PLAB 2 Domestic Violence Station: How to Approach, Mark Scheme & Free Practice

Hold these differentials in your head

Bracket the deadly causes first. If you fail to consider any of these in your reasoning out loud, the clinical-management domain will suffer.

• Fresh injury with an inconsistent mechanism
  Finger-shaped grip marks blamed on a door, or a facial bruise from 'the cupboard'. Do not challenge the cover story head-on - examine, note the inconsistency neutrally, then build safety before asking directly. Confrontation closes the disclosure down.
• Chronic pain or frequent-attender presentation
  Repeated visits with vague aches, low mood, poor sleep, weight loss or new alcohol use. There may be no visible injury at all. The clue is the pattern of attendance - acknowledge it out loud ('I noticed you have been in a few times recently') as your way in.
• Antenatal disclosure
  Pregnancy is the highest-risk window - abuse often starts or escalates then, and the fetus is a second potential victim. Ask about violence in pregnancy specifically, involve the midwifery safeguarding team, and treat any abdominal blow as an obstetric emergency.
• Partner present in the room
  A partner who answers every question or refuses to leave is itself a red flag. Never screen for abuse in front of them. Engineer time alone as a routine step - 'we examine every patient privately' or a chaperoned examination - and ask only once you are alone.
• Patient denies but the signs strongly suggest
  You may ask well and still get a denial. Do not push. Document your concern objectively, state plainly that help exists whenever she wants it, give the helpline number discreetly and leave the door open with follow-up. A refused disclosure today is often accepted next visit.
• Disclosure about someone else
  Sometimes the patient is 'asking for a friend' or discloses that a sister or neighbour is being abused. Take it seriously - it is often a rehearsal of her own story. Give the same information and options, and gently check whether anything similar has ever happened to her.
• Children at risk
  Children who witness abuse, or who are being hurt themselves, change the rules entirely. Her right to confidentiality no longer decides the outcome - you must involve the safeguarding lead and children's services even without her consent, and you must tell her that honestly.

Step-by-step approach

This is the structure that scores. You do not need to follow it verbatim, but every numbered block below maps to a cluster of marks in the rubric.

1. 1. Open gently and secure privacy

   The whole station hinges on whether she feels safe enough to talk. Earn that in the first minute.

   • Greet, introduce yourself with name and grade, confirm her identity.
   • Check she is on her own and the conversation is private - if a partner is present, create time alone as a routine step, never by confrontation.
   • Start with a genuinely open question and let her answer without interruption.
   • Acknowledge the pattern of attendances without accusation: 'I noticed this is your third visit this month, and I wanted to make sure we are not missing anything.'

2. 2. Explore the injury or symptoms without confrontation

   Take the cover story seriously as a history before you probe it. Curiosity, not cross-examination.

   • Ask how the injury happened and listen to the full account.
   • Ask about previous injuries, aches, sleep, appetite, mood and alcohol use - the quiet markers of living under threat.
   • Request examination findings from the examiner: bruises of different ages, grip marks or injuries inconsistent with the story are your objective evidence.
   • Do not say 'that doesn't sound like a door'. Note the inconsistency and move to safety instead.

3. 3. Signal safety and confidentiality, honestly

   State the safe space out loud, including its one limit. Hiding the child-safeguarding caveat and springing it later destroys trust.

   • 'Everything you tell me stays between us and your medical team.'
   • Add the honest caveat: 'The one exception is if I thought a child was at risk of harm - then I would have a duty to involve people who can protect them, and I would tell you first.'
   • Reassure her there is no rush and no judgement.
   • Allow silence. If she is struggling to speak, wait - do not fill the gap.

4. 4. Ask directly - weave in the HARK questions

   Indirect questions alone do not score. NICE guidance expects direct enquiry, and the mark scheme rewards each HARK domain asked naturally, not as a checklist read aloud.

