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Um Hello everyone. I hope you all can hear me if you can. Please let me know in the chat box. That would be great, please. And we'll be starting the session within like a couple of minutes just waiting for a few more people to join. Hello, everyone. This is Doctor Lai. Um Please let me know the chat box if the sound is clear if you can see me clearly so that I can start the session. I'm still waiting for a few people, but that's ok. That's completely fine. Hello, Doctor Strut. Ok. Can you please let me know if the sound is clear and if the video is clear or anything else just come yes or no in the checkbox? That would be fine. All right, perfect. Right. So um few of you might not know who I am. I'm Doctor Nomi. Um I'm one of the GMS registered doctors and I cleared my plap exam in April this year and I finished my attachment in July. Then I did my A LS and now I'm searching for jobs. So the thing is the main purpose of this these sessions is to make sure that we don't start at a point where everything is a bit overwhelming. Like if nothing is clear or we don't really know the basic things about lap two, but all we have is just the notes and everything seems very, you know, very confusing and everything. So I just want to make sure that um people don't really face the challenges and difficulties which I faced personally. So that's the main purpose. So uh I'm going to present a slide now. Just one second. Mhm. Just give me one second. I'm going to press on the slides. Yup. Ok. So can you please confirm once again that if you can see the slides? Ok. No. OK. Just give me one second. Ok. What about now? What about now? Can you see the slides? No. OK. All right. Mm mm hm. No worries. I'm gonna make sure you all do see the slides just one second. I'm really sorry about this. I'm not sure why it's not really. OK. What about now? All right. Is it just the screen that you're seeing me or it gets changed between the power lights and the screen? No slides is visible. OK. I'm sharing the entire only you we can see. Ok. Ok. Right. Um OK. There is a sharing screen uh option here. So I'm actually sharing the powerpoint slide but I'm not sure why it's not visible. OK. No idea what's going on with this one. If I cannot share the slides within a couple of minutes. I'm going to present it from a tab. That's not a problem and we're gonna figure it out from tomorrow's session. No worries about it. Uh The entire screen should be shared. Ok. Ok. I'm gonna turn my video off for a second. Hm. Try screen. Ok. I'm trying to upload the slides as APD file so that it's visible. Just give me one more minute. I'm really sorry about the inconvenience. Is it visible? Now? Please let me know if you can see the PDF slides. Ok, perfect, perfect, perfect, great. Thank you. Thank you doctors. All right. So about me, you all know already that I'm Doctor Nomi and I live in Nottingham. So I just want to make sure that as long as I can remember all the things from the exam I went through, I want to distribute the knowledge to all of you. That's the main objective basically. So um let's talk about uh the exam overview. OK. So pla two is something we think of an exam as a very vague thing. Like everything is confusing. We don't really know where to start. We if we have started uh something just doesn't seem to be working. But uh the thing is the main key is you have to make sure that you are very confident, that's the main thing and main key to success I would say and your approach as well. So these two things actually affect 50% of your exam success. Ok. II am moving forward to the next slide. So the thing is um what happens in the academies? We always join academies and all we can see is some notes um they start taking classes like for 14 days, for 15 days. And what happens is from the very first day. All we can see is people talking about the management, people, talking about the notes, people talking about um what kind of patients you might get. But no one really starts by talking about how many um stations we have. What is the structure, what is the approach and how many, how how much time we might get in terms of the stations, in terms of the waiting period, in terms of um rest stations. These are the things that we have to make sure that we talk about on the very first day when we are starting our preparation. So the thing is basically um there will be uh we all know that there will be 18 stations, but I would still like to repeat it because few of you might be very, very new to this exam. Uh might clear that one very recently. So basically there will be 18 stations and out of six out of those 16 will be the main uh the real real stations and two of them will be the rest stations. Um Each of them will be having like eight minutes and the rest stations as well, but before you enter the room, you will be having 90 seconds like 1.5 minute to uh read the note which will be stuck outside of the door. So what happens is um there will be the information of the patient, like patient's name, patient's age and maybe a few more concerns of the patient. So what happens basically is um if there is a lot of information like the patient's name, the patient's age, the concerns the setting, everything might be there. So what you have to do is you utilize that 90 seconds to make sure that you know the concept and what you will be expecting inside the room. But sometimes what happens is it's just the patient's name and the age and that's it. Nothing. W what is the setting? What the um like what is the concern? Nothing is written over there. So, what we tend to do is we start panicking that, oh my God, we don't have enough information about the patient and what might be inside the room. So to be honest, don't panic. The thing is you, you actually are lucky that you will be having a lot of time, not a lot of time, enough time to make sure that you forget about the previous station and you start um like structuring the things that you already have inside your mind. Like uh you make a mind map kind of thing and you're revising those points and you make yourself mentally prepared for the most unexpected things. So the main thing that I would talk about about the cubicle inside is you have to remember three things before you enter the cubicle. OK? The name of the patient, the setting and smiling. So the name of the patient is so important just because I what happens, there are like 16 stations, 16 different names. There is like 90% chances you might mess the names up. Ok? So what happens is what I used to do is um if the patient's name is Mike, I used to call him Adam because uh the previous station or maybe the last few stations I had a patient named Adam or maybe I practiced with the name Adam a bit too much. So please make sure that you remember the name of the patient just before starting the station. Yes, you do ask the patient, his or her name when you enter the room. But still you have to have that name inside your head stuck so that you do not mess that up. If you forget about the name of the patient, please ask the patient instead of uh calling him or her in in a different name, please make that uh uh like in a thing. Ok? For example, if it's Adam, you cannot really call him Mike. If you do, it might sound a bit offending. Ok? So it doesn't really look very nice. So please make sure you remember the name before entering the cubicle. Ok. So we're talking about the things, those are very important just before you enter the room. Ok. Second thing is the setting. Uh, it can be a GP setting, it can be an emergency department, it can be a medicine department, psychiatry, anything. It can be anything. Right. So what kind of mistakes I used to do? Uh, for example, if it's a GP setting, it's an emergency patient. The patient is having severe headache. Um The like in during the initial stages of my practice sessions, what I used to do is ok. So we're going to admit you. Uh that's not what you do. It's a GP setting. So you have to refer the patient to the hospital. So it's a very common mistake. It seems very silly that like you might think that why would I do that? We, I have the setting in front of me outside the room, inside the