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CASC Communication skills

CASC Communication skills. Dr Alin Mascas ST4 Psychiatry. Overview. CASC structure Theory – communication skills Psychology Do’s and Don’t’s Practice – Introduction Group practice. CASC structure. 16 clinical scenarios (8 single stations and 8 linked stations)

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CASC Communication skills

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  1. CASC Communication skills Dr Alin Mascas ST4 Psychiatry

  2. Overview • CASC structure • Theory – communication skills • Psychology • Do’s and Don’t’s • Practice – Introduction • Group practice

  3. CASC structure • 16 clinical scenarios (8 single stations and 8 linked stations) • Single stations - 7 min( 1 min preparation) • Linked stations – 10 min(2 min preparation) • Break between morning and afternoon sessions (don’t eat excessively).

  4. Areas of concern Poor management of interview/discussion • Lack of focus on the required task. • Lack of fluency to the task. • Interviewer interrupts the role player excessively. • Interviewer allows the role player to dictate the theme of the consultation. • Poor management of the interview. • Fails to follow a line of enquiry/discussion to a logical end point.

  5. Areas of concern Poor communication skills • Use of medical jargon without explanation. • Use of predominantly closed questions. • Use of multiple questions. • Uses inappropriately phrased questions. • Failure to listen/identify/respond to concerns or cues from the interviewee. • Lack of flexibility of questioning style. • Lack of empathic response. • Lack of eye contact/non-verbal responses. • Poor body language.

  6. Areas of concern • Significant deviations from the task • Omissions related to poor prioritisation of the task. • Omissions related to lack of knowledge/ability. • Lack of recognition of importance of aspects of the task. • Inappropriate avenues of enquiry or discussion. • Inaccurate or misleading information discussed. • Lack of analysis of problems and synthesis of opinion.

  7. Areas of concern Lack of professionalism • Harmful interaction likely to cause either psychological or physical distress. • Failure to respect the interviewee‟s rights. • Rudeness or arrogance. • Inappropriate or flippant manner. • Dismissive attitude to interviewee‟s concerns.

  8. Areas of concern Limited depth and/or range to the task • Aspects of history or mental state highlighted but not explored in depth or appropriate manner (not the same as an omission – eg. some aspects of orientation covered in a cognitive test such as time and place, but orientation in person not covered). • Inadequate or superficial risk assessment. • Poor range of symptomatology explored. • Limited/incomplete explanation of concepts/problem. • Limited or incomplete management plan.

  9. Approach • Always READ the task and be 100 % clear of what is the task • Write down quickly patient’s name and the most important “buzz words” from the vignette + the task • Prepare and visualize mentally your introduction-first 1-2 sentences • Make sure you know the setting of the vignette

  10. Approach • Greet the patient and introduce yourself • Explain the purpose of the meeting and check their understand of the reasons for referral (negotiate the agenda). • Go with the flow • Don’t forget, this is an outpatient clinic and treated as such. • If can’t remember the task say it and check the vignette, be honest, don’t try to guess the task.

  11. Approach • Check with patient if they are happy with what you’ve told them, if not seek further concerns/expectations. • 1 minute left-start wrapping up the interview-EQUALLY important as the beginning. • Don’t ask open question in the last minute except if it is pass/fail question (i.e risk of suicide) • Thank the patient and the examiner and put the whole station in a “locked box”.

  12. History taking stations • OPEN question moving gradually to CLOSED questions in a funnel fashion • Listen carefully for 1 minute(golden minute) • When patient stops to breath in you take the lead.

  13. History taking stations-PC • Onset • Duration • Progress • Alleviating • Relieving • Coping/Effects • + ICE (always) • SUMARIZE

  14. History taking stations • Be systematic in approach DO NOT change your format of questioning • ALWAYS start with an open mind • Do not assume you know the diagnosis based on exam practice • ALWAYS check RISK • Actors are generally just doing their job (nobody’s out to get ya’).

  15. Case discussion • Always check their understanding first • Read RCPsych online leaflets • Be prepared to encounter “what on Earth?” situations • Be honest and say you don’t know if you don’t know. • If not sure whether you’ve done well ask the patient and summarize at the end. • Offer the option to read further information and only if happy offer leaflets, etc.

  16. Difficult communication • Most of the stations

  17. Stations • Check Revisenow forum for past papers (Superego café forum) but…. • Have a clear understanding of what stations came previously(approx 150) • DO ALWAYS prepare well for • Psychotherapy • Physical examination (including ECG) • Cognitive examination • MSE • Risk assessment • Management

  18. Psychotherapy stations • Make sure you know the basics of main types of psychotherapy • STRUCTURE-(nr of sessions, with whom, when, timing, exclusion criteria) • CONTENT(what is actually going on in the sesssion)

  19. Physical examination stations • Practice all physical exams and make sure you can do them smoothly • ALCOHOL GEL BEFORE AND AFTER EXAMINATION • Look for what instruments are available -clues • Talk to the patient about what you intend to do, ask permission before you proceed + consider chaperone • Be gentle • Privacy and dignity • Reassure them at the end and mention your findings if any. • No need to talk to examiner except in ECG stations.

  20. Cognitive examination • MMSE ALWAYS-can jot it down on the notepad before you enter the exam (high chance you’ll get it). • Usually single station • Aim for 5 min on MMSE and the rest on parietal/frontal lobes

  21. MSE • At least one station • High expectations • Make sure you cover the depth and range. • Don’t forget cognitive function

  22. Risk stations • ALWAYS in CASC • ABC approach • Check for past H/o incidents(sui, violence, etc) • Always ask about D&A

  23. Management stations • Present the findings as SBAR • Formulate the management plan and offer options • Always bio-psycho-social but….prioritize • Be a safe doctor • Keep talking and look confident

  24. PSYCHOLOGY OF CASC REVISION • Revise theory in advance • Prepare mentally and physically • Eat healthy • Relax…you are already a psychiatrist • Dressing code • CONTROL, CONTROL, CONTROL-YOU ARE THE CONSULTANT • Confident approach

  25. “Do”s and “Don’t”s

  26. Books • ICD 10 • The NICE Guidelines • Sims/Fish psychopathology • Try to review all previous stations • Do your structures for each stations(keep it simple)

  27. Practice….as much as possible • Max 4 people • Regularly • Seek constructive feed back • Don’t take it personally • Combine revision with physical exercise/sleep/outdoor activities • Cut down on sugar and caffeine….he says…

  28. Crash course • Useful but not a must (watch out for external attribution) • Some better than other • They teach you how to pass • Don’t be desperate if you don’t get a pass in the mock • Definitely do a Mock CASC few weeks prior to exam

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