PLAB: Why Guidelines are Important

Hello team! Today we are joined by one of our tutors at Docty, Dr John Smith!

John is a GP based in Harrogate and has been teaching the PLAB for many years. We will hand it over to him as he explains the importance of using clinical guidelines during your preparation for both the PLAB 1 and PLAB 2!

Hi there! Today I’ll be showing you why using clinical guidelines can give you an edge during your PLAB examination.

What are the guidelines?

Guidelines are clinical pathways that include recommendations on how to best optimize patient care and are based upon a systematic review of the evidence available. In the UK, the major body which publishes guidelines is called NICE. Other bodies that publish guidelines include the Royal Colleges and British Thoracic Society.

Why are guidelines important for the PLAB?

Guidelines underpin how we investigate and manage patients in the UK. They are a trustworthy source to turn to when deciding upon the best way to approach patient care. To understand the importance of guidelines for the PLAB, let’s look at this quote from the GMC regarding the examination:

“The exam tests your ability to apply your knowledge for the care of patients. It doesn’t test how well you can remember and recite facts. Questions relate to current best practice in the UK, and equipment routinely available in UK hospitals. You’ll need to answer the questions in relation to published evidence and not according to your local arrangements.”

This means that you should answer the questions according to best practices in the United Kingdom. It just so happens, that clinical guidelines are based upon current best practice.

Guidelines in Action

Imagine that you are confronted with the following question during your PLAB 1 examination:

An 18-year-old woman thinks she is overweight and has a mildly depressed mood. For the last 18 months, she has reduced her food intake and has been exercising for two hours each day. Her body mass index is 15.5 kg/m2 and her blood pressure is 90/60 mmHg.

What is the SINGLE most appropriate management?

  1. Prescribe antidepressants
  2. Refer for psychodynamic therapy
  3. Refer to acute medical services
  4. Refer to dietician
  5. Refer to eating disorder service

First of all, it helps to know what BMI is a clinical feature of anorexia nervosa; according to the NICE CKS guidelines, it is a BMI of less than 17.5 kg/m2. To get the correct answer here, it is useful to be acquainted with the NICE guidelines on Eating Disorders. These guidelines tell us that referral to a community-based ‘eating disorder service’ (1.2.10) is recommended unless the patient shows or is at risk of severe emaciation, in which case they are referred to acute medical services first. In this question, the patient is hemodynamically unstable and therefore requires referral to an acute medical unit as a priority.

The beauty of guidelines does not just end there. In fact, they form the basis of the investigation and management section of your PLAB 2. Good knowledge of guidelines will help you structure an outstanding investigation and management plan, which is an essential component of many of your PLAB 2 stations.

The guidelines are so long! I can’t possibly read them all. 

I agree. They are very long, boring and you really have to dig for the important information. Which is why at Docty, our PLAB 1 and PLAB 2 courses teach you up-to-date UK best practice in an absorbable and easy way.

Spending your precious revision trying to figure out super long guidelines is not a great way to spend that time!

Whenever you choose a revision source, make sure that it is up-to-date with the latest from advice from clinical guidelines. Many resources for the PLAB are outdated and not in line with the latest guidelines.

Final Words

Guidelines will give you an edge during your PLAB examinations. They will help you quickly spot the correct answer and demonstrate to your examiner that you will be a competent doctor on the wards of a UK hospital. Don’t ignore them.