West Midlands IMG Conference 2013 Jim Bartlett Training Lead for CSA Core Group. Who??. GP in Shropshire Trainer Former TPD for Shropshire VTS MRCGP Examiner Training & recruitment for CSA Previously managing the Case Writing Group . Assumptions?. Me?. You?.
Data gathering, examination and clinical assessment skills
Clinical management skills
Behave normally –be yourself
Don’t panic if things go wrong
Be aware of your anxiety ,but think yourself back home
You won’t be the only one feeling stressed about a difficult case
Patronising (use of we)
Uneasy with or unable to acknowledge own ignorance or uncertainty
More scripted summary and checking understanding
Poor use of time
Does not appear to care about the patient
Unaware of personal space
You need to combine good clinical skills with good interpersonal skills.
Demonstrating clinical skills is often a matter of sharing thoughts and explaining well to the patient.
Build on the “raw material” offered to you
"Focus on the patient, not what you imagine the examiner is looking for“
Lots of joint surgeries and CSA practise and seeing patients ,see what the registrars are doing not what they say they are doing
In joint surgeries-at critical points- don't be afraid to ask the trainee what they are thinking ie verbalise (eg diagnostic dilemmas treatment choices etc)
Don't let your registrar practise with friends who might collude!
Make sure your trainee is expanding their knowledge base at the same rate as their consulting skills.
Watch your trainees for clunky / embarrassed/formulaic phrases and work with them to try out more comfortable and natural ones.
Encourage the use of open questions early on, & suggest a time plan so that clinical management gets a fair slice of the 10 minutes available.
Identify the barriers to fluent consulting – any social/cultural barriers?.
Use a variety of settings- home visits, joint surgeries and don’t forget ..
Make the most of the OOH shifts
Take every opportunity to seek and listen to feedback from experienced colleagues
Think of the consultation as a conversation - the patient says something then you say something that naturally follows, then the patient says something etc etc and so the story develops
Think about who is doing all the talking - it shouldn't be the doctor.
Throw away check lists and let it flow naturally.
Focus questions in a progressive manner indicating says something then you say something that naturally follows, then the patient says something etc etc and so the story developsclear thought processes. Don't suddenly in the middle of taking a history interject with "how much alcohol do you take" or "Who is there at home?" when this is completely irrelevant. It may just suggest that you don’t know what to say next.
Patients come in with symptoms, it is important to take the patient along the pathway between the symptom and their diagnosis ( and shared management) without gaps or odd jumps.
Passing candidates connect instantly with patient, remain responsive throughout, are fluent focused and use clear language
Don't ask" Can I ask you some questions?" It wastes time and annoys everybody
Don't use rote-learned questions - especially ICE questions when used at inappropriate times - listen to what the patient is saying and respond to that
Explore the impact of the problem on the patient's life
It is helpful to the patient to explain what you are doing when you examine them - practise examinations so that they are automatic and second nature.
Don't ask the pt "What do you want to do" when the patient has not been given options with the pros and cons of each.
Suspend disbelief, and put yourself in your surgery, believing that these are YOUR patients. Ignore the examiner and don't try to double think what he/she wants to hear - it just causes confusion in your own brain and will be unhelpful to the ‘patient’.
"if you think it say it": an assessor can only mark what they hear so if you have a bright thought you need to share it!