PLAB 2 consent station: how to take consent in 8 minutes

The short version

• Each PLAB 2 scenario lasts eight minutes and is marked in three domains: Data gathering, technical and assessment skills; Clinical management skills; Interpersonal skills [1][2].
• Consent is a conversation, not a signature. Find out what matters to the patient first.
• Explain what the procedure is, why it is recommended, what it involves, the benefits, the risks, and the alternatives, including no treatment [3].
• Start from the presumption that an adult has capacity [3][4]. If in doubt, check the four abilities in the Mental Capacity Act: understand, retain, use or weigh, and communicate [5].
• Use plain words and small chunks, and check understanding with teach-back.
• The patient can say no, or ask for time. Respect that and document it.

What the GMC's consent guidance says

The GMC's "Decision making and consent" guidance came into effect on Nov 9, 2020 and is built on seven principles [3]. The points most useful in a PLAB 2 station are:

The GMC adds that a patient can only be judged to lack capacity to make a specific decision at a specific time, and only after assessment in line with legal requirements [3]. The legal test is in the Mental Capacity Act 2005 (below) [5].

Capacity in a consent station

The Mental Capacity Act 2005 says a person must be assumed to have capacity unless it is established that they lack it, that all practicable steps must be taken to help them decide, and that an unwise decision alone doesn't mean they lack capacity [4]. The test [5][6]:

1. Is there an impairment of, or a disturbance in the functioning of, the mind or brain?
2. If so, does it mean the person can't (a) understand the information relevant to the decision, (b) retain it, (c) use or weigh it as part of making the decision, or (d) communicate the decision?

In most consent stations the patient has capacity, and the task is about explaining well. If the station gives you a confused patient, assess capacity for this one decision, help them first (plain words, glasses or hearing aids, a better time of day), and if they lack capacity, act in their best interests and involve those close to them [3][4].

A structure for an 8-minute consent station

This is Confetto's practice structure, not a GMC rule.

Worked example: consent for a blood transfusion

Example written by Confetto for practice. It is not a real PLAB 2 station and not a GMC sample. Clinical details are kept general; in practice, follow your hospital's transfusion policy.

Candidate instructions (example): You are an F2 doctor on an orthopedic ward. Mrs Joan Patel, 74, had a hip replacement two days ago. Her hemoglobin has dropped and she feels dizzy and breathless when she walks. The registrar has recommended a red cell transfusion. Explain the transfusion to Mrs Patel and seek her consent.

What the simulated patient knows (hidden): she has never had a transfusion; she remembers news stories about people who caught infections from blood years ago and is frightened of this; she wants to get home to her husband, who has dementia and is being looked after by a neighbor; she has capacity. She will agree if her worry is answered honestly.

The walkthrough

Introduce and explore (0:00 to 1:45)

Doctor: Hello, Mrs Patel, I'm Dr Mensah, one of the doctors on the ward. Can I check your full name and date of birth? ... Thank you. I've come to talk about your blood test results and a treatment the team has suggested. Before I start, what have you been told so far?

Patient: Only that my blood is low. Someone mentioned a transfusion. I'm not keen.

Doctor: Can you tell me what makes you not keen?

Patient: You hear about people catching things from blood. It was all over the news.

Explain (1:45 to 4:45)

Doctor: That's a really understandable worry, and I'll come back to it. After your operation, your blood count dropped. That's why you feel dizzy and out of breath when you walk. A transfusion means giving you some red blood cells from a donor through a drip in your arm. It usually takes a few hours, and the nurses check you closely during it. The benefit is that it should help you feel less dizzy and breathless, so you can get moving and go home sooner. Is that OK so far?

Patient: Yes.

Doctor: Now the risks. Some people get a mild reaction, like a temperature or an itchy rash, and we watch for that closely. Serious reactions are rare. On your worry about infections: all blood donations in the UK are tested for infections, and the risk of catching an infection from a transfusion today is very low.

Alternatives (4:45 to 5:30)

Doctor: There are other options. Iron treatment can help your body make more blood, but it works much more slowly. You can also choose not to have the transfusion; then we would watch you closely, but you may feel dizzy and tired for longer, and it may take longer to get you home safely.

Check understanding (5:30 to 6:45)

Doctor: I've given you a lot of information. Can you tell me in your own words what the transfusion is and what the main risks are?

Patient: It's blood from a donor through a drip, to stop me being dizzy. There can be a rash or a temperature, and the blood is tested for infections.

Doctor: That's exactly right. What questions do you have?

Patient: Will it help me get home to my husband? He's not well.

Doctor: It should help you get on your feet faster. Tell me more about your husband. Is someone with him now?

Decision and close (6:45 to 8:00)

Patient: All right. I'll have it.

Doctor: Thank you. I'll give you a leaflet about transfusions, and you can change your mind at any time. I'll record our conversation in your notes. I'll also ask the ward team to talk with you about support for your husband before you go home.

What scores in each domain (labelled practice breakdown)

Sample breakdown written by Confetto for practice. It is not the GMC marking sheet.

Consent station checklist

• Introduced myself, checked identity, explained the purpose of the talk
• Asked what the patient already knows and what matters to them
• Asked about worries and expectations
• Explained what the procedure or treatment is and why it is recommended
• Explained what happens before, during and after
• Gave the main benefits
• Gave the common and the serious risks in plain words
• Gave alternatives, including no treatment, and what happens if they say no
• Used small chunks and checked understanding (teach-back)
• Considered capacity (presumed unless there was a reason to doubt it)
• Answered questions honestly, without pressure
• Offered time to decide and written information
• Told the patient they can change their mind
• Said I would document the conversation and the decision

Common mistakes

Practice this station

Confetto isn't affiliated with the GMC.