PLAB 2 history taking: how to structure an 8-minute history station

The short version

• PLAB 2 has 16 scenarios, each lasting eight minutes, at the level of a doctor in Foundation Year 2 (F2) [1].
• Every scenario is marked in the same three domains, so a history station is not only "data gathering" [2].
• Read the task carefully outside the room: some tasks ask for a history only, others for a history plus a plan. The GMC pages we read don't give the length of the reading time, so practice reading fast.
• Use a fixed order: introduce and open, let the patient talk, focus, screen red flags, background, ICE, summarize, plan, safety-net.
• Ask about ideas, concerns and expectations (ICE) early enough to use them in your plan.
• Leave at least the last 1.5 to 2 minutes for explanation, plan and safety-netting if the task asks for management.

What a PLAB 2 history station is

The GMC describes PLAB 2 as a clinical and professional skills assessment of 16 scenarios, each lasting eight minutes, with at least two rest stations, and the whole exam taking around three hours [1]. You read the instructions and patient information outside each room before you go in [1]. The exam could cover anything a doctor in an F2 role might see at work, and scenarios aim to reflect real settings such as a mock consultation or an acute ward [1][6].

A history station usually looks like this: a GP surgery, A&E or ward setting, a simulated patient with one main complaint, and a task such as "take a history" or "take a history and discuss the management with the patient". In practice stations, and in real clinics, the patient often knows more than they say at first and may have a worry they mention only if you give them space.

A minute-by-minute structure for 8 minutes

This is a structure we suggest for practice, not a GMC rule. Move faster through any part the task doesn't need.

Two notes on this table. First, ICE does not have to wait until minute five: if the patient drops a cue ("my sister had something like this"), follow it then. Second, if the task is history only, use the spare time for a fuller differential, more red flags, and a short summary to the patient.

What earns credit in each GMC domain

The GMC names the three domains and marks each scenario in all three [2]. The GMC pages we read don't publish a checklist for each station. The table below is our practice guidance on what a history station needs in each domain, written by Confetto.

The examiner also makes an overall judgment of your performance in each station: Unsatisfactory, Borderline, Satisfactory or Good [3]. The GMC uses those judgments to set each station's pass score (borderline regression) [3]. To pass the exam you need to meet the overall pass mark and pass a minimum number of stations; the GMC doesn't tell you exactly how many [3].

Worked example: "tired all the time" in general practice

Example written by Confetto for practice. It is not a real PLAB 2 station and not a GMC sample.

Candidate instructions (example): You are an F2 doctor in a GP surgery. Ms Sarah Mills, 41, has come in because she has been feeling tired. Take a history and discuss the next steps with her.

What the simulated patient knows (hidden from the candidate): tired for about three months; periods have become much heavier over six months (she changes protection every hour or two on the heaviest days, sometimes with clots); a bit breathless on stairs; no weight loss, no night sweats, no change in bowel habit, no blood in stool; mood is fine and she sleeps well; no medicines; vegetarian; works as a teacher; two children. Hidden concern: a colleague was recently diagnosed with leukemia and she is frightened she has "something in her blood". Expectation: blood tests.

The walkthrough

0:00 to 0:30, opening.

Doctor: Hello, I'm Dr Patel, one of the doctors working here today. Can I check your full name and age? ... Thanks, Ms Mills. What brings you in today?

Patient: I'm just exhausted all the time. I can barely get through the school day.

0:30 to 3:00, listening and focusing. Let her talk for 20 to 30 seconds, then focus: when it started, whether it is getting worse, whether rest helps, how it affects work and home. Ask about related symptoms: breathlessness, palpitations, dizziness, sleep, mood, thirst or passing more urine, feeling cold, weight change.

Doctor: You said it's been about three months. Has anything else changed in that time, even if it seems unrelated?

Patient: Well... my periods have been awful lately.

Doctor: Thank you for telling me. Can you tell me more about that?

This is the cue that matters. A candidate who moves on to a fixed list here misses the most likely cause.

3:00 to 4:00, red flags. Unintended weight loss, night sweats, fevers, lumps, bleeding from anywhere else, change in bowel habit, blood in the stool. All negative in this example, and saying so out loud in your summary shows the examiner you checked.

4:00 to 5:00, background. No past illnesses, no medicines or supplements, no allergies, no relevant family history, vegetarian diet, does not smoke, drinks rarely.

5:00 to 5:45, ICE.

Doctor: Have you had any thoughts yourself about what might be causing this?

Patient: (pause) A teacher at my school was just diagnosed with leukemia. She was tired too.

Doctor: That must be really worrying, especially seeing it happen to someone you know. I'm glad you told me. Is that the main thing on your mind today?

Patient: Yes. I was hoping you'd do a blood test.

5:45 to 8:00, summary, explanation and plan.

Doctor: Let me check I've got this right. You've felt very tired for three months, a bit breathless on the stairs, and your periods have been much heavier for about six months. You haven't lost weight or had night sweats. Is that right? ... The most likely reason for your tiredness is a low blood count from losing more blood with your periods, which we call iron-deficiency anemia. I understand you're worried about leukemia, and a blood test will help us check that properly. I'd like to do some blood tests today, including a full blood count, your iron levels and your thyroid. I'd also like to talk more about your periods, because we may need to look into why they've become heavier.

Then safety-net with specific symptoms and a timeframe:

Doctor: If you feel faint, have chest pain, get very breathless, or the bleeding becomes much heavier than usual, please don't wait: call 111, or 999 if it feels like an emergency. Otherwise I'll see you when the results are back, in about a week. Can you tell me in your own words what we've agreed?

How this example could score (labelled practice breakdown)

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

Checklist for any PLAB 2 history station

Use this to review a practice station afterward.

• Introduced myself and my role, checked name and age (and date of birth where needed)
• Opened with an open question and let the patient speak
• Picked up at least one cue and followed it
• Covered the presenting complaint in detail (onset, duration, pattern, severity, what helps or worsens it)
• Asked red flags relevant to this complaint
• Asked medicines (including over the counter) and allergies
• Asked past medical, family and social history (smoking, alcohol, work, home, driving if relevant)
• Explored ideas, concerns and expectations, and used them in the plan
• Summarized back to the patient and checked I was right
• Explained the likely cause in plain words, with no unexplained jargon
• Agreed a plan that fits the setting, including escalation if urgent
• Safety-netted: which symptoms, what to do, how soon
• Checked understanding (teach-back) and asked "Is there anything else?"
• Finished inside 8 minutes

Common history-station mistakes

Practice this station

Confetto isn't affiliated with the GMC.