Upload
toby-harvey
View
216
Download
1
Embed Size (px)
Citation preview
nMRCGP
Dr Mark Metcalfe
nMRCGP
Money AKT CSA
Money
Become AiT £492 AKT £360 CSA £1260 Fee to PMETB £780 TOTAL £2892
Course £660 TOTAL £3552
Money
If you have to retake your exams…. £5282
These are figures for this year…. They might increase
Registrar pay
Basic salary £30660 plus 50% £15330 London weighting £2162
TOTAL £48152
Exams
AKT Computer marked ‘multiple choice’ paper
CSA Practical assessment of consulting skills
AKT
Relevance:
The AKT should be relevant to general practice; any topic covered can be one which occurs commonly or one which is significant but less common
High prevalence: Low impact e.g. URTI High impact: Low prevalence e.g. meningitis Topical: e.g. Controlled drugs
Sources
Clinical Evidence Cochrane Database BNF GP Curriculum NICE SIGN BMJ Review articles & original papers BJGP DTB
This is your friend
AKT
Core clinical medicine and its application to problem solving in a general practice context
– 80% of items
Critical appraisal and evidence based clinical practice– 10% of items
Ethical and legal issues as well as the organisational structures that support UK general practice
– 10% of items
Stuff no one bothers with but features heavily in the exam…
Regulatory frameworks Legal aspects, e.g. DVLA Social services, e.g. Certification Professional regulation, e.g. GMC Business aspects, e.g. GP contract Prescribing, e.g. Controlled drugs Appropriate use of resources, e.g. drugs Health & Safety, e.g. needlestick injury Ethical, e.g. Mental capacity, consent
Essentials for AKT
Know latest guidelines
Know the BNF
Know basic stats
Your core medical knowledge is probably already sufficient.
AKT
1164 candidates Mean score 76.5% Pass mark 69.85% Pass rate 83.7%
Pass rate ST2 76% Pass rate ST3 88%
AKT – Areas of weakness
Asthma COPD Certification Travel health (vaccinations and commonly
used drugs) Management of dermatological problems National screening programs
CSA
You must bring: BNF, Stethoscope, Ophthalmoscope,
Auroscope, Thermometer, Patella hammer, Sphygmomanometer (aneroid or electronic), Tape measure, Peak flow meter and disposable mouthpieces
There are no spares at the exam centre Anything else you need is provided
CSA
You have your own room. You have a list of patients – your ‘surgery’ for
the morning. The list contains brief info about the patient. It may or may not include PMH, drugs etc. You probably wont know why they are coming. You have never seen the patient before – but
colleagues might have.
CSA
Buzzer will sound and patient and examiner come in.
You have 10mins after which buzzer will sound again. Anything said or done after this will not count. The patient and examiner then leave.
There is no ‘1min/2min’ warning buzzer. There is a 2 minute break between patients. There is a 15min break after 7 patients seen.
CSA
The examiner sits out of your line of site. Examiner does not participate in the
consultation. Ignore them. All patients are played by actors who have
been well briefed beforehand They will almost certainly not have any
physical signs to elicit on examination
CSA – Exams and investigations
If you want to examine the patient say so and say what you are going to examine.
If they are testing this exam technique they will let you go ahead.
They will then give you the exam findings. If they are not testing this exam they will just
give you the findings and tell you not to examine.
They will only give you results of exams you say you will do.
CSA – Exams and investigations
Examination is what you would normally do as a GP.
This means a lot of it can be done with the patient sitting in the chair.
It does not have to be exhaustive. Eg. Chest exam – percussion and auscultation
is fine.
CSA – Exams and investigations
Any investigation results will be on the table in front of you or, more likely, will be brought in by the patient.
It will list normal levels so you don’t have to remember them.
Abnormal findings will be common GP tests. Eg. Hb, HbA1c, urinalysis etc. It will not be anything obscure.
CSA – Management plans
If you want to prescribe a drug you don’t have to write a prescription
All you need do is say Eg. I will give you omeprazole 20mg once a
day. This is as good as having written it. There are prescription pads on the table. Do
not let these distract you.
CSA – Management plans
DON’T WRITE ANYTHING DOWN There is no time The prescription will be marked There is no penalty for just saying it You have to say what you are giving anyway
CSA – Management plans
The same applies for blood tests and sick notes and any other forms you might write.
Just say what you will do. If you want to make a referral, ask the patient
to wait in the waiting room and you will bring the letter/form out to them.
Leaflets can be ‘collected from reception’
CSA
You have 10 minutes per case. ‘Shows poor time management’ is a reason
they can fail you at the station. And they will.
You MUST be consulting at 10 minutes.
CSA
Each case is marked in 3 domains :
– Data gathering, examination and clinical assessment skills
– Clinical management skills– Interpersonal skills
All domains have equal weighting
Do not spend 8 minutes on history and examination – you will fail the station.
CSA
But those domains have no meaning…
What are they actually looking for?
CSA
DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS
Gathering & using data for clinical judgement Choice of examination Investigations & their interpretation Demonstrating proficiency in performing
physical examinations & using diagnostic and therapeutic instruments
CSA
CLINICAL MANAGEMENT SKILLS Recognition & management of common
medical conditions in primary care Demonstrating a structured & flexible
approach to decision-making. Demonstrating the ability to deal with multiple
complaints and co-morbidity. Demonstrating the ability to promote a positive
approach to health
CSA
INTERPERSONAL SKILLS Demonstrating the use of recognised
communication techniques to gain understanding of the patient's illness experience and develop a shared approach to managing problems.
Practising ethically with respect for equality & diversity issues, in line with the accepted codes of professional conduct.
CSA
The grades will be on a four point scale: Clear Pass Marginal Pass Marginal Fail Clear Fail
There are no merits or ‘grades’ at the end for the exam as a whole.
You pass or fail.
I Failed?
Data Gathering
Disorganised and unsystematic in gathering information from history taking, examination and investigation
Does not identify abnormal findings or results or fails to recognise their implications
Data gathering does not appear to be guided by the probabilities of disease
Does not undertake physical examination competently, or use instruments proficiently
Clinical management
Does not make appropriate diagnosis Does not develop a management plan (including
prescribing and referral) that is appropriate and in line with current best practice.
Follow-up arrangements and safety netting are inadequate
Does not demonstrate an awareness of management of risk, and health promotion
Interpersonal skills
Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues
Does not develop a shared management plan or clarify the roles of doctor and patient
Does not use explanations that are relevant and understandable to the patient
Does not show sensitivity for the patient’s feelings in all aspects of the consultation including physical examination
Global
Disorganised / unstructured consultation Does not recognise the challenge (e.g. the
patient’s problem, ethical dilemma etc.) Shows poor time management Shows inappropriate doctor - centeredness
Essentials for CSA
Be in general practice for a few months
Consult at ten minutes