How not to fail Dr. Louise Riley Trainer (Bradford VTS) Examiner
(CSA component) Slide 2 Slide 3 Introduction to CSA Personal
experiences Case examples from college DVD Marking and discussion
How to prepare Slide 4 Knowledge Competence Performance Slide 5 An
assessment of a doctors ability to integrate and apply appropriate
clinical, professional, communication and practical skills in
general practice Slide 6 Number 1, Croydon (opposite East Croydon
station) Floors 18,19,20 Colour coded DO NOT BE LATE ! Stay at...
Croydon Park Hotel Jurys Hotel Slide 7 Simulated surgery 13
stations,12 live one pilot 10 minutes each 2 minutes between You
stay put, role players and assessors move Slide 8 Slide 9 Passport
or photo-card driving licence Doctors bag containing: BNF
Stethoscope Ophthalmoscope Auroscope Thermometer Patella hammer
Sphygmomanometer (aneroid or electronic) Tape measure Peak flow
meter and disposable mouthpieces Slide 10 Mostly written from GPs
own experiences A spread of cases across the curriculum Each case
mapped to a specific area of the curriculum Slide 11 Clinical
Skills Assessment Case Selection Blueprint Primary nature of case
Primary system or area of disease Acute Illness Chronic Illness
Undiffer entiated Illness Psychol and Social Preventive /lifestyle
Other Cardiovascular Respiratory Neurological/ Psychiatric
Musculo-skeletal Endocrine/ Oncological Eye/ ENT/ Skin Men/ Women/
Sexual Health Renal/ urological Gastro-intestinal Infectious
diseases ETC Slide 12 Cough with ACE inhibitor Young woman with
headache Child with constipation Man with Dupuytrens contracture
Woman with diabetes and depression Man with anxiety and
palpitations Slide 13 D ata gathering C linical Management I
nterpersonal skills 3 Domains: Slide 14 Establishing reason for
attendance Examining chest Ability to negotiate Consider health
promotion issues Practising ethically Management plan in line with
best practice In each domain we look for observed behaviours Slide
15 You get a grade for each domain Clear pass Marginal pass
Marginal fail Clear fail Then you get an overall grade Slide 16
Domain Observed behaviours Grade (CP/MP/ MF/CF) Data gathering,
examination and clinical assessment skills Establish reason for
attendance ie need to get note for gym and what is required for
this Explore any current health problems and past medical history,
including raised cholesterol Show ability to check BP and chest
Clinical management skills Formulate an appropriate plan to address
possible raised cholesterol and BP Consider health promotion issues
eg smoking, wt, alcohol and exercise Show ability to manage request
for note appropriately, recognising implications Interpersonal
skills Elicit any underlying concerns regarding raised cholesterol
and heart problems Show ability to negotiate as necessary re the
note and the management of any health problems, share management
options Take an interest in the patient, avoid lecturing him about
lifestyle Slide 17 Yes, but its feedback on the whole CSA
performance, not an individual case The assessors pick from a list
of feedback statements Slide 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 patients
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 patients feelings in
all aspects of the consultation including physical examination
Global 13. Disorganised / unstructured consultation 14. Does not
recognise the challenge (e.g. the patients problem, ethical dilemma
etc.) 15. Shows poor time management 16. Shows inappropriate
doctor-centredness Slide 19 Domain Observed behavioursGrade (CP/MP/
MF/CF) Data gathering, examination and clinical assessment skills
Take a history of the neck pain and what has been tried so far
Examine neck/shoulders appropriately Explore psychosocial
situation- effect on work and life Clinical management skills Give
appropriate prescription for pain, or advise on over the counter
remedies Advise on other appropriate treatments eg heat, stretching
exercises, avoid collars Indicate how problem may resolve
Interpersonal skills Explain pros and cons of various treatments
Acknowledge patients ideas and expectations about treatment
Negotiate with patient sensitively Slide 20 Slide 21 Turn the
feedback statement into constructive advice What practical steps
might this doctor take to improve performance? Slide 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 patients 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 patients
feelings in all aspects of the consultation including physical
examination Global 13. Disorganised / unstructured consultation 14.
Does not recognise the challenge (e.g. the patients problem,
ethical dilemma etc.) 15. Shows poor time management 16. Shows
inappropriate doctor-centredness Slide 23 Slide 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 Dont be phased
by the cases, stick to the basic principles of patient centred
consulting Dont 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 Slide 25 Any Questions? Slide 26
