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Intensive CASC training day An introduction. 9:15 Introductory lecture/discussion 9:45 Workshops – Dr's mess (groups of 6; switch at half time) 12:15 Lunch 13:00 Mock exam Linked > feedback > single > feedback. Today.

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9:15 Introductory lecture/discussion

9:45 Workshops – Dr's mess

(groups of 6; switch at half time)

12:15 Lunch

13:00 Mock exam

Linked > feedback > single > feedback

mental state examination of a casc candidate

A/B : Appeared rather ill-at-ease. Dressed in formal suit/two piece (?with shoulder pads). Appearing uncomfortable in such formal attire. Avoiding eye contact. Somewhat preoccupied with sympathy, empathy, etc. Extremely apologetic and obsessed with social convention (asked how I wished to be addressed), told me that they were “sorry to hear” of my woes and unnecessarily apologetic throughout our encounter

S: Hesitant, difficulty in maintaining goal direction, appears to communicate in a “tick box”/robotic fashion and lose focus when challenged to move “outside the box”

M : clearly anxious, restriction of affect noted (as if our encounter had been repeated many times before…..)

R :Denies suicidal ideation but intimated that life has not been worth living for the past two months

T : Expressing paranoid ideas about a certain Royal College; Claims that the college are trying to “control” them and is forcing them to conform to a stereotypical psychiatrist (Caucasian, public school educated, speaking BBC English, Maudsley trained, etc.)

P : Admits to a persecutory voice in the third person commenting on their “interview skills”

I : Partial insight into the impact of a significant psychosocial stressor and the effect of being judged, humiliated and scrutinised. ?learned helplessness

Mental State Examination of a CASC candidate
the bigger picture
The bigger picture….
  • RCPsych is probably not trying to fail candidates
  • Unlikely to generate much of a profit
  • GMC places pressure on all colleges to standardise the assessment process
  • CASC not geared up to look for exceptional candidates
  • Levels of competency must be defined in the curriculum
  • Its not an OSCE!
spectrum of station failure
Spectrum of station failure





psychological factors



Task generated interference / “choking”

Study skills deficits


Repetition/exposure - graded

Feedback and its acceptance/use

Use of video/audio

Curriculum coverage

Don’t relax too much!

Psychological factors
knowledge base
Knowledge base
  • The essential reading
  • Icing on the cake
  • Techniques
  • Standardised clinical assessment
  • Safety
    • K.I.S.S.
areas of concern
Areas of concern
  • Poor management of interview/discussion
  • Poor communication skills
  • Significant deviations from the task
  • Lack of professionalism
  • Limited depth and/or range to the task
scenario types
Scenario Types
  • History
  • Mental state
  • Formulation/synthesis/prioritisation
  • +/- Risk assessment
  • +/- Integrative management plan
  • “Address concerns”
  • Negotiation/information giving
  • Physical/cognitive examination
  • Preparation time
  • The curriculum
  • Who writes the scenario?
  • Use video/audio
  • On groups…..
  • Hassle senior clinicians
procedure for workshops
Procedure for workshops
  • Scenarios (material)
  • Planning time
  • Hot seat
  • Group facilitators
  • Live supervision
  • Pause and play
  • Facilitated discussion
  • Video

Mock CASC Format6 single & 3 pairs of linked stations

Time / mins

7m (single), 10m (linked)