Abstract
This is the fourth in our short series of articles on the Clinical Skills Assessment (CSA). The first article focused on how the exam is written and delivered, the second article looked at exam preparation and top tips from the clinical lead for the CSA, while the third article looked at the exam from a trainee’s perspective. In this final article on CSA, Dr Kunal Chawathey, a GP trainer, provides further advice on preparation for the CSA.
Preparing for the Clinical Skills Assessment (CSA)
The demonstration of adequate clinical skills is mandatory before starting work as a GP, and the CSA is designed to assess these skills in a formal, structured manner. As with any examination, planning and preparation are essential pillars of a good performance.
When should I start my preparation?
Remember that old habits die hard. If you are used to casual history taking and performing cursory examinations in your daily clinics, these habits will be difficult to shake off on the day of the assessment. It is therefore important to start planning and preparing as soon as you are settled in your new practice.
How can I make the most out of my regular clinics?
Check the practice demographics with help from your trainer to see whether you might have a reduced exposure to certain population groups (as, for example, in a university practice). Additional practise with appropriate scenarios can broaden experience of patient groups. Acquaint yourself with the CSA consultation model early on and try to conduct structured consultations whenever possible. Remember that you will see many ‘CSA-type’ cases in your daily consultations, but practise only 2–3 cases/week in your study group. With advice from your trainer, ensure that your schedule of clinic appointments is consistent with the CSA format with, for example, 3–4 × 10 minute appointments, followed by a catch up slot. Ensure that your daily clinical exposure includes some telephone consultations and home visits.
How can I structure my tutorials for the CSA?
Plan tutorials well in advance. A tutorial could include a review of 1–2 consultation videos from the previous week, a discussion of selected National Institute for Health and Care Excellence (NICE) guidance or a clinical topic, learning some soft skills, a challenging scenario and time to discuss any other business (AOB) before deciding on the next tutorial agenda. An unstructured tutorial is akin to conducting a haphazard consultation. Make a list of topics that you would like to cover during the course of your placement and mark them off as you go along. This will allow adequate time to plan your case-based discussions (CBDs), clinical examination and procedural skills (CEPS) and avoid last minute panic.
What about further learning resources?
There are numerous books available and it would be advisable to share 2–3 within your study group. Most books will have sample cases for practise. It is useful to write up your own cases from time to time. Although this can be time consuming, it gives deeper insights into consultations from the perspective of both patient and doctor. CSA courses can be a useful adjunct to your preparation, but are not necessary. Role-play sessions in small groups or using a carousel format could be arranged by your Programme Directors (PDs) during the weekly group tutorials. RCGP case cards are another excellent resource for improving your communication skills. They are edited by communication experts and designed for both individual study and small group work. The GP Update course material provides a succinct account of various NICE guidance. InnovAiT is planning to introduce ‘NICE nuggets’ as a regular feature and this will enable quick revision of important guidance. Last but not least, access the RCGP website where you will find a wealth of information about the CSA.
How can I make the most out of my study group?
A good study group will give finishing touches (and often much more) to the skills that you have acquired during your training. A study group will have ideally 3–4 trainees. A larger study group is best divided into two groups working in different rooms. Always use marking sheets for the observer to make notes and ensure that the consultations are timed.
Try to maintain structure to your consultations. If, later on, you panic during your CSA, this will provide a natural fall-back position while you gather your thoughts. Ask the observers to time consultations. As a guide, allow 3–4 minutes for history taking, 3 minutes for examination and about 3–4 minutes for management. However, this is only a guide and particular cases may require variation in the apportionment of time for each task.
Practise your examination technique on simulated patients. Remember that the CSA may include a home visit, a telephone consultation or an acute case, and practise these accordingly. Practise explanation of the same condition to different types of patient during role play. For example, try explaining a rotator cuff tear to an elderly lady, a builder, a worried spouse and an adult with mild learning disability.
Ask your GP trainer to attend one (or more) of your study group meetings. You are likely to get high-quality feedback on the consultations, as well as on how role play should be conducted. Analysis of study group sessions using video recordings can be as useful as the analysis of surgery consultations.
When giving feedback, remember to follow Pendleton’s rules. Check that the learner is ready and willing to receive feedback and allow the learner to give comments and background to the material that is being assessed. The learner, followed by the observer, then describe what was done well before in turn describing what could be improved. Finally, an action plan for improvement is made (Pendleton, Schofield, Tate, & Havelock, 1984).
You should begin to notice, after all this hard work, that your daily consultations flow more smoothly and you get even more positive feedback from your patients and colleagues!
Any tips for the big day?
Now, when the big day arrives you will be well prepared for the CSA and of course a bit nervous. Make sure you have seen the walk-through video of the CSA on the RCGP website.
Check that your equipment is in good working order with new batteries and that you have your identification documents. It is useful to have your British National Formulary (BNF)/BNF for Children tabbed, but the BNF/BNFc should NOT be annotated.
During the examination …
Greet the patient (role-player) as you would in your clinic; you are not expected to interact with the examiner Sometimes additional people may accompany the role-player and/or the examiner; they are probably present for quality assurance and training – ignore them! If examination seems the appropriate next step in the consultation, explain to the role-player what examination you wish to perform, offer a chaperone as appropriate and then proceed – do not turn to the examiner and ask for permission or for the examination results, if the case does not require examination, the examiner will intervene, but sometimes only when satisfied that you actually intend to examine Make sure that you keep to time so that you are able to focus on all the three assessment domains (data gathering, interpersonal skills and clinical management) Unless it is mentioned in the task, you do not have to write a prescription; it is perfectly reasonable to mention the treatment regimen verbally to the patient; if you do write a prescription it should be complete and accurate Always include patients in the decision-making process, whether in organising tests, referrals or offering therapeutic interventions Do NOT discuss the cases during or after your examination in accordance with the non-disclosure agreement that you will be required to sign on the day of your assessment
The MRCGP is always evolving, so for the most up-to-date information please consult the RCGP website. If you would like to contribute to Crammer’s Corner please contact us at editorialoffice@innovaitjournal.co.uk