1220_2009-12-03 csa update

8/6/2019 1220_2009-12-03 CSA Update

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Update on CSA

3 parallel circuits twice daily

13 simulated patient stationsCases last 10 mins

Candidates stay in roomsRole player accompanied by assessor

Prescription pads, certificates ,test formsprovided.

8/6/2019 1220_2009-12-03 CSA Update


CSA Update

More acute and chronic cases

Undifferiented illnessPsychological and Social

Preventive LifestyleOther

All above cover wide area of primarysystems or areas of disease.

8/6/2019 1220_2009-12-03 CSA Update


8/6/2019 1220_2009-12-03 CSA Update


CSA Update

Circuit takes about 3.5 hours

15 minute breaktime,allowed out forrefreshments and toilet

Monitored during breaks to preventdiscussion of cases; morning/afternoonbatches separatedConfidentiality agreement signed

8/6/2019 1220_2009-12-03 CSA Update


CSA Update

Don’t be late

Remember IDBring doctors bag and clean BNF

Details of what equipment needed onwebsite

Can mark BNF for system areas.Avoid disqualification- no mobiles etc

8/6/2019 1220_2009-12-03 CSA Update


CSA Update

No computer

Don’t get tied up with paperworkExplain and talk to the patient

Will get opportunity to read through allcases at beginning(10 mins) and also 2mins to read between cases.Get practice at reading patient summariesto be able to quickly distil relevant info.

8/6/2019 1220_2009-12-03 CSA Update


8/6/2019 1220_2009-12-03 CSA Update


CSA Update

Pool of 260

High proportion GP trainers or PDsSelection and training processQA of assessors and RPs ensure fairness

Ongoing recent hands on experience ofregistrarsEducational/assessment background

Ability to work in teamsFree from prejudiceAbility to rank order correctly

8/6/2019 1220_2009-12-03 CSA Update


CSA Update

Around 600 cases writtenCases change dailyCases reflect spectrum of GPDesigned to fill 10 min slotCostly to create and pilotTrainer case writers work together with RPs in residentialEach case linked to curriculum and learning outcomeCase writers use their personal experienceTrialled extensively

8/6/2019 1220_2009-12-03 CSA Update


Evolution of a Case

Case writer

Group leaderFeedback

Case Bank

Case Assurance GroupFeedback

Pilot

Case Assurance groupFeedback

Goes Live

8/6/2019 1220_2009-12-03 CSA Update


CSA Update

Wide clinical scope

Differing contexts all taken from GPRange of ages including children by proxyEthnicity and disabilityEmotional problems,BBN,depressionConsultation with health care professionals

No mannikins or models (almost do have somelegs and arms)

8/6/2019 1220_2009-12-03 CSA Update


Specifics for trainers to cover

Telephone consultations

Home visitsDifferent ethnicitiesDisabled patients

Difficult patientsUncertain diagnosesHealth care professional consultations

Listen in to trainers on the phone get them tolisten to youGet trainer to come out on home visit with you.

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8/6/2019 1220_2009-12-03 CSA Update


Pitfalls to avoid

Jumping to diagnostic conclusions too

soonMechanistic consulting; coming out withirrelevant stock phrasesForgetting about clinical and examinationskills

Inadequate physical examination skillsLooking for non existent hidden agendaRigid dr- centred consulting

8/6/2019 1220_2009-12-03 CSA Update


8/6/2019 1220_2009-12-03 CSA Update


Expected standard

That of a GPR towards the end of a 3 yr

VTSSafe for independent practice

NOT that of an establishedprincipal,GPWSI,hospital consultant

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Feedback from candidates

Feel it’s a fair exam

Exam centre fir for purposeActors very realistic

Cases reflect real-life GPA stressful experienceExcellent assessment for practiceCSA exam fees are highVery similar to normal practice

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Feedback to candidates

Pass(+excellents) or Fail

Number of cases passed( need to pass 8)Which cases failed-labelled by curriculumstatementFormative feedback statementsFail examiner marks lozenge under that

heading if 2 lozenge under one headinggoes into feedback on eportfolio e.g.disorganised management plan.

8/6/2019 1220_2009-12-03 CSA Update


Key Message for GPSTRs

Revise from most of the curriculum

statements-think broad!Avoid making assumptions based on

previous candidates’ experienceRead the case paperworkClinical, not just consultations skillsManage time; structure consultations.

8/6/2019 1220_2009-12-03 CSA Update


How can trainers help

Allow exposure to a wide variety ofcases/contexts e.g. ethical issues (abortion)Consider short practice swapsUse consultation modelsUse the COT as a way of assessing preparationfor CSA,giving feedbackMove towards 10 min consultations as soon asis feasible2 mins look at patient summary10 mins case2 mins put on computer

8/6/2019 1220_2009-12-03 CSA Update


CSA timing

January/February

MaySeptemberNovember/DecemberCSA must be taken in the final year oftraining(NB part-timers)

Cumulative pass rate is 93%Criterion based pass rate if 100% pass on theday 100% will pass.

8/6/2019 1220_2009-12-03 CSA Update


Training materials

Info on web regularly updated

Wessex DVD parts 1 and 2Books RCGP one out soon

P. Naidoo Cases and conceptsT. Das Clinical scenarios for nMRCGP.

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The grades

4 grades

Clear pass;marginal passClear fail;marginal fail

Clear;marginal for benefit of examiner aslikes to discriminate

Medal for best candidateAppeals system

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The marking schedule

Each case marked in 3 domainsData gathering ,examination and clinicalassessment skillsClinical management skillsInterpersonal skillsOnly the overall grade for the case countsNo compensationNeed to pass all 3 domainsEach case may have different weighting for eachdomain e.g. BBN weighted towardsinterpersonal skills

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Data Gathering, Technical and

Assessment SkillsGathering and using data for clinical

judgement, choice of examination,investigation and their interpretationDemonstrating proficiency in performingphysical examination and using diagnosticand therapeutic instruments.

8/6/2019 1220_2009-12-03 CSA Update


8/6/2019 1220_2009-12-03 CSA Update


Interpersonal Skills

Demonstrating the use of recognised

communication techniques to understandthe patient’s illness experience anddevelop a shared approach to managingproblemsPractising ethically with respect for

equality and diversity in line with theaccepted codes of professional conduct

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Marking guidance for examiners

Case synopsis

Intended Learning outcomes (ILOS)What the candidates must do to pass the

stationGeneric marking schedule

Case-specific marking scheduleDiscussion and roleplay of case at start ofexam day.

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Message to GPRs

Will not fail on a single bad mistake, or

one badly done caseNeed to cover all domains in each casesthough may be skewed according to' nub’No compensation between cases so dowell in as many as possibleBad time management lessens chances ofpassing

8/6/2019 1220_2009-12-03 CSA Update


Message to GPRs

Don’t prejudge the case

No black ballingNo red herrings

If prompted RPs will divulge informationListen to the patient and believe them

Normally not a hidden agenda

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8/6/2019 1220_2009-12-03 CSA Update


URTIs ILOs

The doctor demonstrates the ability to take ahistory and perform an examination of astraightforward case of URTIDemonstrates an appropriate use of the skillstypically associated with good doctor-patient

communicationUnderstanding the evidence regarding antibioticprescribing in URTIs

Negotiate a shared understanding of theproblem and its management empower thepatient to look after her own health

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To pass the station

Should take a focused history, including

any serious illnessMust recognise the patient’s expectationsand health belief and make an attempt toaddress themMust negotiate a sensible managementplan avoiding being over doctor centredExamine the upper respiratory systemappropriately

1220_2009-12-03 csa update

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