Focused Clinical Assessment in 10 Minutes for MRCGP

Featuring Data-Gathering, Clinical Management and Communication Skills

Israr Ahmad Khan

• Publisher: CRC Press
• Year: 2021
• Print ISBN: 9781138449626
• eBook ISBN: 9781000466720
• Edition: 1
• Topic: Medicine
• Subtopic: Family Medicine & General Practice

Part of the Masterpass series, Focused clinical Assessment in 10 Minutes for MRCGP is the definitive study guide for GP trainees at any stage of their specialist training, in particular, those preparing for the CSA. This comprehensive yet straightforward book provides a unique structure for the focused clinical assessment and a new approach to the management of everyday problems encountered in general practice, in 10 minutes. It bridges the gap between consultation theory and the real world; combining language, motivation, knowledge and empathy, enabling GP trainees to gather information, organise their thoughts, pinpoint a diagnosis and communicate this to both patient and examiner.

Chapter 1

About the MRCGP

This chapter contains details of the formal summative assessments that comprise the MRCGP assessment programme. Since September 2007, there has been a single compulsory training and assessment system for UK-trained doctors wishing to obtain a Certificate of Completion of Training in General Practice. Satisfactory completion of the scheme is an essential requirement for entry to the register of GPs maintained by the General Medical Council (GMC) and for the MRCGP.

The MRCGP is an integrated training and assessment strategy that reflects the complete mix of knowledge and skills required for competence in general practice.

The MRCGP assessment has three essential components:

1.  A workplace-based assessment

This is a placement-based competency assessment using an e-portfolio to collect evidence throughout the GPST programme. This assembled evidence needs to be submitted towards the end of your final specialist training year.

2.  Applied Knowledge Test

This is the summative assessment of the knowledge base that underpins independent and safe UK general practice. It is a multi-choice-question exam paper taken during the second year of the specialist training programme (ST2). It comprises 200 questions in various formats: true/false, best from five and extended matching (best from many). Approximately 80% of the questions will focus mainly on various aspects of clinical medicine and therapeutics, 10% on critical appraisal and evidence-based practice (research and statistics) and 10% on administrative, ethical and legal issues.

3.  CSA

This is the clinical consulting skills examination and can only be undertaken during the third and final year of the GP specialist training scheme (ST3). It serves as a summative test for end-point assessment in order to determine whether the candidate has reached the required standard expected of a newly qualified GP.

Each of these components is independent and assesses different aspects of knowledge, understanding, skills and attitude as applied to general practice, but together they encompass the entire curriculum for UK specialty training for general practice.

Chapter 2

Overview of the CSA

The CSA is an essential component of the MRCGP, and is ‘an assessment of a doctor’s ability to integrate and apply clinical, professional, communication and practical skills appropriate for General Practice’.¹

The MRCGP CSA is a challenging examination of a young doctor’s performance in a patient consultation. The CSA aims to test a wide range of clinical and non-clinical skills in an objective fashion. The main aim of the examination is to assess whether a candidate has reached the standard in clinical skills expected of a newly appointed, competent GP who is in the final stages of completing GPST.

To prepare for the CSA, it is useful to understand what is being assessed by the exam. The CSA examination is designed to assess a doctor’s ability to gather relevant information and apply learned understanding of disease processes and person-centred care appropriately in a standardised context, to make evidence-based decisions and to communicate effectively with patients and colleagues. Although up-to-date working knowledge of general practice and of general medicine is necessary to pass this assessment, it is not primarily a test of theoretical knowledge and understanding. It is a test and measure of your ability to integrate and apply clinical and communication skills to the specific scenarios, to produce a consultation that is meaningful to both patient and doctor, and which moves the patient forward towards a justifiable management of their presenting problem. In order to do well, you need to demonstrate different aspects of good consulting.

The CSA assesses your ability to:

Take a focused, yet holistic history

Perform a targeted clinical examination

Assimilate information from the ‘patient notes’ and integrate that into the consultation

Evaluate and interpret the clinical findings of the history and examination, and identify key issues in the data gathered

Establish a working diagnosis/differential diagnoses

Formulate a safe, shared and acceptable management plan

Communicate this information effectively to patients

This makes up the complete knowledge set, skills and attitude expected of CSA candidates, and this book will cover all of these areas in detail.

Candidates are expected to demonstrate proficiency in the following areas:

History-taking, carrying out physical examinations and using diagnostic instruments (i.e. performing a focused clinical assessment of the patient)

Assessing symptoms and signs accurately and integrating these findings

Clinical judgement (diagnosis and management) reflecting information gathered during data gathering

Knowledge and understanding of common and serious medical conditions in UK general practice

Communication – targeted information gathering and information sharing and giving

Professional behaviour

Ethical practice

The CSA exam

During the CSA examination session, you will see 13 patients, all of which are assessed and contribute to the overall final mark. Each consultation will be limited to 10 minutes, followed by a 2-minute resting gap where you have the opportunity to read carefully the case material in preparation for the following consultation. The beginning and end of consultations will be signalled by a buzzing sound.

At the start of the assessment, the buzzer will sound and the first patient will knock and enter the candidate’s consulting room. At the end of 10 minutes, the buzzer will sound again to mark the end of the consultation, and the patient will leave the room, along with the examiner. This process will be repeated until all 13 cases in the surgery have been seen. There is a designated 15-minute break approximately halfway through the assessment circuit.

Domains of performance

The three equally weighted domains of performance (also known as consulting competencies) assessed in the CSA are:

1. Data-gathering, technical and assessment skills

2. Clinical management skills

3. Interpersonal skills

You should appreciate that the CSA is not just a test of your communication skills but is a comprehensive exam testing your clinical knowledge, understanding, practical skills and attitude as applied to general practice. Excellent doctor– patient communication and interpersonal skills alone are not enough. It is not correct to assume that if you are a good commun...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• About the author
• Acknowledgements
• Dedication
• List of abbreviations
• Introduction
• 1 About the MRCGP
• 2 Overview of the CSA
• 3 Data-gathering, technical and assessment skills
• 4 Clinical management skills
• 5 Communication and interpersonal skills
• 6 A systematic template for structuring a consultation in 10 minutes
• 7 Difficult/Challenging consultations
• References
• Index