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This BLOG is FREE!... YES... FREE!... It is Especially for the Smart GP Registrars,... Who Feel Like the 'Little NEMO' Lost within the Deep Blue Ocean...... To Support Each Other and Be Creative... Above All, TO BE SUCCESSFUL in CSA... Woo-Hoo!.... In short.... FOR THE GP REGISTRARS --- BY THE GP REGISTRARS...... I'm HEMA -- In short, I am a Doctor, Jewellery Designer, Blogger --> All by Passion... (Founder of www.royalamore.com - For Fashion With A Mission).. I have grabbed every opportunity to make mistakes in this Blog! I warn you! I am not a Grammar Guru!... ALL THE ARTICLES ARE FREE... YES, FREE...You can Use it... Fax it... Print it... Share it... The Choice is Endless:-)... This Blog is NOT for Gossiping... Whingeing... or Complaining... As They Put Your Precious Creative Attention on the Problem..... Above All...If You Are Struggling Alone and Need Some Extra Support for Your Exam Preparation... Please Email Me... I Will Certainly Try My Best to Help You... I Mean It Truly From My Heart!... To Your Success :-) Hema xoxo.

Sunday 15 July 2012

TOP TEN TIPS TO HELP YOU PASS YOUR CSA EXAM.

Hellooo Friend!
Hema Here!


CSA Exam is a Very Challenging Exam. 




Right?


I am sharing some of my thoughts on how to pass it easily.


1. Decide when you are going to take it very early on. It may sound silly but it is vital. Ideally you must have atleast 3-6 months to actively work and practise various consultations styles and to get the one which suits naturally to you.


2. Make sure you have got specific days for videoing your consultations. So you will get used to it and use them to get the vital feedback from your trainer. I learnt so much just by watching myself (boring many times...).


3. Request your colleagues to give a structured constructive criticism so that you can identify and improve over the coming weeks.


4. Do not be pressurised to go for 10 minutes consultation earlier on. Start at 20 minutes and gradually work down to 10 minutes about 1-2 months before your BIG day. Still have catch up slots in between. Take it easy on you!


5. Use all opportunities as your exam practice. Take your time to identify patients' ICE, PSO, expectations and also to explain your thoughts in simple non jargon language and GIVE management Options!


6. Make a note of anything you are struggling with and ask your Trainer or fellow GPs/ colleagues.


7. Use www.patient.co.uk leaflets in your consultations. It is the best buddy in my csa preparation!


8. Have more joint surgeries with your Trainer! 
It would be extremely useful particularly if you are an IMG like me. You won't believe! I learnt a lot just in one day by requesting my trainer to role play difficult cases like explaining genetical conditions, ethical dilemmas, breaking bad news, etc. 


Please promise me that you will do it.


TO READ MORE- CLICK- http://csasmartgroup.com/?p=140




To Your Success,
Hema xoxo.




Thursday 12 July 2012

CSA EXAM FEEDBACK, APRIL 2012.

Hellooo Friends!
Hema Here.
Give me a biggg Hi5!
What does our RCGP say about our performance in CSA April 2012?
I am sharing this document just for YOU.




                CSA EXAM FEEDBACK  - APRIL 2012.

This feedback is designed to help both GP Educators and candidates in their preparation for the CSA.  Areas addressed include examination statistics, specific candidate issues and feedback from the case management group

1) Examination statistics

The Spring CSA diet remains the most popular diet of the year, particularly for first time exam takers.  The CSA ran for a record 28 days in January, February and March 2012.   2074 candidates were examined in total, 92.5% of whom were first time takers. 

The overall pass rate for all candidates was 71.8%.  

Some technical problems were encountered with the booking process for the Spring diet due to the high volume of bookings in the initial few hours.  A new methodology has been piloted for the May 2012 diet, and these problems appear to have been ironed out.

A detailed annual report on examinations held during 2011/12 will be available later in the year

2) Specific Candidate Issues

Case leakage 
During the Spring CSA diet it became apparent to examiners that there was some leakage of case details between candidates sitting the exam on subsequent days.  This was entirely detrimental to the performance of those candidates involved.  A unique palette of 13 cases is chosen for every day of the exam diet.  

