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Hello, good evening, everyone. Can everyone hear me? All right. Can you hear me? Ok, Ross, I can hear you fine. Yeah, excellent. So um welcome everyone. Thank you for attending this session. This is the pla two mo that's been conducted by myself and Ross as just a moderator. Um Just a little introduction about ourselves. So my name is Dennis. I'm one of the F ones foundation trainees uh working in Ports of General Hospital and just a little background myself. I've passed plas recently and quite fortunately, I've passed all the stations, 16 of them and I've got a few stations, I've got a full marks in. So I've kind of confident that I know what to do around um plap two in terms of what they are expecting and what they are asking for. So I will explain a little bit more later and I will pass the introduction to Raza, who is our moderator? Hi, everyone. Uh My name is Rosa. Some of you may know me from uh previous um I MG serious webinars. I'm here on this mainly as a patient for, for dentists. Really. Um I am an a GMC club examiner. So I'm not actually allowed to do anything else. I'm only going to be a patient for him and to facilitate this session for him. Um and for all of you to, to benefit from this. Of course. All right. Thank you roses. So we've received a overwhelming response of um they've got what got a lot of questions around time management and clinical management, which I understand a lot of people struggle in. So I'm gonna start this session with just giving you a few few tips around how to manage your times in eight minutes because it's quite a short time and lots of people struggle with that and the other one would be clinical management. So later we follow, it will be followed by three months, which results is gonna be the patients. And one of you could kindly volunteer, I think it's really good practice. If you are able to practice and in an audience of probably 10 pa patients, you, it's gonna calm down your nerve and you'll perform better during the exam. So um later, if anyone's interested to be a volunteer, you can just let us know in the comments. So we start, I will start with time management. There's a few tips really about how the most important way to manage time. And we will start with just a very basic introduction, I would say because when you go into the exams, it, you're under a very stressful environment, it's very normal for anyone to just doubt themselves and forget the simplest sentence. So I would strongly advise memorize your names, your, your GMC number. So whenever you go into the room, the timer starts straight away. So you want to save every single seconds on every tiniest details as well. So if you go into the stations, the examiner is gonna be set in front of you, just go straight to him. Give them your name, For example, my name is Shun Ping and give them the GMC number straight away. So it would be really helpful if you could memorize the GMC number and then proceed to sit down. It, it would be quite nice if you ask the patients. May I sit down just a simple things? So you will be scrutinized at every single aspects once you enter the room essentially. So when you sit down you, because 16 stations you will be faced with different examiners. So what would really help is to memorize your introduction? So I'm gonna start with an exam. Just a simple example. Sit down. Hello. My name is Dennis. I'm one of the junior doctors in this GP surgery on, in this, on this ward. Um Can I please check your name? Um How would you like me to call you? So it's just this simple thing that um that is actually help you to save time because a lot of people when they, it's only humans nature to get nervous when you go in and you start to forget your own name, for example, is quite commonly seen. So just memorize every single sentence in your introduction. Go in. Hi, my name is Dennis. I'm one of the junior doctors here. Um, how, how can I call you or can I please check your name or your date of birth? How would you like me to call you then? Very nice to meet you. How can I help you today? Just three simple sentence will save you about 1520 seconds. And you can ask a little bit more around history taking and your management. The second thing I'm gonna say is investigations is because it's gonna be quite similar in every stations. So when you say, um, so I'm just gonna do some examinations on you if that's ok. Um You can memorize these sentence very easily. Um It doesn't have to be the reason that I wanna do this session is I don't want everyone to be scripted because everyone attend academy nowadays. And hence, there's a reason why there's a higher rate of failure because everyone's literally go in, say the same thing and the examiner, they will be examining 100s of pa of students every day. So they just kind of know that what they're expecting. So it's not as interesting enough to them. So if you just can tweak your sentence ever so slightly like can I examine you quickly, please? I'm just gonna perform examinations on you if that's ok. So I'll be doing your blood observations, for example, your BP, heart rate, respiratory rate, temperature, and your oxygen saturations. Then I'll be examining you quickly by having a listen, having a few of your, for example of your respiratory system of your chest. If that's ok, simple as that, nothing else for other investigations. Um If you don't ask, you don't get as simple as that. So if the case, it sounds quite cynical like a pneumonia case. If you don't ask for chest x-ray, you're not gonna get the chest X ray and you're not gonna pass that exam because even though, you know, it's quite clearly a pneumonia case, they know that everyone's gone through all the scenarios. So when you are nervous, you will start forgetting things. So you in your mind, you'll be quite sad. Like this is pneumonia case. This is an ac a s case. I know this, but you still have to ask for every single investigations if that makes sense. All right. And management, I can't stress this enough. A lot of people are one. the I know a lot of people have experience a lot of clinical experience as an IM GS overseas. So, you know, lots of complex management. But the idea behind pla two exam is just very simple. How first how to be a junior doctors in NHS, how to be a safe doctors as simple as that. So we don't want you to come up with Brilliance Management. Just a simple thing. Symptomatic management. I'll give you some painkillers for your pain. I'll give you some antibiotics and I'll give you some just basic management that you don't. I'll give you some, um, anti nauseous medications to help ease your nauseous. That's so. And in the end, as long as you say, I'm gonna have a quick chat with my senior to make sure that he's happy with my plan. Is that ok with you? Very simple state sentence with the patients? And it has to be patient sentence as well, which I will cover later in the session when we are doing the case. All right, always, always re prompt before you start your exams. You have, you are given one minute and 30 seconds to stand outside the stations. A lot of people don't know what to do with the time. So they just started looking around, just look at other people, what other people are doing and it makes you more nervous. So what I did, which I find really helpful was I would go through in my mind, for example, the problem that says patient will present with a chest pain. So just start to have in your mind, just formulate those questions, what you're gonna do like for example, pain stations go through sots every single bits of chest pain. What DD can be as simple as that. And in terms of differential diagnosis a lot of people also struggle with how many differential diagnoses that you actually need to give. So you start asking more and more question around history taking before you realize times is up, you haven't gone into investigations or management and then you failed the stations. So it's not rocket science 2 to 3 red flag symptoms sentence that you have to ask. For example, for