csa - how not to fail (with slide notes)

8/10/2019 Csa - How Not to Fail (With Slide Notes)

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How not to failDr. Louise Riley

Trainer (Bradford VTS)

Examiner (CSA component)



Introduction to CSA Personal experiences

Case examples from college DVD

Marking and discussion How to prepare



Knowledge

Competence

Performance



„ An assessment of a doctor ‟ s ability to

integrate and apply appropriate clinical,

professional, communication and

practical skills in general practice ‟



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



Simulated surgery 13 stations,12 “live” one pilot

10 minutes each

2 minutes between

You stay put, role players and

assessors move



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



Mostly written from GPs‟ own experiences

A spread of cases across the curriculum

Each case mapped to a specific area of thecurriculum



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

/lifestyleOther

Cardiovascular

Respiratory

Neurological/ Psychiatric

Musculo-skeletal

Endocrine/ Oncological

Eye/ ENT/ Skin

Men/ Women/ Sexual Health

Renal/ urological

Gastro-intestinal

Infectious diseases

ETC



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



Data gathering

Clinical Management

Interpersonal skills

3 Domains:



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 forobserved behaviours



You get a grade for each domain

◦ Clear pass

◦ Marginal pass

◦

Marginal fail◦ Clear fail

Then you get an overall grade



Domain

Observed behaviours

Grade

CP/MP/

MF/CF)

Data gathering,examination andclinical assessmentskills

Establish reason for attendance ie need to get notefor gym and what is required for thisExplore any current health problems and past medicalhistory, including raised cholesterolShow ability to check BP and chest

Clinical management

skills

Formulate an appropriate plan to address possible

raised cholesterol and BPConsider health promotion issues eg smoking, wt,alcohol and exerciseShow ability to manage request for noteappropriately, recognising implications

Interpersonal skills Elicit any underlying concerns regarding raised

cholesterol and heart problems

Show ability to negotiate as necessary re the note andthe management of any health problems, share

management options

Take an interest in the patient, avoid lecturing him

about lifestyle



Yes, but it‟s feedback on the whole CSAperformance, not an individual case

The assessors pick from a list of feedbackstatements



Feedback statements

Data Gathering

1. Disorganised and unsystematic in gathering information from history taking, examination andinvestigation

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 inline 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


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



Domain Observed behaviours Grade(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 workand 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 collarsIndicate how problem may resolve

Interpersonal skills Explain pros and cons of various treatments

Acknowledge patient’s ideas and expectations

about treatment

Negotiate with patient sensitively



Turn the feedback statement intoconstructive advice

What practical steps might this doctor take toimprove performance?



Feedback statements

Data Gathering

1. Disorganised and unsystematic in gathering information from history taking, examination andinvestigation

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 inline 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


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



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 ofpatient 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 behindyou 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



Any Questions?

csa - how not to fail (with slide notes)

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