CSA are you ready? West of Scotland Deanery November 2013

Themes  Case writing –from the curriculum- creating a case bank  Preparation-how can we best help?  Giving feedback-using the feedback grid on TeP

Aspects of assessment  Primary Care Management – common medical conditions in primary care  Problem solving skills - gathering and using data for clinical judgment, choice of examination, investigations and their interpretation. Showing a structured and flexible approach to decision making  A comprehensive approach –managing co-morbidity and risk  Person-centred care - communication with patients and the use of recognised consultation techniques to promote a shared approach to managing problems  Attitudinal aspects - practising ethically with respect for equality and diversity, with accepted professional codes of conduct  Clinical practical skills - proficiency in physical examinations and using diagnostic and therapeutic instruments

Case writing  Curriculum area-Clinical (21) 2012 RCGP-Curriculum-1-Being-a-GP.  3.4 Equality and Diversity  3.3 Ethics and values  May be Acute Chronic Undifferentiated Psychosocial or Preventative/lifestyle focused  The ‘focus’ may be the diagnosis or the management or the patient or the situation

Case writing  Begin with a curriculum area arising from need  Think about what the ILO Intended learning outcomes for the trainee should be-write those down(3-4)  Think about and write down 3-4 bullet points ‘what the trainee needs to achieve to pass’(for observer)  Write the case vignette for role player include any emotion/body language aspect and clinical details in everyday language-no more than half a page  Write the ‘candidate’ information-keep it brief  Try the case out and adjust it as necessary

Case types  Curriculum areas  Women’s health  Men’s health  Sexual Health  Endocrine-Diabetes  ENT and Eyes  Dermatology  Psychosocial distress  Home visits Telephone consults

Inter personal skills  Curiosity-actually listening  Caring and compassion  Non judgmental  ‘Connecting’ early-establish and affirm patients beliefs about symptoms illness experience  Reformulating what the patient has presented-to achieve understanding  Adjusting to the patient’s ‘level’

Lingusitic aspects  Think about establish patients ideas concerns expectations but without actually using those words  Stress intonation in English  Smoothness vs ‘jerkiness’-topic shift vs topic glide  Challenging cases: moral dilemma more agonistic-a sense of struggle-the emotional ‘temperature’ of the case

Data gathering  Starts with alertness curiosity and good interpersonal skills-early and effective ‘connection’ with patient  History focused but full  Fluent logical –glide don’t topic shift  Avoid repetition  Avoid being ‘formulaic’  Differentiate between routine and sensitive questioning

Data gathering  Appropriate focused examination  Time management  Approaching a likely diagnosis, differential diagnosis or explaining why uncertainty exists  Beware of not getting to the point e.g. explaining lots of normal results instead of the 1 abnormal result

Clinical management  Does not develop a management plan  Making efficient use of (prescribing referral other team members, time) resources  Keeping it safe sensible; continuity of care, follow-up  Sharing the management and involving the patient  Using understandable language taking account of patients own ideas preferences

Clinical management  Good use of communication interpersonal skills is key  Establish the patients values ideas preferences  Be attentive to verbal non verbal cues  Assess the psychosocial impact of symptoms  Demonstrate clearly that you have listened-use the patients own ideas words in explaining the problem/management  Manage the problem in a safe sensible fashion

After CSA-feedback  TeP grid  Horizontal or curriculum view  Vertical or ‘consultation’ view  Using the marks  Specific focused practical-looking to improvement

Risk factors-CSA o Lower quartile score for Stage 2 or 3 NRO Selection o Failure at AKT o Failure to commit to or complete WPBA o Attitudinal problems, such as lack of insight into own performance, lack of commitment to job, lack of respect for colleagues and patients, failure to take responsibility o English as second language (lowest quartile PLAB scores) o Cultural factors, such as differences in role or status of doctor, learning styles and teaching methods, gender issues o Male gender o Being an International Medical Graduate o Record of complaints from colleagues and/or patients o Personal problems o Health problems (especially mental health or addictions) o Lack of social support

The big issue(s)  Use the curriculum-that’s where CSA comes from  Risk factors for failure  Early recognition and intervention  The tools available in Practices-review video, shared consulting, role play of self written cases, CSA DVD, ‘CASE’ cards.  Feedback on previous performance