PLAB 2 Mock test feedback:: Counseling: Prostate Cancer Pain Management

Practice a case with the AI patient 🤖

Mock Date: 09/08/2025
Case 1:
Topic: Counseling
Case Name: Prostate Cancer Pain Management; CaseUID: CounselingMedication1
Action Items:
Practice and Review the case in the OSCE workbench:	Click Here
Watch the (Private) Mock Test Video Recording:	Click Here
Read the Case Blog:	Click Here
Additional Resources:	Click Here
Deep Dive into your (Private) performance below:
Scenario Summary:
You are an FY2 doctor in the oncology department. Your patient is Martin Johnson, a 70-year-old man referred from the urology team. He was diagnosed with prostate cancer 7 years ago and is now experiencing severe back pain for the past 6 months. Your task is to take a focused history from Mr. Johnson and address his concerns.
My Performance:
🔍Let’s Deep Dive into your performance:
The Domain-wise evaluation shows areas where you did well and others where you have room to grow.
A "Yes" means you covered that point effectively
A "Partial" indicates that you did some of it well but missed some key details.
A "No" means there was an important opportunity that wasn’t addressed.
Don’t worry if you see several areas marked "No" or "Partial"—this is common and simply highlights where you can focus your learning.
By reflecting on these areas and practising, you’ll be able to improve and feel more confident in your consultations. Remember, every bit of feedback is an opportunity to grow, and you’re on the right path by taking these steps.
Timestamps are provided to show exactly when during the consultation you covered or missed key points. Reviewing these can help you see how well you're managing your time and where you might need to be more efficient in addressing important areas.

Data Gathering	Patient identifiers: Confirm full name and age	1:00:18	Yes	You confirmed the patient’s full name and age early on, which was good practice. Well done keeping this clear and professional.
Data Gathering	Use an open-ended opening question to elicit the main reason for today’s visit.	1:00:31	No	You assumed the referral reason instead of asking an open-ended question like “What brought you in today?”. This would have allowed the patient to express their concerns more freely.
Data Gathering	Explore back pain systematically using SOCRATES (site, onset, character, radiation, associated symptoms, timing, exacerbating/relieving factors, severity).	1:00:49–1:02:05	Partial	You covered onset, exacerbating/relieving factors, and some associated symptoms, but missed severity and character. Next time, explicitly ask “Can you describe the pain? How severe is it on a scale of 1–10?” to complete SOCRATES.
Data Gathering	Ask about red flag symptoms suggestive of spinal cord compression (leg weakness, numbness, bladder or bowel incontinence).	1:02:07	Yes	You asked directly about bladder/bowel control which was excellent. Consider also asking about leg weakness and numbness to be thorough.
Data Gathering	Review past medical history, especially details of prostate cancer diagnosis, staging, and treatments to date	1:02:21–1:02:53	Partial	You asked about cancer diagnosis and treatments but didn’t explore staging or timing of diagnosis. This would have helped put his disease progression in context.
Data Gathering	Check current medications, doses, effectiveness, and any side effects experienced. Explore family history of prostate or other cancers.	1:01:15–1:04:00	Partial	You asked about medications and family history but didn’t clarify exact doses or side effects. It would strengthen your assessment to ask “Have you noticed any side effects from these painkillers?”
Data Gathering	Take a brief social history – living situation, support system, and impact of symptoms on daily activities.	1:04:12–1:04:45	Yes	You asked about his wife, support, and daily activities which was good. This showed you were considering his functional status.
Data Gathering	Explore ideas, concerns, and expectations regarding the pain, cancer progression, and treatment goals.	1:07:10	No	You did not ask what he thought was happening or what he expected. You missed a good chance when he mentioned his daughter’s wedding—this was his priority, and exploring it earlier would have made the consultation more patient-centred.
Data Gathering	Social history: Assess impact of pain on daily activities and social life	1:04:26–1:04:40	Yes	You explored this well when he explained he was bedbound. A follow-up about his hobbies or social interactions would have added depth.
Data Gathering	Perform a targeted examination: general physical assessment, check vitals, and examine the back for tenderness, range of movement, and neurological signs in lower limbs.	1:05:19–1:05:40	Partial	You mentioned vitals and back exam but didn’t include neurological signs. Adding lower limb neuro exam would show completeness.
Management	Clearly explain that back pain in the context of prostate cancer could indicate spread to the bones.	1:05:40	Yes	You explained this clearly. It was good you linked his symptoms with the diagnosis directly.
Management	Reassure the patient that the priority is symptom control and quality of life. Recommend MRI spine to assess extent of metastasis and exclude cord compression. Arrange relevant blood tests (FBC, U&E, ALP, PSA) to assess disease status.	1:05:38	Partial	You reassured about pain control but missed mentioning MRI and blood tests. These would have shown safe and thorough management.
Management	Discuss opioid analgesia (e.g., morphine) starting at a low dose, with titration for effective pain control. Prescribe anti-constipation regimen alongside opioids to prevent side effects.	1:06:56	Partial	You offered morphine but didn’t discuss starting low/titration or constipation prophylaxis. Always remember to pair opioids with a laxative plan.
Management	Suggest adjuvant pain relief (NSAIDs if tolerated, bisphosphonates/denosumab, targeted radiotherapy for focal pain).	1:06:28	Partial	You mentioned radiotherapy but didn’t explore NSAIDs, bisphosphonates, or denosumab. These would have shown broader knowledge of adjuvant options.
Management	Offer referral to palliative care for specialised symptom management and holistic support.	-	No	This was missed. Introducing palliative care as a support service would have demonstrated holistic thinking.
Management	Address specific concerns: Tailor pain management to allow participation in granddaughter's wedding	1:07:10	No	You acknowledged his concern but did not adjust your plan to help him attend the wedding. This was a key missed opportunity to show patient-centred care.
Management	Suggest non-pharmacological measures such as gentle physiotherapy, occupational therapy input, and use of mobility aids to maintain independence and reduce pain.	-	No	This was not discussed. Even a brief mention of supportive therapies would have added value.
Management	Safety net: advise urgent review if new neurological symptoms appear; arrange follow-up in a few days to review pain control and side effects.	-	No	You did not provide safety-netting advice. This is crucial in advanced cancer with risk of cord compression.
Management	Provide patient information leaflets on pain management in advanced cancer and safe use of opioids.	-	No	You didn’t mention written information. This is a simple but important addition to reinforce what was discussed.
Interpersonal Skills	Empathy: Acknowledge the patient's pain and emotional state	1:01:52, 1:04:00	Yes	You showed empathy several times, e.g. “I’m so sorry to hear that.” This felt genuine and was well timed.
Interpersonal Skills	Clear communication: Use layman's terms and check for understanding	1:05:54	Partial	You used lay terms mostly, but when explaining radiotherapy you didn’t fully check if he understood. Asking “Would you like me to explain how it works?” would have been better.
Interpersonal Skills	Professional boundaries: Maintain professionalism while being approachable	Throughout	Yes	You maintained good professionalism while being warm and approachable. This was well balanced.
Interpersonal Skills	Reassurance: Offer hope for improvement with proper adjustments	1:06:20	Partial	You reassured about pain control but didn’t balance this with positive hope about attending his daughter’s wedding. Next time, frame treatment in terms of his personal goals.
Interpersonal Skills	Encourage questions: Pause frequently to allow patient to ask questions	1:06:31	Partial	You gave some space, but mostly moved quickly to your plan. Adding pauses like “Do you have any questions so far?” would have encouraged more patient input.

