Preparation for the CSAHow to make it an integral part of education and work in the practice

Dr Allison Law FRCGPCourse organiser Glasgow North District

What do we do now??

What methods\tools do we use to teach CSA to our GPSTs

and

How do we do it?

Can we teach GPSTs how to do well in the CSA exam?

What skills are required?

What areas of the curriculum are tested?

Recognition of what goes wrong & why GPSTs fail

Identify your GPSTs weaknesses

Tailor teaching to individual needs

What skills are required?Data gathering - Gathering & using data for

clinical judgement, choice of examination, investigations & their interpretation. Demonstrating proficiency in performing physical examinations & using diagnostic and therapeutic instruments

Clinical management - 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

Interpersonal skills - Demonstrating the use of recognised communication techniques to gain understanding of the patient's illness experience and develop a shared approach to managing problems. Practising ethically with respect for equality & diversity issues, in line with the accepted codes of professional conduct

Curriculum areas tested in CSA Primary Care Management - recognition and

management of common medical conditions in primary care.

Problem Solving Skills - gathering and using data for clinical judgment, choice of examination, investigations and their interpretation. Demonstration of a structured and flexible approach to decision making.

Comprehensive Approach - demonstration of proficiency in the management of co-morbidity and risk.

Person-centred Care - communication with patient and the use of recognised consultation techniques to promote a shared approach to managing problems.

Attitudinal Aspects - practising ethically with respect for equality and diversity, with accepted professional codes of conduct.

The CSA will also test:

Clinical Practical Skills - demonstrating proficiency in performing physical examinations and using diagnostic/therapeutic instruments.

Why GPSTs FailUnder prepared Sit too early - timing

Insufficient knowledge base – see patients, regular review of consultations, tutorial and application of knowledge base

Cant cope with 10 min appointments – regular and enough exposure prior to exam

Poorly prepared Not enough assessment of skills – use Video to assess 3 Domains

areas & forget COT domains

Time management – how to move the patient along, close the consultation (second half checklist)*

Formulaic use of stock phrases and unable to use sensitively or appropriately

Bad day Housekeeping (Neighbour)

Ignore examiner – focus on the patient (joint consultations)

Getting there – reduce unnecessary stress

Not good enough “cut out” to be a GP

Likely already aware – failed WPBA

CSA – Just like a good story Introduction – sets the scene and context. Why

are they there, what do they want (ICE) How is it affecting them in their life (Psychosocial)

Middle – What’s wrong with them, do I know, How do I find out more (examination), have I missed anything (red flags), what do I tell them is wrong (diagnosis)

End – explanation & Management. Have I told them what is wrong or addressed their concerns, have I decided what to do, do I need to do anything else (tests, referral). Do they know what I’m talking about and what to do (understanding) Safety net & follow up

Summarising – what do we do? Regular review of consultations

Videos (& COTs)

Educate them about the CSA exam, RCGP website, give some direction

Ensure they have sufficient knowledge base – tutorials, case review, RCA

Joint consultations

10 min consultations – get them up to speed

Time management (see later)

Identify and address individuals weaknesses

What else can we do? GPST to write cases, identify from real patient

contacts, review with trainer or role play with shared GPST tutorials

Role play in GPST groups (Care!!)

Case scenarios – Pennine, Bradford website

RCGP DVDs ( Wessex Deanery)

Case cards (Wessex Deanery)

Books – RCGP – CSA scenarios for MRCGP, Get through MRCGP Clinical skills

Case Cards Communicate

Articulate

Simplify

Explain

120 cards – explanation of new diagnoses, drugs and practical advice

Can be used as “quick fire” questions in tutorials or to stimulate CSA scenario cases

Practice explaining common medical conditions

Pennine GP Training

Series of you tube videos explaining common medical conditions, treatments in 3 mins

Can do similar with CASE cards or random case analysis, video review

Use with score cards

Score cardscoring each domain 1-5 where 0= poor

and 5= outstanding

GPST Name

Condition

Comprehension

No medical jargon

Use of analogy

Use of diagram

Use of PILs

Timing

Total

Time management

Get slick at explaining common medical conditions but not rehearsed

Practice focused clinical examination (<2 mins)

Direct the consultation to a conclusion – close the consultation and have a management plan focused in the second half

Second half checklistCheck which of the following tasks were achieved and

make a note of the exact phrases used (Pennine)

Summary

Explaining

Revisiting ICE

Checking understanding

 Sharing options

Agree a management plan

Refer/prescribe/do nothing etc.

Plan for follow-up

Safety netting 

Time management

Watch videoed consultations stopping at 10 mins – helps GPST identify what gets lost and therefore cant be examined

Use of watch\clock – no matter what aim to “round up” the consultation at latest 8 mins

Set screen saver timer to 8 mins

What else?? Be prepared for what you don’t see in practice

Males – gynaecology

Females – male problems, prostate

Drug & social problems

Worried well

Telephone consultations (speaker phone)

Identify consultations where GPST felt uncertain – what if it had been a CSA

Training Groups

Day\Half day release CSA sessions

Mock CSAs – real experience 6-8 cases

Sharing difficult experiences in consultations – increases exposure to different situations