chest pain scenario for the differential diagnosis, what can it be the simple one, pneumonia, pulmonary embolism or pericarditis? Just ask any pain while you are leaning forward. That's the one question is done. Any new cough that you have got is the pain worse when you're breathing in or do you have any travel his, do, have you been anywhere else? Have you traveled on the plane or on a long distance recently? Then that's it, it's covered. So in terms of your history taking, you're gonna get a really good score once you've managed to cover all of these things. Secondly, for clinical management is four points as well. So it's, is as important as your history taking. For example, if you manage to ask all the questions, but you didn't have time to get into management. What if you get, you're gonna get three maximum because you didn't get into ma you didn't get into management, you can get into diagnosis. They don't know what you're asking for. So they don't know what the diagnosis is. So it doesn't matter what did, what you come up with? What investigations, what brilliant management you come up with, you're not gonna get any marks. It's as simple as that. So, pla two is more like a ticking boxes kind of exams. You just have to be yourself. Mm. You have to come up with your own sentence as well if that makes sense. So, I know there's a lot of Academy that will give you scripted textbook, 100s of pages. You can read them, but you still have to formulate your own sentence. I mean, they're really helpful in terms of what you need to ask. The main, the main thing you need to ask and the investigations and management as well. But you just essentially have to be yourself, be a safe doctors and you're gonna pass the exams. It's not a really difficult exams. I know a lot of people think, think of it as a really tough exam where you have to be perfect. You don't eight mark is a pass, 12 mark is a pass. Once you cover those basic things, you will be able to pass. So any questions so far that I'd be happy to answer. If not, we can move into the stations and I'll give them more feedback around, around each station. So we're gonna do three stations today. Essentially. First one is gonna be focused on history taking where it's gonna be quite a long case where it's gonna be quite a long case and you try to do time management. I would, I would do, I will do quite similar to the exams where you will be given one minute 30 seconds to go through the prompt, formulate what you want to ask, what is the differential that you're gonna do? And then you come up with the investigations and management because this is the first session. So I'm not gonna do a really tricky case. I'm just gonna go with basic and second station. Um because of a lot of suggestion that comes in that people struggle with psychiatry stations because it involves a heavily on interpersonal skill and your communication skill. So you just have to be empathetic towards the patients, which I'm quite lucky that I thriving because I've done elected in this country and I have gone with, I've shadowed a lot of consultants and I pick a few sentences from each of them and kind of store it in my own dictionary and use it when time comes and the third station is gonna be Ingman. So instead of doing these stations like an exams, what we gonna, what I'm gonna do is result is gonna be the patients. But I will let you know what you would be expecting. But I want you to perform the stations like how you would during the exams. Ignore me, ignore the examiner, but I'm gonna tell you what to do. But I want you to speak to the patients like what you would do in the same men's stations. All right. So let me just go through the questions. So, differential diagnosis like II explained 2 to 3 maximum, but I will go with the red flag symptoms. What is the most important things patient come in with palpitations. What you need to rule out is hyperthyroidism or any an arrhythmia. So you have to do chest uh E CG. So it's just a basic chest pain, sotus, any other symptoms, if pains go with SOTUS, any other symptoms go with the OD para. So just when did it start, how did it start? Anything make it better? Anything make it worse. So I'm sure everyone has gone through these basic things. So I just want you to focus on the red flag sentence like any weight loss is important if you have a cough. And did you notice any blood when you cough? Do you come? Did you manage to speed up any sputum? All right. The sec, we've got questions about social stuff like the living conditions like skin scenario. So again, it relies heavily on the prom if, if the prompt, say please take focus history and uh give a diagnosis and management. In that case, you know, these stations is gonna be, it's gonna be quite a balanced, spread out history taking stations. So you just have to go through quickly. If it's indicated us. If it's not indicated, you don't have to ask for example, um if it's a skin scenario, it's important to ask about exposure, ask about the living conditions, family history, but it's not that important to ask about. Um For example, um do you have any pain or pain is important? Discharge is important, but it's not important to ask more about past medical history if that makes sense. So you don't have to keep going round and round and round about questions that is not important. So, yeah, I have, I have a question to always address ideas, concern and expectations. So, II know this ice has been overly talked about in pla exams where a lot of academy must, they, they will tell you you must do ice. I've seen a lot of candidates that would do ice, but they will start with any ideas what you have. What's your concern? What are you expecting from us? That's it. But the examiners gonna know that this per the interpersonality of this person isn't from the bottom of the heart. So in terms of ideas, you can very simply just ask them after you ask, um, or after the history, taking after investigations, just a simple sentence. So you, you come in today with these symptoms, any idea what you might have? That's it. So you don't have to go straight into concerns. You can spread them out through the whole case. It's something that you have to adapt and learn when you are practicing with your study partner. So if they look concerned that if they frown their face like this, you there will be concerns like uh you said you look a bit concerning anything that I can help you with or you can just stop post in the middle of the stations. If they look, you have to look at the facial expression as well. So it's not just about what you say about how your body language with the patients like if you are sincere. So body language is part of the interpersonal skill. So another thing before you go into investigation, you can spread them out, say oh since you come to if, if it's in the GP station, since you come and see us today, are you expecting anything in particular from us or anything specific that I can help you with? So that's it, your eyes is covered. The examiner is gonna look at you, wow, these candidates know their eyes knows the interpersonal, you know what they are doing. So you essentially you will score in interpersonal skill rather than just saying, I'm sorry at every single thing that they say, oh I'm in pain doctor. I'm sorry to hear about that. If you're not, if you're not sorry, don't say it as simple as that. What do you say in a situation where you can't answer the patient or answer some, you can be sincerely honest because you're just a junior doctor. We are not expecting, we are not expected to know everything, just say. Um, unfortunately I don't have the question. I don't have the answers to your questions, but I would just speak to my seniors and we will get back to you. Is that ok? Just ask the patients, you, it's more of a communications exam rather than just a full on clinical management exams if that makes sense. Yeah. And, and you do that in real life if you, that was a patient actually in front of you and you didn't know the answer, you would say that. Oh, I'll, I'll