nmrcgp csa

The Clinical Skills Assessment

new membership of the royal college of general practitioners

Arrangements are all subject to change See http://www.rcgp.org.uk/ for latest

info

MRCGP What does it test? nMRCGP

Apply during final year of GP training

Apply when accepted onto scheme (FY2)

Voluntary Required for Certificate of Completion of Training (CCT)

Multiple Choice Paper

Facts Applied Knowledge Test (AKT)

Written Paper Problem solving

Oral exam Attitudes

Video Consultation skills Clinical Skills Assessment (CSA) Workplace Based Assessment (WPBA)

Professionalism & loads more

WPBA leading to enhanced trainers report

MRCGP modules

Summer 2007

Winter 2007

Summer 2008

Winter 2008

Multiple Choice paper

May 2007

October 2007 – nMRCGP AKT

May 2008 - nMRCGP AKT

October 2008 - nMRCGP AKT

Written paper

May 2007 October 2007

May 2008October 2008

Oral examination

June/July 2007

November / December 2007

June/July 2008

November /December 2008

Consulting skills (video)

May 2007 November 2007

May 2008

October 2008 - nMRCGP CSA

Consulting skills (Simulated surgery) Leicester

March & July 2007

October /November 2007 - nMRCGP CSA or video

May 2008 –nMRCGP CSA or video

October 2008 - nMRCGP CSA

Current GPRs Current GPRs Future GPRs

Finish training up to Feb 2008

Finish training from Aug 2008

Start vocational training Aug 2007

MRCGP &/or Summative Assessment

nMRCGP &/or Summative Assessment

nMRCGP

Deadline for applying for old MRCGP extended to 29th August 2007 for these registrars

Need a year in practice to fulfil WPBA

The Clinical Skills Assessment (CSA) is ‘an assessment of a doctor’s ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice’http://www.rcgp.org.uk/nmrcgp_/nmrcgp/csa.aspx

Croydon, initiallyPurpose built centre, eventuallyFirst sitting October 2007Subsequently February, May, October of each year

http://www.rcgp.org.uk/nmrcgp_/nmrcgp/csa.aspx

Each candidate will be given a consulting room and will have appointments with 13 patients, each lasting around 10 minutesThe performance will be graded as Clear Pass, Marginal Pass, Marginal Fail or Clear Failhttp://www.rcgp.org.uk/nmrcgp_/nmrcgp/csa.aspx

The CSA will test mainly from the following areas of the curriculum;-Primary Care Management

Problem Solving Skills

Comprehensive Approach

Person-centred Care

Attitudinal Aspects

Clinical Practical Skills http://www.rcgp.org.uk/nmrcgp_/nmrcgp/csa.aspx

Patient simulators (actors) will be usedCSA assessor will observe and markWhen time is up the ‘patient’ and assessor will get up and leaveThe next ‘patient’ and assessor will then enter for the next assessmentstuff that’s not on the website, that may change

There is a bank of CSA scenarios; currently >250Word is bound to get out – that doesn’t matter

stuff that’s not on the website, that may change

If consultations require examination of the patient, candidates should tell the ‘patients’ they would like to examine themThey then either examine the patient (because this is being tested) or will be given a printout of the examination findings by the ‘patient’stuff that’s not on the website, that may change


Clear Pass CPThe candidate demonstrates sound performance in the domain both in principle and in detail, operating clearly above the level for safe independent clinical practice

Performance is fluent, though not necessarily sophisticated. Positive behavioural indicators of performance are consistently and proficiently met and on balance any negative behaviours are not thought to be of concern.


Marginal Pass MPThe candidate has a sound grasp of the principal of the domain, more so than the detail, operating at, or just above, the level for safe independant clinical practice

Positive behavioural indicators are consistently met, although performance may not be fluent. On balance any negative behaviours are not thought to be of concern.


Marginal Fail MFThe candidate’s performance shows ability but overall is below the level for safe independent clinical practice

The positive behavioural indicators are not demonstrated to a consistently adequate standard and negative behaviours may be of concern


Clear Fail CFThe candidate performs well below the level for safe independent clinical practice

The range and depth of the positive indicators are poorly demonstrated and performances may be inconsistent. Negative behaviours may be of concern.


Other descriptors for exceptional use onlyExcellentPerformance is not necessarily perfect but is consistently proficient, integrated, fluent and time efficient. The candidate’s performance is as good as could be achieved under exam conditions.

Serious ConcernsThe candidate’s performance demonstrates serious deficiencies in thinking and behaviour that may place patients at risk of harm from actions that the doctor takes, or fails to take.

Candidates do not have to pass every scenarioCases will present different levels of challengeEven a clear fail at one of the stations does not mean a candidate will necessarily fail the CSA


GP curriculum

Problem Solving SkillsTechnical SkillsDefined asGathering and using data for clinical judgement, choice of examination, investigations and their interpretation. Demonstration of a structured and flexible approach to decision making.