Candidates sitting on subsequent days are NOT going to see the same selection of cases. However, there are several cases within the case bank in the same clinical area, each with a slightly different focus or challenge.  Candidates who ‘guess’ the case rather than responding to the concerns of the role player often get the focus of the case wrong and perform badly.

Please do not discuss the details of your cases with your colleagues as it likely to put them at a disadvantage and it is contrary to the Examination Regulations. 

The penalties for candidates who disregard this warning are described in a document entitled Guidance on the Conduct of Assessments and may result in disqualification: http://www.rcgp-curriculum.org.uk/docs/Exams_Guidance%20on%20the%20conduct%20of%20assessments%20for%20MRCGP.doc 
  
3) Feedback from the case management group

The CSA case bank contains approximately 600 live cases so providing feedback on individual cases would not be practical.  However, it is possible to provide global feedback on cases based on their Curriculum area and we hope you will find this useful for preparation. 

Genetics in Primary Care:

Despite the fact that at least 1 in 10 patients seen in UK primary care has a disorder with a genetic component, genetics cases consistently pose a high level of challenge to candidates.  

Examples might include: 

·         Prenatal counselling where a couple believe they are at risk of having a child with a single gene disorder such as Sickle cell disease.
·         A woman concerned about the significance of a family history of colon cancer requesting a colonoscopy.
   Most of the cases require the ability to construct a simple family tree, recognise basic patterns of inheritance, communicate risk effectively and refer onto additional specialist services when required. Extensive knowledge of individual rare genetic disorders is not needed to pass.

Examination cases:
Examination skills are tested within the data gathering domain of the CSA.  Not all CSA cases require an examination, so candidates should only offer to perform one where it is clinically indicated.  In cases where an examination is appropriate the candidate may be assessed in 1 or 2 ways; 

1) Choice of examination



I am 100% sure that it would help you in your CSA preparation!


TO READ MORE, CLICK - http://csasmartgroup.com/?p=319

To Your Success,
Hema xoxo.





Monday 9 July 2012

SUCCESS TIPS FROM CSA EXAMINERS!

Hellooo Friend!

Hema Here!

Give me a biggg Hi 5!




 What Will Our Examiners Say About The CSA Exam?

I thank Dr Simon Hall who has kindly send this article specially for You!


This information came from a Q&A system with the examinars on a Deanery CSA course.

CSA Examiner Feedback- Richard Adams, Bill Hall, Louise Riley as interpreted by Simon Hall. White Hart, Harrogate, 2nd May 2012. 


Do

Read all the information provided before the patient enters the room

LISTEN

Understand the reason why the patient is attending today. 


If you don't you won't recognise the issues and priorities in the case. When reviewing consultations with your trainer try stopping the recording when you feel certain you know why the patient has attended. 
Does your trainer agree?

Time Management



Use the 10 minutes you have wisely. 
Digital clocks are provided in the exam but great interpersonal skills and data gathering will not be enough to pass if you don't get to the correct management plan in place in time. 
Avoid repeating yourself when data gathering or developing the management plan.

Have an Evidence Based Management Plan. 

Make sure you review it with your trainer when reviewing cases together in preparation.

Explain and negotiate in order to share the management plan. You need to reference their agenda in doing so. 

A shared management plan is not simply a list of possible options. If different options are available then some will be better than others. The doctor is there to help the patient to make an informed choice.

A short succinct summary then "is there anything else?" opened up a consultation by "encouraging the patient's contribution" but do this in the first half of the consultation NOT right at the end!

Get your management plan out in the 10 minutes perhaps with bullet points "from the way I'm thinking at the moment there are 4 things we are going to need to do" may work whereas a long list may not. 

You should be starting this around the 7 minute mark at the latest. "it also helps if the management plan is the correct one!"

Do acknowledge your uncertainty if unsure but do decide on a diagnosis and treatment at some point. 

Avoiding making a decision becomes obvious to all.

Avoid a rigid structure to "go with the flow" so if the patient says something important follow them but still try to keep the data gathering focused.

COTs are a useful framework for assessment but only help CSA preparation when used for teaching and development purposes. "why and how something needs further development" should be considered. 

We may need a shift of emphasis to make sure we consider the management plans.

