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Lana

How Stress Affects The Psychological And Social Wellbeing Of Students In Higher Education.

How stress affects the psychological and social wellbeing of students in higher education.
  This paper was aimed at highlighting stress in college students as a psychological problem which has underlying medical, genetic or environmental basis.

High prevalence rates of psychological distress in student life in higher education and later professional life indicate a need for deeper analysis of the contributing factors. In order to gain better insight and offer some solutions to some of the causes of stress, the present study aimed at evaluating the effect how stressful life affect the psychological and social life of students in higher education measures distress, coping and psychological morbidity.


A little bit of stress is essential for every student. Because it allows them to develop a sense of competition and helps them to set a goal. By going beyond their limits to achieve their goals in life. But excess of  it can be detrimental to both mental and physical well being.


According to Hans Selye "Stress is the nonspecific response of the body to any demand, whether it is caused by, or results in, pleasant or unpleasant conditions." These demands are called stressors and are the stimuli that lead to stressful external events resulting in a number of responses. Common stressors for students in college include:

•   critical adjustments to college life

•   academic requirements

•   demands of studies (e.g., assignment deadlines and increasing workload)

•   pressure on interpersonal relationships

•   unsatisfactory housing arrangements

•   lack of a support system

•   ineffective coping skills

•   extended commute time

•   greater levels of independence

Further, Dr. Sian Beilock, psychologist, points out that her research indicates that stressful academic situations impact the performance of students. If stress is not managed properly, it can prevent students from successfully achieving their academic goals.

While students want to perform well in their studies, in their quest to achieve these goals, they could experience situations and events that cause stress. Students are expected to balance their school work with other things such extracurricular activities and even jobs.

If students are unable to manage and complete their work in the set time, this could cause them greater stress and feelings of being overwhelmed. They could also be trying to please others and living up to their expectations, leading to greater stress.

The American Institute of Stress points out that "stress can have wide ranging effects on emotion, mood, and behavior." Stress affects both students' physical and mental functioning, and eight ways are discussed in this hub. These negative symptoms could affect the quality of students' academic performance.

College Life Stress contributers

Below are some of the most common causes of stress in a college student life.

                       academic requirements

                       finance difficulties

                       peer pressure

                       interpersonal pressure

                       pressure of studies

                       extracurricular activities

                       bullying

                       lack of support system

                       extended commute time

                       greater level of independence


Physical Symptoms

High levels of stress could lead to physical symptoms that could have a negative effect on student performance. These signs and symptoms include:

•   frequent headaches

•   tremors, trembling of lips

•   neck and back pains

•   nervous habits, e.g., fidgeting

•   rapid or mumbled speech

•   upset stomach

•   elevated blood pressure

•   chest pains

When you experience these symptoms, you might not feel the motivation you once had to do your best on academic tasks such as preparing for tests or completing assignments.

Poor Management Skills

Students who are are suffering from high levels of stress could become disorganized and uncertain of their goals and priorities. This could lead to an inability to effectively budget and manage their time.

Moreover, students who are highly stressed tend to procrastinate and neglect responsibilities such as completing assignments and meeting deadlines. Of course, this will affect their study skills and the quality of their work.

Concentration Difficulties

A high level of stress reduces students' ability to concentrate on their studies. Consequently, it makes it difficult for them to memorize facts for tests.

Even more, poor concentration could limit students' ability to think critically or at optimal levels when they write their papers or during tests. So poor judgment could lead to weak responses on exams and on their course work.

55% of students, nationally, claimed their biggest stressor to be academic in nature.

Memory Problems

Memory is vital to students' academic success, and forgetfulness is one of the symptoms of being stressed. It is clear then that this could adversely affect students' quality of work,

When students are unable to recall necessary details to answer questions, this could lead to poor exam results and limited participation in class activities.

Constant Worry

Stress is characterized by persistent daily worry and restlessness. So when students are constantly worried, this takes the focus off important tasks to be completed at school.

Because of excessive worry about different problems, students might find it difficult to fall asleep. Consequently, the work they complete could be mediocre or they could miss assignment deadlines. They could end up failing courses.

