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Cultural Challenges in PLAB 2: Navigating the Exam as an International Graduate

Greetings, fellow medical professionals! I'm Shanice Gouveia, an International Medical Graduate from India, and I am thrilled to share my journey and insights regarding the cultural challenges encountered during the PLAB 2 examination. Having successfully navigated this significant milestone, I understand the unique struggles faced by IMGs and hope that my experiences and tips will empower you to approach your PLAB 2 journey with confidence and cultural competence.

What are the Examiners looking for? 

The PLAB 2 examination not only evaluates our medical knowledge but also scrutinizes our ability to integrate seamlessly into the cultural fabric of the UK healthcare system. Through extensive practice sessions with fellow IMGs, I have identified some common cultural challenges that many of us face.

  1. Communication Style: In the UK, people really value clear and friendly communication, both at work with colleagues and when talking to patients. If you're a doctor from another country, it might be a bit tricky to get used to how the British talk – they like being polite, using humour, and sometimes talking indirectly. Small differences in language, accents, or everyday expressions can make it a bit hard to communicate effectively.

  1. Professional Etiquette: In the UK, how doctors behave at work might be different from what you're used to in your home country. It's important to understand how the team works together, who's in charge, and how to talk to everyone properly. This helps you work well with your colleagues and fit into the team smoothly.

  1. Cultural Competence: Taking care of patients in the UK means being aware and respectful of their different backgrounds. This includes understanding their beliefs about health, what they like to eat, and their religious practices. Knowing and respecting these cultural differences is really important to make patients trust you and feel comfortable with the care you provide.

  1. Legal and Ethical Frameworks: Doctors from other countries should learn about the rules and ethical standards for healthcare in the UK. This includes understanding how medical ethics work, the procedures for getting patient consent, and knowing your legal responsibilities. It's important to follow these rules to make sure you're doing your job correctly and meeting the standards set in the UK.

  1. Teamwork and Collaboration: In the UK, working together as a team is really important in healthcare. Doctors from other countries might take some time to get used to how the team collaborates, shares tasks, and talks openly. It's a bit different, but adapting to this teamwork style is key in the UK healthcare setting.

Understanding UK Communication Style: A Dialogue Insight into Doctor-Patient Interaction 

(Doctor – D, Patient – P)

P – Well doctor, I have this really bad headache that’s has been bothering me.

D – Okay, tell me more about it. ×

D – I'm sorry to hear that, Susan. Headaches can significantly impact our daily lives. Could you tell me more about the headache you're experiencing?

P – Doctor, I’ve recently delivered and my baby has a red eye.

D – Okay, since when?  ×

D – Firstly, congratulations on your new-born! Is this your firstborn? How has motherhood been so far? I can see that you're concerned about the red eye. Can you tell me more about it?

How to Overcome these Challenges?

PRACTICE, PRACTICE & even more PRACTICE. Engaging in extensive practice sessions with a diverse group of IMGs and, if possible, with colleagues already working in the NHS, is crucial. Personally, I took the initiative to approach NHS doctors and requested practice sessions.

This hands-on experience was instrumental in shifting my approach towards patients. It provided valuable insights into the NHS approach – from understanding the specific workings of the system to grasping the polite language used and adopting a two-way communication style. This not only helped me align with the NHS standards but also ensured that patients felt heard and satisfied with the healthcare services provided. 

Improve communication skills:

  • Participate in role-play scenarios.

  • Attend communication workshops.

  • Seek feedback from mentors.

Enhance cultural competence:

  • Engage with multicultural communities.

  • Participate in case discussions with peers.

Understand teamwork dynamics:

  • Observe team interactions during clinical attachments.

  • Learn about communication styles and hierarchies in the UK healthcare environment.

Embrace feedback:

  • See feedback as a growth opportunity.

  • Use constructive criticism to refine cultural competence, communication skills, and teamwork.

Understanding the UK Healthcare System:

  • Familiarize with NHS structure.

  • Understand referral pathways.

  • Learn common medical practices.


Navigating PLAB 2 as an international graduate is a multifaceted endeavour that extends beyond mere medical proficiency. It involves a concerted effort to understand and adapt to the cultural nuances inherent in the UK healthcare system. Essential steps include the cultivation of cultural competence, honing effective communication skills, and familiarizing oneself with the intricacies of teamwork.

Active engagement in learning opportunities, seeking mentorship, and maintaining openness to constructive feedback are crucial strategies for overcoming cultural challenges and increasing the likelihood of success in the PLAB 2 examination. This journey transcends the mere passing of an exam; it is about evolving into a competent and culturally aware healthcare professional poised for success in the UK.

The following blogs from TrewLink will be useful for your preparation:

Need more tips and help?

If you have any questions and need help practising scenarios effectively, I would be happy to help at Find me as an Ambassador and Follow my profile – Shanice Gouveia - to receive regular support and advice. Follow TrewLink's Instagram and Twitter accounts for regular tips and advice.


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