room, everything is written clearly that this is a setting where I should be referring or this is a hospital setting. So I should be admitting. So we don't really talk about referring in the hospital setting, right? But still out of nowhere, we just say out of reflex that this is a um emergency situation. So we might have to admit you. Uh we don't do that. We just say that we have to refer you and I have to talk to the seniors as well. And what we do is we just work on the symptomatic relief just to make sure that the patient is comfortable. Ok. So this is the second thing that we have to make sure we know before entering the room just to make sure that we don't mess it up when we are inside the room. Ok. Right. All right. So the next thing is smiling, you don't really have to worry about how sad the station is. If it's a, like a like very sad station, it might be a breaking bad news station. It might be a patient of depression, but we don't have to worry about it. Ok? We start the station with smiling. We enter the room with a big smile on our face like you don't really have to laugh. You just have a very subtle smile on your face just to make sure that the patients know that the doctor is friendly. We can trust him, we can talk about confidential things with him or her just to make sure that you have a very good and nice approach. OK? When you face the patient. All right. So these are the three things. Um you can just write these things up and paste it on your wall just to remind yourself each and every day that these are the things you have to memorize and keep in your head before entering the room. Ok. Right. So we are done with the basic things before entering. So I'm moving on to the next slide, right? So we have got like, as I've already said, there are, there are like 18 stations out of which there are like two stations which are rest stations and actual stations will be 16 in number. Ok. So inside the rest stations, what happens inside the rest stations? We have some time to relax, drink a sip of water. We can go to the washroom if you want and we have the best cookies in the world in terms of two rest stations. Yes, II found it like very, very amazing. So 18 stations out of which there will be like 16 proper stations, eight minutes each and two rest stations again, eight minutes each. OK. Um 90 seconds outside each station, which I have already mentioned, right? There are a few categories of uh stations. OK? In terms of his um we um like few of us might know how many stations like how many categories we have. But still it's very important to mention as we might have few people who don't really have any idea it can be history taking where we just follow the basic structure of history taking like data gathering, examination and management. There is ethics, there is counseling ethics is like breaking bad news. We have um we have uh problematic patients, we have problem colleagues. Um We have LGBTQ. So these are the ethics stations where the basic structure is a bit different. We have to deal with those patients in a very, very sensitive way. Ok. So counseling is basically a patient having like already having an issue and we know that the patient is having that issue. We just have to convince the patient that um this management is the best thing for that patient. Ok. So that's basically all about counseling. Then we have teaching, then we have um Simmen procedure and some combined stations as well. So a combined station is nothing but the history taking ones, but with a practical examination. So you either have to examine the patient like in real time or you might have a dummy in front of you and pretend that this is the patient's body part and you have to examine that dummy. OK. So this is, this is the combined station basically, right? So uh the marking will be depending on three domains out of which I think the most important domain is I PS like you might have listened to this thing a lot of times by a lot of people. But that's actually I think is a fact you have to make sure that um you are very confident in terms of talking to the patient and you can build that trust and relationship with the patient. OK? But we still have two more d domains were out of which the first one is history taking and technical assessment. OK. So what we have to do is we have to um ask the patient a lot of things like there will be close questions. II will uh discuss these things in a vast way in the next slides and next sessions. But the just basic things. OK. So we have to ask the patient about his um concern about his uh complaint. And then we have to ask a few um close questions and some open questions as well. But I would personally suggest to start with an open question. Like, what else do you think uh you're going through? Like, what do you think might be going on with you? And like what else in terms of this? OK. So history taking is all about data gathering. Like uh can you please tell me a little bit more about what's going on? So the so that the patient starts speaking on his own and you don't really have to follow the structures that how many times when did it start, the patient might actually reveal a lot of things on his or on her own. OK. So after that, uh the first domain also has uh got technical assessment which is basically examination. You have either to mention the examinations, like I would like to do the vitals. I would like to check your um uh like neurological system or a particular examination that you are going to do in terms of history taking. You have to just verbalize these things. And in terms of combined stations you actually have to do. So that's basically the main difference between the history taking and combined station. So the first point is history taking and technical assessment. So that's done. The second point is management. So management is something that we will be discussing vastly, of course. But still the main thing is you have to make sure you tick all the points. So the first thing is you have to make sure the symptomatic treatment is given so that the patient is a bit relieved and a bit comfortable to talk. And the second thing is you have to make sure unless or otherwise you are 100% sure that this is the treatment I want to give to the patient, you have to mention the seniors. Otherwise, if something goes wrong, like for example, if it's an emergency situation and just by mistake that uh you just uh missed that part, if you do not forget to mention the senior, you might get saved in that station and you might have actually pass that station because the senior is going to take care of the things that you missed. Ok. So the symptomatic relief, the senior um referral and then the main cause and treating the concern as well. These are the things basically about the management. Ok. And the third thing, and I think one of the most important thing is I PS which is basically interpersonal skills. Um It's just not the way you speak. It's just not the smile on your face. It's just not how you manage the patient. It is also how you actually um build the trust and how you actually listen to the patient. That's the main key. So a lot of people actually uh think that I PS is all about how friendly you are, how, how much smile you have got and how, you know, um how good is your English? No, that's not I PS. It's basically, are you listening to the patient? Are you giving enough time to the patient? OK. So that's all about I PS. So these are the basic three domains that we are going to get assessed on. So four points for each domains and we actually have to get at least two and uh out of four in each domain just to be on the safe side. OK? But if your I PS is very, very good that can actually save you. This is the reason why I'm saying that I PS is very important if you got like one out of four in your management and if you got like um maybe one out of four in the history, taking your technical assessment and if you manage to get four out of four in your I PS, you might actually pass the gestation. OK. So this is the key to success. I would say I PS please build and work on that thing. All right. OK. So we have talked about the station categories and number four is inside the cubicle. What do we expect inside? We