just check with my seniors. I'll come back to you in a minute. That's there's no shame in that. We don't know everything. Yeah. So you don't know, you don't need to know everything. Even the consultants, you will see them on the rounds. When patients ask them a question, they will say, oh, I'm sorry, but I ii don't know the answer to these questions, but let me speak to my colleagues and we'll come back or let me find out a little bit more informations on that and they'll come back to you just as simple as that. All right. Yeah. And how do I ask intimate questions? Like sexual partners and sexual activities? So it depends, you don't have to make it awkward. Like if you are awkward yourself, the patient is gonna be awkward. The rooms that the vibe in the room is gonna change. Just say so because um just you can just ask simple questions like I'll be talking, I'll be asking a few sensitive questions if you feel uncomfortable. Let me know and I will stop. That's it. And you carry on asking intimate questions. You are in an exams. Patients knows that you are the doctor. So they will expect you to ask these questions. Of course, you don't ask in every single case. If it's a quite uh obvious STD case, then you can ask those things as HIV case. You can ask those things if it's a chest pain, you don't have to ask sexual partner or sexual activity. All right, we've half an hour into our session. So I'm gonna go into, I'm gonna go into the cases. So anyone who wants to be a volunteer, I go, I think I'm the first one. All right. So just a little housekeeping before the stations. I'm gonna do it like exactly like in the pla two exam where you will hear this bell. So the first bow, it means begin the room, sorry begin. Means you go to the station, stand in front of it. You have got one minute 30 seconds to read the prompt. I want you to utilize it. Think what you want to us, think about differential diagnosis, think about investigations and then you go into the station. So when the one minute 30 seconds is up, it's gonna be like this, enter the room, it's gonna be, enter the room then you go into the room timer starts straight away. So every single second matters. Ok? So she'll read the examiner if I'm in the station or so, I will be the examiner. So you can speak to me, tell me your name, your GMC number and the results will be your patient. So you need to start talking to her. Ok? Any questions maybe don't, maybe don't tell your GMC number. Yeah. No, you can just make one up. Yeah, just rent one. So we can you see this? Ok, prescript where I mean the, it will be, it will be on the screen so you can have a read. Are you ready? Yes. All right. Good luck begin. Right. Hello. Uh, Missus J number 1325610. So, um, constipation. Sorry, you start now. Ok. Yes, thank you. So, um, hello. Uh, I'm Doctor Borgo Novo. Um, I was called to, to have a little chat with you. Are you Mister Harrison? Yeah. Yeah, Mister Smith. Uh All right. Um, may I ask you how can I help? Oh, I've just got this cough, you know, um, I've had it for such a long time now. Right? Ok. So, uh, what I'd like to do is, um, I would like to, uh, look at the monitor please to check the vital signs. So I would like first to check his, um, oxygen situation and, uh, any, any, what's, what's the? Oh, so sorry. Can I just check. Ok, thank you very much. Right. So, um, all right, uh, how, how would you like to be cold? Sorry, this Harry is fine. Harry is fine. Ok. So, can I ask you, do you have any symptoms at the moment? I've got this cough, as I said. Yes. Yes. Sorry. Ok. Um, all right. So I can see that your, um, oxygen situation is a little bit low. So, um, can I ask you if you have c could be a smoker's cough? Well, I've been smoking for a long time, so I suppose that's, yes. Ok. Do you have any medical problems? Um, I'm diabetic and hypertensive. So, uh, what I'd like to do is, uh, I would like to, uh, do my questions, um, uh, me mask, uh, mask type of situation. 80 90 94 98%. And, um, I would also like to check, um, the chest X ray, um, if I can have a look and, um, um, thank you very much. Ok. All right. Mhm. Um, could you please show me again the vital signs? Thank you very much. Ok. Mhm. So, uh, and also what I'd like to do is, um, I would like to take ABG, right? And as the patient is talking to me and he is alert, which means that, um, um, his airways are patent. So, next, what I would like to do is I would like to, um, look at the chest. All that. All right. OK. All right. So um I cannot appreciate any trauma, bleed drain or deformity. All right. So what I'm gonna do is I'm going to um look for a chest expansion if you can breathe in and breathe out for me. Mhm. Thank you very much. Um OK. It's equal. Then I'd like to look at your windpipe. Um it's in central and we'll show your veins and then what I'd like to do is like to check your chest um to see if there is. Ok. Then I would like to uh uh um across your chest as well. And then I'd like to listen to your chest and uh I can see that there is breathing with your muscles and there are cracks on the left. Ok. So at this point uh and has the situation improved? Ok. Thank you very much. So, now, what I would like to do is um I would like to um look uh uh check your um So what I'm gonna do is I'd like to check your refill. Should be, I will come to 12 to 5 seconds should be less than two. I'd like to check your uh red pes. And also I'd like to check your temperature once again. I can see it's uh about 38.5. So my patient is febrile. I would like to um check the BP again. It's 1 45/90. Ok. And then what I'd like to do is I'd like to look at uh have a look at your chest again and um check your cardiac X and then I'd like to listen to your heart sounds uh four point um Any, any heart wellness. Um No, heart sounds clear. Uh 1st and 2nd heart sound. No. Ok, thank you much. So, at this point I would like to do is I would like to request a PCG place to work, can list uh fossa and request watch for if we see U and el CCR P and um also like to um request blood culture as well and take and um yes, so and also I'd like to take sputum cultures as well. Um OK. So how are you feeling now, Harry? Oh I mean as I said earlier. Really? OK. Right. OK. Bear with me please. Um So at this point, what we like to do is um I would like to uh look um at your pulse check uh if there is any pain or any, any pulse problem also like some pain. Yeah, you do have some pain. OK. Which uh which pulse then? Oh, not in my pulse in my chest? Just all in the chest? OK. Uh Does it increase when you breathe in? Yeah. OK. Right. Mhm So you mentioned you've had some cough. Um Do you feel, do, do you, do you have any with it? Any some green stuff? OK. And how long has it been for two weeks, I guess? Two weeks? Ok. Right. I see. Ok. So, now I would like to do is I would also like to take a finger prick to check for your, uh, blood glucose as well because it, like you are a diabetic. So I'd just like to see your sugar levels and then I would like to take approach and check your reflexes as well. And then that I would like to do, I would like to request, um, a, um, drug, please. Um, and check your medications and some on, um, some Modine. Ok. And, uh, as I mentioned, I've checked the pulse. Is there any p with your mind at all? No, no. Ok. And, uh, I would also like, I would like to recheck, um, my patient's, uh, vital signs, please at the moment. Vital signs improving. Ok. Thank you very much. So, how, what do you want us to do is I would like to, um, perform an examination from head to toe. So, what I'd like to do is I would like to see if there is any, any rashes, any swelling, anywhere, any bruising, any bleeding at all. Um, so I think I would like to do this in front and at the back as well. Um, and then I would also like to, um, call my seniors and, uh, discuss with them, uh, the management if that's ok. So what are you gonna do today? So, what I'm gonna do is, uh, we would like to keep you with us for a little while if you don't mind, I'd like to, um, call my seniors. And what I'm gonna do is, um, I'm suspecting