1. Preparing your Registrar for the CSA Facts the Registrar needs to know How the CSA is marked Avoiding common mistakes on the day How to help your Registrar pass the CSA Helping Registrars who are foreign medical graduates

2. Purpose of the CSA ‘An assessment of a doctor’s ability to integrate and apply appropriate clinical, professional, communication and practical skills in general practice’ Integrative skills assessment - tests a doctor’s abilities to gather information and apply learned understanding of disease processes and person-centred care appropriately in a standardised context, making evidence-based decisions, and communicating effectively with patients and colleagues. This is from RCGP website – we need to interpret this for our registrars

3. Facts Registrars need to know 4 times per year - currently in January, May, September and November. When to take it? How much does it cost? 13 cases each of maximum 10 minutes – 7 cases then 20 min break then 6 cases. Usually 1 minute between cases, may be more ( don’t take it personally) Can be telephone triage, home visit, someone coming on behalf of someone else or none of these

4. Examination fees The following fees are payable for examinations with effect from 01 August 2009. Each attempt at Applied Knowledge Test (AKT): Associate in Training £414 Non-AiT £460 Each attempt at Clinical Skills Assessment (CSA): Associate in Training £1389 Non-AiT £1542 Candidates taking AKT and CSA as part of MRCGP pay the AiT rate.

5. CSA: the centre Purpose-built centre –No.1 Croydon –Easy access –Top 3 floors

6. CSA: the centre Left or right handed consulting rooms Temperature and light varies Some rooms video Walk of fear

7. CSA: the 3 domains DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS: Gathering & using data for clinical judgement, choice of examination, investigations & their interpretation. Demonstrating proficiency in performing physical examinations & using diagnostic and therapeutic instruments CLINICAL MANAGEMENT SKILLS: Recognition & management of common medical conditions in primary care. Demonstrating a structured & flexible approach to decision-making. Demonstrating the ability to deal with multiple complaints and co-morbidity. Demonstrating the ability to promote a positive approach to health INTERPERSONAL SKILLS: Demonstrating the use of recognised communication techniques to gain understanding of the patient's illness experience and develop a shared approach to managing problems. Practising ethically with respect for equality & diversity issues, in line with the accepted codes of professional conduct. The grades will be on a four point scale: Clear Pass Marginal Pass Marginal Fail Clear Fail Consider for e.g. a businessman with earache consulting with the expectation of antibiotics

8. CSA: four grades Four grades –Clear pass  –Marginal pass  –Marginal fail × –Clear fail × Grade descriptors –on RCGP website under CSA cases

9. CSA feedback statements Data Gathering 1.Disorganised and unsystematic in gathering information from history taking, examination and investigation 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 in line with current best practice. 7.Does not demonstrate an awareness of management of risk, and health promotion Interpersonal skills 8. Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues 9. Does not identify or use appropriate psychological or social information to place the problem in context 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- centeredness

10. CSA feedback statements Data Gathering 1.Disorganised and unsystematic in gathering information from history taking, examination and investigation 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 in line with current best practice. 7.Does not demonstrate an awareness of management of risk, and health promotion Interpersonal skills 8. Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues 9. Does not identify or use appropriate psychological or social information to place the problem in context 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- centeredness

11. On the day WATER SMART COMFORTABLE CLOTHES READ THE QUESTION: RED PEN/HIGHLIGHTER WELCOME THE PATIENT INTRODUCE YOURSELF – EYE CONTACT- NOT TOO LONG AN INTRODUCTION THERE MAY BE 1-2 EXAMINERS AND 1-2 ACTORS AVOID WRITING SCRIPTS IF POSSIBLE COLLECTING FROM RECEPTION e.g. SCRIPTS, PIL ETC COVER THE BASICS IN THE TEN MINUTES

12. Helping your Registrar prepare for the CSA 10- 12 MINUTE CONSULTATIONS WITH CSA IN MIND MARKED JOINT SURGERIES CASES CREATED FROM REAL PATIENTS PRACTISE WITH PEER GROUP (AVOID BOOKS) OTHER PRACTICE DOCTORS ASSESSING PRACTICE SWAPS (PATIENT TYPES) TIME EFFICIENCY IN CONSULTING EFFICIENT/EFFECTIVE CLINICAL EXAMINATION ‘ICE’ QUESTIONS SHOULD BE AUTOMATIC VISITS/TELEPHONE/SURGERY CONSULTATIONS RIGHT/LEFT HANDED CONSULTING VIDEO CSA PRACTICE CONSULTATIONS FOR ANALYSIS

13. Registrars who are foreign medical graduates British graduates and Bristol VTS do well! “Fish out of water” concept Practise, practise, practise Care with standard statements e.g. “How did that make you feel?”