Transcript CSA Revision Course - General Practice Specialty Training

CSA
are you ready?
West of Scotland Deanery
November 2013
Themes
 Case writing –from the curriculumcreating a case bank
 Preparation-how can we best help?
 Giving feedback-using the feedback
grid on TeP
Aspects of assessment

Primary Care Management – common medical conditions in primary care

Problem solving skills - gathering and using data for clinical judgment, choice
of examination, investigations and their interpretation. Showing a structured
and flexible approach to decision making

A comprehensive approach –managing co-morbidity and risk

Person-centred care - communication with patients 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

Clinical practical skills - proficiency in physical examinations and using
diagnostic and therapeutic instruments
Case writing
 Curriculum area-Clinical (21)
2012 RCGP-Curriculum-1-Being-a-GP.
 3.4 Equality and Diversity
 3.3 Ethics and values
 May be Acute Chronic Undifferentiated Psychosocial or
Preventative/lifestyle focused
 The ‘focus’ may be the diagnosis or the management or the
patient or the situation
Case writing
 Begin with a curriculum area arising from need
 Think about what the ILO Intended learning outcomes for the
trainee should be-write those down(3-4)
 Think about and write down 3-4 bullet points ‘what the
trainee needs to achieve to pass’(for observer)
 Write the case vignette for role player include any
emotion/body language aspect and clinical details in everyday
language-no more than half a page
 Write the ‘candidate’ information-keep it brief
 Try the case out and adjust it as necessary
Case types
 Curriculum areas
 Women’s health
 Men’s health
 Sexual Health
 Endocrine-Diabetes
 ENT and Eyes
 Dermatology
 Psychosocial distress
 Home visits Telephone consults
Inter personal skills
 Curiosity-actually listening
 Caring and compassion
 Non judgmental
 ‘Connecting’ early-establish and affirm patients beliefs
about symptoms illness experience
 Reformulating what the patient has presented-to achieve
understanding
 Adjusting to the patient’s ‘level’
Lingusitic aspects
 Think about establish patients ideas concerns expectations
but without actually using those words
 Stress intonation in English
 Smoothness vs ‘jerkiness’-topic shift vs topic glide
 Challenging cases: moral dilemma more agonistic-a
sense of struggle-the emotional ‘temperature’ of the
case
Data gathering
 Starts with alertness curiosity and good interpersonal
skills-early and effective ‘connection’ with patient
 History focused but full
 Fluent logical –glide don’t topic shift
 Avoid repetition
 Avoid being ‘formulaic’
 Differentiate between routine and sensitive questioning
Data gathering
 Appropriate focused examination
 Time management
 Approaching a likely diagnosis, differential diagnosis or
explaining why uncertainty exists
 Beware of not getting to the point e.g. explaining lots of
normal results instead of the 1 abnormal result
Clinical management
 Does not develop a management plan
 Making efficient use of (prescribing referral other team
members, time) resources
 Keeping it safe sensible; continuity of care, follow-up
 Sharing the management and involving the patient
 Using understandable language taking account of
patients own ideas preferences
Clinical management
 Good use of communication interpersonal skills is key
 Establish the patients values ideas preferences
 Be attentive to verbal non verbal cues
 Assess the psychosocial impact of symptoms
 Demonstrate clearly that you have listened-use the
patients own ideas words in explaining the
problem/management
 Manage the problem in a safe sensible fashion
After CSA-feedback
 TeP grid
 Horizontal or curriculum view
 Vertical or ‘consultation’ view
 Using the marks
 Specific focused practical-looking to improvement
Assessment Date:
09/02/2013
Result:
Fail
Mark out of 117:
56
Mark needed to pass:
73
Formative Feedback
Areas of your performance identified as deficient by two or more assessors are flagged below with an X.
Click here for an explanation of these generic feedback statements and for guidance on interpreting this
feedback
Station Title
1
2
3
4
5
6
7
X
X
8
9
10
11
12
13
14
15
16
Middle aged female with a skin problem
Middle aged female with digestive problems
Middle age female learning disabilities with carer
Middle aged female with gynaecological problems
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Young adult male requesting medication
Teenage mother phoning about her daughter
X
X
X
X
X
X
X
X
X
X
X
X
Middle aged male with lower limb problem
Middle aged female with a women's health problem
X
X
X
Middle aged male with a respiratory problem
Young adult female with a mental health problem
X
X
X
X
X
Young adult female with upper limb problem
Young adult male with a urinary problem
Middle aged male with neurological problems
X
X
X
X
X
X
X
X
X
X
Assessment Date:
15/05/2013
Result:
Pass
Mark out of 117:
79
Mark needed to pass:
74
Formative Feedback
Areas of your performance identified as deficient by two or more assessors are flagged below with an X.
Click here for an explanation of these generic feedback statements and for guidance on interpreting this
feedback
Station Title
1
2
3
4
5
6
7
Young adult male with respiratory problems
9
X
Young adult male with musculoskeletal problems
Middle aged male with diabetes
8
X
X
X
X
10
11
12
13
14
X
15
X
X
X
X
X
Middle aged female with gynaecological problems
Female health professional with a throat problem
X
X
Young adult male with a sexual health problem
X
Adolescent female with head pain
Young adult female with skin problem
Mother attends requesting help regarding daughter
X
X
X
Middle aged female returns for result of her tests
Elderly female home vist after a fall
Middle aged male with cardiovascular problems
Young adult female with an acute illness
X
X
X
X
16
Risk factors-CSA
o
Lower quartile score for Stage 2 or 3 NRO Selection
o
Failure at AKT
o
Failure to commit to or complete WPBA
o
Attitudinal problems, such as lack of insight into own performance, lack of commitment to job, lack
of respect for colleagues and patients, failure to take responsibility
o
English as second language (lowest quartile PLAB scores)
o
Cultural factors, such as differences in role or status of doctor, learning styles and teaching
methods, gender issues
o
Male gender
o
Being an International Medical Graduate
o
Record of complaints from colleagues and/or patients
o
Personal problems
o
Health problems (especially mental health or addictions)
o
Lack of social support
The big issue(s)
 Use the curriculum-that’s where CSA comes from
 Risk factors for failure
 Early recognition and intervention
 The tools available in Practices-review video, shared
consulting, role play of self written cases, CSA DVD,
‘CASE’ cards.
 Feedback on previous performance