what you might be having is, um, is a condition which we call, uh, pneumonia. So, basically, it's a, it's a, it's a chest infection. So I got you. Thank you, Anastasia. Thank you very much. Thank you. I do apologize. It's not as that. We haven't actually was very clear about what this station is. This is um, supposed to be a history taking station, but you've made it into a seaman station, which I think you did it very well. I thought it was a sea because you, I think you mentioned it was a seaman first. The first station will be history taking. But I mean, in all fairness you did very well for a Seamen station. Yeah, I thought it was sorry. But yeah, that's all right. But you did very well for Semen station, but I'll go through the Seamen's stations later in a bit more about how to be systematic. But in terms of these stations, we can just speak. This is just a study group so you can just interact with us in terms of these stations. What would you focus on? Yeah. So if it's a history taking station, I would like to do. So like I'm doctor. So uh introduction. So I would like to check my patient's name and age. And, uh, g then I would like to do, how can I help? Um, give us a complain, the com the complain if it is cough, then I would like to produce a also progress such as symptoms, um, because of vit liver factors. And then I would move on to my Redflex. I'll ask a few questions there. Then I want to general health, um, to get your habits about bladder movements. And then, uh, I would move on to, uh, past medical history, surgical history, medications, allergies, family history, social habits, smoking is very important, drinking, potential drugs but not really in this case. And then I move on to home circumstances, um, occupation called well. And, uh, so, so are you worried about anything? Is there anything in particular that you would like us to do today? And, um, I would want investigations there. I would cover, I would check his vital signs, um, respiratory rate situation. Uh, heart rate, BP, temperature. I'd like to examine your chest to listen to your heart and then, um, a message the management, um, which will include, uh, prescription, an EC GX Ray if it hasn't been done. Um, blood cultures, sputum cultures. Um, actually start you on antibiotics to your, um, anti medications if needed and, uh, ignoring my s so. Yes, excellent. So you've got all the grounds covered, but I've just got a few tips around stations like this. These stations essentially would be a history taking stations as such. So when the prompt, say if you look at the prompt again, talk to the patients take relevant history, assess the patients discuss about initial management. So it's kind of prompt. You telling you that we just want initial management. You don't have to come up with very something, very extreme. I'll give you IV Tazocin, but you just have to give the first line you are in A&E you're not gonna do much. I'm sure Raza has got a lot of experience about stabilizing the patients, send them to the ward. So most importantly is history taking in patients like this diagnosis has to be right. So you will start with all the red flags such as any weight loss, any night sweats, any recent travel history because there is there is an oxygen requirement. So assess the patients when you're assessing. You just say like I told you, you can save time by just saying that I'm gonna do a quick examinations on you if that's ok, I'm gonna take observations, your BP, heart rate, respiratory rate, temperature and your oxygen saturations and they're gonna give you this. You look at it. Ok. Fine. You just have a quick chat. Looks like it's pneumonia. Fine. We move on. I'm just gonna have a quick listen to your chest and I'm just gonna examine you quickly. They're gonna give you this. So on the prom itself. If you go back, it says chest X ray has been taken. So if you don't ask for chest X ray, you're not gonna pass. So I'm just gonna have a quick look at the chest X ray because they normally would put it in front of the table. So bear with me a second. I'm just gonna look at the chest X ray in front of me. Then you pick up a chest x-ray, have a quick look. That's it. Just like. So since you have had this cough for a few, a few days now, so do you have any idea what is, what is causing this? There's your ideas done, isn't it? So it's quite straightforward. Any ideas what this can be said? I don't know. I've been told that it might be chest infection. So just say you're quite right. So I think you do have a chest infection. So, but I will need further tests to confirm the diagnosis. These are the tests where you can just set it out. You don't have that. So if it doesn't tell you that it's in the stations, they won't give it to you, but you have to still set it anyway. So like an rightly say, I'm gonna take sputum culture, I'm gonna take blood culture and everything else. So in cases like this, if you look at this for management, initial management, what would you do? Obvious chest X ray. I'm in pain doctor pain killers as simple as that. Give some fluids, antibiotics done. I'm gonna speak to my seniors to see if there's anything else that we can give you. That's it. So, it's gonna be straightforward. We're not asking too much from you. The pla examiners don't expect you to practice as a consultant level. If you are better than the consultant level, you're not gonna pass the exams. I've heard of a dermatologist and I MG dermatologist that fell dermatology stations. Quite ironic, but it did happen before. So just simple management. All right. So I'm gonna move on to the second case. Anyone that would like to do a volunteer? Thank you very much by the way. And uh sorry, I messed it up on you. I thought it was a no, no problem at all. You did very well. Thank you. No worries. The second volunteer is uh much some major. Ok. Hello? Hello? Is it ok? If I don't switch on my video? Yeah, that's fine. That's absolutely fine. So this station I'm going to give a problem. It's going to be, it's not going to be cement, it's not going to be prescribing. It's not, it's just going to be a basic stations. But can you hear us all right? Yes. Can you hear me? OK. Yeah, fine. So like I say just now the timer is gonna be one minute. Um So it's gonna be enter the stations, then you will get a prompt at two minutes remaining. And then it will say leave the room. So that's the end of the station at eight minutes. Ok. Are you ready? Yes, doctor. Excellent. Let's start again. Mhm. Enter the room. Hi, I'm much there major. I'm one of the junior doctors in the department. Can I just confirm your name and date, please? My name is Colin White. Um, 35 year old. Is it ok if I call, call in? Yeah, that's fine. It's a pleasure to meet you. Colin. Tell me what brings you here today, Colin, I just, I just don't feel like I'm getting any better, you know. Oh dear. I'm so sorry to hear that. Colin. Could you tell me what's been going on with you? Well, my wife left me about two months ago and have been depressed ever since. Mm. Right. I'm so sorry to hear this. Colin, this must be very difficult on you. How have you been coughing since then? Well, I saw my GP and he given me, well, he sent me for some CBT treatment. Um, but I don't really think it's doing anything. And why do you feel that way? Colin if I may ask? Cause I still feel really low. I don't feel like like my mood is still very low. I haven't improved. Oh dear, you do sound local and I'm so sorry with what you're going through. Um Let me ask you a few questions just to get a better understanding of what's going on and hopefully we can come up with a plan. How does that sound? Colin? That sounds great. Thank you. Um Colin, so you, you mentioned that your GP had uh um uh uh prescribed you to see a CBT. Could you tell me more about it? Like, how many times have you visited the patients? Um I think six sessions so far? Ok. Did you visit all sessions or did you skip in between? I didn't skip any. Ok. That's good to hear. And could you tell me, was it in a groups or was it individual? He