Preparing your RegistrarPreparing your Registrar for the CSA for the CSA

• Facts the Registrar needs to know• How the CSA is marked• Avoiding common mistakes on the day• How to help your Registrar pass the CSA• Helping Registrars who are foreign medical

graduates

Purpose of the CSAPurpose of the CSA‘An assessment of a doctor’s ability to integrate and apply appropriate clinical, professional, communication and practical skills in general practice’

Integrative skills assessment - tests a doctor’s abilities to gather information and apply learned understanding of disease processes and person-centred care appropriately in a standardised context, making evidence-based decisions, and communicating effectively with patients and colleagues.

This is from RCGP website – we need to interpret this for our registrars

Facts Registrars need to knowFacts Registrars need to know• 4 times per year - currently in January, May, September and

November. When to take it?• How much does it cost?• 13 cases each of maximum 10 minutes – 7 cases then 20 min

break then 6 cases. Usually 1 minute between cases, may be more ( don’t take it personally)

• Can be telephone triage, home visit, someone coming on behalf of someone else or none of these

• Examination fees• The following fees are payable for examinations with

effect from 01 August 2009.•  • Each attempt at Applied Knowledge Test (AKT):  Associate in Training £414 Non-AiT £460 

• Each attempt at Clinical Skills Assessment (CSA):• Associate in Training £1389 Non-AiT £1542 

• Candidates taking AKT and CSA as part of MRCGP pay the AiT rate.

CSA: the centreCSA: the centre• Purpose-built centre

– No.1 Croydon– Easy access– Top 3 floors

CSA: the centreCSA: the centre• Left or right

handed consulting rooms

• Temperature and light varies

• Some rooms video

• Walk of fear

CSA: the 3 domainsCSA: the 3 domains• DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS: 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 SKILLS: 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.

• The grades will be on a four point scale:• Clear Pass Marginal Pass Marginal Fail Clear Fail

• Consider for e.g. a businessman with earache consulting with the expectation of antibiotics

CSA: four gradesCSA: four grades

• Four grades

– Clear pass – Marginal pass – Marginal fail ×– Clear fail ×

• Grade descriptors – on RCGP website under CSA cases

CSA feedback statementsCSA feedback statementsData Gathering1. Disorganised and unsystematic in gathering information from history taking, examination and investigation2. Does not identify abnormal findings or results or fails to recognise their implications3. Data gathering does not appear to be guided by the probabilities of disease4. Does not undertake physical examination competently, or use instruments proficiently

Clinical management5. Does not make appropriate diagnosis 6. Does not develop a management plan (including prescribing and referral) that is appropriate and in line with current best practice.7. Does not demonstrate an awareness of management of risk, and health promotion

Interpersonal skills8. Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues 9. Does not identify or use appropriate psychological or social information to place the problem in context10. Does not develop a shared management plan or clarify the roles of doctor and patient11. Does not use explanations that are relevant and understandable to the patient12. Does not show sensitivity for the patient’s feelings in all aspects of the consultation including physical examination

Global13. Disorganised / unstructured consultation14. Does not recognise the challenge (e.g. the patient’s problem, ethical dilemma etc.)15. Shows poor time management16. Shows inappropriate doctor- centeredness

CSA feedback statementsCSA feedback statementsData Gathering1. Disorganised and unsystematic in gathering information from history taking, examination and investigation2. Does not identify abnormal findings or results or fails to recognise their implications3. Data gathering does not appear to be guided by the probabilities of disease4. Does not undertake physical examination competently, or use instruments proficiently

Clinical management5. Does not make appropriate diagnosis 6. Does not develop a management plan (including prescribing and referral) that is appropriate and in line with current best practice .7. Does not demonstrate an awareness of management of risk, and health promotion

Interpersonal skills8. Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues 9. Does not identify or use appropriate psychological or social information to place the problem in context10. Does not develop a shared management plan or clarify the roles of doctor and patient11. Does not use explanations that are relevant and understandable to the patient12. Does not show sensitivity for the patient’s feelings in all aspects of the consultation including physical examination

Global13. Disorganised / unstructured consultation14. Does not recognise the challenge (e.g. the patient’s problem, ethical dilemma etc.)15. Shows poor time management16. Shows inappropriate doctor- centeredness

On the dayOn the day• WATER

• SMART COMFORTABLE CLOTHES

• READ THE QUESTION: RED PEN/HIGHLIGHTER

• WELCOME THE PATIENT

• INTRODUCE YOURSELF – EYE CONTACT- NOT TOO LONG AN INTRODUCTION

• THERE MAY BE 1-2 EXAMINERS AND 1-2 ACTORS

• AVOID WRITING SCRIPTS IF POSSIBLE

• COLLECTING FROM RECEPTION e.g. SCRIPTS, PIL ETC

• COVER THE BASICS IN THE TEN MINUTES

Helping your Registrar prepare Helping your Registrar prepare for the CSAfor the CSA

• 10- 12 MINUTE CONSULTATIONS WITH CSA IN MIND• MARKED JOINT SURGERIES• CASES CREATED FROM REAL PATIENTS• PRACTISE WITH PEER GROUP• (AVOID BOOKS)• OTHER PRACTICE DOCTORS ASSESSING• PRACTICE SWAPS (PATIENT TYPES)• TIME EFFICIENCY IN CONSULTING• EFFICIENT/EFFECTIVE CLINICAL EXAMINATION• ‘ICE’ QUESTIONS SHOULD BE AUTOMATIC• VISITS/TELEPHONE/SURGERY CONSULTATIONS• RIGHT/LEFT HANDED CONSULTING• VIDEO CSA PRACTICE CONSULTATIONS FOR ANALYSIS

Registrars who are foreign Registrars who are foreign medical graduatesmedical graduates

• British graduates and Bristol VTS do well!• “Fish out of water” concept• Practise, practise, practise• Care with standard statements e.g. “How

did that make you feel?”