The CSA: How can my ST3 fail?. Trainer’s workshop Nov 2012. Today. The CSA exam: Standards Why failure happens How might we avoid this? A CSA case. CSA data. ~ 3000 candidates pa Pass rate ~ 70% (75 first time) UK Grads ~ 80-90% Mean score ~ 80 (Max 117, range 40-110). IMG.
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The CSA: How can my ST3 fail?
The CSA exam: Standards
Why failure happens
How might we avoid this?
A CSA case
“to assess a doctor’s ability to integrate and apply appropriate clinical, professional, communication and practical skills in general practice”
Data gathering, technical and assessment skills
Clinical management skills
Four possible grades for each domain
Clear Pass 3 marks
Each domain counts equally!
Not cut out for the job
Go to pieces on the day
“As long as you’re nice you’re OK”
“The patient didn’t want me to call 999”
“I didn’t do anything about his arthritis but I was terribly understanding”
Prevention: Know and implement NICE Guidance Developing skills in negotiation/challenge
On the day: Up to date management must be demonstrated
Be familiar with the exam and how it is marked
Offer feedback on each domain, be a hawk!
‘Diagnose’ your registrar’s particular problems
Gather psychosocial information ie homelife, workplace, caring responsibilities, community etc
Pick up on cues
Establish the patient’s thoughts, fears and hopes
Avoid early closed questions and assumptions
Reach agreed shared understanding of the problem
Assimilate/interpret the written material provided
Be appropriately selective e.g. does systems review, orders batteries of tests
Get to the diagnosis e.g. depression
Get this far due to time pressure
Be patient centred and give options and negotiate
Take account of patient’s thoughts, fears and hopes
Follow best medical practice
Manage risk safely, safety net appropriately etc
Poor rapport building
Consultations are formulaic and wooden
Doctor centred, not patient centred
Unable to summarise, empathise, state what they are seeing “You seem upset about that”
“I don’t know what went wrong – after all I ICE’d all the patients.......”
Pros: give structure to the consultations and remind the registrar about key areas
Cons: can be formulaic rather than natural, may use up too much time if not focussed
Does not recognise the issues or priorities in the consultation (eg the patient’s problem, ethical dilemmas etc)
Does not develop a management plan (including prescribing and referral) that reflects knowledge of current best practice
Does not develop a shared management plan
Observed consultations, videos, (COTs), joint surgeries
Feed back on all three domains