was in a group? Ok. I see. Ok. And, um, what, apart from CBT, were you getting any other treatment at all? Colin? No. Um, they did talk about maybe, um, some medications but they thought they will try this first and see how it goes. Right. Usually that's what we do, but I'm glad that you're here. It's definitely the right thing to do for you coming back. Um, Colin, if I may ask you, tell me, uh, how is your mood of L? Hello? Um, I'm sorry to hear that. Colin, could you tell me on a scale of 1 to 1010 being your happiest? Where would you scale yourself? Maybe a two or three? Oh, that's pretty local. And, and how have you been managing? I've just been sleeping a lot. Really? Oh, dear. That must be very difficult. Have, um, could you tell me, have you been able to do the things that you like to do? Not really, I haven't been enjoying him, you know, kind of lost interest in everything. Ok. I'm sorry to hear that. Colin what about your meals? You mentioned that you sleep more? Do you eat at all? Oh, when I remember, um, um, could you tell me, um, are you able to sleep? Do you wake up? No, I wake up really early. You know, it's very strange. I sleep a lot of the days, but then I wake up really early in the morning. And do you feel refreshed when you wake up? Never? Do you feel like you need to go back to sleep again? So that maybe you can feel a little bit better? Well, I feel that, but I can't really go back to sleep. II don't know why I wake up that early. I wake up around four or something and I can't go back to sleep. Ok. I see. This must be very frustrating for you. Colin, could you tell me, um, when people feel low they usually some people do, um, have bad thoughts. Um, have you ever thought about taking any things like alcohol just to relieve your, with your low mood and to be fair, I have been drinking quite a bit. Or could you tell me more about the drinking? Mm. Well, I buy lots of bottles online and I drink a lot throughout the day and then I sleep. I see. Mm. Ok. And what do you drink exactly? Call them. But really, um, I mean, a lot of vodka mostly, I guess. Ok. All right. Um, Colin, um, by, do you, by any chance take, um, any drugs and illicit drugs? No. Ok. And then I just wanna know some in cases like these people do have thoughts like coming themselves that be the case for you. No. Ok. Do you, do you have any thoughts about helping other people at all? No. All right. It's ok. Um, Colin, um, um, thank you for open up, opening up to me. This must be quite, um, frustrating for you. And, um, clearly it doesn't, it does seem that you're not, the CBD is not working. Um, I just want to know, do you have, sorry, your voice car. Uh, do you have any support at all? Oh, well, I'm, I've got some friends but II don't really, I don't really feel like seeing them, you know. Mm, I see. What about work? I'm a plumber so I don't really have to talk to many people but, um, I guess with the drinking it's been a little hard at work. Have you gone to, have you, have you gone to work recently a few times? But I got sent back. I told to take some time off. All right. All right. Um, so, um, Colin, I just want to, um, check your vitals real quick and, um, also could you tell me by any chance do you think you're losing weight? Yeah. Well, I think my pants don't fit as well, so, probably. Ok. All right, I'll have, uh, I'll, I'll check your weight and height. Your BMI and your vitals do look normal. Yeah. Um, I would like to involve Myia because it does seem like you're quite getting serious at this point. Is that ok if I could have a chat with about? Ok, what do you think they'll do? Um So usually I would recommend that we start you on um antidepressants. Do you think you, you're willing to consider that? I do want to try. I just wanna feel better. Ok, perfect. We'll try that. But II must warn you. Um They make you a little bit, you know, make you feel a little bit uh bad and then until you get better, but it takes a bit at least two weeks until you feel better. They would when they make me feel bad. WW what exactly does that mean you, I mean, in terms of your mood will still be low for, for two weeks, but I recommend don't stop taking the sorry. That was really good. That was really good. How did you think you did? I feel like I didn't have a compassionate match. It does feel like you're very sincere, which is a good thing. It does, it does feel like it really low and no, she did sound very low and her favorite person I tried but you made me laugh. Um Right. So how did you think you did in that stations? Um, I, II don't know. I don't know. Ok. So I think you did like Rosa say you did very well. Um, in terms of your history taking, I think it's impeccable. I will give you a four out of the four, no doubt at all. You've asked most, a lot of questions where most, even most um Psychiatry juniors won't be asking. So I think that's a good start. But in, if you look back at the prompt again, it says talk to the patients, address his concerns. So in stations like this, if you ask you, I do, I appreciate that asking a lot of questions is important in the psychiatry stations. But if you don't have time to go into management, it doesn't matter if you get a full, full, a full score in history taking, but you get one or two in management. So in these exams, in these exams, you can get a 33 and three in the three domains, you get a nine. So that's a pass. So I think it's important to go into management when you feel like you've asked enough questions. OK. So in the Psychiatry stations, what I would normally device is um it's about communication, skill and history taking obviously. So you did ask about the social problem like the family, alcohol, drugs, self harming. So you did ask about a lot of red flags with compassionate. Excellent. But I would just go through them like you've been drinking alcohol. Ok. So move on first. You can always come back and address those problems when you know that you have got time otherwise in these patients, I'm feeling very low and you try and um, you have tried, I have tried a lot of medications you can always ask. So you know that this CBT didn't help and you come to us, II appreciate that you come to us today. Are you expecting anything from us? So you can ask them what the expectation is and concerns as well. You can always say, um, you have had this long move for quite a while now, does it concern you or anything in particular that's concerning? So you can always, when he say something you can always go into when things like this happen, people have thoughts about harming themselves or harming others. Have you had any thoughts like this? So that, that's it, it's covered. So I will breathe through the famish thinking what is more important? But in this case, if you look at the prompt again, address his concerns. So you didn't have time in the end to actually address these concerns in this patient. The concern will be around. You're gonna start, I'm gonna start you on antidepressants. What are you go? The patient is gonna have questions around those medications so you just have to be ready and spend some times on those things. That's the most of the things that people struggle with is time management in clinical because you have taken such a good history and you realize that you don't have time to go through management. So you will suffer some marks in that if that makes sense. Yes, it does, doctor. Yeah. So for interpersonal skill, I would go in details in depth in the next sessions or possibly the future session. We don't have too much time. But for those who have who's having exams sooner before we go into that, it's just a few sentence in your mind that you have to just remember and find the right time to spit them out instead of saying I'm so sorry to hear that. I'm so sorry to hear that. Just a simple. Oh, bless you. That sounds difficult or just, oh, I'm really sorry. Just simple as that. That's it. You don't have to be like I said again, like I said before, I'm gonna say it again. If you are not sorry, you don't have to say it like simple. I can see how