GP training: Structuring the consultation in the CSA exam

Dr Pipin Singh provides tips on how to structure a consultation during the CSA exam.

(Photo: iStock.com/MartinPrescott)
(Photo: iStock.com/MartinPrescott)

This article should be read in conjunction with the article Preparing for the CSA exam.

The structure of your consultation is essential for a successful outcome in the CSA and also in real practice. Cambridge Calgary1,2 is a widely accepted model of safe efficient consulting, so putting this into practice from an early stage of your rotation is essential.

Below are some tips on how to structure a consultation during the CSA exam.

Starting the consultation

  • Introduce yourself.
  • Use open question e.g. 'What are we doing today?' or 'Why have you come in today?'
  • Allow the patient to 'tell their story'. Early interruptions could lead to missed cues and a catastrophic breakdown in the doctor-patient relationship.
  • An empathetic statement after this (if appropriate).
  • Summarise at this point.
  • Agenda set. Check if patients have come about anything else at this point. This will hopefully avoid the dreaded 'oh and by the way, doctor'.
  • Signpost as to how the consultation will progress.

Data gathering

  • With the agenda set and your relationship with the patient having started, the history taking process can begin.
  • Ensure a good mix of open and closed questions are used. One approach is to use an open to closed cone. Start with open questions i.e. 'you mentioned headache, tell me a bit more about that' and close it down as appropriate. This may be important for example when trying to establish the aetiology of a specific type of pain.
  • Avoid leading questions.
  • Echoing the patients’ own words shows that you have been listening.
  • Ensure that red flag symptoms are covered.
  • Risk assessment is critical for psychological cases.
  • Ensure full exploration of patients’ social circumstances if relevant.
  • Ideas concerns and expectations are vital.

Examination

  • Conduct a focused physical or mental state exam

Explanation

  • Find out what the patient already knows.
  • Tell the patient what you think the diagnosis could be.
  • Avoid jargon and use diagrams where appropriate.
  • Chunk and check.

Planning

  • Give the patient options if appropriate. This generates a shared management plan. The patient's ideas, concerns and expectations will be crucial at this point.

Final check and closing

  • Ask the patient to recap the important points of the consultation.
  • Appropriate safety net with specific red flag symptoms to look out for.
  • Specify follow up.
  • Provide any relevant patient information leaflets.

Learning points

  • Ensure that the agenda is set early.
  • Always be alert to verbal and non verbal cues.
  • Good non-verbal communication is important.
  • Familiarise yourself with a few consultation models.
  • Try and avoid using the computer.
  • Ensure you familiarise yourself with the patient's history, medication list, last few consultations and letters before you see them.

Dr Pipin Singh is a GP trainer in Northumberland

References

  1. Kurtz SM, Silverman JD, Draper J. Teaching and Learning Communication Skills in Medicine. Oxford: Radcliffe Medical Press, 1998
  2. Silverman JD, Kurtz SM, Draper J. Skills for Communicating with Patients. Oxford: Radcliffe Medical Press, 1998

Useful resources on GPonline

More GP training advice

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us: