Transcript CSA Presentation

Clinical Skills Assessment
Overview of CSA
Col Robin Simpson FRCGP
CSA Core Group
Lead Case Management Group
Nov 14
The MRCGP
 Three part assessment
– Applied knowledge test (AKT)
– Clinical skills assessment (CSA)
– Work place assessment (WPBA)
 Each test is independent and will test
different skills
 Together will cover whole GP curriculum
MRCGP: an integrated
assessment programme
CSA
AKT
WBA
CSA
 “An assessment of a doctor’s ability to integrate and
apply clinical, professional, communication and
practical skills appropriate for general practice”
 Assessment of consulting and examination skills
 Standard set as “safe for independent general
practice”
 £1563 ( each attempt)
Why do we need the CSA?
 Provides external validation / triangulation with
the other testing methods used
 Using simulated patients is a validated and
reliable method for testing clinical skills, so long
as quality assurance of case production, role
player and assessor training is carried out.
 Able to offer a standardised, pre-determined level
of challenge to candidates and to vary this level
of challenge as needed by the assessment
requirements
New RCGP Euston 2012
IPAD
What happens at the CSA?
 Arrive on time at Euston
 Security - ID
 Taken to briefing room
 “Quarantined during changeover”
 Toilets
 Water / Drinks
 Brief
 Taken to floor
What happens at the CSA?
 Room and locker
 All possessions put in locker
 Medical Equipment put into clear plastic brief
case – checked
 Taken to room
 Notes IPAD in order you will see cases
 Water
 Hand wash
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CSA
 13 Station Simulated Surgery
 Each station 10 minutes
 Patient will enter room and present as a case
that could be expected in GP
 Patient accompanied by an examiner
 Examiner sits “out of direct line of sight of
candidate
 2 minute gap between patients
 Buzzer at beginning and end of case
 Nothing said after buzzer will count
 Break in middle of surgery for a tea / coffee
What should you bring?
On RCGP website
 Please note that there is no need to bring a
sphygmomanometer
 Your responsibility to bring your medical examination
equipment
 Have all equipment in a bag – saves time unpacking
 BNF + Children’s BNF
 N.B. All BNFs must be free of hand-written notes: they
may be checked before the start of the assessment and
removed if they contain notes.
 Clock in each room
What should you bring?
 Any additional equipment will be provided.
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prescriptions
certificates
laboratory forms
Possible props
• Peak flow reading
• Growth charts
• Pictures
How is the CSA constructed?
 Cases represent everyday GP and could be:
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Acute medical problem
Chronic multiple pathology
Adapted from real life
One of:
• Out of Hours situations
• Telephone Consultation
Discussion about a child
Breaking Bad News
Palliative Care advice
Medical Certification
What happened today in your surgery?
How is the CSA constructed?
The simulated patients (trained actors)
could be.
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male or female.
old or young (including child role players).
mother / father
different races, cultures, class or religions.
disabled.
Case Writing
 Case writers.
– document instructions to the role player playing the
part of the patient,
– instructions to the assessor.
– case notes.
– detailed marking schedule for assessors.
– Case note for candidate.
• short notes detailing the PMH.
• available at the beginning of the “surgery.”
• brief but may include previous consultations,
laboratory results or correspondence from
secondary care.
Sample case notes
•Susan Davison
•Date of birth (Age) 28
•Address
•47 Florentine Way Croydon
•Social and Family History
•Single but lives with partner
•Past medical history
•Nil of note
•Current medication –
• Microgynon 30
•Last consultation
•Saw Practice Nurse 3 weeks previously for a Pill and BP check.
BP 110/70. Never smoked
Case Writing
The cases will be chosen to cover the areas
of the GP curriculum that can be tested by
CSA.
ENT Curriculum Statement
The Marking Schedule
 Each case is marked in 3 domains :
– Data gathering, examination and clinical
assessment skills
– Clinical management skills
– Interpersonal skills
Each Domain has the same number of
marks.
Three domains for each case
1.
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.
2.
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.
3.