that. I can only imagine how difficult it is for you. You have to be a good actor in PLA two. All I can say the examiner is gonna sit there and think, oh this, this candidate is actually all right. He's different from the 100s other candidates that's at 10 academy and the academy tell them say you're sorry? Ok. Ok. So a lot of juniors ju I mean, a juniors doctors like myself practicing the system. We have never say we are sorry. We are not sorry. We're just here to treat you, but we'll go around interpersonal skill in terms of you can say the simplest thing like I was, I had the stations where I was just talking uh what your, what's your occupation? They say I'm an aero engineer. So I actually asked two questions on it. So what do you do? Sounds in your job sounds interesting. And I got a full marks in that station for asking non relevant questions to that station because you just have to stand out. There's too many, too many candidates that's done pla two. Nowadays, they have gone to the same academy, everyone's study partner with everyone. So you just have to be authentic. So it's something that we do every day in our life is a junior doctors. They will be expecting you to practice at, at that level. So a lot of things, if it's in a breaking bad news station, you can just stop in my breaking bad news station. I just stop. I don't do anything. I push the tissues toward her towards her, give her the tissues. That's it. I just stop until she start talking and they are proper good actors and actresses. I would say they actually cry in the stations. I don't know how to do it for the whole day, but I'm hoping they will get paid enough for that, but they do actually cry. So just be sincere be what you gonna do when somebody cried in front of you in stations like this, you don't have to rush to finish it. You take the basic sense, take the basic history and spend lots of time addressing the concerns, answering questions. All right, any questions of uh around interpersonal skill that I can just answer immediately. But I will be careful around saying I'm sorry because I feel like lot of I've done this as my in my free time, a lot practicing with lots of candidates. What I notice is and even with my previous study partner, what I notice is because English is not our first language for most of us, we are not as good as the local the natives here where they have got loads of sentence in their bank where they can just pull it out and use it straight away. So what we tend to do is I'm sorry. So just be very mindful with that with doing the exams. You can always say something, just look passionate, look empathetic, your body language, you just have to lean forward a little bit. You don't have to touch them, just lean forward a little bit with your open body language and just tell them slowly, speak slowly and answer questions. There's something called Chuck and check two sentences later. Any questions so far or they would look confused and look at you. They will look like they want to interrupt you, but they didn't, they won't because they have been paid not to interrupt you until you say something. You have to get the queue. So there will be, uh, so you just say, oh, it seems that you have, you, you, you, you look a bit concerned or you look a bit confused, anything that I can do for you, anything that any questions at all or you'll be explaining management, for example, in the stations, it's a CBT. So you're gonna start them on antidepressant. You just have to explain a little bit more what's important in antidepressant. You have to carry on taking it until you see effect. You can't stop it immediately. So patient will have concerns around that will reduce my libido. So I have to be honest with you, the cases, the concerns are very similar to the scenarios that you get during academy. It's just one or two questions which they might change, but essentially to maintain the standard of the exams, they're gonna be very similar. So you just have to be ready for them and answer the questions. OK. So are we ready to move on to the next stations? Yes. Thank you, Prana. Are you on? Yes, hi. Hello. Right. But it's gonna be similar. But in this station it's a semen station, but we don't have a proper segment. What I'm gonna do is Rajas RAAS will be your patient. So I want you to speak to her. But whenever you say something, I will let you know if you say I'm gonna look at the monitor, the things is gonna be, the monitor is gonna be on the screen. But if you wanna say something, you actually do it. I'm not expecting you to finish the eight minutes, but I just want to run through what's important in C men's stations. A to e being systematic. That's what we are looking for in these stations, uh, tonight. Ok. Right. Let me just get the timer ready. Are you ready? Yes. Brilliant. Begin. Enter the room. GMC number 365290. hello. Hi. Uh, I'm doctor, uh, one of the junior doctors working in the department. Uh, can I confirm your name please? Janine, my name is Janine. Ok, Janine. Uh, you know, I got a call from the nurse saying that you weren't feeling. All right. Uh May I know how I can help you? I've just been feeling really rubbish. I thought I should be getting better but I'm not. Ok. All right. Um, well, I'll see how I can help you with that. Uh Do you wanna tell me more about how you're feeling poorly? I've been feeling really hot. I've been sweating for like the last 24 hours and it hasn't, it hasn't gone anywhere. Ok. All right. Um, is there anything else apart from what you've told me? Well, I'm still, you know, I came here for, they said I had a UTI, um, but I'm still, it still burns. It hasn't improved either. Ok. Um, so, you know, I'll just connect you to the monitor and, and, uh, check the, check your vital signs to see if, uh, to see what's going on. Ok. Um, Well, since you're speaking to me, you know, your airway is patent. So that's good. Um uh There's no, you know, any problems with your breathing. So I'm happy with that as well. Um And uh you're talking to me fine. So, you know, there's no issues um with your consciousness. Um uh So I can see that your saturation is a bit low. Um And I'd like to, you know, give you oxygen to help you breathe better. Um uh Do you have a smoker's cough by any chance? No, I've never smoked. Ok. All right. That's good to know. Um So I'm just gonna give you oxygen via nonrepeat the mask up to 15 L per minute. Um So, you know, you're just gonna feel a gush of air once I uh uh put the mask over your face. Uh and II, just like you to relax and just breathe uh normally. Is that OK? Yeah, that's fine. OK. Um So I'm gonna check the monitor in a few minutes again to see if you know, your uh breathing has improved. Um And uh uh I see that uh your respiratory rate is 25. So I'm gonna assess both of these things later to see if there is uh any sort of improvement. Um So now, you know, I'd just like to examine you, uh, examine your face to see if there's any sort of sinois um or nasal flaring. Um I'm just going to touch your neck as well to see if uh your trachea is sent if uh I know everything's all right with your neck and if your trachea is central, uh and I'm gonna listen to your chest and lungs um as well to see if you know, I can hear anything uh uh which is not very normal. Uh And I'm also gonna look and tap on your chest to uh uh see if there are any skin changes or uh uh and uh yeah, and I'll also see if you know your chest is expanding properly and to assess the symmetry of your chest wall movements. And uh yeah, and also tap on your chest to check for any dullness, resonance or hyperresonance. OK. Um All right. So, uh I'd like to see and I, I'd like to li listen to your lungs to see if uh you know your breathing is normal. So, breathing is um ee equal air entry bilaterally. Um You can hear a little bit of crackers on the right side. OK. All right. Um Well, I do hear, you know, AAA bit of abnormality on your right side. But uh um I just like to re reassess the monitor again to see if there was any improvements in your oxygen saturation or your Respi uh your