PLAB 2 Mock Test Feedback :: Riluzole in ALS :: Medicine

Mock Date: 02/05/2025

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your performance below:

Scenario Summary:

You are an FY2 doctor in a GP surgery. Your patient, Mr. Tom Riddle, is a 57-year-old man diagnosed with Amyotrophic Lateral Sclerosis (ALS) 8 months ago. He has been following up with neurology every 3 months. Mr. Riddle is seeking information and a prescription for the medication Riluzole. He is feeling weak and worried about his condition, which is affecting his daily activities.

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 practicing, 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	Confirm the patient's full name and age.	0:25	Yes	You asked for the patient’s name and age right at the start, which was clear and efficient.
Data Gathering	Acknowledge patient’s feelings and explain that you will ask a few questions to better understand his condition before making a plan (signposting).	1:37	Partial	You acknowledged the patient’s coping and said you would ask questions, but there was no clear forward signposting about the structure of the consultation (e.g., “I’d like to start by asking some questions, then we’ll talk about treatment options”).
Data Gathering	Ask about understanding of ALS and clarify any misconceptions.	0:50, 1:22	Yes	You asked what he knows about ALS and directly addressed the misconception that Riluzole is a cure.
Data Gathering	Explore current symptoms such as muscle weakness, cramps, slurred speech, weight loss, weak grip, or breathing difficulty.	2:14–2:54	Yes	You asked about muscle cramps, weakness, walking and feeding. Good job on covering most cardinal symptoms.
Data Gathering	Inquire about any treatments they have received and their adherence.		No	You missed this. You didn’t ask if the patient was taking any medications or if he had tried any treatment before. This could have been asked when discussing current condition or before management.
Data Gathering	Ask about their knowledge of Riluzole and where they learned about it.		No	You acknowledged he heard about it, but didn’t probe how he came to know about Riluzole. A question like “Where did you come across this medication?” would have helped.
Data Gathering	Ask about the current support they have and involvement in their day to day activities	4:50–5:00	Yes	You asked who he lives with and confirmed family support and OT involvement, which was well done.
Data Gathering	Take full past medical history including comorbidities (e.g., diabetes, liver disease), family history of neurological diseases, allergies, and current medications, family history of neurological diseases		No	None of this was asked. It’s crucial in chronic disease assessment and before prescribing a drug like Riluzole.
Data Gathering	Assess lifestyle factors such as smoking, alcohol, occupation, and physical activity which might influence treatment decisions.	3:41–4:22	Yes	Good work – you covered smoking, alcohol, diet, and mobility. Clear and concise.
Management	Explain the diagnosis of ALS and the role of Riluzole in its management.	6:02–6:38	Yes	You correctly explained that ALS damages nerves and that Riluzole helps slow the progression, though it is not a cure.
Management	Describe Riluzole’s role: It slows the progression slightly and may increase life expectancy by a few months, but it’s not a cure.	6:17–6:28	Partial	You mentioned that it reduces progression and improves quality of life, but you didn’t mention the slight increase in life expectancy by a few months.
Management	Discuss mechanism of action: It reduces glutamate levels to protect nerve cells from damage.		No	You didn’t explain how Riluzole works, which would’ve helped clarify its benefit. A short sentence like “It reduces the level of a chemical called glutamate that damages nerves” would have sufficed.
Management	Offer referral to the neurologist for eligibility for the medication and for initiating the treatment	7:21–7:33	Yes	You clearly said you’ll refer him to a neurologist who will initiate the treatment after his own assessment. Well done.
Management	Explain possible side effects: fatigue, dizziness, nausea, and more seriously, liver toxicity.	8:01	No	Patient asked about side effects but you didn’t get a chance to answer. You missed the opportunity to address this before or earlier when mentioning liver monitoring.
Management	Explain pre-treatment investigations: LFTs, CBC, U&Es, and chest X-ray are needed before starting Riluzole.	7:28–7:36	Partial	You said monitoring of the liver is needed, but did not mention the other baseline tests (CBC, U&E, chest X-ray).
Management	Discuss ongoing monitoring: Monthly LFTs for the first 3 months, then every 3 months, and eventually annually.		No	You didn’t mention the long-term LFT monitoring schedule. That’s essential to show understanding of safety monitoring.
Management	Offer supportive care referrals: physiotherapy (mobility), occupational therapy (daily activities), speech and language therapy (swallowing/speech).	4:30–4:40	Partial	You asked if he had seen physio and OT, but you didn’t actively offer referrals or suggest SLT support, which is relevant for ALS.
Management	Address emotional and psychological support: Suggest referral to counseling or support groups for coping with chronic illness.		No	You acknowledged his coping well, but didn’t offer psychological support or services like counselling or ALS support groups.
Management	Safety net: Advise on red flag symptoms (jaundice, dark urine, unusual tiredness) and the importance of urgent review if they occur.		No	You missed safety netting entirely. It would’ve fit naturally after mentioning liver monitoring.
Management	Provide educational materials: Give written leaflets or trusted online resources about ALS and Riluzole.		No	There was no offer of any leaflets or websites. A simple offer at the end would have added value.
Interpersonal Skills	Use sensitive and empathetic language throughout the consultation.	1:37, 3:06	Yes	You showed natural empathy and warmth, especially when you acknowledged his feelings and family support.
Interpersonal Skills	Signpost the conversation to ensure the patient understands each step.	1:57, 3:35	Partial	Some signposting was present, but it wasn’t consistent. You could improve by clearly breaking down transitions, e.g., “Let’s now talk about lifestyle” or “I’ll now explain the medication.”
Interpersonal Skills	Validate the patient's feelings and provide emotional support.	1:39, 3:06	Yes	You acknowledged how hard it must be and praised his coping. This felt genuine and supportive.
Interpersonal Skills	Ensure clear and concise communication, avoiding medical jargon.	6:05–6:28	Partial	You used good lay language mostly, but “initiate the medication” and “monitoring circumstances” might be slightly technical. Keep it simpler.
Interpersonal Skills	Involve the patient in decision-making and respect their autonomy.		No	You didn’t explicitly involve the patient in deciding the next steps. A question like “How do you feel about starting this medication if the neurologist agrees?” would have helped.

