Clinical Skills Assessment

1. Clinical Skills Assessment Cumberland Lodge May 18th 2010 Richard de Ferrars

2. Workshop Plan • CSA Overview • Organisation • Style of cases • Information for cases • Examination & investigations • Marking • Feedback from Examiners 2009-10 • Helping STs prepare • CSA stations – 4 scenarios with marking.

3. The CSA Centre (Croydon) “Virtual Tour” is available on the RCGP website (MRCGP/ WPBA/ CSA)

4. CSA Organisation Read “Information for Candidates” - RCGP Website (Travel details, equipment list, photo ID etc) Cost £1400 - £1550 • Single room, single observer • Thirteen scenarios (one pilot case) • Ten minutes then buzzer • Two minute break • Observer changes with patient • May be a break in the middle or a “rest station”.

5. Types of Cases • Acute & chronic illness, undifferentiated illness covering many different curriculum areas • Mainly GP surgery face-to-face usually also one other (home visit, phone) • Case mix typically includes: • one case involving disability • one case with major psychological problems • one case involving elderly patient • one case involving child health issues.

6. Information Provided • Simple one sentence summary of case • Appendix with brief patient summary (if relevant): • Name & age • Social and family history • PMH summary • Current medication • Recent investigations • Recent relevant consultations – GP, OOH, hospital.

7. Examination & Investigation • Targeted simple examinations - joints, neuro, ENT, chest • Full system examinations are rarely expected • When “simulation findings” differ, given on a card • BUT, no examination attempted means no card given • May be given card as starts to examine or as finishes • Simulator will try and steer candidate away from inappropriate examinations • Need to use CORRECTLY simple equipment – ENT, PEFR (Bring own bag and simple equipment) • Expected to interpret (& explain) simple test results.

8. Marking • Three domains of equal weighting: • Date gathering, examination & clinical assessment skills How you get to the nub of the problem • Clinical management skills What you do about moving the problem forward • Interpersonal skills How you go about it • Marked in each of the 3 domains: clear pass marginal pass marginal fail clear fail • Each domain - list of positive and negative descriptors • Then given overall grade for that case • Typically pass-mark will be 8/12 cases.

9. Examiner’s Feedback Data Gathering Does not undertake a physical examination competently, or use the instruments proficiently Clinical Management Does not develop a management plan that is appropriate and in line with current best practice Interpersonal Skills Does not identify patient’s agenda/ preferences, does not make use of cues Does not develop a shared management plan Global Does not recognise the challenge (issue).

10. Helping STs Prepare Strong correlation between starting video work before week 6 and CSA pass Make use of video and joint surgeries: • Patient-centredness • Identifying patient’s expectations • Focussed history & targeted examinations • Management plans are clear to patient (and to observer) • Shared management plans.

11. CSA Stations Four stations/ 4 simulators • One person in the hot seat • Look at the single briefing page only • Others are observers • Take a couple of minutes to read the full scenario with the marking schedule • Makes the victim sweat a bit more • One take the lead with time-keeping & examination findings • Discussion at the end • Pendleton rules (victim first) • Talk to the simulator • Mark using the grid

12. CSA Stations Two stations before coffee, two after: Station 1 09:30 – 10:00 Station 2 10:00 – 10:30 Coffee 10:30 – 10:45 Station 3 10:45 – 11:15 Station 4 11:15 – 11:45 Plenary 11:45 – 12:00 For convenience – we move, simulator stays Leave ALL paperwork behind in the room!

13. The End