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How not to fail Dr. Louise Riley Trainer (Bradford VTS) Examiner (CSA component)

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Presentation on theme: "How not to fail Dr. Louise Riley Trainer (Bradford VTS) Examiner (CSA component)"— Presentation transcript:

1 How not to fail Dr. Louise Riley Trainer (Bradford VTS) Examiner (CSA component)

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3 Introduction to CSA Personal experiences Case examples from college DVD Marking and discussion How to prepare

4 Knowledge Competence Performance

5 An assessment of a doctors ability to integrate and apply appropriate clinical, professional, communication and practical skills in general practice

6 Number 1, Croydon (opposite East Croydon station) Floors 18,19,20 Colour coded DO NOT BE LATE ! Stay at... Croydon Park Hotel Jurys Hotel

7 Simulated surgery 13 stations,12 live one pilot 10 minutes each 2 minutes between You stay put, role players and assessors move

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9 Passport or photo-card driving licence Doctors bag containing: BNF Stethoscope Ophthalmoscope Auroscope Thermometer Patella hammer Sphygmomanometer (aneroid or electronic) Tape measure Peak flow meter and disposable mouthpieces

10 Mostly written from GPs own experiences A spread of cases across the curriculum Each case mapped to a specific area of the curriculum

11 Clinical Skills Assessment Case Selection Blueprint Primary nature of case Primary system or area of disease Acute Illness Chronic Illness Undiffer entiated Illness Psychol and Social Preventive /lifestyle Other Cardiovascular Respiratory Neurological/ Psychiatric Musculo-skeletal Endocrine/ Oncological Eye/ ENT/ Skin Men/ Women/ Sexual Health Renal/ urological Gastro-intestinal Infectious diseases ETC

12 Cough with ACE inhibitor Young woman with headache Child with constipation Man with Dupuytrens contracture Woman with diabetes and depression Man with anxiety and palpitations

13 D ata gathering C linical Management I nterpersonal skills 3 Domains:

14 Establishing reason for attendance Examining chest Ability to negotiate Consider health promotion issues Practising ethically Management plan in line with best practice In each domain we look for observed behaviours

15 You get a grade for each domain Clear pass Marginal pass Marginal fail Clear fail Then you get an overall grade

16 Domain Observed behaviours Grade (CP/MP/ MF/CF) Data gathering, examination and clinical assessment skills Establish reason for attendance ie need to get note for gym and what is required for this Explore any current health problems and past medical history, including raised cholesterol Show ability to check BP and chest Clinical management skills Formulate an appropriate plan to address possible raised cholesterol and BP Consider health promotion issues eg smoking, wt, alcohol and exercise Show ability to manage request for note appropriately, recognising implications Interpersonal skills Elicit any underlying concerns regarding raised cholesterol and heart problems Show ability to negotiate as necessary re the note and the management of any health problems, share management options Take an interest in the patient, avoid lecturing him about lifestyle

17 Yes, but its feedback on the whole CSA performance, not an individual case The assessors pick from a list of feedback statements

18 Feedback statements Data Gathering 1. Disorganised and unsystematic in gathering information from history taking, examination and investigation 2. Does not identify abnormal findings or results or fails to recognise their implications 3. Data gathering does not appear to be guided by the probabilities of disease 4. 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. 7. Follow-up arrangements and safety netting are inadequate 8. Does not demonstrate an awareness of management of risk, and health promotion Interpersonal skills 9. Does not identify patients agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues 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 12. Does not show sensitivity for the patients feelings in all aspects of the consultation including physical examination Global 13. Disorganised / unstructured consultation 14. Does not recognise the challenge (e.g. the patients problem, ethical dilemma etc.) 15. Shows poor time management 16. Shows inappropriate doctor-centredness

19 Domain Observed behavioursGrade (CP/MP/ MF/CF) Data gathering, examination and clinical assessment skills Take a history of the neck pain and what has been tried so far Examine neck/shoulders appropriately Explore psychosocial situation- effect on work and life Clinical management skills Give appropriate prescription for pain, or advise on over the counter remedies Advise on other appropriate treatments eg heat, stretching exercises, avoid collars Indicate how problem may resolve Interpersonal skills Explain pros and cons of various treatments Acknowledge patients ideas and expectations about treatment Negotiate with patient sensitively

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21 Turn the feedback statement into constructive advice What practical steps might this doctor take to improve performance?

22 Feedback statements Data Gathering 1. Disorganised and unsystematic in gathering information from history taking, examination and investigation 2. Does not identify abnormal findings or results or fails to recognise their implications 3. Data gathering does not appear to be guided by the probabilities of disease 4. 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. 7. Follow-up arrangements and safety netting are inadequate 8. Does not demonstrate an awareness of management of risk, and health promotion Interpersonal skills 9. Does not identify patients agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues 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 12. Does not show sensitivity for the patients feelings in all aspects of the consultation including physical examination Global 13. Disorganised / unstructured consultation 14. Does not recognise the challenge (e.g. the patients problem, ethical dilemma etc.) 15. Shows poor time management 16. Shows inappropriate doctor-centredness

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24 Ten Top Tips To Pass The CSA Arrive on time Bring your bag and identification Read carefully the information provided for each case Practice ten minute consultations Practice focussed examinations Dont be phased by the cases, stick to the basic principles of patient centred consulting Dont forget psychosocial and family history Remember treatment by other means as well as drugs Remember Housekeeping skills i.e. put the last case behind you and concentrate on the rest. You do not have to pass all thirteen cases Remember there is often not a right or wrong answer, examiners are looking for how you tackle the cases

25 Any Questions?

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