Preparing your Registrar for the CSA

1. Preparing your Registrar for the CSA • Facts the Registrar needs to know • How the CSA is marked • Avoiding common mistakes on the day • How to help your Registrar pass the CSA • Helping Registrars who are foreign medical graduates

2. Purpose of the CSA ‘An assessment of a doctor’s ability to integrate and apply appropriate clinical, professional, communication and practical skills in general practice’ Integrative skills assessment - tests a doctor’s abilities to gather information and apply learned understanding of disease processes and person-centred care appropriately in a standardised context, making evidence-based decisions, and communicating effectively with patients and colleagues. This is from RCGP website – we need to interpret this for our registrars

3. Facts Registrars need to know • 4 times per year - currently in January, May, September and November. When to take it? • How much does it cost? • 13 cases each of maximum 10 minutes – 7 cases then 20 min break then 6 cases. Usually 1 minute between cases, may be more ( don’t take it personally) • Can be telephone triage, home visit, someone coming on behalf ofsomeone else or none of these

4. Examination fees • The following fees are payable for examinations with effect from 01 August 2009. • Each attempt at Applied Knowledge Test (AKT):  Associate in Training £414 Non-AiT £460  • Each attempt at Clinical Skills Assessment (CSA): • Associate in Training £1389 Non-AiT £1542  • Candidates taking AKT and CSA as part of MRCGP pay the AiT rate.

5. CSA: the centre • Purpose-built centre • No.1 Croydon • Easy access • Top 3 floors

6. CSA: the centre • Left or right handed consulting rooms • Temperature and light varies • Some rooms video • Walk of fear

7. CSA: the 3 domains • DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS:Gathering & using data for clinical judgement, choice of examination, investigations & their interpretation. Demonstrating proficiency in performing physical examinations & using diagnostic and therapeutic instruments • CLINICAL MANAGEMENT SKILLS:Recognition & management of common medical conditions in primary care. Demonstrating astructured & flexible approach to decision-making. Demonstrating theability to deal with multiple complaints and co-morbidity. Demonstrating theability to promote a positive approach to health • INTERPERSONAL SKILLS:Demonstrating theuseof recognised communication techniques to gain understanding of the patient's illness experience and develop a shared approach to managing problems. Practising ethically with respect for equality & diversity issues, in line with the accepted codes of professional conduct. • The grades will be on a four point scale: • Clear Pass Marginal Pass Marginal Fail Clear Fail • Consider for e.g. a businessman with earache consulting with the expectation of antibiotics

8. CSA: four grades • Four grades • Clear pass  • Marginal pass  • Marginal fail × • Clear fail × • Grade descriptors • on RCGP website under CSA cases

9. CSA feedback statements 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 proficiently Clinical management 5. Does not make appropriate diagnosis 6. Does not develop a management plan (including prescribing and referral) that is appropriate and in line with current best practice. • Does not demonstrate an awareness of management of risk, and health promotion Interpersonal skills 8. Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues 9. Does not identify or use appropriate psychological or social information to place the problem in context 10. Does not develop a shared management plan or clarify the roles of doctor and patient 11. 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 Global 13. Disorganised / unstructured consultation 14. Does not recognise the challenge (e.g. the patient’s problem, ethical dilemma etc.) 15. Shows poor time management 16. Shows inappropriate doctor- centeredness

10. CSA feedback statements 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 proficiently Clinical management 5. Does not make appropriate diagnosis 6. Does not develop a management plan (including prescribing and referral) that is appropriate and in line with current best practice. • Does not demonstrate an awareness of management of risk, and health promotion Interpersonal skills 8. Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues 9. Does not identify or use appropriate psychological or social information to place the problem in context 10. Does not develop a shared management plan or clarify the roles of doctor and patient 11. 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 Global 13. Disorganised / unstructured consultation 14. Does not recognise the challenge (e.g. the patient’s problem, ethical dilemma etc.) 15. Shows poor time management 16. Shows inappropriate doctor- centeredness

11. On the day • WATER • SMART COMFORTABLE CLOTHES • READ THE QUESTION: RED PEN/HIGHLIGHTER • WELCOME THE PATIENT • INTRODUCE YOURSELF – EYE CONTACT- NOT TOO LONG AN INTRODUCTION • THERE MAY BE 1-2 EXAMINERS AND 1-2 ACTORS • AVOID WRITING SCRIPTS IF POSSIBLE • COLLECTING FROM RECEPTION e.g. SCRIPTS, PIL ETC • COVER THE BASICS IN THE TEN MINUTES

12. Helping your Registrar prepare for the CSA • 10- 12 MINUTE CONSULTATIONS WITH CSA IN MIND • MARKED JOINT SURGERIES • CASES CREATED FROM REAL PATIENTS • PRACTISE WITH PEER GROUP • (AVOID BOOKS) • OTHER PRACTICE DOCTORS ASSESSING • PRACTICE SWAPS (PATIENT TYPES) • TIME EFFICIENCY IN CONSULTING • EFFICIENT/EFFECTIVE CLINICAL EXAMINATION • ‘ICE’ QUESTIONS SHOULD BE AUTOMATIC • VISITS/TELEPHONE/SURGERY CONSULTATIONS • RIGHT/LEFT HANDED CONSULTING • VIDEO CSA PRACTICE CONSULTATIONS FOR ANALYSIS

13. Registrars who are foreign medical graduates • British graduates and Bristol VTS do well! • “Fish out of water” concept • Practise, practise, practise • Care with standard statements e.g. “How did that make you feel?”