GP curriculum

Problem solving & technical skillsPositive indicators

Clarifies the problem and nature of the decision required

Uses an incremental approach, using time and accepting uncertainty

Negative indicatorsMakes immediate

assumptions about the problem

Intervenes rather than using appropriate expectant management

GP curriculum


Gathers information from history taking, examination and investigation in a systematic and efficient manner

Is appropriately selective in the choice of enquiries, examinations and investigations

Negative indicatorsIs disorganised or

unsystematic in gathering information

Data gathering does not appear to be guided by the probabilities of disease

GP curriculum


Uses instruments appropriately and fluidly

When using instruments or conducting physical examinations, performs actions in a rational sequence

Negative indicatorsAppears unsure of

how to operate/use instruments

Appears disorganised or unsystematic in the application of the instruments or the conduct of physical examinations

GP curriculum

Primary Care ManagementComprehensive ApproachDefined asRecognition and management of common medical conditions in primary care.Demonstration of proficiency in the management of co-morbidity and risk.Demonstrating the ability to promote a positive approach to health.

GP curriculum

Management and comprehensive approachPositive indicators

Recognises presentations of common physical, psychological and social problems

Makes plans that reflect the natural history of common problems

Offers appropriate and feasible management options

Negative indicatorsFails to consider

common conditions in the differential diagnosis

Does not suggest how the problem might develop or resolve

GP curriculum


Management approaches reflect an appropriate assessment of risk

Makes appropriate prescribing decisions

Negative indicatorsFails to make patient

aware of relative risks of different options

Decisions on whether or what to prescribe are inappropriate or idiosyncratic

GP curriculum


Refers appropriately & co-ordinates care with other healthcare professionals

Manages risk effectively, safety-netting appropriately

Simultaneously manages multiple health problems, both acute and chronic

Negative indicatorsDecisions on whether

& where to refer are inappropriate

Follow up arrangements are absent or inappropriate

Fails to take account of related issues or co-morbidity

GP curriculum


Encourages improvement, rehabilitation &, where appropriate, recovery

Encourages the patient to participate in appropriate health promotion and disease prevention strategies

Negative indicatorsUnable to construct a

problem list and prioritise

Unable to enhance patient's health perceptions and coping strategies

GP curriculum

Person Centred ApproachAttitudinal Aspects= Interpersonal SkillsDefined asCommunication with the patient and the use of recognised consultation techniques to promote a shared approach to managing problems.Practising ethically with respect for equality and diversity, with accepted professional codes of conduct.

GP curriculum

Interpersonal SkillsPositive indicators

Explores patient’s agenda, health beliefs and preferences

Appears alert to verbal or non-verbal cues

Negative indicatorsDoes not enquire

sufficiently about the patient’s perspective or health understanding

Pays insufficient attention to the patient’s verbal and non-verbal communication

GP curriculum


Explores the impact of the illness on the patient’s life

Elicits psychological and social information to place the patient’s problem in context

Negative indicatorsFails to explore how

the patient’s life is affected by the problem

Does not appreciate the impact of the patient’s psychosocial context

GP curriculum


Works in partnership, finding common ground to share a management plan

Communicates risk effectively

Shows responsiveness to the patient’s preferences, feelings and expectations

Negative indicatorsInstructs the patient,

rather than finding common ground

Uses a rigid approach to consulting that fails to be sufficiently responsive to the patient’s contribution

GP curriculum


Enhances patient autonomy

Provides explanations that are relevant and understandable to the patient

Responds to needs and concerns with interest and understanding

Negative indicatorsFails to empower the

patient or encourage self-sufficiency

Uses inappropriate (eg technical) language

Shows little visible interest or understanding. Lacks warmth.

GP curriculum


Has a positive attitude when dealing with problems. Admits mistakes & shows commitment to improvement.

Backs own judgment appropriately

Demonstrates respect for others

Negative indicatorsAvoids taking

responsibility for errors

Does not show sufficient respect for others

GP curriculum

Interpersonal Skills

Positive indicatorsDoes not allow own

views/values to inappropriately influence dialogue

Shows commitment to equality of care for all

Acts in an open non-judgmental manner

Negative indicatorsInappropriately

influences patient interaction through own views/values

Displays inappropriate favour or prejudice

Is quick to judge

GP curriculum


Is cooperative & inclusive in approach

Conducts examinations with sensitivity for the patient’s feelings, seeking consent where appropriate

Negative indicatorsAppears patronising

or inappropriately paternalistic

When conducting examinations, appears unprofessional and at risk of hurting or embarrassing the patient


BriefingBoth simulator and assessor will have been thoroughly briefed on the scenario

The patient will have a name

The case will have a title (known to the simulator and assessor)

Simulator and assessor will have a context for the case – i.e. what domain(s) is this case assessing


Briefing (continued)

There will be a marking schedule which specifically lists what positive and negative descriptors the case is designed to highlight

If the candidate misses (for example) an important cue which is crucial to the case, the simulator will try again


Briefing (continued)Most scenarios will allow assessors to mark each of the following domains as CP, MP, MF or CF;-

Data gathering, technical and assessment skills

Clinical management skillsInterpersonal skills

Assessors will make notes whilst observing, to aid them in coming to a judgement

The candidate is then given an overall mark (CP, MP, MF or CF) for that scenario, and this is the one which counts

nmrcgp csa

Documents

nmrcgp csaconsulting

consulting skills videomay

nmrcgp aktoctober

nmrcgp aktmay

practical skills appropriate

nmrcgp aktwritten papermay

bank of csa scenarios

assessment wpbaprofessionalism