I WILL BREATHE.

I will think of solutions.

I will not let worry control me.

I will simply breathe and it will be okay because I don't quit.

— Shayne McLendon


Self-Defeating Thoughts

Students who are experiencing stress, are likely to be consistently thinking about the adverse situation that they find themselves in. They could also be constantly be focused on their failures and weaknesses.

These self-defeating thoughts affect how they feel and how they behave. This results in lack of confidence in their abilities which hinders them from performing to their highest potential and succeed in school.

Irritability and Short Temper

One of the symptoms of stress is irritability which could affect students' relationships with peers, family members, and teachers. Students could find that a significant amount of the work in some courses take place in groups.

Students are required to work with other students to achieve the learning objectives. If they are stressed, they could be short-tempered and irritable, and this could affect the cohesiveness of the group. The result could be the group’s inability to effectively achieve its goals.

Social Withdrawal

Students who are highly stressed, tend to isolate themselves from others. In doing so, they cut themselves off from a valuable support network. Family, peers and other connections could be helpful links in assisting them in achieving their personal and educational goals.

In response to stressors, students could get preoccupied and overwhelmed with the stressful situations giving little attention to relationships. Lack of nurturing relationships could affect their mental health leading to problems such as reduced productivity in their school work, in the form of failed projects and poor test scores.

Find Ways to Manage Stress

Some ways to Manage Stress in College:

1.Avoid Caffeine, Alcohol, and Nicotine.

2.Indulge in Physical Activity.

3.Get More Sleep. 

4.Try Relaxation Techniques. 

5.Talk to Someone.

6.Keep a Stress Diary. 

7.Take Control.

8.Manage Your Time.

9. learn to say NO

10. Rest if you are ill. 

College can be demanding, and this leads to a high level of stress for many students. This requires you to develop a healthy, balanced lifestyle and access the resources that are available at your school.

If you are a student and you are experiencing stress, take steps to manage it, considering the effects it could have on your health, well-being, and academic performance. Get advice and help regarding managing stress from your university or college. For example, New York University outlines specific stress management resources that are available to its students.


References and Resources

1.Beilock, S (2011). Back to school: Dealing with academic stress. Retrieved from the American Psychological Association.org. Accessed August 9, 2015.

2.Best Colleges Resources (n.d. ). A Student's guide to balancing stress. Accessed August 9, 2015.

3Health News (2015). How stress affects academic Performance. Accessed August 9, 2015.

4.New York University ( n.d.). Stress. Accessed August 14, 2015

5.The American Institute of Stress (n,d.). 50 Common signs and symptoms of stress. Accessed August 20, 2015.

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Lana

ENDOMETRIOSIS CASE PRESENATATION

BIODATA

  Name: R.F
  Age: 30years
  Parity: P3ᶧ⁰
  LMP:10/03/17, LCB 3 Years ago
  Marital Status: Married
  Sex: Female
  Address: Soma, Religion: Islam, Tribe: Mandinka, Level of Education: Primary

PRESENTING COMPLAIN
  Feeling of movement in the abdomen
  Intermittent lower Abdominal Pain
   
HISTORY OF PRESENTING COMPLAIN
  She was apparently well until 5 months PTP When she started to experience feeling of movement in the abdomen and a sharp pain. She has a urine analysis and blood test done and was dx with gonorrhea on 2/03/2017. for which she was tx with flaggyl 2g, cipro 500mg, Doxy 100mg and Pcm 1g. On the 5/04/2017, pt. again presented with the same complain and USS was done on 30/3/2017 which showed a thick endometrium containing fluid measuring 15mm and presence of abundant free fluid in the douglas sac.The pt. took local herbs to help relieve the symptoms.

GYNAECOLOGICAL HISTORY

 Menarche was at 14years
 Menstruate for 5days in a regular cycle of 28days
 Associated with dysmenorrhea, but no clots, or intermenstrual bleeding.
 Changes 3 pads daily on 1st 3 days
 Coitarche was at 20years, no dysparenia, or post coital bleeding.
 She has no hx of vx infection
 Has hx of contraceptives which she started in 2015 (injectables which she received at a 3m interval) and    stopped use in May, 2016.
 Not aware of PAP smear and has not had one.