will be having two people inside the cubicle uh out of which one will be the examiner and one will be the simulator. So don't really think about simulator as a simulator. Please think that this is the patient that I have to deal with. Ok, we are all doctors, we have dealt with patients uh throughout our life. Ok. So if you treat the person as a patient, you will not be having the burden of acting good to him or her. Ok, you don't have to really um act nice. You don't have to worry about that. Um Oh my God, this is a person who is uh having a lot of complaints. So I have to make sure um II don't skip the tricky questions. No, this is a patient. The patient will act like a patient. They are very professional. They, you can actually go through it and you can actually have no idea whether it's a person or a patient without any complaints or with actual complaints. So I still remember that I had a person um who was having a chest. Uh there was a a pulmonary embolism patient. The patient was having chest pain and I could actually see the discomfort on his face. So he was actually acting like that he is having chest pain. And then there was another patient a very old lady but she was having some sort of cancer. I uh this was a breaking bad news station. So the person was almost going to cry and I was almost going to cry. This is how real the patients act. Ok. So you please treat them as your patients. I'm sure you will be fine. You will be more than fine if you treat them. Ok? As a patient. So inside the cubicle examiner will be taking your name and your GMC registration number. That's it. Uh You don't have to deal with the examiner after that. Ok? You start dealing with the patient then, so you approach the patient by telling your name by uh telling him or her that you are one of the doctors in this department and you confirm the patient's name and age as well. Ok. Right. But if it's written that that's the patient's relative, we don't really have to ask the age, just the patient's name and you ask the patient that how do would you like me to address you? Ok. Just to be making sure that the patient is comfortable enough. Ok. Right. So the next thing is um during the examination, there is one more time you have to deal with the examiner when there is the examination results. Like for example, you have mentioned E CG or x-ray. So the examiner will be handing you the results and then you might have to take a couple of seconds to have a glance at your report and you don't really have to have an awkward silence. You can actually tell the patient that, um, can I please have some moments with myself just to make sure that everything is all right? Ok. So there's no awkward silence just to make sure. Ok. Right. If you have any questions so far, you can write that up in the chat box. I will get back to you after the end of the session. All right. So this is the triangle that I always call is a success triangle because this is the thing that we start with in the initial days of her preparation. OK. So the success triangle is actually something that has uh three things. You have to time yourself when you are practicing, you have to actually have practicing partners. And the next thing is you have to read the notes, you have to read the notes. A lot of people say that if you read the notes, you are going to get structured or scripted or something like that. But the thing is reading the notes is actually very important unless you are planning to memorize the notes. OK? You can go through the notes and still make sure that you're not being scripted. I will tell you how. So before starting your practicing, like you, for example, you haven't started your preparation. What you do is you go through the notes, you make sure that you read the entire note, you know how the management goes on and you know what the structure is, but you don't really remember. You don't really memorize that what the patient's complaint is. Ok. We'll be having patients with different complaints, with different um sort of, you know, issues and whatnot. OK. There will be a lot of things going on with the patient. So the most, the like the most important thing that you don't have to remember and you make sure that you do not remember is the patient's complaints. Ok. The rest of it, the management, the examination, the investigations, everything you can memorize. Yes, you can. But please make sure you don't get scripted after reading the notes. Ok. So what you can do is after reading the notes, when you practice with a person, you tell that person to change the complaints a bit. Ok? You slightly change the, uh, complaints of the patient so that you can make sure you both can make sure that you don't get structured or scripted. Ok. So that's how you actually practice. You can do, uh, in person practicing or a video call is fine or an audio call is fine. But please make sure that you actually practice, uh, for like two or three hours a day. Uh, actually depends on person to person. I'm gonna talk about that later as well. But just to make sure that you actually do practice, practice with the person in real time and you read the notes before practicing. Ok. Can be any note. There are free materials online. There are like few academies who provide notes as well, but do read the notes. Ok. Ok. So make sure you time yourself for eight minutes. If you are starting initially, you can start with 10 minutes as well. But please make sure you time yourself. What I used to do is um when I started initially, it was like um oh II used to take like 30 minutes each station, which is terrible. I know, but the thing is you have to time yourself. If you don't, then you actually start asking all the questions and you don't really worry about that. The time is like uh passing by. You don't have to worry about the time. Like you can take as much time as you want. That's not how it works. So you have to structure the things you have to remind yourself that you don't really have that much time of talking a lot to the patient. You have to listen, you have to address the concerns and you have to treat the patient accordingly within that short period of time. So timing yourself doesn't really necessarily mean that you have to finish the station within eight minutes. Now, you don't do that. You have to make sure you at least address the concerns of the patient and you listen to the patient. You give enough time to the patient. That's actually what you do. You don't have to uh rush. OK. So, and the real exam, what happens is after six minutes, there is a two minutes reminder that like two minutes left and w what we tend to do is, which is very natural. I would say we start rushing to the end of the station. Like, for example, if we took six minutes in terms of taking the history and then we hear the bell and then we are like, oh my God, I have to finish the examination, I have to finish the management and everything is there. So we just rush, we do. What we do is we just talk about the examinations very, very quickly without even listening to the patient. And we just force the management and treatment plans on our patient. We just um can try to convince the patient as much as we can to take the medications and uh continue those things. That's not how we do it. We ask the patient again and again, that what is your main concern? What is the thing that is bothering you? And what is the thing that might be helping you? And are you ok with this management plan? So you take consent, you address the concerns and then you treat the patient. So this is how the management part works. So timing yourself will actually make you better in terms of practicing how to structure the three domains inside that eight minutes. OK. That will actually help you on the day of your exam. So you don't have to rush after the two minutes. Well, OK. So this is the success triangle, which I call the success triangle. Read the notes, then practice and time yourself when you're practicing. All right, any questions, just make sure you leave the thing in the chat box and I will be coming back. All right, there are a few things that we have to make sure we do and there are a few things that we have to make sure we don't do. Ok. So I was