The Clinical Skills Assessment new membership of the royal college of general practitioners

Arrangements are all subject to change See for latest infohttp://

MRCGPWhat does it test?nMRCGP Apply during final year of GP training Apply when accepted onto scheme (FY2) VoluntaryRequired for Certificate of Completion of Training (CCT) Multiple Choice PaperFactsApplied Knowledge Test (AKT) Written PaperProblem solving Oral examAttitudes VideoConsultation skillsClinical Skills Assessment (CSA) Workplace Based Assessment (WPBA) Professionalism & loads more WPBA leading to enhanced trainers report

MRCGP modules Summer 2007 Winter 2007Summer 2008 Winter 2008 Multiple Choice paper May 2007 October 2007 – nMRCGP AKT May nMRCGP AKT October nMRCGP AKT Written paper May 2007 October 2007 May 2008October 2008 Oral examination June/July 2007 November / December 2007 June/July 2008 November /December 2008 Consulting skills (video) May 2007 November 2007 May 2008 October nMRCGP CSA Consulting skills (Simulated surgery) Leicester March & July 2007 October /November nMRCGP CSA or video May 2008 – nMRCGP CSA or video October nMRCGP CSA

Current GPRs Future GPRs Finish training up to Feb 2008 Finish training from Aug 2008 Start vocational training Aug 2007 MRCGP &/or Summative Assessment nMRCGP &/or Summative Assessment nMRCGP Deadline for applying for old MRCGP extended to 29 th August 2007 for these registrars Need a year in practice to fulfil WPBA

The Clinical Skills Assessment (CSA) is an assessment of a doctors ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice

Croydon, initially Purpose built centre, eventually First sitting October 2007 Subsequently February, May, October of each year

Each candidate will be given a consulting room and will have appointments with 13 patients, each lasting around 10 minutes The performance will be graded as Clear Pass, Marginal Pass, Marginal Fail or Clear Fail

The CSA will test mainly from the following areas of the curriculum;- Primary Care Management Problem Solving Skills Comprehensive Approach Person-centred Care Attitudinal Aspects Clinical Practical Skills

Patient simulators (actors) will be used CSA assessor will observe and mark When time is up the patient and assessor will get up and leave The next patient and assessor will then enter for the next assessment stuff thats not on the website, that may change

There is a bank of CSA scenarios; currently >250 Word is bound to get out – that doesnt matter stuff thats not on the website, that may change

If consultations require examination of the patient, candidates should tell the patients they would like to examine them They then either examine the patient (because this is being tested) or will be given a printout of the examination findings by the patient stuff thats not on the website, that may change

Clear Pass CP The candidate demonstrates sound performance in the domain both in principle and in detail, operating clearly above the level for safe independent clinical practice Performance is fluent, though not necessarily sophisticated. Positive behavioural indicators of performance are consistently and proficiently met and on balance any negative behaviours are not thought to be of concern.

stuff thats not on the website, that may change Marginal Pass MP The candidate has a sound grasp of the principal of the domain, more so than the detail, operating at, or just above, the level for safe independant clinical practice Positive behavioural indicators are consistently met, although performance may not be fluent. On balance any negative behaviours are not thought to be of concern.

stuff thats not on the website, that may change Marginal Fail MF The candidates performance shows ability but overall is below the level for safe independent clinical practice The positive behavioural indicators are not demonstrated to a consistently adequate standard and negative behaviours may be of concern

stuff thats not on the website, that may change Clear Fail CF The candidate performs well below the level for safe independent clinical practice The range and depth of the positive indicators are poorly demonstrated and performances may be inconsistent. Negative behaviours may be of concern.

stuff thats not on the website, that may change Other descriptors for exceptional use only Excellent Performance is not necessarily perfect but is consistently proficient, integrated, fluent and time efficient. The candidates performance is as good as could be achieved under exam conditions. Serious Concerns The candidates performance demonstrates serious deficiencies in thinking and behaviour that may place patients at risk of harm from actions that the doctor takes, or fails to take.

Candidates do not have to pass every scenario Cases will present different levels of challenge Even a clear fail at one of the stations does not mean a candidate will necessarily fail the CSA stuff thats not on the website, that may change

GP curriculum Problem Solving Skills Technical Skills Defined as Gathering and using data for clinical judgement, choice of examination, investigations and their interpretation. Demonstration of a structured and flexible approach to decision making.

GP curriculum Problem solving & technical skills Positive indicators Clarifies the problem and nature of the decision required Uses an incremental approach, using time and accepting uncertainty Negative indicators Makes immediate assumptions about the problem Intervenes rather than using appropriate expectant management

GP curriculum Problem solving & technical skills Positive indicators Gathers information from history taking, examination and investigation in a systematic and efficient manner Is appropriately selective in the choice of enquiries, examinations and investigations Negative indicators Is disorganised or unsystematic in gathering information Data gathering does not appear to be guided by the probabilities of disease

GP curriculum Problem solving & technical skills Positive indicators Uses instruments appropriately and fluidly When using instruments or conducting physical examinations, performs actions in a rational sequence Negative indicators Appears unsure of how to operate/use instruments Appears disorganised or unsystematic in the application of the instruments or the conduct of physical examinations

GP curriculum Primary Care Management Comprehensive Approach Defined as Recognition and management of common medical conditions in primary care. Demonstration of proficiency in the management of co-morbidity and risk. Demonstrating the ability to promote a positive approach to health.

