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Get Through MRCGP – Clinical Skills Assessment This page intentionally left blank Get Through MRCGP – Clinical Skills Assessment Bruno Rushforth MA(Cantab) MBChB MA GP Specialty Registrar West Riding GP Specialty Training Programme Yorkshire Deanery Val Wass BSc FRCGP FRCP MHPE PhD Professor of Community Based Medical Education Manchester Medical School University of Manchester CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2008 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20140113 International Standard Book Number-13: 978-1-85315-885-8 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Foreword vii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Acknowledgements viii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Preparing for the Clinical Skills Assessment: The ‘why’, ‘what’, ‘when’ and ‘how’ ix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Examination 1 Station 1 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 2 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 3 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 4 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 5 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 6 52 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 7 62 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 8 72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 9 82 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 10 92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 11 102 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 12 110 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 13 118 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Examination 2 Station 1 128 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 2 138 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 3 148 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 4 156 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 5 164 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 6 174 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 7 182 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 8 192 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 9 200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 10 208 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 11 218 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 12 228 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station 13 238 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix 1 247 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix 2 249 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index 251 ...................................................................................... v This page intentionally left blank Foreword From time to time books are published which every doctor studying the sub- ject will have and refer to. I believe that this is such a volume. Although it is intended as a guide to the Royal College of General Practitioners Clinical Skills Assessment, it is also a wonderful guide to thinking holistically in a clinical setting and would be equally useful to medical students or any doctor working in a clinical setting which involves front-line care of patients. The RCGP Clinical Skills Assessment tests a doctor’s ability to assess and manage patients with common conditions; it also tests the candidate’s ability to work effectively in a clinical setting. It is a test of performance rather than knowledge and so tests competence under a range of different pressures. Each scenario in the book (there are 26) is a standalone revision of a common condition with up-to-date guidance of best practice management. It encour- ages the learner to think about different settings and how they would approach the presenting problem; readers are encouraged to consider what might lie behind the presenting problem and how they might use their interpersonal skills effectively. The book could be used for individual study or revision, but would be particularly useful as a basis for group study. It gives insight into the thought processes of our examiners and it encourages a holistic approach to study rather than a ‘box-ticking’ approach or rote learning. It approaches the Clinical Skills Assessment positively and encourages trainees to think about the domains which need to be assessed (and demonstrated) to assure the public of fitness for completion of training. It provides a helpful approach to the assessment, which would apply equally well to a busy surgery, such as moving to the next patient rather than dwelling on the previous consultation and making mental notes about revising knowledge when it is lacking. I am certain that this will be a popular volume with trainees, trainers and programme directors. Professor Jacky Hayden Dean of Postgraduate Medical Studies North Western Deanery and Manchester University Principal in General Practice Unsworth, Bury vii Acknowledgements We would like to thank the following individuals for kindly giving helpful feedback on earlier drafts: Amy Grundy, Rafik Taijbee, Wendy Brown, Nicola Cooper, Nat Wright, Jacki Barson, Linda Cusick and John Hamlin. We are particularly indebted to Amy Evans for constructive comments on all 26 sce- narios. Thanks also to our models Rebecca Court and Sheena Ninan and to Windsor House Group Practice for allowing the use of their premises. The editorial team at the Royal Society of Medicine Press has been supportive throughout and we are particularly grateful to Peter Richardson for his posi- tive response to the initial proposal and to Sarah Burrows for accommodating our various requests. We thank the individuals and publishing bodies that gave permission for us to reproduce extracts from their work. All are credited in the text. Finally, we are very grateful to Arja Kajermo for her observant and witty illustrations. viii Preparing for the Clinical Skills Assessment: The ‘why’, ‘what’, ‘when’ and ‘how’ This chapter outlines the Clinical Skills Assessment (CSA) and offers a strat- egy for revision. We consider ‘why’ there needs to be a skills test, and discuss ‘what’ it involves and ‘when’ to apply to take it. Advice on ‘how’ to use this book to prepare for the CSA is then given. Why a clinical skills assessment? Formal examinations have come under increasing scrutiny now that it is acknowledged that assessment on performance in the workplace – i.e. what a doctor actually does – is the gold standard to aim for. The new MRCGP is no exception. There is now considerable emphasis on the e-portfolio of workplace-based assessment tasks that need to be completed throughout GP specialty training, supported by discussion and formative review with your trainer. So why have an examination as well? The reasons are perhaps self-evident. We cannot yet be assured that assessments of performance are robust. The range of cases covered using the workplace-based tools will vary widely across different placements. The challenge of the tasks will differ as will the quality of judgements made by assessors. From the patient’s perspective, the e-portfolio alone cannot assure a licensing body that the training curriculum has been covered. On the other hand, candidates in the past have not always felt their trainer has been fair. This can be difficult in the one-to-one supervi- sion offered by general practice. Inevitably examinations must stay. However, assessment is changing. There is an understanding that the methods selected to assess trainees must complement each other. The results need to be compared and integrated to ensure that a full and accurate perspective of the candidate’s ability and level of performance is obtained. It is important to recognize this when studying for the CSA. Do not approach it in isolation as separate from the Applied Knowledge Test (AKT) or from your e-portfolio. The applied evidence-based knowledge tested in the AKT is essential to your performance in the CSA to demonstrate, for example, that you can use guide- lines to reach appropriate management decisions. Formative assessments for the e-portfolio should be planned to inform your CSA preparation. Identical patient-centred, evidence-based, shared management structures underpin all components of the new MRCGP. Workplace-based assessment presents an ideal opportunity to get feedback on areas you are concerned about. Harness the thinking behind the new MRCGP to your advantage. View the CSA as part of an assessment package. Do not study for it in isolation. ix
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