Why people fail the CSA

1. Why people fail the CSA

2. Indicators of poor performance 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 proficient

3. Indicators of poor performance 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

4. Indicators of poor performance 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

5. Indicators of poor performance 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

6. Reasons for poor performance • Lack of preparation • Inappropriate preparation schedule • No CSA work group • Lack of consultation structure • ICE – on shot docs. • Lack of option sharing & shared decision making. • Lack of role play & consultation skills training with their trainer