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CASC Communication skills. Dr Alin Mascas ST4 Psychiatry. Overview. CASC structure Theory – communication skills Psychology Do’s and Don’t’s Practice – Introduction Group practice. CASC structure. 16 clinical scenarios (8 single stations and 8 linked stations)

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casc communication skills

CASC Communication skills

Dr Alin Mascas ST4 Psychiatry

overview
Overview
  • CASC structure
  • Theory – communication skills
  • Psychology
  • Do’s and Don’t’s
  • Practice – Introduction
  • Group practice
casc structure
CASC structure
  • 16 clinical scenarios (8 single stations and 8 linked stations)
  • Single stations - 7 min( 1 min preparation)
  • Linked stations – 10 min(2 min preparation)
  • Break between morning and afternoon sessions (don’t eat excessively).
areas of concern
Areas of concern

Poor management of interview/discussion

  • Lack of focus on the required task.
  • Lack of fluency to the task.
  • Interviewer interrupts the role player excessively.
  • Interviewer allows the role player to dictate the theme of the consultation.
  • Poor management of the interview.
  • Fails to follow a line of enquiry/discussion to a logical end point.
areas of concern1
Areas of concern

Poor communication skills

  • Use of medical jargon without explanation.
  • Use of predominantly closed questions.
  • Use of multiple questions.
  • Uses inappropriately phrased questions.
  • Failure to listen/identify/respond to concerns or cues from the interviewee.
  • Lack of flexibility of questioning style.
  • Lack of empathic response.
  • Lack of eye contact/non-verbal responses.
  • Poor body language.
areas of concern2
Areas of concern
  • Significant deviations from the task
  • Omissions related to poor prioritisation of the task.
  • Omissions related to lack of knowledge/ability.
  • Lack of recognition of importance of aspects of the task.
  • Inappropriate avenues of enquiry or discussion.
  • Inaccurate or misleading information discussed.
  • Lack of analysis of problems and synthesis of opinion.
areas of concern3
Areas of concern

Lack of professionalism

  • Harmful interaction likely to cause either psychological or physical distress.
  • Failure to respect the interviewee‟s rights.
  • Rudeness or arrogance.
  • Inappropriate or flippant manner.
  • Dismissive attitude to interviewee‟s concerns.
areas of concern4
Areas of concern

Limited depth and/or range to the task

  • Aspects of history or mental state highlighted but not explored in depth or appropriate manner (not the same as an omission – eg. some aspects of orientation covered in a cognitive test such as time and place, but orientation in person not covered).
  • Inadequate or superficial risk assessment.
  • Poor range of symptomatology explored.
  • Limited/incomplete explanation of concepts/problem.
  • Limited or incomplete management plan.
approach
Approach
  • Always READ the task and be 100 % clear of what is the task
  • Write down quickly patient’s name and the most important “buzz words” from the vignette + the task
  • Prepare and visualize mentally your introduction-first 1-2 sentences
  • Make sure you know the setting of the vignette
approach1
Approach
  • Greet the patient and introduce yourself
  • Explain the purpose of the meeting and check their understand of the reasons for referral (negotiate the agenda).
  • Go with the flow
  • Don’t forget, this is an outpatient clinic and treated as such.
  • If can’t remember the task say it and check the vignette, be honest, don’t try to guess the task.
approach2
Approach
  • Check with patient if they are happy with what you’ve told them, if not seek further concerns/expectations.
  • 1 minute left-start wrapping up the interview-EQUALLY important as the beginning.
  • Don’t ask open question in the last minute except if it is pass/fail question (i.e risk of suicide)
  • Thank the patient and the examiner and put the whole station in a “locked box”.
history taking stations
History taking stations
  • OPEN question moving gradually to CLOSED questions in a funnel fashion
  • Listen carefully for 1 minute(golden minute)
  • When patient stops to breath in you take the lead.
history taking stations pc
History taking stations-PC
  • Onset
  • Duration
  • Progress
  • Alleviating
  • Relieving
  • Coping/Effects
  • + ICE (always)
  • SUMARIZE
history taking stations1
History taking stations
  • Be systematic in approach DO NOT

change your format of questioning

  • ALWAYS start with an open mind
  • Do not assume you know the diagnosis based on exam practice
  • ALWAYS check RISK
  • Actors are generally just doing their job (nobody’s out to get ya’).
case discussion
Case discussion
  • Always check their understanding first
  • Read RCPsych online leaflets
  • Be prepared to encounter “what on Earth?” situations
  • Be honest and say you don’t know if you don’t know.
  • If not sure whether you’ve done well ask the patient and summarize at the end.
  • Offer the option to read further information and only if happy offer leaflets, etc.
difficult communication
Difficult communication
  • Most of the stations
stations
Stations
  • Check Revisenow forum for past papers (Superego café forum) but….
  • Have a clear understanding of what stations came previously(approx 150)
  • DO ALWAYS prepare well for
  • Psychotherapy
  • Physical examination (including ECG)
  • Cognitive examination
  • MSE
  • Risk assessment
  • Management
psychotherapy stations
Psychotherapy stations
  • Make sure you know the basics of main types of psychotherapy
  • STRUCTURE-(nr of sessions, with whom, when, timing, exclusion criteria)
  • CONTENT(what is actually going on in the sesssion)
physical examination stations
Physical examination stations
  • Practice all physical exams and make sure you can do them smoothly
  • ALCOHOL GEL BEFORE AND AFTER EXAMINATION
  • Look for what instruments are available -clues
  • Talk to the patient about what you intend to do, ask permission before you proceed + consider chaperone
  • Be gentle
  • Privacy and dignity
  • Reassure them at the end and mention your findings if any.
  • No need to talk to examiner except in ECG stations.
cognitive examination
Cognitive examination
  • MMSE ALWAYS-can jot it down on the notepad before you enter the exam (high chance you’ll get it).
  • Usually single station
  • Aim for 5 min on MMSE and the rest on parietal/frontal lobes
slide21
MSE
  • At least one station
  • High expectations
  • Make sure you cover the depth and range.
  • Don’t forget cognitive function
risk stations
Risk stations
  • ALWAYS in CASC
  • ABC approach
  • Check for past H/o incidents(sui, violence, etc)
  • Always ask about D&A
management stations
Management stations
  • Present the findings as SBAR
  • Formulate the management plan and offer options
  • Always bio-psycho-social but….prioritize
  • Be a safe doctor
  • Keep talking and look confident
psychology of casc revision
PSYCHOLOGY OF CASC REVISION
  • Revise theory in advance
  • Prepare mentally and physically
  • Eat healthy
  • Relax…you are already a psychiatrist
  • Dressing code
  • CONTROL, CONTROL, CONTROL-YOU ARE THE CONSULTANT
  • Confident approach
books
Books
  • ICD 10
  • The NICE Guidelines
  • Sims/Fish psychopathology
  • Try to review all previous stations
  • Do your structures for each stations(keep it simple)
practice as much as possible
Practice….as much as possible
  • Max 4 people
  • Regularly
  • Seek constructive feed back
  • Don’t take it personally
  • Combine revision with physical exercise/sleep/outdoor activities
  • Cut down on sugar and caffeine….he says…
crash course
Crash course
  • Useful but not a must (watch out for external attribution)
  • Some better than other
  • They teach you how to pass
  • Don’t be desperate if you don’t get a pass in the mock
  • Definitely do a Mock CASC few weeks prior to exam