CSA

1. CSA How not to fail Dr. Louise Riley Trainer (Bradford VTS) Examiner (CSA component)

2. Help!

3. Agenda • Introduction to CSA • Personal experiences • Case examples from college DVD • Marking and discussion • How to prepare

4. What you can test... Knowledge Competence Performance

5. The Theory... ‘An assessment of a doctor’s ability to integrate and apply appropriate clinical, professional, communication and practical skills in general practice’

6. Where... • Number 1, Croydon (opposite East Croydon station) • Floors 18,19,20 • Colour coded • DO NOT BE LATE ! • Stay at... • Croydon Park Hotel • Jury’s Hotel

7. What’s it like ? • Simulated surgery • 13 stations,12 “live” one pilot • 10 minutes each • 2 minutes between • You stay put, role players and assessors move

8. It’s not like this!

9. What do I need ? • Passport or photo-card driving licence • Doctor’s bag containing: • BNF • Stethoscope • Ophthalmoscope • Auroscope • Thermometer • Patella hammer • Sphygmomanometer (aneroid or electronic) • Tape measure • Peak flow meter and disposable mouthpieces

10. How are cases selected? • Mostly written from GPs’ own experiences • A spread of cases across the curriculum • Each case mapped to a specific area of the curriculum

11. Case Selection Blueprint

12. What sort of cases are there? Cough with ACE inhibitor Young woman with headache Child with constipation Man with Dupuytren’s contracture Woman with diabetes and depression Man with anxiety and palpitations

13. What are they looking for? • Data gathering • Clinical Management • Interpersonal skills 3 Domains:

14. What are they looking for? In each domain we look for observed behaviours • Establishing reason for attendance • Examining chest • Ability to negotiate • Consider health promotion issues • Practising ethically • Management plan in line with best practice

15. Marking • You get a grade for each domain • Clear pass • Marginal pass • Marginal fail • Clear fail • Then you get an overall grade

16. Marking Scheme Case 1- Note for the Gym

17. Do I get any feedback? Yes, but it’s feedback on the whole CSA performance, not an individual case The assessors pick from a list of feedback statements

18. Feedback statements  • Data Gathering  • 1. Disorganised and unsystematic in gathering information from history taking, examination and investigation • 2. Does not identify abnormal findings or results or fails to recognise their implications • 3. Data gathering does not appear to be guided by the probabilities of disease • 4. Does not undertake physical examination competently, or use instruments proficiently • Clinical management • 5.  Does not make appropriate diagnosis • 6. Does not develop a management plan (including prescribing and referral) that is appropriate and in line with current best practice. • 7. Follow-up arrangements and safety netting are inadequate • 8. Does not demonstrate an awareness of management of risk, and health promotion • Interpersonal skills  • 9. Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues • 10. Does not develop a shared management plan or clarify the roles of doctor and patient • 11. Does not use explanations that are relevant and understandable to the patient • 12. Does not show sensitivity for the patient’s feelings in all aspects of the consultation including physical examination • Global  • 13. Disorganised / unstructured consultation • 14. Does not recognise the challenge (e.g. the patient’s problem, ethical dilemma etc.) • 15. Shows poor time management • 16. Shows inappropriate doctor-centredness

19. Marking Scheme 2: Pain in the Neck

20. Pick one feedback statement

21. How can Dr X Improve? • Turn the feedback statement into constructive advice • What practical steps might this doctor take to improve performance?

22. Feedback statements  • Data Gathering  • 1. Disorganised and unsystematic in gathering information from history taking, examination and investigation • 2. Does not identify abnormal findings or results or fails to recognise their implications • 3. Data gathering does not appear to be guided by the probabilities of disease • 4. Does not undertake physical examination competently, or use instruments proficiently • Clinical management • 5.  Does not make appropriate diagnosis • 6. Does not develop a management plan (including prescribing and referral) that is appropriate and in line with current best practice. • 7. Follow-up arrangements and safety netting are inadequate • 8. Does not demonstrate an awareness of management of risk, and health promotion • Interpersonal skills  • 9. Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues • 10. Does not develop a shared management plan or clarify the roles of doctor and patient • 11. Does not use explanations that are relevant and understandable to the patient • 12. Does not show sensitivity for the patient’s feelings in all aspects of the consultation including physical examination • Global  • 13. Disorganised / unstructured consultation • 14. Does not recognise the challenge (e.g. the patient’s problem, ethical dilemma etc.) • 15. Shows poor time management • 16. Shows inappropriate doctor-centredness

23. How can I prepare?

24. Ten Top Tips To Pass The CSA • Arrive on time • Bring your bag and identification • Read carefully the information provided for each case • Practice ten minute consultations • Practice focussed examinations • Don’t be phased by the cases, stick to the basic principles of patient centred consulting • Don’t forget psychosocial and family history • Remember treatment by other means as well as drugs • Remember “Housekeeping skills” i.e. put the last case behind you and concentrate on the rest. You do not have to pass all thirteen cases • Remember there is often not a right or wrong answer, examiners are looking for how you tackle the cases

25. Any Questions?

26. Good Luck!