CASC Communication skills

1
CASC Communication skills

• Dr Alin Mascas ST4 Psychiatry

2
Overview

• CASC structure
• Theory communication skills
• Psychology
• Dos and Donts
• Practice Introduction
• Group practice

3
CASC structure

• 16 clinical scenarios (8 single stations and 8
  linked stations)
• Single stations - 7 min( 1 min preparation)
• Linked stations 10 min(2 min preparation)
• Break between morning and afternoon sessions
  (dont eat excessively).

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Areas of concern

• Poor management of interview/discussion
• Lack of focus on the required task.
• Lack of fluency to the task.
• Interviewer interrupts the role player
  excessively.
• Interviewer allows the role player to dictate the
  theme of the consultation.
• Poor management of the interview.
• Fails to follow a line of enquiry/discussion to a
  logical end point.

5
Areas of concern

• Poor communication skills
• Use of medical jargon without explanation.
• Use of predominantly closed questions.
• Use of multiple questions.
• Uses inappropriately phrased questions.
• Failure to listen/identify/respond to concerns or
  cues from the interviewee.
• Lack of flexibility of questioning style.
• Lack of empathic response.
• Lack of eye contact/non-verbal responses.
• Poor body language.

6
Areas of concern

• Significant deviations from the task
• Omissions related to poor prioritisation of the
  task.
• Omissions related to lack of knowledge/ability.
• Lack of recognition of importance of aspects of
  the task.
• Inappropriate avenues of enquiry or discussion.
• Inaccurate or misleading information discussed.
• Lack of analysis of problems and synthesis of
  opinion.

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Areas of concern

• Lack of professionalism
• Harmful interaction likely to cause either
  psychological or physical distress.
• Failure to respect the interviewee?s rights.
• Rudeness or arrogance.
• Inappropriate or flippant manner.
• Dismissive attitude to interviewee?s concerns.

8
Areas of concern

• Limited depth and/or range to the task
• Aspects of history or mental state highlighted
  but not explored in depth or appropriate manner
  (not the same as an omission eg. some aspects
  of orientation covered in a cognitive test such
  as time and place, but orientation in person not
  covered).
• Inadequate or superficial risk assessment.
• Poor range of symptomatology explored.
• Limited/incomplete explanation of
  concepts/problem.
• Limited or incomplete management plan.

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Approach

• Always READ the task and be 100 clear of what
  is the task
• Write down quickly patients name and the most
  important buzz words from the vignette the
  task
• Prepare and visualize mentally your
  introduction-first 1-2 sentences
• Make sure you know the setting of the vignette

10
Approach

• Greet the patient and introduce yourself
• Explain the purpose of the meeting and check
  their understand of the reasons for referral
  (negotiate the agenda).
• Go with the flow
• Dont forget, this is an outpatient clinic and
  treated as such.
• If cant remember the task say it and check the
  vignette, be honest, dont try to guess the task.

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Approach

• Check with patient if they are happy with what
  youve told them, if not seek further
  concerns/expectations.
• 1 minute left-start wrapping up the
  interview-EQUALLY important as the beginning.
• Dont ask open question in the last minute except
  if it is pass/fail question (i.e risk of suicide)
• Thank the patient and the examiner and put the
  whole station in a locked box.

12
History taking stations

• OPEN question moving gradually to CLOSED
  questions in a funnel fashion
• Listen carefully for 1 minute(golden minute)
• When patient stops to breath in you take the lead.

13
History taking stations-PC

• Onset
• Duration
• Progress
• Alleviating
• Relieving
• Coping/Effects
• ICE (always)
• SUMARIZE

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History taking stations

• Be systematic in approach DO NOT
• change your format of questioning
• ALWAYS start with an open mind
• Do not assume you know the diagnosis based on
  exam practice
• ALWAYS check RISK
• Actors are generally just doing their job
  (nobodys out to get ya).

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Case discussion

• Always check their understanding first
• Read RCPsych online leaflets
• Be prepared to encounter what on Earth?
  situations
• Be honest and say you dont know if you dont
  know.
• If not sure whether youve done well ask the
  patient and summarize at the end.
• Offer the option to read further information and
  only if happy offer leaflets, etc.

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Difficult communication

• Most of the stations

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Stations

• Check Revisenow forum for past papers (Superego
  café forum) but.
• Have a clear understanding of what stations came
  previously(approx 150)
• DO ALWAYS prepare well for
• Psychotherapy
• Physical examination (including ECG)
• Cognitive examination
• MSE
• Risk assessment
• Management

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Psychotherapy stations

• Make sure you know the basics of main types of
  psychotherapy
• STRUCTURE-(nr of sessions, with whom, when,
  timing, exclusion criteria)
• CONTENT(what is actually going on in the
  sesssion)

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Physical examination stations

• Practice all physical exams and make sure you can
  do them smoothly
• ALCOHOL GEL BEFORE AND AFTER EXAMINATION
• Look for what instruments are available -clues
• Talk to the patient about what you intend to do,
  ask permission before you proceed consider
  chaperone
• Be gentle
• Privacy and dignity
• Reassure them at the end and mention your
  findings if any.
• No need to talk to examiner except in ECG
  stations.

20
Cognitive examination

• MMSE ALWAYS-can jot it down on the notepad before
  you enter the exam (high chance youll get it).
• Usually single station
• Aim for 5 min on MMSE and the rest on
  parietal/frontal lobes

21
MSE

• At least one station
• High expectations
• Make sure you cover the depth and range.
• Dont forget cognitive function

22
Risk stations

• ALWAYS in CASC
• ABC approach
• Check for past H/o incidents(sui, violence, etc)
• Always ask about DA

23
Management stations

• Present the findings as SBAR
• Formulate the management plan and offer options
• Always bio-psycho-social but.prioritize
• Be a safe doctor
• Keep talking and look confident

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PSYCHOLOGY OF CASC REVISION

• Revise theory in advance
• Prepare mentally and physically
• Eat healthy
• Relaxyou are already a psychiatrist
• Dressing code
• CONTROL, CONTROL, CONTROL-YOU ARE THE CONSULTANT
• Confident approach

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Dos and Donts
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Books

• ICD 10
• The NICE Guidelines
• Sims/Fish psychopathology
• Try to review all previous stations
• Do your structures for each stations(keep it
  simple)

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Practice.as much as possible

• Max 4 people
• Regularly
• Seek constructive feed back
• Dont take it personally
• Combine revision with physical exercise/sleep/outd
  oor activities
• Cut down on sugar and caffeine.he says

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Crash course

• Useful but not a must (watch out for external
  attribution)
• Some better than other
• They teach you how to pass
• Dont be desperate if you dont get a pass in the
  mock
• Definitely do a Mock CASC few weeks prior to exam