respiratory rate, patients breathing more comfortably. Now, saturation has gone up to 96% on 15 L. Ok. All right. Um So, you know, I'd like to, uh I see that your uh BP uh I see that your BP and your heart rate, uh BP is on the lower side and your heart rate is a bit high as well. Um So I'd like to uh insert two large IV Canula. What colors are they into your um G? Mhm. Uh So, you know, I'm just gonna insert these two needles into your arm. Um And, you know, you may feel a bit of a discomfort and uh you know, if uh you feel any pinch, that's OK. Um And uh I'll just try to be uh as quick as possible. Uh May I proceed with that? Ok. So I've inserted Tar Cannula. So at this point, I'm gonna take um certain bloods as well uh including a full blood count, uh inflammatory markers like CRP ESR. Um. Um Also, I'm gonna do uh ABG and that would include drops, lactate um um chops lactate. Um OK. Uh And uh also I'm going to do uh since there was urinary symptoms Uh I'm gonna, you know, check the, uh, take a urinary sample as well. Um, and blood culture and urinary culture as well. Ok. Um uh, since your BP is low, I'd like to give you some fluids if that's ok. Uh But fluids how much, uh ha uh I would like to give uh Harman's. Um, I'd like to give hot MS of uh, I think 1 L2 minutes remaining. Um, yeah. Uh 1 L. Um, ok. Uh, so I'm gonna also, you know, reassess the monitors to see if there have been, uh, in a few minutes to see if there have been improvements in the, uh, heart rate, uh, in the BP if it's come up. Um, so I'm just gonna examine you, uh, a bit more listen to your chest, uh, to check if there are any signs of pallor, um, uh, to check the peripheral pulses as well, um, or cold extremities. So, um, sorry, um, cold extremities won't peripherally. Um, no parlor warm. Um, well, well, perfused, um, kept refuse four seconds. Ok. All right. Uh, so, you know, I'm happy with, um, the circulation. I'd like to check the monitor again to reassess the BP, BP has come up quite nicely to 100 to 80. Ok. All right. Um, since the patient was speaking to me, uh, uh, uh, there was no sort of neurological deficits. Um, so I'm gonna perhaps chase, uh, to see if any of the investigations have come up like the ABG results if they've come back. Um, they're still waiting. Ok. All right. Um, so, uh, you know, now I'd like to just expose you to see if, uh, uh, and if there's a catheter inserted to check the catheter as well. Um, um, so, uh, I'd just like to expose you. Uh, I'll have a chaperone with me to ensure your privacy. I'd like to exposure from head to toe and to check for any signs or any rashes or anything that I've missed so far and uh check the catheter as well to see if there's any blood in it or if this. So there's no catheter. OK. All right. Um So at this point, um uh I would like to hands up. Oh my God. Well done, well done. II think you did very well. It's not, it's not the easiest station of all and practicing like this is not, it's not, it's not, it's not ideal. I know, but you just have, you just have to program your mind systematically. If you go into the stations a to e most people won't finish the station. So if you can finish the station with the diagnosis, you're gonna walk out of the station knowing that you pass because there are not many scenarios around cement. They are about 8 to 10 and they're gonna keep repeating. So what you need to go whe when you look at the problem and when you look at the prom, you know that it might be a seamen stations. Uh If you are at Harman Square, there's a little window where you can just have a little peek around and you see somebody lying down. So, you know, it's a seamen station, just a little tips around that. Um If you walk, once you walk in the stations, you just look around, just calm your mind down, look around to see if there's any drug charts on, on top of the crush trolley to look at the patients and then you walk to the patients. You did very well. So you start to intro in, in, in, in introduction. So you know what, you're gonna ask the patients that I'm gonna be here to help you. What I would suggest to do is a lot of it's got different pattern, but I think a more systematic way of and more time saving way of asking question is ask why you do it. I'm not saying that if you can ask the question, take the history first and then you do the examinations, it's not wrong. But sometimes you tend to forget the time and while you're asking you keep, you forgot that you have to assess them. These patients assess how you manage patients acutely. So you go into them to take your history. Hi, my name is and one of the junior doctors here. Can I just check your name and age or just look at the, the wristband if he's not answering. But, oh, he's gonna be some of them go. Oh, they are really good. So they, so I'm just gonna check your name and your age quickly. Just look at the wristband and don't worry, I'm here to help you. So, if the patients are not, well, doctor, since you are talking to me, your airways pattern, I'm happy with that. Move on airway is always the most important. It is something that I would check immediately because if you are taking history, it will collapse, you're too late. So it's something junior doctors do every day in real life. Assessing acutely, our patients go in check the airway patients since you're talking to me, your airway is patent. So let me just have a quick look at the monitor so you go straight into b nothing else. Mhm. So I can see that you're struggling with breathing John uh Janine. In this case, Janine, um your situation is a bit low. I'm gonna give you some oxygen. Can I just check if you're if you are a smoker, I'm not a smoker doctor. So just start actually take the thing from the crash trolley. Put it on them. Examiner sometimes will ask you how much oxygen you want. You can just keep it up to 15 L via non breather mask. Majority of the case, I would say majority of the case you need to give 15 L, you need to know where they are in terms of the crush trolley. It's ABCD E so it follows, if you are systematic, you follow every single drawers, you know where you find the things. So put the oxygen on. Look at the monitor again. Let me just check quickly. So you can just ask. So what brought you into the hospital? I heard you're a bit unwell. Tell me a little bit more. So you don't have to say uh the nurse has called me. Just say, um I heard that you're a little bit unwell. Tell me a little bit more. So he will tell you, I've been admitted to the hospital uti but I'm not. Well, I'm feeling poorly. Don't worry, I'm here to help you. That's your interpersonal skill. Then you carry on what you want to do. Let me have a quick view of your chest. Always talk to the patients prom. Remind them what you're gonna do. Have a few of your chest just gonna tap on it. Have a quick listen. So if you listen, do exactly what you're gonna do in real life because they will look at them. Just not say I'm gonna have a listen. Take the stethoscope, put it in your ear, start auscultating because the seamen, they've, you've paid so much money. So it only makes sense for them to spend some money on the cement. The cement is actually real. You can hear wheeze, you can hear crackers whatever that they want you to hear and they are gonna be easy case because they're very, they're very prominent. The signs are very prominent. So you're gonna do what you want. ABG. I'm gonna, or I'm gonna request a portable X ray for you. Just, they will just come, you just say it, you don't have to wait for it. Just say I'm gonna order the, I'm gonna request a portable x-ray for you. I'm gonna do ABG and then you move on before you move on. Look at the monitor again, you're, you're saturating a bit better now. Um Janine and see can I can see that you're breathing more comfortably, so I'm just gonna move on. So the examiner know your trend of thoughts in the mind you move on to see. Let me have a quick look at the morning you can, oh Janine, your BP is a bit low. I need to give you some fluids. You see the sign you manage it straight away, you