Preparation for the CSA - Dr Allison Law

for the CSA
How to make it an
integral part of education
and work in the practice
Dr Allison Law FRCGP
Course organiser Glasgow North District
What do we do now??
What methods\tools do we use
to teach CSA to our GPSTs
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
 Identify your GPSTs weaknesses
 Tailor teaching to individual needs
What skills are required?
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
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
Why GPSTs Fail
Under 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
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 card
scoring each domain 1-5 where 0= poor and
5= outstanding
Use of
Use of
Use of
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 checklist
Check which of the following tasks were achieved and
make a note of the exact phrases used (Pennine)
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
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
 Sharing difficult experiences in
consultations – increases exposure to
different situations