OBSTRETICS HISTORY
  P3ᶧ⁰, LCB: 2014
  1st pregnancy was in 2006, carried to term with no complications during or after pregnancy, delivered by SVD at Serrekunda Hospital leading to 3.0 kg a boy. The boy was breast fed for 1 year and 7 months, is 11 y/o, is healthy and is in school.
  2nd pregnancy was in 2013, carried to term with no complications during or after pregnancy, delivered by SVD at hospital in Soma leading to a girl. The girl was breast fed for 1 year and 4 months, is 4 y/o, and is healthy.
  3rd pregnancy was in 2014, carried to term with no complications during or after pregnancy, delivered by SVD at hospital in Soma leading to a girl. The girl was breast fed for 1 year and 7 months, is 3 y/o, and is healthy.

PAST MEDICAL HISTORY
  Not a known HTN, DM, Asthmatic, TB, SCD, Epilepsy, or any other chronic conditions.

PAST DRUG HISTORY
  Not on any herbal medication currently but was taking some 5 months PTP.
  No known food or drug allergy.

FAMILY AND SOCIAL HISTORY
  She is from a polygamous family, father had 2 wives, mum was the 2nd wife.
  No family history of hypertension, diabetes, TB, asthma or any other chronic condition.
  She is a housewife, she is the 1st out of 6 children. She does not smoke cigarette nor drink alcohol.
  Her husband is currently unemployed, smokes but have no hx of DM, HTN, asthma or TB as well as his      family and denies any hx of sexual infections.

Summary
  A 30 y/o multiparous woman, P3+0, LMP:10/03/17, LCB 3 years ago has presented with feeling of movement in the abdomen and intermittent sharp LAP urine analysis and blood test done and was dx with gonorrhea on 2/03/2017. for which she received appropriate treatment.                   

EXAMINATION
•       General examination - stable, not in any obvious distress, afebrile, not pale, anicteric and no signs of lymphadenopathy. No presence of kolechyia or edema. BP 130/90mmHg, PR 98bpm, R 19cpm

SYSTEMIC REVIEW
•       CNS: Headache, Dizziness
•       CVS: HS-S1 and S2 no mumurs
•       RESPIRATORY: NAD
•       GIT: NAD
•       REPRODUCTIVE: feeling of movement in the abdomen and intermittent sharp LAP
•       URINARY: Polyuria
  Abdomen: Full, MWR and umblicus is inverted. no scar or scarrification, female pattern hair distribution.

 ASSESSMENT: Endometriosis

PLAN: Cipro 500 mg BD 1/57
  Flaggyl 500 mg TDS 1/57
  PCM 1g TDS 1/57
  Appoitment 19-4-2017


Literature review
 
DEFINITION

Presence of functioning endometrium (glands and stroma) in sites other than uterine mucosa is called endometriosis. It is not a neoplastic condition, although malignant transformation is possible.
These ectopic endometrial tissues may be found in the myometrium when it is called endometriosis interna or adenomyosis. More commonly, however, these tissues are found at sites other than uterus and are called endometriosis externa or generally referred to as endometriosis.
Endometriosis is a disease of contrast. It is a benign but it is locally invasive, disseminates widely. Cyclic hormones stimulate growth but continuous hormones suppress it.

INCIDENCE
      Ten to fifteen percent of reproductive-aged women. 
      Occurs primarily in women in their 20s and 30s. Common in nulliparous woman. 
      Accounts for 20% of chronic pelvic pain. 
      One-third to one-half of women affected with infertility, have endometriosis. 

PATHOPHYSIOLOGY 

      The ectopic endometrial tissue is physiologically functional. It responds to hormones and goes through cyclic changes, such as menstrual bleeding. 
      The result of this ectopic tissue is “ectopic menses,” which causes bleeding, peritoneal inflammation, pain, fibrosis, and, eventually, adhesions. 

