CSA

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CSA

• How not to fail
• Dr. Louise Riley
• Trainer (Bradford VTS)
• Examiner (CSA component)

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Help!
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Agenda

• Introduction to CSA
• Personal experiences
• Case examples from college DVD
• Marking and discussion
• How to prepare

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What you can test...

• Knowledge
• Competence
• Performance

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The Theory...

• An assessment of a doctors ability to integrate
  and apply appropriate clinical, professional,
  communication and practical skills in general
  practice

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Where...

• Number 1, Croydon (opposite East Croydon station)
• Floors 18,19,20
• Colour coded
• DO NOT BE LATE !
• Stay at...
• Croydon Park Hotel
• Jurys Hotel

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Whats it like ?

• Simulated surgery
• 13 stations,12 live one pilot
• 10 minutes each
• 2 minutes between
• You stay put, role players and assessors move

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Its not like this!
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What do I need ?

• Passport or photo-card driving licence
• Doctors bag containing
• BNF
• Stethoscope
• Ophthalmoscope
• Auroscope
• Thermometer
• Patella hammer
• Sphygmomanometer (aneroid or electronic)
• Tape measure
• Peak flow meter and disposable mouthpieces

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How are cases selected?

• Mostly written from GPs own experiences
• A spread of cases across the curriculum
• Each case mapped to a specific area of the
  curriculum

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Case Selection Blueprint
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What sort of cases are there?

• Cough with ACE inhibitor
• Young woman with headache
• Child with constipation
• Man with Dupuytrens contracture
• Woman with diabetes and depression
• Man with anxiety and palpitations

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What are they looking for?
3 Domains

• Data gathering
• Clinical Management
• Interpersonal skills

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What are they looking for?
In each domain we look for observed behaviours

• Establishing reason for attendance
• Examining chest
• Ability to negotiate
• Consider health promotion issues
• Practising ethically
• Management plan in line with best practice

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Marking

• You get a grade for each domain
• Clear pass
• Marginal pass
• Marginal fail
• Clear fail
• Then you get an overall grade

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Marking Scheme Case 1- Note for the Gym
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Do I get any feedback?

• Yes, but its feedback on the whole CSA
  performance, not an individual case
• The assessors pick from a list of feedback
  statements

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• 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. 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 patients 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 patients
  feelings in all aspects of the consultation
  including physical examination 
• Global 
• 13. Disorganised / unstructured consultation

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Marking Scheme 2 Pain in the Neck
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Pick one feedback statement
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How can Dr X Improve?

• Turn the feedback statement into constructive
  advice
• What practical steps might this doctor take to
  improve performance?

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• 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. 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 patients 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 patients
  feelings in all aspects of the consultation
  including physical examination 
• Global 
• 13. Disorganised / unstructured consultation

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How can I prepare?
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• 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
• Dont be phased by the cases, stick to the basic
  principles of patient centred consulting
• Dont forget psychosocial and family history
• Remember treatment by other means as well as
  drugs
• Remember Housekeeping skills i.e. put the last
  case behind you 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

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• Any Questions?

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Good Luck!