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation. Includes illogical and disordered approach to questioning. You did not demonstrate sufficiently the ability to follow a logical structure in your consultation. For example, your history taking may have appeared disjointed, with your line of questioning erratic and not following reasoned thinking. You may have undertaken practical tasks or examination in an illogical order that suggested you did not have a full grasp of the reason for completing them or a plan for the consultation.
Diagnosis	Does not make the correct working diagnosis or identify an appropriate range of differential possibilities.
Examination	Does not undertake physical examination competently, or use instruments proficiently.
Findings	Does not identify abnormal findings or results or fails to recognise their implications. You did not identify or recognise significant findings in the history, examination or data interpretation.
Issues	Does not recognise the issues or priorities in the consultation (for example, the patient’s key problem or the immediate management of an acutely ill patient). You did not recognise the key element of importance in the station. For example, giving health and lifestyle advice to an acutely ill patient.	✔️
Management	Does not develop a management plan reflecting current best practice, including follow up and safety netting.	✔️
Rapport	Does not appear to develop rapport or show sensitivity for the patient’s feelings and concerns, including use of stock phrases. You did not demonstrate sufficiently the ability to conduct a patient centred consultation. Perhaps you did not show appropriate empathy or sympathy, or understanding of the patient’s concerns. You may have used stock phrases that show that you were not sensitive to the patient as an individual, or failed to seek agreement to your management plan.
Listening	Does not make adequate use of verbal & non-verbal cues. Poor active listening skills. You did not demonstrate sufficiently that you were paying full attention to the patient’s agenda, beliefs and preferences. For example, you may have asked a series of questions but not listened to the answers and acted on them.	✔️
Language	Does not use language or explanations that are relevant and understandable to the patient, including not checking understanding. The examiner may have felt, for example, that you used medical jargon, or spoke too quickly for the patient to take in what you were saying.
Time	Shows poor time management. You showed poor time management, probably taking too long over some elements of the encounter at the expense of other, perhaps more important areas.	✔️

Data_gathering	Management	IPS
3	1	3