talking about the do s um, like the most, the most things that you have to do, you have to make sure. So the first thing is to make sure we keep in mind that it can be any station, it can be history taking, it can be, um, a combined station, it can be, um, it can be anything basically. So what you have to do is when you enter the room, you, you actually take a glance around the room when you enter. Ok. So you have to, uh, make sure that this is not a combined station, this is a station where, um, the, just the history taking station or if there is a dummy placed, you can actually see inside um, the room that dummy. So it is very important to take a glance around the room. It can be a teaching station as well. Um For example, I know one of my friends who said that uh she entered the room and she finished the station as a regular history taking station, but she forgot to look around the room, but it was actually a combined station. So there was a dummy uh just at the corner of the room, but she didn't really notice that thing. So it is very, very important to take a quick glance around the room when you enter, just to make sure that whether it's a combined station, whether it's a teaching station or whether it's just a basic history taking station, ok? Because the simulator or the examiner will not really like guide you or like really help you when you miss something. If you miss the dummy, they will, they're not going to say that uh there is a dummy, you have to examine. No, that's not how it works. So you have to be very careful in terms of that. Ok? So just to take, taking a quick glance is going to take like a couple of seconds maybe. And that's it, you know what the session is. OK? You're good to go, right. The second thing we have to make sure we uh do is let the patients peak, ok. Uh Most of the times what we do is uh when you are panicking or anxious, which is very normal in terms of plateau, we enter the room there is a patient, we ask about a lot of things from the patient and the patient says that I have this, this and this issue, I have headache, I have chest pain or something else. And what we do is we follow the structure and we ask about so close, close questions. OK. So when did it start? How uh uh is it radiating somewhere? Uh and uh on a scale of 1 to 10, what do you think will be your pain uh falling at? So what we forget to do is actually listen to the patient. So w when we let the patient speak, the patient reveals a lot of things on his or on her own. OK, the patient might say something which you might not be expecting but which might be relevant to the um concerns that he might be having at this point. But we actually missed that thing out. When we do not let the patient speak, we speak on our own. We keep speaking, we follow the structure, we do the examinations, we provide the management. And uh after the exam, we are like, OK, at that stage, it was really good because I actually uh I had all the, I listened to the patient, I had all the complaints, I knew what was going on. Um I prescribed this, this and that frequent was uh top notch and the management was there, the examination, the investigations, the reports, everything was going perfectly smoothly. So most of the time, what we do is we do not let the patient speak. So what we think inside is that patient, that uh station went really good. So it was a perfect station and I'm getting like 12 out of 12 on that station. What happens is we see completely opposite when the result is out, we fail gestation. The main thing is we didn't let the patient speak. So we didn't really know what the main concern is. OK? For example, the patient might be having sleeping problems. OK? So we just get the, you know, the uh like the disadvantage of being stricter. What we guess is OK. So patient is having insomnia. So there might be something uh wrong with his bed or maybe migraine or might be having some sort of personal issues. But what the real problem was is the person was going through some sort of abuse. The person was actually shaky. The person was actually very reluctant to talk about her problems. She was actually getting abused by her husband. So what happens is we, I don't really notice that thing. We rush so much into those points that we are supposed to speak and get to the end of the station is our main aim. So that actually makes us not to listen to the patient and observe what is going on with the patient. So in terms of these ab uh abuse things, which is like non accidental injury. Uh patients, what happens is the patient is a bit shy at first. So if you do not let the patient speak much, you don't really have the idea that the patient is actually very um uncomfortable. The patient is having some sort of mental issues as well. The patient might also be schizophrenic. You don't really know what's going on with the patient. So for that purpose, you have to let the patient speak. So if it's an abused patient abusing, uh like a patient who is getting abused, the patient might be like, uh, ok, can you please give me the medications and I have to go home. Uh I don't really feel safe over here. So if you don't give the patient enough time to speak, the patient might not say these things and you don't have any idea that I actually was a non accidental injury patient and you treat the patient as a regular patient without even addressing the concerns. The aim of these sort of patients is to make sure that you involve the safeguarding and make sure the patient is safe. So that's the main reason why a lot of candidates fail the exam. Um not letting the patient speak enough. Ok, so please make sure you do that right? So the next thing is I see it, how many of us we know about it? I think a lot of us. So idea concern and expectations. Ok, idea. We don't really ask the patient that, do you have any idea what's going on with you or do you have any idea what might be going on with you? If we ask this patient, this thing, the patient might be thinking that this doctor is not capable enough to diagnose on his or her own. If we say that like in your life, I have seen a lot of people complaining about the GPS that they ask them that. What do you think is going on with you? What is your um idea about it? So the patients actually have some hard time to believe that that's actually a doctor. So you have to make sure you don't really uh say that thing straight away this way. OK. You have to paraphrase up a little bit. You can say that, ok, so I can see that this, this, this is leading to some sort of diagnosis. But what is your main um concern about this thing? So you can combine the idea and concern together just to make sure that the patient knows what's going on with him or her or what you can do is you can say that, ok, so this is leading to this diagnosis but still I would like to get some um uh some of your uh thoughts about your own problems. OK. Do you have anything to say about your own problems? Like anything else? Apart from the things that you have already mentioned? So technically, you have to get some idea from the patient out of the patient. OK. So you can't really ask the patient that, what is your idea about it? It's like you are asking the patient to diagnose himself or herself can't really, it's a, it's a bad approach. OK. That's it. And in terms of concern, which is the sea of ice, um that is actually something we keep asking the patient after every while. OK. We have to make sure that we ask the patient, what is your main concern after the patient is done with his or her complaints? You have to ask the patient the concern. OK. When you are managing the patient, you can ask them about the concern again. When you are done with the station, you can ask the patient about the concern again, just to make sure you do not miss out anything. So it's not like you have to ask about the concern just once at your station. It's not like that. Like when I initially started my um preparation, I didn't have a good idea about IC. So I was like, OK, so there might be a certain point of the station where I have to ask about the idea. And there is some certain stage where I have to ask the concern and expectation is something I have to ask in terms of a certain space of the