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CSA Practice

CSA Practice. Clinical Skills Assessment (trivia). Is it fun? No! Is it easy to pass? No! Is this a cheap exam? No! (now £ >1400) How many candidates fail on first attempt? 20% How many candidates fail on 2 nd attempt? 10%. What is CSA?. Component of nMRCGP – mandatory

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CSA Practice

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  1. CSA Practice

  2. Clinical Skills Assessment (trivia) • Is it fun? • No! • Is it easy to pass? • No! • Is this a cheap exam? • No! (now £ >1400) • How many candidates fail on first attempt? • 20% • How many candidates fail on 2nd attempt? • 10%

  3. What is CSA? • Component of nMRCGP – mandatory • CSA is ‘an assessment of a doctor’s ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice’ (RCGP) • Taken in ST3 year • Three CSA exam periods per year

  4. Format of CSA (1) • Surgery from Hell! • 13 consultations of 10 minutes each • Candidate stays in 1 room, simulators and examiners rotate • Marked on 12 consultations, 1 pilot • Four grades – CP, MP, MF, CF • Need to get 8 CP or MP to clear

  5. Format of CSA (2) • The key focus of exam is on assessing • Primary Care Management • Problem Solving Skills • Comprehensive Approach   • Person-centred Care  • Attitudinal Aspects  • Clinical Practical Skills

  6. Format of CSA (3) • 30 minute briefing • 0900 or 1300 be punctual • 3 hours • 10 mins per station then 2 min gap • 20 min break after 7 cases

  7. How is CSA Marked? 3 Domains: • Date Gathering, Technical and Assessment Skills • Clinical Management Skills • Interpersonal Skills Each case has a ‘nub’ e.g. hidden agenda/ clinical examination / breaking bad news etc

  8. How is the CSA marked (2) ? • 16 feedback statements • And specific marking criteria for each case

  9. Cases – 12 areas • Care of older adults • Care of children • Men’s health • Cardiovascular problems • Drug and alcohol problems • Neurological Problems • Musculoskeletal/ rheumatological • Skin problems

  10. Cases – 12 areas • Respiratory • Healthy People • Women’s Health • Digestive Problems

  11. Consultation Structure • Introduction • Open with open questions • Golden Minute • Main consultation (remember ICE) • Summarising • Shared decisions • Closure – safety net / understood? / give prescription or sick note.

  12. Communication Tasks • Explain diagnosis • Explain procedure • Explain result • Check patient understanding re the above • Breaking bad news

  13. RCGP Consultation Model • Doctors are encouraged to consider the following aspects for each presentation: • Physical • Psychological • Social

  14. Why do people fail cases? • Does not develop appropriate management plan (14%) – READ NICE GUIDELINES • Does not recognise the challenge (9%) • Does not develop shared management plan or clarify roles of doctor/patient (9%) • Does not identify patient’s agenda , health beliefs or pick up on cues (9%)

  15. Equipment • BNF • Stethoscope • Opthalmoscope • Auroscope • Tuning Fork • Thermometer • Patella hammer • Sphyg – preferably digital • Tape measure • Peak flow meter

  16. When to take the Exam? • Don’t sit the exam too early – should have been on 10 min consultations for at least 2 months. • Don’t leave it too late either – allow yourself at least 2 attempts during the ST3 year • Deanery will consider extending training if someone fails twice on individual basis to allow for a third attempt

  17. Top Tips • Go on a course • Do plenty of role-play practice with friends • Practice your examination skills • Identify Knowledge base gaps and address them • Do plenty of COTS – in 10 minutes • Recommended books: • ‘Get Through’ MRCGP: Clinical Skills Assessment • by Bruno Rushworth and Val Wass. • Cases and Concepts for the new MRCGP • By P Naidoo

  18. Over to you! • Working in groups of three • Reflect on some single problem consultations you have had in the last week and if any of those may a useful basis for a CSA scenario • Using the CSA case scenario template write you scenario and case marking sheet

  19. Time for coffee

  20. Working in your small groups • Role play (10 mins only) your scenario with one GPST as the patient, one as the candidate and one as the examiner. • Reflect on what went well and what might have gone better and how you might have improved the candidate’s performance • Swap scenarios with the group next to you and have a go with their scenario

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