CASC Communication skills
Dr Alin Mascas ST4 Psychiatry
Overview
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CASC structure
Theory – communication skills
Psychology
Do’s and Don’t’s
Practice – Introduction
Group practice
CASC structure
• 16 clinical scenarios (8 single stations and 8
linked stations)
• Single stations - 7 min( 1 min preparation)
• Linked stations – 10 min(2 min preparation)
• Break between morning and afternoon
sessions (don’t eat excessively).
Areas of concern
Poor management of interview/discussion
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Lack of focus on the required task.
Lack of fluency to the task.
Interviewer interrupts the role player excessively.
Interviewer allows the role player to dictate the
theme of the consultation.
• Poor management of the interview.
• Fails to follow a line of enquiry/discussion to a
logical end point.
Areas of concern
Poor communication skills
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Use of medical jargon without explanation.
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.
Areas of concern
• Significant deviations from the task
• Omissions related to poor prioritisation of the
task.
• Omissions related to lack of knowledge/ability.
• Lack of recognition of importance of aspects of
the task.
• Inappropriate avenues of enquiry or discussion.
• Inaccurate or misleading information discussed.
• Lack of analysis of problems and synthesis of
opinion.
Areas of concern
Lack of professionalism
• Harmful interaction likely to cause either
psychological or physical distress.
• Failure to respect the interviewee‟s rights.
• Rudeness or arrogance.
• Inappropriate or flippant manner.
• Dismissive attitude to interviewee‟s concerns.
Areas of concern
Limited depth and/or range to the task
• Aspects of history or mental state highlighted but not
explored in depth or appropriate manner (not the
same as an omission – eg. some aspects of orientation
covered in a cognitive test such as time and place, but
orientation in person not covered).
• Inadequate or superficial risk assessment.
• Poor range of symptomatology explored.
• Limited/incomplete explanation of concepts/problem.
• Limited or incomplete management plan.
Approach
• Always READ the task and be 100 % clear of
what is the task
• Write down quickly patient’s name and the
most important “buzz words” from the
vignette + the task
• Prepare and visualize mentally your
introduction-first 1-2 sentences
• Make sure you know the setting of the
vignette
Approach
• Greet the patient and introduce yourself
• Explain the purpose of the meeting and check
their understand of the reasons for referral
(negotiate the agenda).
• Go with the flow
• Don’t forget, this is an outpatient clinic and
treated as such.
• If can’t remember the task say it and check the
vignette, be honest, don’t try to guess the task.
Approach
• Check with patient if they are happy with what you’ve told them, if not
seek further concerns/expectations.
• 1 minute left-start wrapping up the interview-EQUALLY important as the
beginning.
• Don’t ask open question in the last minute except if it is pass/fail question
(i.e risk of suicide)
• Thank the patient and the examiner and put the whole station in a “locked
box”.
History taking stations
• OPEN question moving gradually to CLOSED
questions in a funnel fashion
• Listen carefully for 1 minute(golden minute)
• When patient stops to breath in you take the
lead.
History taking stations-PC
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Onset
Duration
Progress
Alleviating
Relieving
Coping/Effects
+ ICE (always)
SUMARIZE
History taking stations
• Be systematic in approach DO NOT
change your format of questioning
• ALWAYS start with an open mind
• Do not assume you know the diagnosis based on exam practice
• ALWAYS check RISK
• Actors are generally just doing their job (nobody’s out to get ya’).
Case discussion
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Always check their understanding first
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Read RCPsych online leaflets
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Be prepared to encounter “what on Earth?” situations
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Be honest and say you don’t know if you don’t know.
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If not sure whether you’ve done well ask the patient and summarize at the end.
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Offer the option to read further information and only if happy offer leaflets, etc.
Difficult communication
• Most of the stations
Stations
• Check Revisenow forum for past papers (Superego café forum) but….
• Have a clear understanding of what stations came previously(approx 150)
• DO ALWAYS prepare well for
1. Psychotherapy
2. Physical examination (including ECG)
3. Cognitive examination
4. MSE
5. Risk assessment
6. Management
Psychotherapy stations
• Make sure you know the basics of main types
of psychotherapy
• STRUCTURE-(nr of sessions, with whom,
when, timing, exclusion criteria)
• CONTENT(what is actually going on in the
sesssion)
Physical examination stations
• Practice all physical exams and make sure you can do them
smoothly
• ALCOHOL GEL BEFORE AND AFTER EXAMINATION
• Look for what instruments are available -clues
• Talk to the patient about what you intend to do, ask
permission before you proceed + consider chaperone
• Be gentle
• Privacy and dignity
• Reassure them at the end and mention your findings if any.
• No need to talk to examiner except in ECG stations.
Cognitive examination
• MMSE ALWAYS-can jot it down on the
notepad before you enter the exam (high
chance you’ll get it).
• Usually single station
• Aim for 5 min on MMSE and the rest on
parietal/frontal lobes
MSE
• At least one station
• High expectations
• Make sure you cover the depth and range.
• Don’t forget cognitive function
Risk stations
• ALWAYS in CASC
• ABC approach
• Check for past H/o incidents(sui, violence, etc)
• Always ask about D&A
Management stations
• Present the findings as SBAR
• Formulate the management plan and offer
options
• Always bio-psycho-social but….prioritize
• Be a safe doctor
• Keep talking and look confident
PSYCHOLOGY OF CASC REVISION
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Revise theory in advance
Prepare mentally and physically
Eat healthy
Relax…you are already a psychiatrist
Dressing code
CONTROL, CONTROL, CONTROL-YOU ARE THE
CONSULTANT
• Confident approach
“Do”s and “Don’t”s
Books
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ICD 10
The NICE Guidelines
Sims/Fish psychopathology
Try to review all previous stations
Do your structures for each stations(keep it simple)
Practice….as much as possible
• Max 4 people
• Regularly
• Seek constructive feed back
• Don’t take it personally
• Combine revision with physical exercise/sleep/outdoor
activities
• Cut down on sugar and caffeine….he says…
Crash course
• Useful but not a must (watch out for external
attribution)
• Some better than other
• They teach you how to pass
• Don’t be desperate if you don’t get a pass in
the mock
• Definitely do a Mock CASC few weeks prior to
exam