station. No, it's not like that. It actually depends on the on the station and how you are dealing with the patient in terms of the expectations. What I used to prefer is when you are done with the examination. Ok, you are done with the examination. You can ask the patient that, uh is there anything specific or anything particular that you are expecting us to do for you today? So for example, if the patient is having some sort of headache, you might not give uh the patient. Uh so uh some sort of medications, but the patient might actually say that, you know what, I think some sort of painkillers might help me. Or for example, if a patient comes of with lipoma, the doctors, uh yes, the doctor will be like, ok, so I will be giving you some sort of uh medication so that there is no pain, if, if a patient comes with lipoma, some sort of discomfort or pain or something like that, maybe discoloration. So the doctor might actually prescribe some sort of painkiller initially. But if you, when you ask the patient that what do you expect me to do? The patient might ask that. Yes, it seems like a very small lipoma, but I would still like to get scanned. Ok. It, it seems very small. But um, um, as it's a bit painful and there is some discoloration, I would like to have a scan, please. An ultrasound scan, please. So this is how you actually do not miss out any sort of, uh, you know, investigations in terms of, um, asking the patient what sort of expectations the patient might be having at the end of the station you can ask about the expectation again, like, is there anything else that we can do for you that is actually also considered, like, considered as an ex uh expectation of the patient? So these are things idea which is like, you have to actually change the words a bit just to make sure you don't sound very scripted and you don't sound like the patient. You want the patient to diagnose himself. The second thing is concern, which is actually something you have to keep asking the patient a lot of the times during your station and the expectation which I said I prefer um after the examination, you can actually use it according to your um convenience where I like how you actually deal with the patient. It actually depends, the timing is not very important, to be honest when you are dealing with the patient, it actually comes up on its own. OK? So you don't have to remember that. Uh oh my God. Now that examination is done now is that I might have to ask about the expectation that that's not how it works. It actually depends on how slowly or how fast the patient speaks, depending on their um speed. You have to make sure you fit those things in. OK. Right. So I see is, uh, uh, I, uh, that's something I talked about. Ok. Focus on the symptomatic relief first. Ok. This is something we think that we are not going to miss. But that's the thing we always miss. To be honest, I have seen a lot of people missing this thing and that's one of the main reasons of failing, to be honest. For example, if the patient comes with migraine at this point, the patient might be having some sort of headache, ok. She's already having some sort of um, pain. So you don't have to talk about the pain management on the long term thing. Ok. You have to give the patient the painkiller after making sure there is no allergies and after making sure how many painkillers he or she has already taken. Ok, so please make sure that you actually work on the symptomatic relief at the first place and then you talk about the other management. Otherwise the patient might be uncomfortable the whole time and the patient will not be having some sort like the patient is not comfortable enough to talk to you about her long term thinkings about how she feels about her concerns and she might be thinking that, ok, this doctor didn't have treat me on the first place, so I'm not willing to talk to the doctor that much. Ok. So please make sure you actually give the management like the shortest, like simplest management at first and then you'll talk about the other things, the senior, the referral, the, um, the safety netting everything else. Ok. Right. The last thing that we have to do is double check with senior, which I already mentioned, I guess, which is actually very, very important. So some of us are like, ok, I know what the treatment is, but I don't really talk, I want to talk about it to the senior with the senior. Um, To be honest, if you are not 100% sure, please make sure you mention the seniors just to be on the safe side if you miss out even the slightest thing. And if you think that's actually a very minor point, but whereas it's a very important thing that you missed, the senior is going to come there. Like if you mention the senior, there will be a senior to double check that thing. Ok? So that you actually pass the station because you mentioned the senior and you didn't really take all the responsibilities by yourself. And just to just to be a safe doctor, that's, that's the main key. Basically, if you mentioned the senior, uh it will actually reflect that you are being a safe doctor. You are double checking with your colleagues and then you are referring discharging or admitting the patient. Ok. So that's a very important thing to do. All right, moving on to the next slide, which is basically the don't OK. I think the dots are like more important than the do s because the do s are very basic. The do s are something that we always remember, but the dots are something that we actually miss out a lot of times. Ok. So the first point is do not try to finish the station. Um I used to do that a lot. I used to have like eight minutes time up and I was like, ok, so I have to rush, I have to make sure I have talked about all the managements. I have talked about all the examinations. I have talked to the patient enough. I have all the concerns and I just always had this tendency of fitting all the things in within that eight minutes, which is actually not very practical. To be honest, you just have to make sure that you actually address the concerns. You have the main key points of the patient and you at least at least provide the symptomatic relief. So that's the main key. Basically, you don't really have to get to the end of the station and then you actually say thank you for coming and thank you for visiting us. No, you don't have to make sure everything is perfect. It's just that you listen to the patient, you address the concerns and you at least give the symptomatic relief. That's the main aim of each station. So you don't really try to finish the station and rush especially after the two minute. Ring bell. Ok. So that's, that's something that's very triggering. I know it's very common. That's something we are actually scared of. Like, it used to give me panic attacks when I used to practice and there was like two minutes raining and I still get PTSD from that, uh, you know, um, that notification or announcement that two minutes remaining. It's very natural to act that way. But please make sure you practice enough not to get intimated by that two minute ring or bell, whatever it is, just don't rush. Ok. So the only key is to practice and make sure that you practice enough to make sure you're not um, uh being scripted and you are getting to the end of the station because I have seen a lot of candidates who actually finish the stations but do not pass the station. The reason is they were not talking enough about the concerns. They forgot to give the symptomatic relief. They didn't listen to the patient and the patient actually was not getting enough opportunities or scopes to actually talk about the main concerns. So it doesn't really matter if you, uh you know, finish the station. It does not matter even, not, not even single 1%. Ok. Um, so just don't do it. Ok. That's the thing, right? Next thing that we don't do is, uh we do not say I understand. We don't understand. Please trust me. We don't understand what the patient is going through. If we don't understand, we are not supposed to say we understand the patient might be having some sort of personal issues. Like the patient might be having some problems with her Children. The patient might be having some sort of issues with her