Transcript CASC Practice - Communication Skills

Communication Skills CASC Practice
Cambridge MRCPsych Course
Dr Anne Aboaja
Consultant Psychiatrist
South Intake and Treatment Team, Cambridge
26 June 2012
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Acknowledgements
Dr Nimalee Khanakkahewa (slides 6-9)
Dr Chris O’Laughlin (slide 5)
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Objectives
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To know structure of CASC exam
To consider personal communication
strengths and weaknesses
To be aware of strategies for improving
performance in CASC exam
To participate in an original observed CASC
station as a doctor
To identify a clinical topic for further
communication skills practice in supervision
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Topics I hope do not come up…
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I will prepare for topic no.  by…………July
2012 and ask to discuss it in supervision.
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CASC stations
 1 minute preparation, 7 minute station (stand-
alone)
 2 minute preparation, 10 minute "linked"
station (eg: assess risk, discuss with
consultant)
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Passing the CASC- Grade descriptors
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Clear Pass - The candidate demonstrates a clear level of competence expected of a newly appointed ST4 with a
clinical approach that is justifiable, well communicated and technically proficient.
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Pass - The candidate demonstrates an adequate level of competence expected of a newly appointed ST4
displaying a clinical approach, which whilst it may not be fluent, is clinically justifiable and technically proficient.
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Fail - The candidate fails to demonstrate an adequate level of competence, displaying a clinical approach that at
times is unsystematic or inconsistent with practice at the ST4 level. Technical proficiency may be a concern. The
candidate fails to adequately cover the essential issues or makes too many omissions of less important factors.
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Clear Fail - The candidate clearly fails to demonstrate an adequate level of competence, displaying a clinical
approach that is frequently unsystematic or inconsistent. Their approach lacks fluency and focus. Many essential
and desirable components are omitted, not achieved, or inaccurate.
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Severe Fail - The candidate fails to demonstrate competence, with a clinical approach that is incompatible with
accepted practice. Their performance may show inadequate reasoning and/or technical incompetence. The
candidate may show lack of respect, attention or empathy for the patient, carer or other individual involved in the
clinical interaction.
Examinations Unit – March 2011
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Calgary Cambridge guide to the medical interview – expanded framework
Initiating the session
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Preparation
Establishing initial rapport
Identifying the reason for consultation
Gathering information
Providing
structure
E
Exploration
of the patient’s problem to discover the:
E
o Biomedical perspective
Making
organisation
overt
o
Patient’s perspective
Background information - context
Physical Examination
Attending to
flow
Building the
relationship
Using
appropriate
non verbal
behaviour
Explanation and planning
Developing
rapport
o providing the correct amount and type of
information
o aiding accurate recall and understanding
o achieving a shared understanding:
incorporating the patient’s illness framework
o planning: shared decision making
Involving the
patient
Closing the session
o
o
ensuring appropriate point of closure
forward planning
Silverman JD, Kurtz SM, Draper J (2005) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford)
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Passing the CASC- Communication skills
 The candidate should
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show an appropriate mix of open and closed
questioning
demonstrate advanced listening skills
elicit information in a structured, focused, fluent
manner
demonstrate empathy with the patient’s experience
avoid the use of jargon
In some stations the, focus of the task may centre
around interview/communication skills.
MRCPsych CASC Candidate Guide
Royal College of Psychiatrists Examinations Unit – April 2012
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Poor communication skills
 This domain is focused on the style of interaction between the
doctor and the interviewee and includes concerns such as:
 Use of medical jargon without explanation.
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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.
Examinations Unit – March 2011
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My Communication Skills
Strengths (list 3)
Eg, empathy, use of silence, volume of sound,
clarity, eye contact, smile, tone, reassuring,
confidence, rate of speech
1.
2.
3.
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My Communication Skills
Weaknesses (list 3)
Eg, tone, structure, English language, grammar,
dress and hygiene, repetitive, posture,
jargon, “annoying habits”
1.
2.
3.
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My feedback
Verbal communication:
Non-verbal communication:
Overall:
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Scenario 1
An 18 year old man not previously known to
services has been charged with arson. You
are interviewing him for a detailed court
report. Assess his risk of fire-setting.
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Prompts for actor
 I am pleading guilty
 I dropped a lit cigarette at a petrol station
 I didn’t think it would cause a fire
 I had smoke cannabis and had a lot to drink
 I cannot remember exactly what happened
 I have felt low in mood for months
 I do not hear voices
 I like watching fires on TV
 My friends and I used to set fire to paper in the local
field when no one was around
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Scenario 2a
You are about to see a 30 year old patient in
the outpatient clinic. Please assess his or her
personality. You are not required to share a
diagnosis.
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Prompts for actor
Happy-go-lucky
My feelings are like the weather, always changing
Other say I am moody
1 driving offence under influence of alcohol
Often I feel empty inside
I sometimes scratch myself until I bleed
I let others make important decisions for me
People think I am odd
I am a bit of a perfectionist
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Scenario 2b
 After establishing a diagnosis of emotionally
unstable personality (borderline type) with
dependent traits, the patient asks you to
speak to his or her partner individually about
the diagnosis and treatment. With the
patient’s full consent to share all information,
you meet with the partner to explain the
diagnosis and discuss treatment options.
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Prompts for actor
Questions you might ask:
 So it’s basically schizophrenia, a split personality?
 What caused it?
 Is there a cure?
 Will she ever get back to work?
 Will our children get it?
 How can I support him/her?
Also at some point:
 Show a confused face
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Scenario 3
A GP refers a 70 year old person with a history
of self-neglect, and forgetfulness. You are
asked to see this patient in clinic and assess
his/her mental state.
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Prompts for actor
 My memory has been bad for about a year and half
 I am not sad, just frustrated that I keep forgetting
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things
My son tells me that I sometimes forget to change my
clothes
I go to the shops and forget what I need to buy
I don’t hear voices but occasionally I hear my
husband/wife calling me (he/she dies 3 months ago)
I do not wish I were dead
(If tested, you have poor short-term memory and any
other cognitive deficits you wish to throw in!)
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Additional strategies
 Phrasing eg, to ask about purging
behaviour/sexual dysfunction/medication
concordance/suicidal thoughts/forensic
history
 Daily clinical work/on-call
 Supervision sessions
 Study group
 College website
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Helpful resources
http://www.rcpsych.ac.uk/examinations/about/mrcpsy
chcasc.aspx
MRCPsych: Passing the CASC Exam by Justin
Sauer
Trickcyclists
How to Pass the MRCPsych CASC by Iles, Woodall
& Leslie
Any others???
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