The clinical skills assessment (CSA) tests the candidate's ability to gather and assess medical information, make structured, evidence-based and flexible decisions and communicate with patients in a way that moves the consultation forward in an ethical and responsible manner.
The candidate passes if they ask the patient the right questions, at the right time, in the right way, perform the right examination correctly and communicate effectively, all within 10 minutes.
Performing mock cases with your tutor or fellow registrars is a way of gaining valuable feedback and to see how your skills are improving along the way.
In this series of mock CSA cases, patient and doctor roles are provided along with examiner feedback to see how you score across the three CSA marking domains.
Do not turn over the page until you are ready to read the marking guide and debrief. The marking guide and debrief also provide useful pointers towards the knowledge base needed for passing a CSA consultation such as this.
How to use this article
This article can help GP trainees prepare for CSA. It is written for use in a study group, ideally consisting of three trainees.
The marking grid in this article models an ordered, step-wise approach to data gathering, management and communication and the group debrief is essential to review the actual performance.
The feedback as a whole informs the doctor about their current knowledge and communication skills and advises them how to improve their performance for success in the CSA.
The trainee playing the patient should read the 'brief to the patient' section to enable her to understand the expectations of the patient so she can then answer the doctor's questions.
If an examination is expected, the patient is briefed about the findings and may have to make up a card containing the relevant information prior to starting the consultation.
If the patient brief does not contain this information, for example a BP reading, and the doctor wishes to examine the patient, the patient should allow the examination to occur. Performing irrelevant or unjustified examinations eats into the consultation time. Intimate examinations are not permitted.
The trainee playing the doctor should read the 'patient medical record' section at the start of consultation because it contains a summary of the patient's relevant details.
A recent test result, such as a fasting glucose result, may be provided. Sometimes, a copy of the last patient consultation is given. The background information often provides a clue about the consultation or gives important data relevant to management decisions.
Ideally, the third trainee playing the examiner should enter the consulting room with the patient and sit unobtrusively where the doctor cannot see them.
The examiner should mark the case using the marking guide by ticking against the positive or negative indicators as the consultation unfolds.
At the end of the consultation, the examiner should also make a global judgment of whether the doctor, based on this consultation, is fit for independent practice. The examiner times the case sounding an alarm when the 10 minutes are up.
|Patient: Brief to patient|
|Doctor: Patient medical record|
Name: Mariam Aziz (71 years)
Past medical history: Not known - patient is a temporary resident.
|Examiner: Marking guide|
|GENERIC INDICATORS FOR TARGETED ASSESSMENT DOMAINS||DESCRIPTORS - POSITIVE AND NEGATIVE|
A. Data gathering, technical and assessment skills:
|B. Clinical management skills ||Positive indicators: |
|C. Interpersonal skills ||Positive indicators: |
- Assess the doctor's verbal and non-verbal response to the patient and her son. Were assumptions made about the patient based on her ethnic or cultural background?
- Was the patient's medical confidence preserved?
- Did the doctor seem genuinely interested in helping the patient obtain her medication and in prescribing it safely?
- Was the patient given the opportunity and time to answer questions?
- Was there a shared management plan that incorporated the patient's concerns and expectations?
- A common reason for failure in the CSA is the doctor 'does not identify the patient's agenda, health beliefs and preferences or does not make use of verbal and non-verbal cues'. Did the doctor detect and respond to the patient becoming uncomfortable with detailed questioning in her son's presence?
- Another common reason for failure is 'does not recognise the challenge (for example, the patient's problem or ethical dilemma)'. Was the doctor mindful of the recent cardiology recommendation and check if this had been added to the patient's repeat medication? Evaluate whether the patient's medical confidence was protected throughout the consultation.
National Prescribing Centre. A guide to medication review 2008. www.npci.org.uk/medicines_management/review/medireview/resources/agtmr_web1.pdf