ENDOMETRIOSIS SITES
      Common
                        Ovary (bilaterally): 60%. 
                        Peritoneum over uterus. 
                        Anterior and posterior cul-de-sacs. 
                         Broad ligaments/fallopian tubes/round ligaments. 
                        Uterosacral ligaments. 
                        Bowel. 
                        Pelvic lymph nodes: 30%.

Less Common
      Rectosigmoid: 10–15%. 
      Cervix. 
Vagina. 
      Bladder. 
      Rare 
      Nasopharynx. 
 Lungs. 
      Central nervous system (CNS). 
      Abdominal wall. 
      Abdominal surgical scars or episiotomy scar. 
      Arms/legs.
      
      THEORIES OF ETIOLOGY
Though the mechanisms and etiology are unknown, there are four theories commonly cited. It is likely that multiple theories may explain the diverse nature of this disorder: 
a. Retrograde menstruation: Endometrial tissue fragments are retrogradely transported through the   fallopian tubes and implant there or intra- abdominally with a predilection for the ovaries and pelvic  peritoneum. 
b. Mesothelial (peritoneal) metaplasia: Under certain conditions, peritoneal tissue develops into    functional endometrial tissue, thus responding to hormones. 
c. Vascular/lymphatic transport: Endometrial tissue is transported via blood vessels and lymphatics. This can explain endometriosis in locations outside of the pelvis (i.e., lymph nodes, pleural cavity, kidneys). 
d. Altered immunity: There may be deficient or inadequate natural killer (NK) or cell-mediated response. This can explain why some women develop endometriosis, whereas others with similar characteristics do not. 
e. Iatrogenic dissemination: Endometrial glands and stroma can be im- planted during a procedure (e.g., C-section). Endometriosis can be noted in the anterior abdominal wall. 

      GENETIC PREDISPOSITION 
      A woman with a first-degree relative affected with endometriosis has a 7% chance of being similarly
affected as compared with 1% in unrelated persons. With a positive family history, a patient may develop endometriosis at an earlier age than the family member. 

COMPLICATIONS OF ENDOMETRIOSIS
                           Endocrinopathy his may be mostly responsible for infertility 
                           Rupture of chocolate cyst 
                           Infection of chocolate cyst 
                           Obstructive features:
                –  Intestinal obstruction 
                        –   reteral obstruction hydroureter hydronephrosis renal infection 
                           Malignancy is rare, the commonest one being 
adenoacanthoma. 

      CLINICAL PRESENTATION
1.     Pelvic pain (that is especially worse during menses, but can be chronic): Secondary dysmenorrhea (pain begins up to 48 hrs. prior to menses). Dyspareunia (painful intercourse) as a result of implants on pouch of Douglas; occurs commonly, with deep penetration. Dyschezia (pain with defecation): Implants on rectosigmoid. 
2.     Infertility.
3.     Intermenstrual bleeding.
4.     Cyclic bowel or bladder symptoms (hematuria).
5.     Up to one-third of women may be asymptomatic.

SIGNS
1.     Fixed retroflexed uterus, with scarring posterior to uterus. 
2.     Tender uterus or presence of adnexal masses. 
3.     “Nodular” uterosacral ligaments or thickening and induration of utero- 
sacral ligaments. 
4.     Ovarian endometriomas: Tender, palpable, and freely mobile implanted   masses that occur within the ovarian capsule and bleed. This creates a small blood-filled cavity in the ovary, classically known as a “chocolate cyst.” 
5.     Blue/brown vaginal implants (rare).
The classic findings on physical exam are nodularities on the uterosacral ligament and a fixed retroverted uterus.

      DIAGNOSIS 
Clinical diagnosis is by the classic symptoms of progressively increasing secondary dysmenorrhea, dyspareunia and infertility. This is corroborated by the pelvic findings of nodules in the pouch of Douglas, nodular feel of the uterosacral ligaments, fixed retroverted uterus and unilateral or bilateral adnexal mass. However, physical examination has poor sensitivity and specificity. Many patients have no abnormal findings on examination.

Serum marker CA 125—A moderate elevation of serum CA 125 is noticed in patients with severe endometriosis. It is not specific for endometriosis, as it is significantly raised in epithelial ovarian carcinoma. However, it is helpful to assess the therapeutic response and in follow up of cases and to detect any recurrence after therapy. Monocyte Chemotactic Protein (MCP-1) level is increased in the peritoneal fluid of women with endometriosis.