see the sign, you manage it straight away. So I'm I can see that your BP is a bit low. Um I'm gonna assess you quickly you can do. So it's just a few things you need to do. Listen to the heart cap review. So you don't have to do a lot of extra things because you don't have time. I'm gonna pop two candy light in you and you just have to pick it up it's orange or gray. You have to actually pick it up, put it on the patient. The examiner will tell you fine carry on. So what fluids you wanna give low BP bonus? You have to pick the fluids up. I'm gonna give you 250 M or 500 M bonus as soon as possible. Or if the patient is not acutely, if he is not hypotensive, we can give, I can give you some fluids maintenance over eight hours. You have to actually go in the drawer. Sometimes they will put it on top of the drawer, just grab it, pop it on the top, pop it on the back and then if you're happy with C move on your heart rate is fine. Uh Heart rate will come down eventually it's fine. Move on D um patients talk to me. I let G CS of 15. Quite happy with that. Carry on. I'm gonna take out the torch, shines the lights. Equal pary reflex fine. Move on. So you don't waste any single seconds in the stations. You just go in and manage the patients, get out. So I'll do a quick BM on you as well. That's it. Nothing extra. So move on to e like move on to e because you need to spend some time on management. You move on to e let me just expose you quickly and check for any bruises. There is a bleeding case. There will be a lot of bruises on the coming. So check for rash, just a few basic things. I'm just gonna expose you and I'll get a chaperone. I'm gonna expose you just to check. So you look at, look through them fine. I'm happy. Go back again. So by the time you say, OK, I'm suspecting that you might have a blood infection or sepsis. Then you start with your management. I'm gonna check lactate, I'm gonna check. So when you say you're taking some blood spot, bloods that you're gonna take in that one is in C So I'm gonna check take your blood FBC. These are the things where you can actually memorize because they're gonna be the same in every case. I'm not asking you guys to memorize the script, but it's just to memorize what you're gonna do. I'm gonna do FBC. Check your kidney function, check how your kidneys function, your liver function. I will take blood culture. If it's spiking fever, I would do a procalcitonin and they will be impressed I examined, be like, oh, this is different and I will do a quat swab with spiking temperature if you want. So you move on. So just manage, C move on, manage D move on, manage E move on. And then you start talking to the patients. Since the patient will decide if you look at the monitor at the end of your assessment, you will find that oh, this patient's vital is actually improving because once you manage them, they will just change the state, vital state straight away. So you said, oh, it's improving. So what do you think you have? Just, you can start explaining now so you can get interpersonal skill. But in so what do you think you have? So I think you might have blood, you have sepsis or blood infection. So what I'm gonna do, I'm just gonna wait for the blood to come back. So you know that take three gives free and I have given you this and this and this, I've, I'm gonna put a catheter in. If so, normally they wouldn't expect you to actually put a catheter. I'm gonna put the catheter in just to measure your urine output. So leave the management at the end, I'm gonna give you some antibiotics as well. So if you are keen, you can say I'm gi give you some IV called Amoxiclav. But A to e assessment is the thing that they assess you on that. They want you to do it on the patient. The rest of the things are extra so you can get those extra point in. But if you can pass, if you want to pass, you do a to e well stabilize the patients, that's good enough and then tell them, you can always say to them, I'm gonna speak to my senior, I'm gonna get my senior to come and see you again or you can say something X Right. I'm gonna get some E CG. You can say it in C if you forget, doesn't matter, you can always say it in the end. So in terms of uh A to e always remember, go in, start with ABCD E. Start taking history from B if you want, you can take a quick history in the beginning. That's fine. No one's stopping you, you can take a quiz. I'm feeling unwell. I've been limited three days ago. So um any past medical history or sometimes there's a drug chart lying on top of the cross trolley. I'm just gonna have a quick look at your drug chart or in the asthma case, you will see inhalers lying on top. So in nebulizer, I just say I'm gonna give you in in B I'm gonna start manage you straight away. You sound a bit wheezy Jenny. I'm gonna give you some naps. How much do you wanna give 5 mg aut or nebulizers? You actually, they've got vial in there so you can look at them know the trolley. So if you are at your academy, what you could do is go through, see men stations by looking at the trolley, see what's in there where you're gonna find your stuff. Any questions so far, you can inform your seniors, but it depends on what kind of case if you feel like it's something that you're unsure of. But in semen case, I would say, always inform your seniors because if you look at the new score that's been used in the UK, if there are news of seven and above, then you need to get a registrar to review them anyway. But you would need to do the basic management. I'm gonna hand you over to the senior. That's it. So it sounds a bit daunting. But if you keep practicing, you will eventually get used to it and during the exams, you will be less nervous because nerve is the thing that would actually make you struggle during the exams. I think we've got about six minutes. So any questions. Um So I have got this, let me just share it to you. I have made this for myself during my exams. Oh, sorry. Let me just show you. I have got this flashback that I can share with you guys. It's not a Bible for Pla two. I'm not saying it's a Bible for Pla two, just a disclaimer. But I think it's a really good um a flash card for you to refresh your mind um before your exam. So it's got all the basic stations, all the stations that commonly come out with basic clinical management, especially if you are nervous. So let me just show you something like this. So I've got chest pain DBS, what's important, what you need to ask. So if you want them, I it would be much appreciated if you could give us some feedback. Uh Once you've done the feedback, I can email them to you. So I think we've got emails of those uh those of you that joined the session. So I hope these sessions actually help even at the slightest tiniest bit. Um Thank you everyone for attending. Um I think we are aimed to have these sessions, this kind of sessions every two weeks, um every two weeks. And I will go through every single bits like prescribing, um interpersonal skill or counsel, drug counseling, um teaching stations. So we'll go through them. I'm, I do apologize for those of you who have exam earlier, but we're doing it once every two weeks. So if you are interested, there's a link where we can sign up um results. Do you know if we have got the email address or um, the people who have signed in? Then if, if people can just put the email address, I think in the comments section, at least we will, everyone will, will be there. Ok? So anyone who's interested in the flash cards that I made and uh we've got, if there's any updates, I'm always happy to send out an email just to let you know, but we'll be doing these kind of sessions every two weeks. Anything else that you from yourself versus? No, I think that's it. Thank you, everyone. Thank you everyone for attending and I hope you have a good one and good luck for those who have these exams soon. Ok. I'm just going to leave it open and wait for um everybody's emails to, to come through um but feel free to, to leave guys. All right, thanks. Once you've done that. Thank you very much, guys. Cheers.