PLAB 2 Mock Test Feedback:: Counseling:: PSA Asymptomatic Friend With Prostate CA

Mock Date: 07/07/2025
Case 1:
Topic: Counseling
Case Name: PSA Asymptomatic Friend With Prostate CA
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 a GP surgery. Your patient, Andrew Sutton, aged 55, has requested a PSA test because he is worried about prostate cancer. His friend had prostate cancer that spread, which has made Andrew very anxious about his own health. Andrew has no symptoms, no family history of prostate cancer, and is generally fit and well.
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.

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Introduction and Rapport: Greet Andrew warmly and introduce yourself. Confirm his name, age and address	00:13, 00:21, 00:29, 00:40	yes	You greeted him warmly, introduced yourself clearly, and confirmed name, age, and address efficiently. Good confident start.
Data Gathering	Telephone etiquette: Check connection clarity and confirm best contact number if line gets cut.	0:25	partial	You checked audibility, which is good, but you did not confirm the best contact number if the line gets cut. Next time, ask “If we get disconnected, what is the best number to reach you back on?”
Data Gathering	Focused History Taking: Ask Andrew about his main concern and why he wants the PSA test.	00:48, 01:10	yes	You explored his main concern and why he wants the PSA test thoroughly.
Data Gathering	Inquire about any family history of prostate cancer.	1:03:02	yes	You asked about family history of prostate problems, which included cancer implicitly. Good coverage here.
Data Gathering	Check for symptoms of prostate cancer: back pain, weight loss, blood in urine, nocturia, frequency, dribbling, hesitancy, weak stream, incomplete voiding.	01:01:51 - 01:02:25	partial	You covered urinary symptoms, hesitancy, stream, frequency, urgency, nocturia, and weight loss. You missed asking about blood in urine and incomplete voiding. Next time, explicitly ask about blood in urine and sense of incomplete emptying.
Data Gathering	Ask about any systemic symptoms: back pain, weight loss, fatigue, blood in urine.	01:02:21 - 01:02:39	partial	You asked about weight loss and lumps, but missed fatigue and blood in urine. Next time include them systematically under systemic check.
Data Gathering	Assess lifestyle factors: smoking, alcohol intake.	01:03:18 - 01:03:25	yes	You assessed smoking and alcohol intake clearly and sensitively.
Data Gathering	Ask about previous PSA tests and their results if any. Past medical conditions or medications that he is on.	01:02:41 - 01:03:00	partial	You asked about past medical conditions and medications but did not ask about previous PSA tests. Next time ask, “Have you had a PSA test before?”
Data Gathering	Empathy and Validation: Express sympathy for his concern about his friend’s cancer. Ask if his friend is doing well now.	1:01:29	partial	You expressed sympathy for his friend’s cancer but did not ask if his friend is doing well now. Asking about his friend’s current health would have shown deeper empathy.
Data Gathering	Explore his ICE: ask about Ideas (“What are your thoughts about why you need this test today?”), Concerns (“Is there something specific you’re worried about?”), and Expectations (“What were you hoping I could do for you today?”).	01:04:40, 01:06:21	partial	You explored his concerns and expectations implicitly, but did not directly ask about his Ideas. Next time structure ICE explicitly to show a logical approach.
Management	Explain PSA Testing: Explain that PSA (Prostate-Specific Antigen) is produced by both normal and cancerous prostate cells.	1:04:10	yes	You explained clearly that PSA is produced by both normal and cancerous cells. Well done.
Management	Clarify that PSA is not very specific for prostate cancer. Discuss that raised PSA may indicate prostate cancer but can also be due to benign enlargement or infection of the prostate. Explain that PSA levels can rise with benign enlargement, infection, or recent ejaculation, not just cancer.	01:05:23 - 01:05:56	partial	You explained that PSA is not specific and mentioned benign enlargement and infection, but missed recent ejaculation as a cause of raised PSA. Always include all major causes to ensure informed consent.
Management	Outline the steps following a raised PSA: further investigations like MRI and biopsy.	1:07:05	partial	You mentioned biopsy but did not mention MRI as the next step. Next time, outline “If it is raised, we may do an MRI and then a biopsy if needed.”
Management	Mention that a raised PSA requires further evaluation. Discuss treatment options if cancer is detected: watchful waiting, surgery, radiotherapy, and hormonal treatment.	-	no	You did not discuss treatment options if cancer is detected. Next time summarise “If cancer is found, treatments include watchful waiting, surgery, radiotherapy or hormonal treatment depending on stage and your preference.”
Management	Discuss the Implications: Explain that a normal PSA reduces the likelihood of prostate cancer but does not rule it out completely.	-	no	You did not explain that normal PSA does not rule out cancer. Important for informed decision-making. Please incorporate this next time.
Management	Explain advantages of PSA testing: possibility of early detection and treatment.	1:06:41	yes	You explained early detection benefit well.
Management	Explain disadvantages: possibility of false positives leading to unnecessary investigations.	1:06:41	yes	You explained false positives and anxiety clearly. Good.
Management	Advice: Offer to perform a prostate examination. Discuss the possibility and procedure for PSA testing.	-	no	You did not offer prostate examination or explain the procedure for PSA testing. Next time mention both even if it is telephone consultation, explain that it would be needed before PSA.
Management	Provide written information about PSA testing and prostate cancer (leaflet or email).	-	no	You did not offer written information. Next time say, “I will email you a leaflet summarising this discussion.”
Management	Safety netting: Advise Andrew to watch for symptoms such as back pain, blood in urine, nocturia, frequency, and weight loss.	-	no	You did not provide safety netting advice. Always close with “If you notice symptoms such as blood in urine, back pain, or urinary issues, please see us immediately.”
Interpersonal Skills	Communication: Use clear, non-technical language. Provide empathetic responses to Andrew’s concerns.	Throughout	yes	You used clear, simple language and showed empathy. Good rapport maintained.
Interpersonal Skills	Allow Andrew to ask questions and provide thorough answers.	1:05:39	yes	You allowed questions and answered patiently.
Interpersonal Skills	Reassurance: Reassure Andrew about the steps involved in PSA testing and subsequent actions based on the results.	1:06:33	partial	You reassured partially but did not explain what would happen based on results clearly. Next time outline stepwise reassurance.
Interpersonal Skills	Offer emotional support regarding his fears about prostate cancer.	1:01:29	yes	You offered emotional support about his friend’s cancer and his fears.
Interpersonal Skills	Patient Education: Educate Andrew on the importance of monitoring for symptoms.	-	no	You did not educate him on monitoring for symptoms. Next time summarise key symptoms to watch for.
Interpersonal Skills	Explain the purpose and process of the PSA test.	1:04:10	yes	Explained purpose and process well.
Interpersonal Skills	Provide information on lifestyle changes that can reduce the risk of prostate cancer.	-	no	You did not provide lifestyle advice. Next time add “Maintaining healthy weight, diet, and physical activity can reduce risks.”
Interpersonal Skills	Legal and Ethical Considerations: Handle the situation with sensitivity and professionalism.	Throughout	yes	You were sensitive, professional and respectful throughout. Well done.
Interpersonal Skills	Ensure Andrew understands his options and respects his preferences.	1:07:48	yes	You asked for his decision and respected his preference about testing.

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
2	2	2