Clinical Skills Assessment

Cumberland Lodge May 18th 2010

Richard de Ferrars

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.

The CSA Centre (Croydon)

“Virtual Tour” is available on the RCGP website (MRCGP/ WPBA/ CSA)

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”.

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.

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.

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.

Marking• Three domains of equal weighting:

1. Date gathering, examination & clinical assessment skillsHow you get to the nub of the problem

2. Clinical management skillsWhat you do about moving the problem forward

3. Interpersonal skillsHow you go about it

• Marked in each of the 3 domains: clear pass marginal pass marginal fail clear fail

• Each domain - list of positive and negative descriptors

• Then given overall grade for that case

• Typically pass-mark will be 8/12 cases.

Examiner’s Feedback

Data GatheringDoes not undertake a physical examination competently, or use the instruments proficiently

Clinical ManagementDoes not develop a management plan that is appropriate and in line with current best practice

Interpersonal SkillsDoes not identify patient’s agenda/ preferences, does not make use of cues

Does not develop a shared management plan

GlobalDoes not recognise the challenge (issue).

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.

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

CSA Stations

Two stations before coffee, two after:Station 1 09:30 – 10:00

Station 2 10:00 – 10:30

Coffee 10:30 – 10:45

Station 3 10:45 – 11:15

Station 4 11:15 – 11:45

Plenary 11:45 – 12:00

For convenience – we move, simulator stays

Leave ALL paperwork behind in the room!

The End