   • Start soft: 'How are things at home?' and 'How are things between you and your husband?'
   • Humiliation - 'Does anyone at home put you down or make you feel bad about yourself?'
   • Afraid - 'Are you ever afraid of your partner?'
   • Rape - asked sensitively: 'Has anyone ever forced you into anything sexual you did not want?'
   • Kick - the direct question you must not skip: 'Has anyone at home ever hit, kicked or physically hurt you?'

5. 5. Respond to disclosure with belief

   The first sentence after she discloses is the most heavily weighted moment in the station.

   • Thank her for trusting you. Say clearly: 'I believe you. This is not your fault. You do not deserve this.'
   • Never ask 'why don't you just leave?' - on average it takes many attempts to leave, and leaving is the most dangerous point in an abusive relationship.
   • Validate her fear: 'It makes complete sense that you would be frightened.'
   • Do not appear shocked, and do not criticise her partner - she may still love him, and attacking him can close her down.

6. 6. Assess risk - now, escalation, children

   Cover the components of a structured risk assessment (DASH or equivalent). Two questions here are safety-critical.

   • Is she safe to go home today? Ask it in those words.
   • Escalation - is it getting worse or more frequent? Any strangulation or threats to kill? Weapons in the house?
   • Is she pregnant, and has violence ever occurred in pregnancy?
   • Children at home now - are they being hurt, have they witnessed anything? Explain honestly that where children are at risk you must involve the safeguarding lead and children's services, even without her consent, and that the aim is support, not taking her children away.
   • Ask about coercive control - money, phone, contact with family and friends - and about her partner's alcohol or drug use.

7. 7. Explain her options without pressure

   Your job is to hand her the map, not to march her down a route. She keeps control of every adult-facing decision.

   • Referral to an IDVA (Independent Domestic Violence Advisor) for specialist one-to-one support.
   • The National Domestic Abuse Helpline - 0808 2000 247, free and open 24 hours.
   • Women's refuges if she ever needs somewhere safe at short notice.
   • The police and 999 in an emergency - offered as her choice, never as your condition. You do not report to the police without her consent unless children are at risk.
   • MARAC referral for high-risk cases, explained in plain terms as agencies working together to keep her safe.
   • Discuss how to contact services discreetly, since her phone may be monitored - the surgery can be her cover story.

8. 8. Safety plan, document, follow up and close

   End with something concrete she can hold onto, and a reason to come back.

   • Help her think through a safety plan: where she would go, who she would call, a packed bag with documents, keys and some money kept somewhere safe.
   • Explain you will document her injuries carefully and confidentially - the record can support her later if she ever wants it to.
   • Arrange follow-up in a way she can attend safely, and make the open door explicit: 'Whatever you decide, you can always come back to me.'
   • Summarise the next steps, thank her for trusting you, and close warmly.

Common pitfalls

• Asking about abuse with the partner in the room - it endangers the patient and fails the station instantly. Create time alone first, every time.
• Never asking the direct question. 'How did you get the bruises?' on its own lets the cover story stand - the mark scheme requires a direct 'has anyone hurt you?' at some point.
• Disbelief or minimising - 'are you sure?', 'every couple argues' - or visibly reacting with shock. Belief and validation carry some of the heaviest weights in the station.
• Ordering her to leave, or making help conditional on her reporting to the police. Respecting her pace is safety-critical; coercion collapses the clinical-management domain.
• Breaching her confidence to the police against her wishes when no child is at risk - a competent adult's disclosure stays confidential under GMC guidance unless a safeguarding duty overrides it.
• Forgetting to ask about the children - whether they are being hurt and what they have witnessed. This is both a safety-critical item and the one situation where confidentiality gives way.
• No immediate-danger check. 'Is it safe for you to go home today?' is a single question and a safety-critical mark - candidates lose it by drifting straight into helpline numbers.
• Promising absolute confidentiality at the start and then revealing the child-safeguarding limit only after she discloses. State the caveat honestly and early.

Frequently asked questions