INTERPERSONAL SKILLS:
Demonstrating the use of recognised communication techniques to understand the patient’s illness
experience and develop a shared approach to managing problems. Practising ethically with respect for
equality and diversity, in line with the accepted codes of professional conduct.
Four possible Grades
 Clear Pass (CP)(3)
 Pass (P)(2)
 Fail (F)(1)
 Clear Fail (CF)(0)
The Marking Schedule
Assessor uses word pictures
– help decide grade for each “domain”
Examiners will also separately rate the
candidate as a pass, a fail or a borderline,
overall.
Feedback to candidates
Serious concerns box
CSA Pass Mark
The examiner marks each case on three
domains or areas - Data Gathering, Clinical
Management and Interpersonal Skills. This
creates an overall numerical mark for the
case. Each domain carries the same
number of marks (3). The marks for each
case (Max 9) are added to create a final
mark (out of 117)
CSA Pass Mark
The pass mark is created using the
borderline “group method” which
establishes the pass mark for each different
daily mix of cases.
As well as marking the domain scores, the
examiners will also separately rate the
candidate as a pass, a fail or a borderline,
overall
CSA Pass Mark
For each case the overall numerical case
marks of the candidates in the borderline
group are averaged. These averaged scores
are then aggregated across all the 13 cases
to create the “cut score”, ie the
approximation between a passing and a
failing score.
Key features in
Data Gathering
Focused but full history
Open listening style then closed questions
Embed questions in previous responses to
move the consultation forward
Late data gathering is associated with lower
marks
Key Features in
Clinical Mx
Most common failing domain
Insufficient knowledge base, or ability to
think of realistic and effective alternatives
Fails to integrate and apply knowledge
Puts off making clinical decisions or a clear
diagnosis
Doesn’t appear to grasp the dilemma if there
is one
Poor time keeping – Run out of time
Key features in
IPS
Combine clear explanations with
“alignment to patients”
Make talk more conversational
Customise phrases to avoid sounding
formulaic
Communicate with fewer hesitations and
false starts
Repair misunderstandings and
misalignments more easily
Tips
• Cases originate in the GP Curriculum.
• Curriculum statements available on the RCGP
website.
• Each has a section on common and important
conditions. This may be a useful checklist of
the sort of cases that may be used.
Identify your areas of weakness with your
trainer – who are your least favorite
patients?
Covering the Curriculum
Are there any groups of patient that you are
not seeing?
– patients with diabetes
– female patients
Involve other members PHCT
– practice manager dealing with a complaint
– nurses in
• chronic disease management clinics
• Smoking cessation
• Ear syringing
Tips
 You must be able to.
– Undertake common clinical examinations.
• Proceed with examination as you would usually do
• May be asked “what you want to examine”
• Listen carefully if assessor s steps in and gives examination
result
• May be passed a card with results
• Think of examinations covered in NICE
• Do you need a chaperone?
– Use medical instruments likely to be part of the
examination.
– Explain hospital or laboratory reports to patients.
– Break bad news.
Tips
 Familiarise yourselves with the marking domains
of the CSA.
 Regularly review your own consultations with
your Trainer.
 Use COT – need to be achieving “excellent”
 Get the video camera out and use it!
 Use several trainers / TPD to review COT
 Must be able to consult in 10 mins
Tips
Read supporting notes for the candidate.
– may give a clue as to the direction expected in
the consultation.
Have “good housekeeping skills.”
– Must move on from each case.
– Each case is marked separately.
Make the most of your OOH shifts, which
are ideal for CSA practice
Study Groups
Best results when in a study group
Use your own patients as examples for cases
Writing your own cases in groups
Practise explaining things to patients
Summary
Well prepared candidates Pass!
Trainers can make all the difference
Good Luck!
CSA Dates 2013 /2014
Further resources
RCGP website www.rcgp.org.uk
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CSA regulations
GP Curriculum
Wessex Faculty RCGP DVD on CSA
A Guide to the COT of Workplace Based
Assessment
– Consulting: Communication Skills for GPs in
Training
Questions ?