1. Clinical Skills Assessment Cumberland Lodge May 18 th 2010 Richard de Ferrars

2. Workshop Plan CSA Overview –Organisation –Style of cases –Information for cases –Examination & investigations –Marking Feedback from Examiners 2009-10 Helping STs prepare CSA stations – 4 scenarios with marking.

3. The CSA Centre (Croydon) “Virtual Tour” is available on the RCGP website (MRCGP/ WPBA/ CSA)

4. CSA Organisation Read “Information for Candidates” - RCGP Website (Travel details, equipment list, photo ID etc) Cost £1400 - £1550 Single room, single observer –Thirteen scenarios (one pilot case) –Ten minutes then buzzer –Two minute break Observer changes with patient May be a break in the middle or a “rest station”.

5. Types of Cases Acute & chronic illness, undifferentiated illness covering many different curriculum areas Mainly GP surgery face-to-face usually also one other (home visit, phone) Case mix typically includes: –one case involving disability –one case with major psychological problems –one case involving elderly patient –one case involving child health issues.

6. Information Provided Simple one sentence summary of case Appendix with brief patient summary (if relevant): –Name & age –Social and family history –PMH summary –Current medication –Recent investigations –Recent relevant consultations – GP, OOH, hospital.

7. Examination & Investigation Targeted simple examinations - joints, neuro, ENT, chest –Full system examinations are rarely expected When “simulation findings” differ, given on a card –BUT, no examination attempted means no card given –May be given card as starts to examine or as finishes Simulator will try and steer candidate away from inappropriate examinations Need to use CORRECTLY simple equipment – ENT, PEFR (Bring own bag and simple equipment) Expected to interpret (& explain) simple test results.

8. Marking Three domains of equal weighting: 1.Date gathering, examination & clinical assessment skills How you get to the nub of the problem 2.Clinical management skills What you do about moving the problem forward 3.Interpersonal skills How you go about it Marked in each of the 3 domains: clear passmarginal passmarginal failclear fail Each domain - list of positive and negative descriptors Then given overall grade for that case Typically pass-mark will be 8/12 cases.

9. Examiner’s Feedback Data Gathering Does not undertake a physical examination competently, or use the instruments proficiently Clinical Management Does not develop a management plan that is appropriate and in line with current best practice Interpersonal Skills Does not identify patient’s agenda/ preferences, does not make use of cues Does not develop a shared management plan Global Does not recognise the challenge (issue).

10. Helping STs Prepare Strong correlation between starting video work before week 6 and CSA pass Make use of video and joint surgeries:  Patient-centredness  Identifying patient’s expectations  Focussed history & targeted examinations  Management plans are clear to patient (and to observer)  Shared management plans.

11. CSA Stations Four stations/ 4 simulators One person in the hot seat –Look at the single briefing page only Others are observers –Take a couple of minutes to read the full scenario with the marking schedule –Makes the victim sweat a bit more –One take the lead with time-keeping & examination findings Discussion at the end –Pendleton rules (victim first) –Talk to the simulator –Mark using the grid

12. CSA Stations Two stations before coffee, two after: Station 109:30 – 10:00 Station 210:00 – 10:30 Coffee10:30 – 10:45 Station 310:45 – 11:15 Station 411:15 – 11:45 Plenary11:45 – 12:00 For convenience – we move, simulator stays Leave ALL paperwork behind in the room!

13. The End