Clinical Skills Assessment
Cumberland Lodge May 18th 2010
Richard de Ferrars
Workshop Plan
• CSA Overview
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Organisation
Style of cases
Information for cases
Examination & investigations
Marking
• Feedback from Examiners 2009-10
• Helping STs prepare
• CSA stations – 4 scenarios with marking.
The CSA Centre (Croydon)
“Virtual Tour” is available on the RCGP website (MRCGP/ WPBA/ CSA)
CSA Organisation
Read “Information for Candidates” - RCGP Website
(Travel details, equipment list, photo ID etc)
Cost £1400 - £1550
• Single room, single observer
– Thirteen scenarios (one pilot case)
– Ten minutes then buzzer
– Two minute break
• Observer changes with patient
• May be a break in the middle or a “rest station”.
Types of Cases
• Acute & chronic illness, undifferentiated illness
covering many different curriculum areas
• Mainly GP surgery face-to-face
usually also one other (home visit, phone)
• Case mix typically includes:
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one case involving disability
one case with major psychological problems
one case involving elderly patient
one case involving child health issues.
Information Provided
• Simple one sentence summary of case
• Appendix with brief patient summary (if relevant):
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Name & age
Social and family history
PMH summary
Current medication
Recent investigations
Recent relevant consultations – GP, OOH, hospital.
Examination & Investigation
• Targeted simple examinations - joints, neuro, ENT, chest
– Full system examinations are rarely expected
• When “simulation findings” differ, given on a card
– BUT, no examination attempted means no card given
– May be given card as starts to examine or as finishes
• Simulator will try and steer candidate away from
inappropriate examinations
• Need to use CORRECTLY simple equipment – ENT, PEFR
(Bring own bag and simple equipment)
• Expected to interpret (& explain) simple test results.
Marking
• Three domains of equal weighting:
1. Date gathering, examination & clinical assessment skills
How you get to the nub of the problem
2. Clinical management skills
What you do about moving the problem forward
3. Interpersonal skills
How you go about it
• Marked in each of the 3 domains:
clear pass
marginal pass
marginal fail
clear fail
• Each domain - list of positive and negative descriptors
• Then given overall grade for that case
• Typically pass-mark will be 8/12 cases.
Examiner’s Feedback
Data Gathering
Does not undertake a physical examination competently,
or use the instruments proficiently
Clinical Management
Does not develop a management plan that is appropriate
and in line with current best practice
Interpersonal Skills
Does not identify patient’s agenda/ preferences, does
not make use of cues
Does not develop a shared management plan
Global
Does not recognise the challenge (issue).
Helping STs Prepare
Strong correlation between starting video work
before week 6 and CSA pass
Make use of video and joint surgeries:
 Patient-centredness
 Identifying patient’s expectations
 Focussed history & targeted examinations
 Management plans are clear to patient (and to
observer)
 Shared management plans.
CSA Stations
Four stations/ 4 simulators
• One person in the hot seat
– Look at the single briefing page only
• Others are observers
– Take a couple of minutes to read the full scenario with the
marking schedule
– Makes the victim sweat a bit more
– One take the lead with time-keeping & examination findings
• Discussion at the end
– Pendleton rules (victim first)
– Talk to the simulator
– Mark using the grid
CSA Stations
Two stations before coffee, two after:
Station 1
Station 2
09:30 – 10:00
10:00 – 10:30
Coffee
10:30 – 10:45
Station 3
Station 4
10:45 – 11:15
11:15 – 11:45
Plenary
11:45 – 12:00
For convenience – we move, simulator stays
Leave ALL paperwork behind in the room!
The End