IMAGING
Ultrasonography is not much helpful to the diag nosis. TVS can detect ovarian endometriomas. Transvaginal (TVS) and Endorectal ultrasound are found better for rectosigmoid endometriosis. Magnetic Resonance Imaging (MRI) is a diag nostic tool. There is a characteristic hyperintensity on T1 weighted images and a hypointensity on T2 weighted images.
CT is better compared to ultrasonography in the diagnosis. It is useful for deep infiltrating endo metriosis.
Colonoscopy, rectosigmoidoscopy and cystoscopy are done when respective organs are involved.
Laparoscopy is the gold standard. Confirmation is done by double puncture laparoscopy or by laparotomy.

Other benefits are: Confirmation of the lesion with site, size and extent. Biopsy can be taken at the same time. Staging (p. 309) can be done. Extent of adhesions could be recorded. Opportunity to do laparoscopic surgery if needed (p. 306) .

The classic lesion of pelvic endometriosis is described as ‘powder burns’ or ‘match stick’ spots on the peritoneum of the pouch of Douglas (see p. 309). indings may be recorded on video or ( 2006) Microscopically some of these lesions contain endometrial glands, stroma and hemosiderin laden macrophages.

Biopsy confirmation of excised lesion is ideal but negative histology does not e clude it. one of the imaging techniques including ultrasound, can diagnose specifically the peritoneal endometriosis. Emperic medical treatment is usually not recommended except for pain relief and to reduce menstrual flow.

CLINICAL COURSE
·Thirty-five percent are asymptomatic. 
·Symptomatic patients may have increasing pain and possible bowel 
pain and possible bowel complications. 
·Often, there is improvement with pregnancy secondary to temporary  cessation of menses. 
·May be associated with infertility.

  TREATMENT
Medical (temporizing). The primary goal is to induce amenorrhea and cause regression of the endometriotic implants. 
All of these treatments suppress estrogen:
Gonadotropin-releasing hormone (GnRH) agonists (leuprolide): Suppress follicle-stimulating hormone (FSH); create a pseudomenopause. 
Depo-Provera (progesterone [+/– estrogen]): Creates a pseudopregnancy (amenorrhea). 
Danazol: An androgen derivative that suppresses FSH/luteinizing hormone (LH), thus also causing pseudomenopause. 
Oral contraceptives (OCPs): Used with mild disease/symptoms. 

Surgical 
Conservative (if reproductivity is to be preserved): Laparoscopic lysis and ablation of adhesions and implants. 
Definitive: Total abdominal hysterectomy and bilateral salpingo-oophorec- tomy (TAH/BSO). 
A GnRH agonist can be used in conjunction with surgical treatment. It is associated with osteoporosis and should be used for only six months. 

The pulsatile fashion of endogenous GnRH stimulates FSH secretion. GnRH agonists cause down regulation of pituitary receptors and suppress FSH secretion

General treatment issues
Patient participation in the decision-making process is essential as multiple options exist and endometriosis is potentially a chronic problem. Choosing which treatment to have will depend upon a number of factors. Summarizing how these factors influence decision making is difficult because each patient is different and the decisions are often complex. However, some general principles apply. For example, a woman in her late 40s with debilitating pain and severe disease who has completed her family can be offered a hysterectomy and bilateral salpingo-oophorectomy provided that all the endometriotic tissue is removed at the same time. On the other hand, a young nulliparous woman with a similar presentation will want as much normal tissue as possible conserved if she opts for surgery.

Conclusion  
The patient came to hospital complaining of feeling of movement in the abdomen and  intermittent lower abdominal pain for 5 months PTP. She has a urine analysis and blood test done and was dx with gonorrhea on 2/03/2017 for which she was treated with flaggyl 2g, ciprofloxacin 500mg, Doxycycline 100mg and Paracetamole 1g. However, on the 5/04/2017, pt. again presented with the same complain and USS was done on 30/3/2017 which showed a thick endometrium containing fluid measuring 15mm and presence of abundant free fluid in the douglas sac.

