulty. You do not need to pass every individual station to pass the exam overall, but consistently poor performance in any domain across multiple stations will likely result in failure.
How to Practise Effectively
1. Practise with a Partner Daily
The most effective OSCE preparation involves daily practice with a study partner. Take turns being the doctor and the patient. Give specific, constructive feedback on structure, content, and communication style.
2. Record Yourself
Recording your practice sessions reveals habits you may not be aware of - filler words ("um", "ah"), poor eye contact, looking at the floor, or rushing through explanations.
3. Practise Under Timed Conditions
Always use a timer. Two minutes reading time followed by eight minutes for the station. Time pressure is one of the biggest challenges in the real exam.
4. Focus on Communication
Clinical knowledge alone will not pass PLAB 2. The exam is primarily a test of communication skills. Practise explaining medical concepts in plain English that a 12-year-old could understand.
5. Use AI-Powered OSCE Platforms
When study partners are not available, AI-powered OSCE platforms provide realistic practice scenarios with structured feedback on your performance.
Essential Frameworks for PLAB 2
| Framework | Use | Components |
|---|---|---|
| SOCRATES | Pain history | Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/Relieving, Severity |
| ICE | Communication | Ideas, Concerns, Expectations |
| SPIKES | Breaking bad news | Setting, Perception, Invitation, Knowledge, Empathy, Strategy |
| ABCDE | Emergency management | Airway, Breathing, Circulation, Disability, Exposure |
| Calgary-Cambridge | Consultation structure | Initiating, Gathering, Explanation, Closing, Safety netting |
| SBAR | Handover | Situation, Background, Assessment, Recommendation |
Common Errors to Avoid
- Not washing hands - This is a critical safety marker. Always wash before and after every station.
- Missing ICE - Forgetting to explore Ideas, Concerns, and Expectations will cost you marks in every communication and history station.
- Medical jargon - Using terms patients cannot understand demonstrates poor communication.
- Poor time management - Running out of time before completing essential tasks.
- No consent - Beginning examinations or procedures without explaining and obtaining consent.
- Abrupt closing - Ending without summarising, checking understanding, or outlining next steps.
- Not introducing yourself - Every station must begin with your name, role, and confirmation of the patient's identity.
- Overfocusing on knowledge - PLAB 2 tests skills, not knowledge. Communication is more important than clinical detail.
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Frequently Asked Questions
How many OSCE stations are in PLAB 2?
PLAB 2 consists of 16 stations total: 14 scored stations and 2 rest stations. Each station lasts 8 minutes with 2 minutes of reading time.
What is the pass rate for PLAB 2?
The pass rate for PLAB 2 is approximately 70-75% per sitting. Thorough preparation, especially of communication skills, significantly improves your chances.
How is PLAB 2 different from the nurse OSCE (NMC OSCE)?
While both are OSCE formats, the PLAB 2 OSCE is designed for doctors and tests clinical knowledge, diagnostic reasoning, prescribing, and medical management appropriate for an FY1 doctor. The NMC OSCE for nurses focuses on nursing-specific skills and competencies.
Can I fail PLAB 2 and still pass the exam?
The exam uses borderline regression analysis. You do not need to pass every individual station, but your overall performance must meet the passing standard. Consistently failing the same domain across multiple stations will likely result in overall failure.
How long should I prepare for PLAB 2?
Most successful candidates prepare for 6-10 weeks full-time. Part-time preparation typically requires 3-4 months. Consistent daily practice is more important than total hours.
Are the scenarios on this page real PLAB 2 questions?
The scenarios on this page are representative of the types of stations you will encounter in PLAB 2 but are not actual past exam questions. The GMC does not publish past papers. These scenarios are designed for practice purposes.