GP curriculum Management and comprehensive approach Positive indicators Recognises presentations of common physical, psychological and social problems Makes plans that reflect the natural history of common problems Offers appropriate and feasible management options Negative indicators Fails to consider common conditions in the differential diagnosis Does not suggest how the problem might develop or resolve

GP curriculum Management and comprehensive approach Positive indicators Management approaches reflect an appropriate assessment of risk Makes appropriate prescribing decisions Negative indicators Fails to make patient aware of relative risks of different options Decisions on whether or what to prescribe are inappropriate or idiosyncratic

GP curriculum Management and comprehensive approach Positive indicators Refers appropriately & co-ordinates care with other healthcare professionals Manages risk effectively, safety-netting appropriately Simultaneously manages multiple health problems, both acute and chronic Negative indicators Decisions on whether & where to refer are inappropriate Follow up arrangements are absent or inappropriate Fails to take account of related issues or co- morbidity

GP curriculum Management and comprehensive approach Positive indicators Encourages improvement, rehabilitation &, where appropriate, recovery Encourages the patient to participate in appropriate health promotion and disease prevention strategies Negative indicators Unable to construct a problem list and prioritise Unable to enhance patient's health perceptions and coping strategies

GP curriculum Person Centred Approach Attitudinal Aspects = Interpersonal Skills Defined as Communication with the patient and the use of recognised consultation techniques to promote a shared approach to managing problems. Practising ethically with respect for equality and diversity, with accepted professional codes of conduct.

GP curriculum Interpersonal Skills Positive indicators Explores patients agenda, health beliefs and preferences Appears alert to verbal or non-verbal cues Negative indicators Does not enquire sufficiently about the patients perspective or health understanding Pays insufficient attention to the patients verbal and non-verbal communication

GP curriculum Interpersonal Skills Positive indicators Explores the impact of the illness on the patients life Elicits psychological and social information to place the patients problem in context Negative indicators Fails to explore how the patients life is affected by the problem Does not appreciate the impact of the patients psychosocial context

GP curriculum Interpersonal Skills Positive indicators Works in partnership, finding common ground to share a management plan Communicates risk effectively Shows responsiveness to the patients preferences, feelings and expectations Negative indicators Instructs the patient, rather than finding common ground Uses a rigid approach to consulting that fails to be sufficiently responsive to the patients contribution

GP curriculum Interpersonal Skills Positive indicators Enhances patient autonomy Provides explanations that are relevant and understandable to the patient Responds to needs and concerns with interest and understanding Negative indicators Fails to empower the patient or encourage self- sufficiency Uses inappropriate (eg technical) language Shows little visible interest or understanding. Lacks warmth.

GP curriculum Interpersonal Skills Positive indicators Has a positive attitude when dealing with problems. Admits mistakes & shows commitment to improvement. Backs own judgment appropriately Demonstrates respect for others Negative indicators Avoids taking responsibility for errors Does not show sufficient respect for others

GP curriculum Interpersonal Skills Positive indicators Does not allow own views/values to inappropriately influence dialogue Shows commitment to equality of care for all Acts in an open non- judgmental manner Negative indicators Inappropriately influences patient interaction through own views/values Displays inappropriate favour or prejudice Is quick to judge

GP curriculum Interpersonal Skills Positive indicators Is cooperative & inclusive in approach Conducts examinations with sensitivity for the patients feelings, seeking consent where appropriate Negative indicators Appears patronising or inappropriately paternalistic When conducting examinations, appears unprofessional and at risk of hurting or embarrassing the patient

stuff thats not on the website, that may change Briefing Both simulator and assessor will have been thoroughly briefed on the scenario The patient will have a name The case will have a title (known to the simulator and assessor) Simulator and assessor will have a context for the case – i.e. what domain(s) is this case assessing

stuff thats not on the website, that may change Briefing (continued) There will be a marking schedule which specifically lists what positive and negative descriptors the case is designed to highlight If the candidate misses (for example) an important cue which is crucial to the case, the simulator will try again

stuff thats not on the website, that may change Briefing (continued) Most scenarios will allow assessors to mark each of the following domains as CP, MP, MF or CF;- Data gathering, technical and assessment skills Clinical management skills Interpersonal skills Assessors will make notes whilst observing, to aid them in coming to a judgement The candidate is then given an overall mark (CP, MP, MF or CF) for that scenario, and this is the one which counts