mother or the patient might be having some sort of, you know, um schizophrenic issues like the patient might be saying, ok, I'm hearing some sounds, there are a few, you know, um things that I see at night like the hallucinations, I'm talking about. We don't say OK. Yeah, I understand. No, we don't. Patient is saying he's seeing things and you are saying, I understand that's the most irrelevant thing you can ever say to the patient. So what you have to do is we can say that I can see that you are disturbed. I can see that you're concerned and I'm really sorry that you're going through this. But we don't use this phrase. I understand which we tend to do a lot of the times because that's how we speak. Like if you are speaking to a normal person, we say that. Oh yeah, I understand. But that's not how it works in terms of pla tube. We don't really say that. Yes, I understand your concerns. We say that yes, I can see that you're concerned about these things. OK? You acknowledge but you don't say that I understand you are going through this. There are a lot of things. That's something the patient is going through, but that's their concern. OK? We cannot relate to that thing. So don't say, OK, don't say I understand. OK. So the third thing that I will talk about is to not be robotic. OK? For example, if it's a very depressed patient, the patient is going through some sort of sad phase of her life. The patient is saying that, ok, you know, um my Children left me ii, stay in a care home and, uh, you know, um, I'm, I'm very depressed all the time. It's also the weather and it's like, um, I don't have much people to talk to. Ok. I don't really have anyone to talk to. I don't have any friends. So what you have to, I'm sorry. So, what you have to do is you have to say that, um, uh, yes, I'm, I'm really sorry that you're going through this. But your tone, please make sure you are having some sort of difference between your tones. You cannot sound monitor this. Ok. You cannot really sound like, ok, I understand you're going through this. Ok. So, you know what, I'm going to do this, this, this for you, you have to have variations when you're speaking to some sort of, uh, depressed or some sort of person who is actually going through some issues or maybe a general person as well. The person is having severe headache, like maybe the worst headache of her life and you're like, ok, I understand that you are having some sort of pain. Ok, I'm going to give you, give you this painkiller. No, this is not how it works. You have to be like, ok, um, I'm really sorry that you're going through this but you know what, we have some management for you. So this is how you actually make a difference in your tone. Like, do you notice how it, how I spoke at the first place and the second place. So there is a massive difference. OK. Uh For example, if the person comes up with some sort of um um ok, insomnia again. So he's having some sort of sleeping problems. So one thing we can do is yes, I can see that you are having some sort of sleeping problems and what are the other things that you would like to talk about? You don't have enough empathy in your tone? Ok. The patient might be feeling that, ok, this doctor is just here for the sake of giving me treatment. It's not really trying to connect, OK? You do not have to connect, but the patient is just always expecting you to connect with the person just to make sure you, you know, get the trust of the patient because in a lot of ethics station, you have to build the trust with the patient. So you have to work on your tone. Ok? I practiced a lot or on a, on, um, making a difference in my tone because I used to sound monotonic a lot of the times. So, what I used to do is I was like, ok, I can see that you're having some sort of problem. So, you know what? I have some sort of management for you. I have this medication, I have this sort referral. What would you like to have? See there is a very, um, you know, uh it's very boring. It sounds very boring. OK? But if you empathize with the patient that um OK, I can see that you are having a lot of issues going on. Is there anything else that I can talk about uh that we can discuss about? Ok. So after the patient is done? All right. So you know what, we have a lot of options for you. Um uh What would you like to have? We have this, we have this and you know what your results are amazing. So what we can do as we go for this medication first and we can try for like a few months and then after that, we can switch to a different one or what do you think uh about it? So you ask for the patient's feedback as well. What they think about the management plan, you don't really force that thing, you ask about the feedback as well. So these are the things that actually helps you not to get robotic with the patient and sound a bit more empathetic towards the person. OK. So please make sure you don't be robotic at all. OK. That's the last thing we want. All right. The next thing is something we always uh hear, we just don't be scripted. Uh It sounds very basic, it sounds very, you know, um common and it sounds very mainstream, but it is actually the most important thing you do not be scripted. So we, I spoke about this thing uh on the first slide that we have notes in front of us, we actually read the notes, but all we have to make sure is we do not memorize the complaints. We do not memorize the age. We do not memorize the name. We do not memorize the concerns because if you are me trying to memorize, even if you are not doing it intentionally, it will be some sort of subconscious mind of yours that might want to memorize the concerns. They might be wanting to memorize the age of the patient as well. For example, I would give you exa an example. Uh there was one station which I terribly, terribly failed is uh the patient was uh actually mimicking some sort of complaints that I actually read in the notes. OK. So what uh what ha what happened is when the patient came and mentioned the first complaint, I was actually guessing that OK, so this person is that person that I read and might be having similar complaints. Ok, I made questions up. I started making things up. I started making complaints up. I was like, ok, do you think you have this complaint as well? Might be a slightest chance you might be having some sort of issues with your, uh, this, this and this, you know, I was trying to relate that thing to the notes that I read. This is what happens when I try, I tried to memorize the uh complaints. So that's the last thing you do. That's when you become structured. So and scripted. So if you get scripted, you actually miss out the actual com complaints or concerns. So for example, if it is some sort of complaint in terms of a chest pain and you read in the notes that this is because of the medication side effects, you try to ask a lot of questions in terms of her medication history, which was like very, very unnecessary. So that's what you tend to do when you are actually scripted. So that's the last thing we need. We don't have to be, we don't want to be scripted. OK? So please make sure that you read the notes thoroughly. You have an idea, you have a basic structure, but you don't memorize this. Ok. Right. The next thing we have already spoken about is do not rush after two minute bell. Now we have a lot of time after two minute bell, we can cover a lot of things. Not necessarily, we have to end the station, but we don't have to have that expression on our face that oh my God, two minutes and I have to finish the station now. Don't change your expression. Don't change your approach and do not speed up. OK? Do not like II just I said these things already, but I just want to make sure you don't rush after two minutes because you have to make sure that you do it while you are practicing. Ok? When you hear the OK, there is an app actually, I'm going to send a screenshot and the link in the group in the whatsapp group that we have just to make sure that we actually practice uh the real time in real time uh announcements so that when the station starts, we have the real feeling of how it actually goes on inside the cubicle. OK? So that we have the uh we don't have the tendency of rushing