Feedback Statement Checklist

Feedback Statements:	Needs Improvement
Consultation	The consultation lacked consistent structure; transitions between topics like history, support, and management were not clearly signposted. Use clearer roadmap statements to guide the patient through the discussion.	✔️
Diagnosis
Examination
Findings	The candidate did not seek or document abnormal findings like comorbidities, allergies, or current medications, all of which are vital in ALS management and Riluzole initiation.	✔️
Issues	The candidate did not fully recognise the priorities—he missed safety netting, mental health support, and side effects—key to the safe use of Riluzole.	✔️
Management	Several management elements were missed: red flag advice, full monitoring explanation, side effects, supportive therapy referrals, and education.	✔️
Rapport	Although the candidate was warm and compassionate, some of the emotional support felt scripted or generic. Deeper individualisation could have improved this.	✔️
Listening	The patient asked directly about side effects (8:01), but this was not answered due to running out of time. This missed cue demonstrates a lapse in active listening.	✔️
Language	Language was mostly clear, but phrases like “initiate treatment” and “monitoring circumstances” could have been simplified for better patient understanding.	✔️
Time	Time was not well balanced—too much time was spent on general rapport, leaving out critical elements like side effects, safety netting, and education.	✔️

Additional Remarks:

Data Gathering:

You built a warm rapport and explored many relevant symptoms and social background. However, you need to remember the importance of a full medical history (allergies, medications, comorbidities) – especially in drug discussions. Make sure to clarify how patients come to know about treatments, and don't forget adherence. From the top tips: structure your data gathering better using clearer transitions, like “Now I’d like to ask about your medical history”.

Management:

You were calm and confident when talking about Riluzole. Great work on correcting the misconception and initiating a referral. However, you missed key safety and patient education elements. Be more comprehensive about side effects and investigations, and never skip safety netting. From the top tips: don't assume the patient won't understand details like liver toxicity or monitoring – they often want this clarity.

Interpersonal Skills:

You came across as very caring and attentive. Try to give more structure using signposts to help the patient follow your thoughts. Avoid slightly clinical terms when a simpler word would do. Importantly, make sure the patient feels like a partner in the plan. Ask their views and preferences before wrapping up. Remember: empathy isn’t just kind words – it’s also listening and offering choice.