Post on 02-Jun-2018
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 1/26
How not to failDr. Louise Riley
Trainer (Bradford VTS)
Examiner (CSA component)
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 2/26
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 3/26
Introduction to CSA Personal experiences
Case examples from college DVD
Marking and discussion How to prepare
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 4/26
Knowledge
Competence
Performance
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 5/26
„ An assessment of a doctor ‟ s ability to
integrate and apply appropriate clinical,
professional, communication and
practical skills in general practice ‟
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 6/26
Number 1, Croydon (opposite East Croydon station)
Floors 18,19,20
Colour coded
DO NOT BE LATE !
Stay at...
◦ Croydon Park Hotel
◦ Jury‟s Hotel
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 7/26
Simulated surgery 13 stations,12 “live” one pilot
10 minutes each
2 minutes between
You stay put, role players and
assessors move
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 8/26
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 9/26
Passport or photo-card driving licence
Doctor
s bag containing:
BNF
Stethoscope Ophthalmoscope Auroscope Thermometer Patella hammer
Sphygmomanometer (aneroid or electronic) Tape measure Peak flow meter and disposable mouthpieces
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 10/26
Mostly written from GPs‟ own experiences
A spread of cases across the curriculum
Each case mapped to a specific area of thecurriculum
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 11/26
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
/lifestyleOther
Cardiovascular
Respiratory
Neurological/ Psychiatric
Musculo-skeletal
Endocrine/ Oncological
Eye/ ENT/ Skin
Men/ Women/ Sexual Health
Renal/ urological
Gastro-intestinal
Infectious diseases
ETC
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 12/26
Cough with ACE inhibitor
Young woman with headache
Child with constipation
Man with Dupuytren‟s contracture
Woman with diabetes and depression
Man with anxiety and palpitations
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 13/26
Data gathering
Clinical Management
Interpersonal skills
3 Domains:
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 14/26
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 forobserved behaviours
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 15/26
You get a grade for each domain
◦ Clear pass
◦ Marginal pass
◦
Marginal fail◦ Clear fail
Then you get an overall grade
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 16/26
Domain
Observed behaviours
Grade
CP/MP/
MF/CF)
Data gathering,examination andclinical assessmentskills
Establish reason for attendance ie need to get notefor gym and what is required for thisExplore any current health problems and past medicalhistory, including raised cholesterolShow ability to check BP and chest
Clinical management
skills
Formulate an appropriate plan to address possible
raised cholesterol and BPConsider health promotion issues eg smoking, wt,alcohol and exerciseShow ability to manage request for noteappropriately, recognising implications
Interpersonal skills Elicit any underlying concerns regarding raised
cholesterol and heart problems
Show ability to negotiate as necessary re the note andthe management of any health problems, share
management options
Take an interest in the patient, avoid lecturing him
about lifestyle
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 17/26
Yes, but it‟s feedback on the whole CSAperformance, not an individual case
The assessors pick from a list of feedbackstatements
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 18/26
Feedback statements
Data Gathering
1. Disorganised and unsystematic in gathering information from history taking, examination andinvestigation
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 inline 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 patient‟s 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 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-centredness
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 19/26
Domain Observed behaviours Grade(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 workand 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 collarsIndicate how problem may resolve
Interpersonal skills Explain pros and cons of various treatments
Acknowledge patient’s ideas and expectations
about treatment
Negotiate with patient sensitively
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 20/26
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 21/26
Turn the feedback statement intoconstructive advice
What practical steps might this doctor take toimprove performance?
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 22/26
Feedback statements
Data Gathering
1. Disorganised and unsystematic in gathering information from history taking, examination andinvestigation
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 inline 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 patient‟s 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 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-centredness
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 23/26
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 24/26
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
Don‟t be phased by the cases, stick to the basic principles ofpatient centred consulting
Don‟t forget psychosocial and family history
Remember treatment by other means as well as drugs
Remember “Housekeeping skills” i.e. put the last case behindyou 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
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 25/26
Any Questions?
8/10/2019 Csa - How Not to Fail (With Slide Notes)
http://slidepdf.com/reader/full/csa-how-not-to-fail-with-slide-notes 26/26