How not to fail

Dr. Louise Riley

Trainer (Bradford VTS)
Examiner (CSA component)

Introduction to CSA
Personal experiences
Case examples from college DVD
Marking and discussion
How to prepare

Knowledge
Competence
Performance

An assessment of a doctors ability to

integrate and apply appropriate clinical,

professional, communication and

practical skills in general practice

Number 1, Croydon
Floors 18,19,20
Colour coded
DO NOT BE LATE !

(opposite East Croydon station)

Stay at...
Croydon Park Hotel
Jurys Hotel

 Simulated

surgery
13 stations,12 live one pilot
10 minutes each
2 minutes between
You stay put, role players and
assessors move

Passport or photo-card driving licence

Doctors bag containing:
BNF
Stethoscope
Ophthalmoscope
Auroscope
Thermometer
Patella hammer
Sphygmomanometer (aneroid or electronic)
Tape measure
Peak flow meter and disposable mouthpieces

Mostly written from GPs own experiences

A spread of cases across the curriculum

Each case mapped to a specific area of the

curriculum

Clinical Skills Assessment

Case Selection Blueprint
Primary system or area of
disease

Cardiovascular
Respiratory
Neurological/ Psychiatric
Musculo-skeletal
Endocrine/ Oncological
Eye/ ENT/ Skin
Men/ Women/ Sexual Health
Renal/ urological
Gastro-intestinal
Infectious diseases
ETC

Primary nature of case

Acute
Illness

Chronic
Illness

Undiffer
entiated
Illness

Psychol
and Social

Preventive
/lifestyle

Other

Cough with ACE inhibitor

Young woman with headache

Child with constipation

Man with Dupuytrens contracture
Woman with diabetes and depression
Man with anxiety and palpitations

3 Domains:
Data gathering

Clinical Management
Interpersonal skills

In each domain we look for

observed behaviours

Establishing reason for attendance

Examining chest
Ability to negotiate
Consider health promotion issues
Practising ethically
Management plan in line with best
practice

You get a grade for each domain

Clear pass
Marginal pass
Marginal fail
Clear fail

Then you get an overall grade

Domain

Observed behaviours

Data gathering,
examination and
clinical assessment
skills

Establish reason for attendance ie need to get note

for gym and what is required for this
Explore any current health problems and past medical
history, including raised cholesterol
Show ability to check BP and chest

Clinical management
skills

Formulate an appropriate plan to address possible

raised cholesterol and BP
Consider health promotion issues eg smoking, wt,
alcohol and exercise
Show ability to manage request for note
appropriately, recognising implications

Interpersonal skills

Elicit any underlying concerns regarding raised

cholesterol and heart problems
Show ability to negotiate as necessary re the note and
the management of any health problems, share
management options
Take an interest in the patient, avoid lecturing him
about lifestyle

Grade
(CP/MP/
MF/CF)

Yes, but its feedback on the whole CSA

performance, not an individual case
The assessors pick from a list of feedback
statements

Feedback statements

Data Gathering

1. Disorganised and unsystematic in gathering information from history taking, examination and
investigation

2. Does not identify abnormal findings or results or fails to recognise their implications

3. Data gathering does not appear to be guided by the probabilities of disease

4. Does not undertake physical examination competently, or use instruments proficiently

Clinical management

5. 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. Follow-up arrangements and safety netting are inadequate

8. Does not demonstrate an awareness of management of risk, and health promotion

Interpersonal skills
9. Does not identify patients agenda, health beliefs & preferences / does not make use of verbal &
non-verbal cues

10. Does not develop a shared management plan or clarify the roles of doctor and patient

11. Does not use explanations that are relevant and understandable to the patient

12. Does not show sensitivity for the patients feelings in all aspects of the consultation including
physical examination

Global

13. Disorganised / unstructured consultation

14. Does not recognise the challenge (e.g. the patients problem, ethical dilemma etc.)

15. Shows poor time management

16. Shows inappropriate doctor-centredness

Domain

Observed behaviours

Data gathering,
examination and
clinical assessment
skills

Take a history of the neck pain and what has

been tried so far
Examine neck/shoulders appropriately
Explore psychosocial situation- effect on work
and life
Give appropriate prescription for pain, or
advise on over the counter remedies
Advise on other appropriate treatments eg
heat, stretching exercises, avoid collars
Indicate how problem may resolve
Explain pros and cons of various treatments
Acknowledge patients ideas and expectations
about treatment
Negotiate with patient sensitively

Clinical management
skills

Interpersonal skills

Grade
(CP/MP/
MF/CF)

Turn the feedback statement into

constructive advice
What practical steps might this doctor take to
improve performance?

Feedback statements

Data Gathering

1. Disorganised and unsystematic in gathering information from history taking, examination and
investigation

2. Does not identify abnormal findings or results or fails to recognise their implications

3. Data gathering does not appear to be guided by the probabilities of disease

4. Does not undertake physical examination competently, or use instruments proficiently

Clinical management

5. 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. Follow-up arrangements and safety netting are inadequate

8. Does not demonstrate an awareness of management of risk, and health promotion

Interpersonal skills
9. Does not identify patients agenda, health beliefs & preferences / does not make use of verbal &
non-verbal cues

10. Does not develop a shared management plan or clarify the roles of doctor and patient

11. Does not use explanations that are relevant and understandable to the patient

12. Does not show sensitivity for the patients feelings in all aspects of the consultation including
physical examination

Global

13. Disorganised / unstructured consultation

14. Does not recognise the challenge (e.g. the patients problem, ethical dilemma etc.)

15. Shows poor time management

16. Shows inappropriate doctor-centredness

Ten Top Tips To Pass The CSA

Arrive on time
Bring your bag and identification
Read carefully the information provided for each case
Practice ten minute consultations
Practice focussed examinations
Dont be phased by the cases, stick to the basic principles of
patient centred consulting
Dont forget psychosocial and family history
Remember treatment by other means as well as drugs
Remember Housekeeping skills i.e. put the last case behind
you and concentrate on the rest. You do not have to pass all

thirteen cases

Remember there is often not a right or wrong answer,

examiners are looking for how you tackle the cases

Any Questions?