after the two-minute. OK. Right. Uh The next thing is we don't really pretend to remember the name of the patient, which is basically we, I already spoke about earlier, but still, I would like to repeat that. Uh 16 stations, 16 different names. We don't know all of them and it's really hard to remember all of them. So if by any chance, unfortunately, you forget one of the patient's names, you don't really have to pretend that. Ok, maybe his name was Adam. Ok, Adam. So what do you think might be going on with you? That's not how we do it. We can actually ask the patient that I'm really sorry. I uh forgot your name. Can you please repeat that for me once again? And I'm once again, really sorry for that, you apologize and you ask, ok, instead of calling him with someone else's name that's very offending. Ok. Some people are very nice. They might not get offended, but majority of them do. Yes, they do. You think about yourself, if somebody else, if, if someone uh calls you by someone else's name, it's actually a bit awkward, isn't it? So, yeah, please make sure you don't really um uh pretend that you actually know the name, you forget you ask and that's it. Ok. Right. Uh Do not force the answer. As I've already said that there was a station where there was a patient in my exam. So I'm just gonna say it was a patient with some sort of um chest pain. So it was a pe station pulmonary embolism and the patient was actually um, uh having some sort of transgender medications taking. So there was a station in the notes where this was one of the side effects of that medication. So I tried to force the answer. I kept asking the patient that, what sort of medication are you taking? The patient said, said that I'm taking this medication and what happened is in the note, I remember that the patient was not really prescribed to pa take the medication. It was one of his friend medication. So I asked the patient that, are you taking it as prescribed? The patient said yes. But what I saw is some sort of hesitation on his face, which was not really an issue. So I asked the patient, are you really sure? Which is really silly of me? Are you really sure that you know, this is uh something that you have been prescribed with? Uh Are you sure you're not taking one of your friends medication? Which is very stupid of me. So I tried to force this answer and this is the biggest red flag of being scripted. This is the biggest and the like terrible sign of being scripted. So please make sure you don't really force an answer just to be comfortable. Like you might feel a bit, you know that uh OK, so if this station goes this way, I might be able to finish the station or I might be remembering the management. So subconsciously what we do is we tend to structure or tailor our station towards how we want it instead of how the patient wants it. OK. So we don't talk about the concerns enough and we are like, OK, so you know what uh you are having this. So I'm going to prescribe this to you. OK? You don't have to talk about other concerns. This is the medication I'm going to prescribe to you. So that's how, how not, how it works. You don't force an answer the moment you stop forcing the answer. You can actually see that the patient is opening a little bit more up and you are having more and more concerns coming up, which is actually good. You can know that how to manage this patient. What are the medications that you have to deal with? Ok. So please make sure you don't uh do the same mistake as I did. All right. Uh The last thing that we have to uh mention is try not to finish the station, we, which we already spoke about previously, just not to, just to make sure that we don't end the station and we don't rush. That's it. Ok. So these are the bones basically, right? To be honest, this is the end of our presentation. And actually, um, I just want to summarize a little, um, bit of my presentation is like, um, all you have to do is you, you, yes, you can join the academies. Uh, just to make sure that, yeah, of course, we have to join the academy, but please make sure you at least have a very basic idea before joining any academy because if you join the academy and you don't know how many structures are there? How many domains are there? How many stations are there? Um It's really difficult to understand what's going on because few of the academies, I'm not gonna take any names. But what happens is, um, a lot of the academies, they tend to start you with some sort of notes, they actually discuss the notes, they talk about the management plans, they talk about a lot of things that actually you do not understand. Ok. So please make sure that you actually, uh, have some basic idea before you start the pre uh before you join the academy. Ok. So that's one thing. And um as I have um mentioned, the three things before you enter the cubicle is you have to make sure, you know the name, you have to make sure you know the setting and you have to make sure that you have a good settled smile on your face. These three things sound very basic, but you know what this actually affect 50% of your success because if you mess the name up, if you mess the setting up, if it's not an emergency um department, and you say that I'm going to admit you to the GP setting, where do you admit the patient? So if you say that that's a very big mistake, please make sure you actually do remember these things. Um Doctor Sabin for her. Can you please repeat about the IC? Yes, of course. So IC is, is basically idea concern and expectations. Um What the main thing about the idea at the ice is, uh we tend to think that I see is basically some, we have to fit these things inside the station somewhere in between. Like there's a certain point of the station where we have to talk about the idea where we have to talk about the concern and there is a certain point we have to talk about the expectation and it doesn't work this way. OK. So what we have to do is what I personally did is um about the idea, I didn't ask the patient um straightforward that um uh you know, do you have any idea what's going on? We do, we have to paraphrase that thing. OK. We have to say that. OK. Uh Do you think that you might be knowing anything about what's going on with you? We just technically ask it, we don't ask it straightforward or straight away that uh you, do you know any idea, do you have any idea what's going on with you? So that you don't sound very structured and shifted and the patient might think that you have no idea about it. OK. So please make sure you don't uh say it that way. So you can ask about the idea after you are done with the history taking. That's what I used to do. I used to prefer. OK, in terms of concern, that's one thing we can ask the patient a lot of the times in the um in between the history taking in between the management. So, what I used to do is, um, after I was done with my history, taking before the examination, I used to ask that, do you have any other concerns? Like, do you have anything that's been bothering you that might be, you know, bothering you a lot? Uh So the patient used to come up with, you know, there is one more thing that's been uh going on. I have this sleeping problem a as all uh um as well. And I also have this, you know, uh tummy uh issues as well. So the patient used to come up with a lot of things, a lot more things unexpectedly. So please make sure you ask about concerns in between and maybe after you are done with gestation, you can say that. OK, so that now that we are done with all the management, do you have any other concerns that, you know, you want to speak about? So if you keep the, keep asking about concerns to the patient, you can actually make sure that you are not really missing out anything. OK? Just to be on the safe side. Ok. And in terms of expectations, we have to make sure that uh we uh do ask about the expectations before the ma uh management. Yes. So what I used to do is, and this is my personal preference. You can actually do it at your own convenience. But I, I would suggest you should ask about the expectations after the examination. Like for example, you can say that, ok, so these are the investigations that I'm going to conduct. Um, these are the blood