Other positive finding was dysmenorrhea which is present in 70% cases. There is progressively increasing secondary dysmenorrhea. The pain starts a few days prior to menstruation; gets worsened during menstruation and takes time, even after cessation of period, to get relief of pain, (co menstrual dysmenorrhea). and usually begins after few years pain free menses. The site of pain is usually deep seated and on the back or rectum. 
Increased secretion of  PGF 2a, thromboxane B2 from endometriotic tissue is the cause of pain.

There were no other associated risk symptoms like abnormal menstruation, infertility, dyspareunia,  chronic pelvic pain, abdominal pain, etc in her case. Patient was prescribed Cipro 500 mg BD 1/57, Flaggyl 500 mg TDS 1/57, PCM 1g TDS 1/57 and given appoitment for 19-4-2017 for which she has not yet turned up.

References
1. Diamanti-Kandarakis, Evanthia; Dunaif, Andrea (December 2012). " Endometriosis Revisited: An Update on Mechanisms and Implications". Endocrine Reviews. 33 (6): 981–1030. doi:10.1210/er.2011-1034. PMID 23065822.
2. Endometriosis: First Aid for the Obstetrics and Gynecology, Third Edition by MATTHEW S. KAUFMAN, MD..
3. Endometriosis: Kaplan USMLE step 2 CK Obstetrics and Gynecology Lecture notes; 2014.
4. Endometriosis: DC Dutta’s Textbook of Obstetrics 7E Revised edition; 2014.
5. Munir, Iqbal; Yen, Hui-Wen; Geller, David H.; Torbati, Donna; Bierden, Rebecca M.; Weitsman, Stacy R.; Agarwal, Sanjay K.; Magoffin, Denis A. (January 2004). "Insulin Augmentation of 17α-Hydroxylase Activity Is Mediated by Phosphatidyl Inositol 3-Kinase But Not Extracellular Signal-Regulated Kinase-1/2 . Endocrinology. 145 (1): 175–183. doi:10.1210/en.2003-0329.

 

 

 

 

 

 

 

 

 

 

 

 

 

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Abel

How To ACE IELTS And PLAB1 In First Attempt

Salam and Hello to everyone who is reading this guide. It’s a little endeavor to help future aspirants to go through PLAB.

A little background about me.. I graduated in 2013 finished my internship in 2014 took IELTS right after finishing my internship and by the grace of Almighty, got the required band in one go. Then, took PLAB1 in March 2015 and declared successful in first attempt. I did not take any tuItions or courses and I am willing to Help others.

For IELTS:

The most Frequent question I receive is how long does it take to preapre for ielts. The answer is, it depends on the person.. If you have a background in English I am pretty sure you will get the required band in 1-1.5 month’s preparation. If you have difficulty understanding English you might need 6 months. I trained a couple of friends for ielts so it’s only my opinion, which might be wrong, but it will give you a general idea. I took ielts with 1 month of very casual preparation and got the required band.

To assess yourself try a couple of practice tests (from Cambridge books) and see where you stand.

Tips for Listening:
For beginners try to watch cartoons and actively listen to what is being said.. Watch English movies with subtitles and try to understand what dialogues are being delivered. Pause and rewind if you want to. Watch BBC and other News channels often. If you skip some words, don't feel bad about yourself its part of the learning process. Overtime you will feel that your listening has improved and you will be able to understand 90% of what is being said. For people who have good listening skills Just solve the Cambridge ielts series and Barron’s ielts Do all the tests and when you are done with them try to take some free listening tests which are available on the internet..(google them). Practice different accents too, as in my test, one section was in Aussie accent which I found a bit difficult. NOTE: When writing answers, always use correct spellings. Incorrect spellings deduct marks

Tips for Reading:
For beginners Start with Novels as fiction is easy to digest and is interesting to read. Underline new words and phrases. Try to learn the sentence structure. Use a dictionary and thesaurus often to learn some antonyms and synonyms. Once you are comfortable, start reading articles and Newspapers and follow the same guidelines (underline new words etc.) For People who are good at reading Just solve the Cambridge series 1-9 and you will get the target band. NOTE use correct spellings. Some teachers say to read the questions first and look at the passages and recommend skim reading. I found it very unhelpful and a waste of time. I used to read the passage first quickly, underline the dates and names (that saves time when u start solivnig questions) then Look at the questions and skim through the passage. Remember Time management is very important. For passage 1 allocate 16 minutes, 18minutes for passage 2 and 20 minutes passage 3. Practice using a stop watch.