Pick up on cues such as changes in facial expression, responding with "you look, sound" etc for non verbal cues or perhaps echoing "special or strong" words and phrases. 

Also look out for things that don't quite fit. "These patients aren't going to ramble on about grandma's illness unless grandma's illness is relevant, so be nosey especially if something doesn't quite fit!"

Housekeeping

Nerves and anxiety will affect you but once a case is completed and if it hasn't gone well then "it's past, it's history, move on"




Do what you normally do (so long as it's sensible!) in your own surgery.

Don't do things differently.

Don't try to second guess what the examiner is looking for. 

For example "if you are not a natural summariser then don't start summarising for the exam in May [the next exam diet]."

A systems review checklist uses up valuable time and often fails to provide any further useful information if a proper history has been taken. It appears to be a pet hate of some examiners.

Any examination should be undertaken to the standard of a GP fit for independent practice. If an examiner says nothing when you move to examine the patient then the examination should be undertaken in a focused way. If they give you an examination card then there is no expectation of undertaking an actual examination of the patient.

Listen to the feedback. 

People are trying to help you. 

Let them!




Don't

Go immediately/ very early to expectations "two sentences in going to what are you worried about?" and "what do you want me to do about it?" there was no listening, no time spent, no rapport. 

A candidate may appear "formulaic and over coached". 
The role players are briefed not to respond to such questions. Patients won't either.

Avoid the use of formulaic phrases "what were you hoping we could do for you today?" after a patient tells you their livelihood and marriage are threatened because of illness. The question "needs to sit in the right place."


TO READ MORE - CLICK
http://csasmartgroup.com/?p=313







Hi Friend!
Me Again!

I thank Dr Simon Hall from the bottom of my heart for sending this article JUST FOR YOU & YOUR SUCCESS.
Thank You, Dr Hall.

What are you waiting for?
Start Practising from Now!

T o Your Success,
Hema xoxo.




Sunday 8 July 2012

BREAK FROM CSA - HOORAY!

Hellooo Friend!
Hema Here!
Now this...is something else!!


Definitely NOT csa related.
But you won't regret, honestly!

I am sharing this awesome video- Where the Hell is Matt?
Just for YOU!

14 months in the making, 42 countries, and a cast of thousands.

Are you ready for this ?...
If you have never seen this before -- 
I warn you!
Be prepared to be AMAZED!!!

Go Ahead!
ENJOYYYYY ! :-)




Have you started planning your holiday now?
When I looked my stats, many of you on holiday!
I can't wait for my holiday - in July to ATLANTA, US!!!!
Few weeks to go!!!!




TO READ MORE


CLICK- http://csasmartgroup.com/?p=311



To Your Success,
Hema xoxo


P.S.

I 'd love to hear from You...

Share your Comments ---> Join with us!

Go Ahead, It's FREE - Share it!

Saturday 7 July 2012

HOW TO PREPARE FOR THE CSA EXAM?


Hellooo Friend!
Hema Here!
Give me a biggg Hi5!


Are You Worried About How to Prepare for Your CSA Exam? 
DON'T WORRY :-)
I am going to tell you all the cases that will come up in your CSA exam.
I can hear you laughing in doubt!


Yes, Listen carefully-
~~ You will ONLY get the cases YOU see in your daily surgery ~~
Thats all.


Think on your day of Exam!  (Try in different accents - Have Fun!)
 '' Yeah! Right! I have already dealt with all the cases.
 I am Ready for the ride! Come On...Easy Peasy! ''


Now, I am sharing with you the sample cases I found in our RCGP website. I have shared my thoughts as well!
Enjoy the RIDE!




Sample CSA Cases
     
1.    Diabetes and depression

Summary of the case presentation:

The patient is a woman with well controlled Type 1 diabetes mellitus. 
She is presenting with the symptoms of depression. 


Of course, It will not be in the csa case sheet. 


Patient will TELL if you listen to her without starting our lecture on Diabetes and HbA1c. 
You can imagine our patient's eyes spinning like in cute cartoon characters when we DO that!


Don't Laugh! I have done this mistake (Oops) when I started my GP post after been in the hospital posts for yrs.  
I had to relearn my skills many times!



