PLAB 2 counselling stations: smoking, contraception and starting a medicine

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].
• Start with what the patient knows, wants and worries about. Don't start with a lecture.
• Give information in small chunks and check after each one ("chunk and check") [3].
• Discuss the risks, benefits and consequences of each option, including doing nothing [3].
• If you give numbers, use absolute risk and natural frequencies ("out of 100 people like you...") rather than relative risk [3].
• End with teach-back: ask the patient to explain the plan in their own words [3].
• Don't give exact doses from memory. Say the dose will follow the prescription, the leaflet and the BNF.

What NICE says about sharing decisions

NICE guideline NG197, "Shared decision making" (2021), describes shared decision making as a collaborative process between a person and their healthcare professional [3]. The parts that matter most in a counselling station [3]:

The GMC's "Decision making and consent" guidance makes a similar point: doctors should find out what matters to patients so they can share information about the benefits and harms of options and reasonable alternatives, including the option to take no action [4].

A structure for any counselling station

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

Worked example: stopping smoking

Example written by Confetto for practice. It is not a real PLAB 2 station and not a GMC sample. No doses are given; in practice, follow the BNF and local stop smoking service guidance.

Candidate instructions (example): You are an F2 doctor in a GP surgery. Mr Gary Collins, 48, was recently found to have high blood pressure. He smokes about 20 cigarettes a day and says he wants to stop. Counsel him about stopping smoking.

What the simulated patient knows (hidden): smokes 20 a day for 30 years; tried "cold turkey" twice, lasted a week each time, got very irritable and put on weight; his daughter is pregnant with his first grandchild and that's why he wants to stop now; worried about gaining weight again; doesn't know there is free support; has heard "vaping is just as bad".

The walkthrough

Introduce and explore (0:00 to 2:30)

Doctor: Hello, Mr Collins, I'm Dr Iqbal, one of the doctors here. I understand you'd like to talk about stopping smoking. That's a great step. Can I ask what's made you think about it now?

Patient: My daughter's expecting. I want to be around for the baby, and I don't want to smoke near them.

Doctor: Congratulations. That's a really good reason. Have you tried to stop before?

Patient: Twice. Cold turkey. I was a nightmare to live with, and I put on weight.

Doctor: That sounds tough. What worries you most about trying again?

Patient: The weight, mainly. And the cravings.

Options in chunks (2:30 to 5:00)

Doctor: Can I go through a few options, one at a time? First, there are free NHS stop smoking services. A trained adviser supports you each week, and they can give you medicines to help with cravings. Many people find that support and medicine together work better than trying alone. Does that make sense so far?

Patient: Yes. I didn't know that was free.

Doctor: The second part is the medicines. One option is nicotine replacement, like a patch that works all day plus something quick, like gum or a spray, for strong cravings. Another is a tablet that you take for a few weeks, which I can prescribe if it's right for you. The adviser or pharmacist will go through exactly how to use them. Is that clear?

Patient: What about vaping? I heard it's as bad as smoking.

Doctor: Vaping isn't completely risk-free, but it's much less harmful than smoking, and some people use it to help them stop. It's one of the options we can talk about.

Choice and practical plan (5:00 to 6:30)

Doctor: About the weight: some people do put on a little weight when they stop. The adviser can help with that, and being active helps with cravings too. Which of these options feels right for you?

Patient: The service, and the patches and gum.

Doctor: Good. Would you like to set a quit date, maybe in the next couple of weeks?

Teach-back and close (6:30 to 8:00)

Doctor: Just so I know I've explained it well, can you tell me what you're going to do?

Patient: Ring the stop smoking service, use a patch plus the gum when I'm craving, and pick a quit date.

Doctor: That's exactly right. Let's book a review here in a few weeks, and we'll check your blood pressure then too.

What scores in each domain (labelled practice breakdown)

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

Contraception: what a good station covers

Practice guidance from Confetto. Method suitability depends on current UK guidance and the patient's history.

• Explore first: what she knows, what she has used before, what matters (how reliable, hormones or not, effect on periods, plans for pregnancy, how easy to use), medical history, medicines, smoking.
• Options in chunks: long-acting methods (implant, coils), the pill, the injection, condoms. Two or three at a time, then check.
• Infections as well as pregnancy: ask about the risk of sexually transmitted infections and talk about condoms and testing, not only about preventing pregnancy.
• Plan: what she chose, how to start it, what to do if something goes wrong (missed pills, side effects), follow-up.
• Age: if the patient is under 16, the station is also testing competence and confidentiality. See our guide to Gillick competence and the Fraser guidelines.
• Teach-back at the end.

Starting a new medicine: what to explain

Practice guidance from Confetto. Don't state doses from memory in the exam.

Phrase bank

• "What do you already know about...?"
• "What matters most to you when choosing?"
• "Can I explain a few options, one at a time?"
• "Does that make sense so far?" (chunk and check)
• "Out of 100 people like you..." (natural frequencies, only with real numbers from a source)
• "One option is to do nothing for now. If you choose that, ..."
• "Which of these feels right for you?"
• "Just so I know I've explained it well, can you tell me in your own words...?" (teach-back)

Practice this station

Confetto isn't affiliated with the GMC.