Three domains for each
case - all have equal weighting
1. DATA-GATHERING, TECHNICAL &
ASSESSMENT SKILLS :
9
9
9
9
Gathering & using data for clinical judgement
choice of examination
g
& their interpretation
p
investigations
demonstrating proficiency in performing
physical examinations & using diagnostic and
therapeutic instruments
Three domains for each
case - all have equal weighting
2. CLINICAL MANAGEMENT SKILLS :
9 Recognition & management of common
medical conditions in primary care.
9 Demonstrating
D
t ti a structured
t t d & fl
flexible
ibl
approach to decision-making.
9 Demonstrating the ability to deal with
multiple complaints and co-morbidity.
9 Demonstrating the ability to promote a
positive approach
p
pp
to health.
Three domains for each
case - all have equal weighting
3. INTERPERSONAL SKILLS:
9 D
Demonstrating
t ti th
the use off recognised
i d
communication techniques to understand
th patient’s
the
ti t’ ill
illness experience
i
and
dd
develop
l
a shared approach to managing problems.
9 Practising ethically with respect for equality
and diversity, in line with the accepted
codes of professional conduct.
Results and feedback
Results
R
lt will
ill b
be provided
id d as grades
d on
the thirteen assessed cases and an
overallll pass or ffailil mark
k calculated.
l l t d
€ Assessor uses word pictures to help
decide grade for each domain, then
uses this information to make a
j d
judgement
t on th
the grade
d ffor th
the case
overall
€ Quantitative and qualitative feedback is
given to all candidates. This has been
i
improved
d with
i h fformative
i suggestions.
i
€
The decision
€ There
are 4 grades that could be
a arded in each domain
awarded
domain:
y Clear pass
y Marginal
M i l pass
y Marginal fail
y Clear
C
ffail
Marking
After taking into account the
performance over the
candidate's p
three domains, the assessor will
decide on an overall rating
rating.
Fail “borderline”
borderline Pass
Criterion
C
it i referenced
f
d
€ Reasons
€
The decision
€ It
is worth noting that if an
assessor has serious concerns
about a candidate's
candidate s performance
such that patient safety might be
forced to be compromised,
he/she has to act in accordance
of a doctor's obligations
g
to the
GMC and the public.
€ In a very
y small minority
y of cases,,
it is possible that a candidate
could be referred to the GMC.
What sort of cases to expect
€
€
€
€
The cases in
Th
i the
th CSA will
ill reflect
fl t th
those iin
real life general practice.
The simulated patients may be young or
old, and from a variety of backgrounds i.e.
representing
g different races, cultures,
religions, and social classes.
It is possible that candidates will encounter
patients representing disabilities
disabilities.
Apart from the surgery setting, home visits
and out of hours situations could be
covered.
What sort of cases to expect
The patients may present with acute
medical problems, or chronic diseases.
€ They may come with more than one
problem or present with vague
problem,
symptoms.
€ Some cases will
ill test clinical e
examination
amination
or practical skills.
€
What sort of cases to expect
Candidates
C
did t will
ill b
be expected
t d tto examine
i
the simulated patients.
€ Where findings are different from those
found a card specifying the 'simulated'
findings will be handed to the candidate.
€ Intimate examinations will not be
expected but if candidates do not
indicate the examination, they would
undertake no card will be given.
€
What sort of cases to expect
Because of the difficulty in using child
actors, paediatric cases are likely to be
in the format of a parent presenting on
the child's behalf.
€ Although in the future the CSA exam
might include OSCE style clinical
examinations using models or manikins
€ There
Th
is
i NOT always
l
a Hidd
Hidden A
Agenda!
d !
€
Failure!
€
CLINICAL MANAGEMENT!!
y Does not develop a management
g
plan
(including prescribing & referral) that is
appropriate and in line with current best
practice or make adequate arrangements for
follow up and safety netting
y Does not develop a shared management
plan or clarify the roles of the doctor and the
patient
ti t
Doctor centredness
€ Failure to share management options
€ Assume y
you should examine – yyou will be
told the findings if appropriate. The actors
like to take their clothes off!
€ Prescriptions will be marked
€ You can talk whilst you examine the patient
€ Random access memory
y is bad
(disorganised)
€ Numbers needed to pass – no longer the
case!
€
If you fail…
fail
The e-portfolio is very important
€ Speak
p
to yyour PD / Deanery
y
€ Everyone can have a bad day!
€
Tips for success
€
A i early
Arrive
l (9
(9.30
30 & 12
12.45)
45)
€
Keep to time - it is worth practicing 10
minute consultations in yyour p
preparation
p
before the exam
€
Read through any information provided
before each case commences
Tips for success
Make sure your consultations are
balanced - do not omit any of the
domains
€ Apply your knowledge of clinical
medicine
€ Think thro
through
gh your
o r management plan
and explain this to the patient, including
any proposed
dd
drugs or iinvestigations
ti ti
€
Tips for success
Be patient-centred and involve patients
in the decision-making process
€ Practice "housekeeping" skills - once
you have completed a station
station, put it
behind you in order to be able to focus
your full attention on the next one
€
Key Features in clinical
management
€
€
€
Passing
Appears knowledgeable
and refers to recognised
algorithms or modes of
practice
Able to suggest
solutions to problems or
a range of reasonable
management options
likely to be agreeable to
the patient
€
€
€
€
Failing
Insufficient knowledge
base or ability to think of
realistic and effective
alternatives
Puts off making clinical
decisions
D
Does
nott appear tto
grasp the dilemma if
there is one
Key features in data gathering
Passing
P
i
€ Can take a focused
but full history
€ Embedding of
questions in
previous response
€
Failing
F
ili
€ Formulaic
questioning which
can become
interrogative
€ Different types of
information elicited
in the same way
€ Sequence of
questions
i
d
does not
seem to make sense
€
Key features in interpersonal
skills
€
€
€
€
€
€
Passing
Connects instantly with
the patient
Non-judgemental
Interested in the patient
Reformulates
explanations using
helpful metaphors
Can meet the patient
half way – picks up the
patient’s agenda, accent
or cultural approach
€
€
€
€
€
Failing
Unable to explain
effectively – may be
wrong or not tuned to
the patient
Inappropriate use of
terms
D centred
Dr
t d / patient
ti t
concerns not addressed
Over patient centred to
the detriment of clinical
outcome
General features / behaviours
observed
€
€
€
€
€
Passing
P
i
Fluent, interactive and
relevant
Is able to take the
patient into the medical
world as a shared
partner (use of we)
Open about lack of
knowledge or certainty
and may use this
constructivelyy
Active monitoring during
the consultation
€
€
€
€
€
€
€
Failing
F
ili
Poor use of time
Patronising (use of we)
Unable to keep control
Uneasy with or unable
to acknowledge own
ignorance or uncertainty
Does not appear to care
about the patient
More scripted summary
and
d checking
h ki
understanding
Headline results
Key Points
Examine
€ Not always
y a hidden agenda
g
€ There has to be an outcome
€ Think
Thi k off the
th simulators
i l t
as patients
ti t
€ Do not role p
play
y being
g a doctor!
€ Preparation – see patients!
€
COT v CSA domains
€ Joint surgeries
g
€
s