Your task is to find out why she has presented and obtain the relevant details that enable the following decisions to be made:
1. What is the main problem here? 
2. Is it the diabetes or something else?
3. If it is something else, could it be low mood in which case is the patient clinically depressed or just fed up?

Having made these decisions,  You have to 
- Formulate a diagnosis. (Very Important. No beating the bush kind of things!)
- Consider the clinical priorities.
- Involve the patient in developing a shared management plan


All of this has to be done in a patient-centred way, obtaining her ideas, concerns and expectations and incorporating these into the explanation given to her.


Think - 'ICE BABY, ICE'!  (Have you ever watched THAT video on youtube?)

Sample case notes


It shows a ‘typical’ set of case notes, as you might expect to see in the CSA.


HAVE A HIGHLIGHTER PEN TO MARK THE IMPORTANT POINTS! (Yellow one!)


EVERY POINT IS FOR A REASON!   (No Blah-Blah-Blah Here!)

You are a locum General Practitioner who has recently finished the local vocational training scheme. Here You Go!


Name                                      Clare Morgan  


( I always tend to use their 1st name if appropriate or Surname if elderly pt)

Date of birth (Age)                45

Address                                 47 Boxter Close, Stoke Newington

Social and Family History    Married, two children

Past medical history     Type 1 diabetes since age 17, currently on Mixtard 30, bd injections.

Regular annual reviews, compliant with medication and follow ups. 


Well controlled for many years with no significant complications.

Current medication     Mixtard 30 insulin, Aspirin 75, Simvastatin 20mg daily.

Blood tests  Diabetes blood tests done 2 weeks previously at Annual Review Clinic by practice nurse:

HbA1c                                     7.3%
Fasting Cholesterol                 4.0 mmoll-1
Triglycerides                           1.0 mmoll-1
BP                                           128/78

All diabetes blood screening checks normal.

· feet examination normal
· eyes recent check at optician - normal.


Why is this type of case being chosen?

This case illustrates the co-morbidity often seen in general practice presentations. 


YOU are given the opportunity to demonstrate YOUR skill in identifying the constituents at play, prioritising them and dealing with the problem presented in the consultation. 


In this case, the woman’s diabetes is well controlled and she has no diabetic complications. 


YOU simply have to establish this and then move on to diagnosing her presenting ‘problem’. 


On the face of it, having two conditions in a consultation may seem complicated and challenging, but the task required is much more focused and should be manageable in the 10 minutes allowed for the case.

 2. ‘Tired all the time’

Summary of the case presentation

This woman has just returned to work after the birth of her second child


She has seen the practice nurse recently for a contraception check up, and told her she was feeling tired all the time


(Tell me one patient who has not told 'TATT')


A series of blood tests, including full blood count, thyroid function tests, urea and electrolytes, creatinine, liver function tests and fasting blood sugar have all come back as normal


She is hoping for a diagnosis and treatment, probably in the form of some sort of medication.

The task here is to take account of the normal blood results and, with a focussed history, ensure that all likely physical causes of tiredness have been excluded. 


At the same time YOU must obtain the patient’s view of her tiredness and ascertain her expectations


A social history should be taken.

Having decided that the patient’s tiredness does not appear to have a physical cause, and that she is not clinically depressed either, YOU need to explain this assessment sensitively, suggesting that there are important social factors from the history that could be causing the tiredness (back to work after maternity leave, a busy job and two small children at home). 


YOU, having helped the patient recognise this likely cause, should then discuss with her ways in which these factors could be manipulated to help her manage more easily (opportunities for time for herself, using parents to help out with child care, possible job share or job change etc).

Why is this type of case being chosen?

This case is a good example of an undifferentiated presentation. 


YOU need to work through a diagnostic sieve to get to the decision that the cause of tiredness in this instance is likely to be due to social factors. 


In order to explain this properly to the patient, 


YOU need to adopt a patient centred approach that both gathers all the necessary personal information as well as uses this information in the explanation back to the patient. 


YOU need to explore the various ways in which the patient could adapt her lifestyle to help her cope and reduce her tiredness levels.


3. Constipation in a child

Summary of the case presentation

This is typical of the type of paediatric case that might appear. 
Due to constraints with using child role players, some cases are written in such a way that a parent comes to talk about their child in that child’s absence.

