CSA are you ready?

1. CSA are you ready? West of Scotland Deanery November 2013

2. Themes Case writing –from the curriculum- creating a case bank Preparation-how can we best help? Giving feedback-using the feedback grid on TeP

3. Aspects of assessment Primary Care Management – common medical conditions in primary care Problem solving skills - gathering and using data for clinical judgment, choice of examination, investigations and their interpretation. Showing a structured and flexible approach to decision making A comprehensive approach –managing co-morbidity and risk Person-centredcare - communication with patients and the use of recognised consultation techniques to promote a shared approach to managing problems Attitudinalaspects - practising ethically with respect for equality and diversity, with accepted professional codes of conduct Clinical practical skills - proficiency in physical examinations and using diagnostic and therapeutic instruments

4. Case writing Curriculum area-Clinical (21) 2012 RCGP-Curriculum-1-Being-a-GP. 3.4 Equality and Diversity 3.3 Ethics and values May be Acute Chronic Undifferentiated Psychosocial or Preventative/lifestyle focused The ‘focus’ may be the diagnosis or the management or the patient or the situation

5. Case writing Begin with a curriculum area arising from need Think about what the ILO Intended learning outcomes for the trainee should be-write those down(3-4) Think about and write down 3-4 bullet points ‘what the trainee needs to achieve to pass’(for observer) Write the case vignette for role player include any emotion/body language aspect and clinical details in everyday language-no more than half a page Write the ‘candidate’ information-keep it brief Try the case out and adjust it as necessary

6. Case types • Curriculum areas • Women’s health • Men’s health • Sexual Health • Endocrine-Diabetes • ENT and Eyes • Dermatology • Psychosocial distress • Home visits Telephone consults

7. Inter personal skills Curiosity-actually listening Caring and compassion Non judgmental ‘Connecting’ early-establish and affirm patients beliefs about symptoms illness experience Reformulating what the patient has presented-to achieve understanding Adjusting to the patient’s ‘level’

8. Lingusitic aspects Think about establish patients ideas concerns expectations but without actually using those words Stress intonation in English Smoothness vs ‘jerkiness’-topic shiftvs topic glide Challenging cases: moral dilemma more agonistic-a sense of struggle-the emotional ‘temperature’ of the case

9. Data gathering Starts with alertness curiosity and good interpersonal skills-early and effective ‘connection’ with patient History focused but full Fluent logical –glide don’t topic shift Avoid repetition Avoid being ‘formulaic’ Differentiate between routine and sensitive questioning

10. Data gathering Appropriate focused examination Time management Approaching a likely diagnosis, differential diagnosis or explaining why uncertainty exists Beware of not getting to the point e.g. explaining lots of normal results instead of the 1 abnormal result

11. Clinical management Does not develop a management plan Making efficient use of (prescribing referral other team members, time) resources Keeping it safe sensible; continuity of care, follow-up Sharing the management and involving the patient Using understandable language taking account of patients own ideas preferences

12. Clinical management Good use of communication interpersonal skills is key Establish the patients values ideas preferences Be attentive to verbal non verbal cues Assess the psychosocial impact of symptoms Demonstrate clearly that you have listened-use the patients own ideas words in explaining the problem/management Manage the problem in a safe sensible fashion

13. After CSA-feedback TeP grid Horizontal or curriculum view Vertical or ‘consultation’ view Using the marks Specific focused practical-looking to improvement

16. Risk factors-CSA • Lower quartile score for Stage 2 or 3 NRO Selection • Failure at AKT • Failure to commit to or complete WPBA • Attitudinal problems, such as lack of insight into own performance, lack of commitment to job, lack of respect for colleagues and patients, failure to take responsibility • English as second language (lowest quartile PLAB scores) • Cultural factors, such as differences in role or status of doctor, learning styles and teaching methods, gender issues • Male gender • Being an International Medical Graduate • Record of complaints from colleagues and/or patients • Personal problems • Health problems (especially mental health or addictions) • Lack of social support

17. The big issue(s) Use the curriculum-that’s where CSA comes from Risk factors for failure Early recognition and intervention The tools available in Practices-review video, shared consulting, role play of self written cases, CSA DVD, ‘CASE’ cards. Feedback on previous performance