Tips For Writing:
It is the most difficult part as most people say. I have seen some good writers score 6.5 or 6.0 If that happens don't be disappointed take it again Inshallah you will reach there. Practice is the key for writing at least write 1 essay a day. For beginners have a look at sample essays (given in the Cambridge books and/or internet) try writing them with some paraphrasing. Never cram the essay word to word. Trust me they will know that and mark you accordingly. Once you are habitual of writing try to use some advanced words in your sentences which you have learnt through your reading practice. Don’t try to impress the reader with some 'heavy' words which you don't know how to use. Instead keep it simple and elegant. Avoid punctuation mistakes. Focus on Paragraphing

For Task1:
Do not give your conclusion in the end. Only reproduce the information that is provided. Try to use a rich vocabulary instead of borrowing words from the Question. Always paraphrase the atatement provided to you. Keep it short and simple and don't write too much.. Ideally, it should be 150-170 words

For Task2:
Focus on your opening and conclusion as these are the two things that create an impression on the reader. Practice some common writing topics (use Google) and make your own essay and finalize it. Show your essays to a friend/teacher who has scored high in ielts. Use some idioms in the essay (but use them correctly). Ideally your essay should be of 4 to 5 paragraphs with 1 opening and 1 closing paragraphs. Always write a minimum of 250 words. You will lose marks if you are short of words no matter how beautifully you have written. Ideally, 250-275 Words would suffice. Avoid long paragraphs. Stay on topic and Try to cover what is being asked in the question. For instance Cover both views, Pros and cons, etc. Do not agree or disagree in the same essay. Give reasons if you agree with something in 2 3 paragraphs.
NOTE: always proofread your essay and report. Even native English speakers make mistakes. Proof reading will easily avoid you save you some marks.

Tips For Speaking:
For Beginners and good speakers: Speaking Can only be improved if you speak! Find a partner online. Practice speaking with him/her. Speak infront of a mirror. Dont overthink while you speak. Remember! its Okay to make mistakes. Just speak whatever comes in your mind. If you make a mistake in the real exam and realise it, Relax, Say " I am sorry" and speak the correct sentence. Avoid repetitive words. For instance, instead of using I think over and over, substitute with in my opinion, I believe etc. DONOT answer with only a YES or NO. Try to elaborate your answer. Maintain a good eye contact. Speak clearly. Pronunciation does not matter a lot so speak naturally. For task 2 cover everything that is being asked. You will lose marks if you don't. As mostly there are doctors in this group so speaking won't be a problem for most of them.. I found speaking challenging because of my stammering but I am glad I got over it.

Books recommended: Cambridge IELTS series 1-9.. Barron’s ielts. www.engvid.com (its a great website)

For PLAB

Time required to prepare for plab is 3-3.5 months at maximum. If you were a good student during your finals (unlike me :-)) and have done your internship correctly trust me you can pass PLAB1 with just a month preparation.

The material you need is all in this group. Start gathering and organising the mocks. It took me about 2 weeks just to organize the material.

Previously people have said that oxford is a must read to pass PLAB so I followed them.. I read oxford cover to cover. It definitely helped me to achieve a high score but, scores don't matter in PLAB so relax. You will be fine fine even without it. There were certain questions even oxford couldn't answer so my advice to future plabbers is DONT study too much from oxford.. Use it strictly for reference purposes. I will mention the topics that can be done from OHCM and OHCS in the end.