tests, these are the scans that I'm going to conduct. But is there anything else that you are expecting today? Like anything else, anything the patient might be like? Ok, so you have, um, II have this knee pain, you have, um, prescribed this medication, but I would like to have an x-ray actually because II think there might be a fracture or something like that. So that's how you make sure that you are actually fulfilling the expectations of the patient as well. OK. But just remember that there is no certain time of IC in terms of the whole station. OK? You can actually ask about these things. I hope I'm clear. Doctor Sabri, Doctor Sabrina. OK. Uh Which whatsapp group you mentioned uh Doctor Isra Jha Omi. I'm going to paste the length of that whatsapp group just one second. Mm mhm Right. So this is the ones up group that I was talking about. Um you can join here. Um To be honest if you just get registered to this um um conference, this uh webinar session, I'm sorry, this webinar session that should be more than enough because the timetable, the schedule, everything else is mentioned over here. But still if you would like to have some more updates or some extra tips or some extra study materials. Um That's, that's something the whatsapp group is for so you can just join it if you want. Ok. Right. Um mm mm mm mm. Any other questions about today's session? So this session is actually going to stay recorded so you can just come and play it anytime you want according to your convenience. Ok. Doctor. Hi Doc. How do we close out the station if we don't finish before time runs out? For example, if you, we are on management and time runs out. Ok. That's a very important questions. Question and that's actually very concerning, you know, so when we are talking about the uh management, for example, um OK, migraine, we are talking about the medication, ok? Um and we still have a lot to talk about, we have to talk about the safety netting, we have to talk about the stress management. We have to talk about a lot of things, ok? And there it goes, move on to the next patient. You just say thank you and then move on to the next station. That's it. You don't really say you have to say that uh I will get back to you or you know what? I'm really sorry that I could not finish. That is going to take a lot of time. Ok? They don't really count anything you say after there is well, OK, so you don't really have to worry about it. You just say thank you to the examiner. They say thank you to the simulator and you leave the room. That's it. You don't have to worry about anything else. Uh, Doctor Chris, how do you deal with the nerves outside the cubicle? Mm. Dealing with the nerves. Ok. What happens outside the cubicle is, uh, I'm not really sure but, uh, I can say that, you know, the red flag of calming our nerves is we tend to take a lot of medications before the exam, which is the last thing we ha we would like to do. Ok. So I have seen a lot of my friends taking a lot of medications just to calm their nerves. That's the last thing you have to do because if you are someone who actually, uh, deals with a lot of panic attacks or actually have some sort of anxiety issues, the medications are going to make it worse. Don't listen to others. They are going to say that the eye actually helps you with the nerves. It doesn't, no, it doesn't. So, what you can help is, uh, I know it's very difficult to sleep on the night of your exam before the night of your exam. But please make sure that you sleep a bit early, like you can't really change that overnight. So what you can do is you can start sleeping a bit early for like one week before your exam. You try to sleep like at 10 a.m. Maybe you don't have to worry about w which time your exam is at, it might be in the afternoon, but still you have to get the night sleep. Ok. So make sure that you, uh, sleep throughout the night. A very good sleep you get. And I would not recommend practicing the day before your exam. Ok. I didn't do that. I didn't really, uh, practice intensely. I didn't go to the academy before my exam day. What I used to do is I actually had a good, you know, um, uh, get together with my friends and I, um, hang a little bit out with few of my cousins and then I was like, ok, so, ok, tomorrow my exam it's not the end of the world. So, um, you know what, um, I'm gonna face it. So that's what, um, you deal with before the exam, uh, day. Ok. And outside the cubicle, what happens is, uh, ok, so, uh, I, the people, what you have to do is you have 90 seconds. Right. Right. 90 seconds, like passes by, like within, um, a few, you know, seconds. So you don't look at around you. Ok. You just have to make sure that what is in front of you, you prepare yourself for the best for the worst and uh you read the stem memorize, uh, I don't think that you will be having much time to get anxious outside the cubicle because you'll be too busy to memorize. What's, uh, written on the note outside the door? Ok. So I would say that, uh, that's one thing and, uh, to be honest if you, and when you enter your exam center, uh, you have a very friendly atmosphere. There, there are people who will actually make you feel a lot lighter. They're very friendly. I would say they're like, uh, making and cracking some jokes. They'll be, um, uh, asking a few, you know, irrelevant things to you and they'll be, like, very friendly with you. So you actually lighten up a bit. And when you are standing outside the cubicle, the last thing you want to do is thinking about the previous station because that's gone. Right. You cannot do anything about it. I know it's very normal. It's very normal to have the tendency of thinking about the previous station. But still think about, uh, this, like more stations you are going through. Think about that. Oh, my God, I'm closer to ending this flap two. I'll be having a free time. I'll be able to do a lot of things that I'll be II have been planning to do. Ok. So that's the thing you can think about outside the cubicle if that helps. Ok. Uh, the, these sound very silly but still, I hope that helps. Ok. Um, the door you enter is the one you leave from to. Yes, that's the one. No, that, that does not sit, sound silly at all. Ok. So that's the door. We have si uh 18 doors, 16 doors to the actual cubicles and two doors for the rest stations. So that's the door. When you are having a rest station, the door is actually a bit open so that there are people outside, they will be looking after you. If you are inside the uh rest station, you'll be having cookies, you'll be having, those are very delicious. I'm telling you, uh, cookies, water and if you want, you can use the washroom as well. There'll be people outside roaming around and they'll be looking after you. They'll be asking you that if you need anything. Are you doing fine if you need any sort of help or you are actually having some sort of panic attacks? They are going to make sure that everything is checked. So, yeah, the door you enter is the one you leave from. Yes, that's the exact same door. All righty. So I think we can call this a day if you guys are done with your questions. Uh, I'm there actually a feedback form. I'm going to share that as well so that you can actually, um, write some feedbacks and I can actually, um, you know, make some improvements on changes if there is any. So if you want to talk about something that you want to learn, um, uh, there is a schedule already in the middle app, you can actually go through that schedule and if there is anything else you would like, like me to add? Um You can mention that thing up. Ok. Right. OK. Thank you very much. Thank you doctor. Uh This is very enlightening. Thank you. Thank you so much. It's, it's my honor. All right, so we can call it a day. Thank you so much, uh everyone for joining the session and this will be recorded if you want to share the recorded versions with someone. Um The only thing they have to do is register to the event so that uh they can actually have access to their videos. It's completely free. The registration is free. You don't have to pay a single penny for it. So that's it. Thank you very much, everyone. I hope you all have a very good day ahead. Ok, bye and take care.