In this case, the child is aged 2 and is troubled with constipation. 


Her diet is low in fibre and is similar to her mother’s. Mum has her own stresses, being a single unemployed parent with low-income. 


She brought the child last week to the GP (another partner), who did not prescribe anything and advised a high-fibre diet and plenty of fluids. 


Mum is not happy for this situation to carry on and wants something for the child to relieve the problem.

YOU would be expected to take a focussed history from the mother about the nature and duration of the constipation. 


The case notes from the previous consultation show that the mother appeared to want a prescription (which she did not get). 


YOU would need to confirm and explore the mother’s expectations in this respect. 


If the candidate mentioned a growth chart to the mother, he/she would receive the chart from the assessor. This shows normal growth and development to date. 


To be successful, YOU would be required to show their ability to negotiate and develop a shared plan with the patient, for example negotiating with the mother to work on the child’s diet while perhaps agreeing to the prescription of a laxative. (NICE GUIDELINES!!!)


Appropriate use of other members of the team, such as the Health Visitor in the first instance or perhaps a paediatric dietician could also be mentioned, demonstrating an understanding of team working. 


Because this case is designed to test the ability to share understanding, giving the mother a leaflet on prevention of constipation in children would not gain any marks unless its contents were also discussed and explained.


DO NOT OFFER LEAFLETS WITHOUT EXPLAINING FIRST!

Why is this type of case being chosen?

This type of case has been chosen to illustrate how problems affecting quite young children can be introduced into the CSA, so that ability to deal with a range of age groups can be demonstrated.

4. Palpitations

Summary of the case presentation

The patient is a businessman who has noticed intermittent but apparently severe palpitations while at a conference in Dublin recently. 


He noticed that they came on when he was eating, so much so that he was forced to sit down on a couple of occasions. 
He was previously an infrequent attender at the practice. 


This is his second consultation – at the first one, another partner saw him and arranged some preliminary tests. 
He has no pain or palpitations at the time he sees either doctor.

This case is an example of an acute presentation of a man with intermittent palpitations. 


It is designed to test YOUR approach to taking a focussed cardiovascular history, performing a suitable cardiovascular examination and from this constructing a rational investigation and management plan with the patient.

In order to give YOU time to do a cardiovascular examination if YOU think it necessary, much of the history has already been provided.


Another task for the candidate is to confirm the history, interpret the results and explain them to the patient.

Why is this type of case being chosen?

In this case, the assessor will expect YOU to examine the patient and some of the marks awarded will be for the nature of this examination, the technique and fluency with which it is carried out. 


The role player will not have any cardiac physical signs, but YOU could be asked to look at an ECG taken ‘earlier’, for example. 


A full cardiovascular examination is NOT expected here, as this is a case that should (and can) be performed in 10 minutes, but it should be focussed so that any significant cardiac pathology is unlikely to be missed. 


This would include examination of the pulse, blood pressure, JVP and auscultation of the chest.



5    Sick note request

Summary of the case presentation

This is a case testing YOUR attitudes to patients and YOUR value judgements in an ‘ethical’ issue. 



The patient is a middle-aged lorry driver, an ex-drug user, Hepatitis C +ve, with intermittent low back pain. 


He has just lost his job because his driving licence has been taken away for repeated speeding offences. 
He is requesting a sick note, hoping YOU will give him one on the grounds of stress. 
He is annoyed to be in this position as he feels the ‘system’ has been unjust towards him.

YOU have to find out the reason for his attendance and take a good social and psychological history from this patient. Beware! you might miss this!


YOU need to decide if a sick note is warranted in this situation and if the patient has a condition that precludes him from working, in compliance with the Department of Work and Pensions guidelines


Integrated with this, YOU need to demonstrate continued interest and empathy with the patient and respect for his autonomy, while negotiating the issues surrounding the request for a sick note. 


If this is done successfully it is unlikely the patient will cause a major fuss, although he is likely to remain dissatisfied


You cannot make everybody Happy!

Why is this type of case being chosen?



TO READ MORE, CLICK-
http://csasmartgroup.com/?p=305




What are you waiting for?

Go Ahead... Start Preparing from NOW...

To Your Success,
Hema xoxo.