The most important thing are MOCKS. Try to do as many and as often you can. You will be seeing most past plabbers emphasizing on doing MOCKS and they are 100% right. "Doing mocks" mean that you try to answer the question and understand the logic instead of blindly following the keys. Even if you do not find the answer of a particular question, by the time you have finished your hunt for the right answer, your entire topic would have been covered. I would recommend pass medicine for people who want to broaden the knowledge for other exams along PLAB but definitely not for PLAB. The exam has a similar pattern of MOCKS so your primary focus should be doing them.

Material Nedded to pass:
1700 questions qbank.
Swammy mocks 2015.
Samson mocks and Samson notes. 
Time needed to pass: 40 days

Material Needed to ACE PLAB:
Above plus OHCM and OHCS (important topics only)
Oxford assess and progress.
Make notes of the additional points from Oxford books on Samson notes.
Find your references from www.patient.co.uk and read the professional articles instead of reading the general leaflets and guidelines from the mentioned website. www.nice.org.uk can also be used for the same purpose.
Never ever use Ncbi.nlm or other websites because they have researches and studies published on them and they will confuse you even more. Time needed to ace: 3 months

Take part in the discussions even if you don't know the answer but if a fellow doctor comes with a reference and better explanation always thank him. Don't try to prove your point like a stubborn if you are not sure ( I hated that thing Btw :-p) I took part in most discussions tried to explain as much as I could and learnt a lot. Remember no matter how brilliant you are, there is always a better doctor in this group. Try to make friends because I prefer that study environment more but you can tailor that according to your preference (some people keep it strictly professional)

This is a detailed guide in which I tried to cover all the important points. I will keep adding things into it if I recall any. Honestly speaking, I was no genius but an average student still I Passed with a decent score. It is an easy exam trust me you can do it (although i was worried before the results:-p)

I can guarantee 90% (I always leave 10% for luck) that if you follow this guide and others' as well, you will succeed. Feel free to contact me if you need any help. I will try to answer whatever I know.

Topics to be done From OHCM. These are recommended (only if you have spare time or you are on the ace side ;-) in addition to the Samson notes. Otherwise samson notes are enough. I have added brackets to the topics which I feel are deficient in Samson notes.

Emergencies:- (must)

Cardiology:-
ACS, Complications OF MI, arrythmias Hypertension, RF, Mitrials and Aortic lesions

Chest medicine:-
Pneumonia and specific pneumonias Cystic Fibrosis,Asthma, Pulmonary embolism Weils score(very important)

ENDO:-
DM, Adrenals, DI, SIADH,Thyroid

Gastroentology:-
Dyspepsia and Peptic ulcer disease, Constipation, Jaundice, Upper Gi bleed, Cirrhosis, IBD Alcoholism(vimp)

Renal Medicine:-
UTI, GN, ARF, Transplantaion

Neurology:-
Headaches, Trigeminal neuralgia, Migraine, Stroke TIA, Delirium, Demntia, Parkinsons, Bells palsy, MG

Oncology and Palliative Care:-
Oncological emergencies, oncoligical genetics(table only), Palliative care (Vimp), Tumour markers

Rheumatology:-
Back pain, OA, RA, Gout, Spondyloarthropathies, Polymyositis and dermatomyositis, Plasma autoab(table), Systemic conditions casuing EYE signs and Skin manefestaions of systemic disaeases(vimp)

Surgery:-
Diabetics undergoing Surgery, Consent, Prophylactic Antibiotics and Bowel prep, Pain control, Skin diagnosis not to be missed( i got a q wrong even after going through this :-/), Acute abdomen, Hernias, Obstruction, Renal stones(imp), Retention and BPH and Breast

Hematology:-
Bleeding disorders.(table is vimp), spleen and the splenectomy, leukemias and lymphomas, Myeloma

Gynae OBS:- (IMP)
Ecclampsia, preeclampsia, HTN in preg, Anti D, APH and PPH, Contraception, PCOS, Menopause, Cervical CA

Eye:-
Glaucoma, Cranial nerve palsies, Red Eye.

ENT:-
Otitis media and externa. Acoustic neuroma, Stridor, Epistaxis

Dermatology:-
Psoriasis, Eczema

Paediatrics:-
ADHD, Childhood jaundice( imp), Varicella, Childhood Asthma, developmental milestones.

Psychiatry:-
Depression, Schizophrenia