Post on 14-Jun-2015
transcript
RCGP AKT
What your Registrar needs to know!
Outline
Format and content of exam
Rules
Scoring
Computer based testing
Revision strategies
Examples
No stats teaching here……but…..
Format
Designed to test knowledge and interpretation of data
Three hours 200 item multiple choice test
No multiple true false questions
No negative marking
Delivered on computer terminal at invigilated test centre – runs Oct, Jan, May.
Rules
No limit on number of attempts
Pass only valid for three years
Can attempt any time during VTS training but best sat during year three.
Scoring
Pass mark approx 68% 85.5% pass first time. 95.2% after second attempt.For Registrar yr 3Overall pass rate 75% This includes multiple sitters. Pass rate clinical medicine 73.9%, evidence interpretation 73.2%, organisational 67.9% NB
Construction
Relevance – covers high prevalence low impact e.g. UTI and low prevalence high impact e.g. meningitis
Scenarios from clinical work, practice issues and topical issues. E.g. CD regs
All question writers are working GPs
Reference material
Clinical evidenceCochraneBNFGP curriculumNICESIGNBMJ review articles and original papersBJGPDrugs and therapeutics bulletin
Subject content
Core clinical medicine and its application to problem solving in GP context 80% of items
Critical appraisal and evidence based clinical practice 10% of items
Ethical and legal issues organisational structures supporting G Practice 10%
Clinical medicine
Subdivided into groups of body systems in approx equal numbersEach group will have sections on disease factors, symptoms, investigation, and managementCovers CVS, Dermatology, Endocrinology, ENT, Gastroenterology, Genetics, Haematology, Immunology, Infection, Mental health and learning disabilities, Musculo-skeletal, Opthalmology, Neurology, Paediatrics, Renal, Reproductive medicine, Respiratory,Therapeutic indications and adverse reactions.
Research Epidemiology and Statistics
Principles and application of audit
Application of critical appraisal skills and interpretation of research data
Application of terms used in both interferential statistics and EBM e.g. as in appendices of clinical evidence BMJ
www.clinicalevidence.org
Administration and management
Regulatory frameworks e.g. DVLALegal aspects – e.g. DVLASocial services e.g. certificationProfession regulation e.g. GMCBusiness aspects e.g. GP ContractPrescribing e.g. CDsAppropriate use of resources e.g. drugsHealth and safety e.g. needlestick injuryEthical e.g. mental capacity consent etc
So what are the learning needs?
State benefits, sickness certification, incapacity, disability benefits and fitness to drive.
Dermatology – esp acne, eczema, psoriasis
Eye problems e.g. visual loss, approp management
Prophylaxis against pandemics e.g. flu
Meningococcal disease
Evidence based management of high prevalence conditions
Contraception.
And yet more learning needs….
Loss of consciousnessDiagnosis and management of serious neonatal problemsClinical risk management about working in a safe clinical environmentChildren –prescribing, development, chronic disease.Access to medical recordsTravel medicine
Question formats
Single best answerExtended matching questionsTables and algorithms e.g. BTS algorithmPicture format – e.g. alopecia areataData interpretation – complex data, risk tablesSeminal trials – ASCOT etcAll scored equally 1 mark each correct answer No negative marking
Single best answer
According to national guidelines –not local practice
Often using clinical scenario
Only one answer is correct
Other options may be plausible.
Example cardiac anatomy
The way to a mans heart is….
single most likely answer….
Through his aorta
Down the M6 and off at Junction 4
Through his pulmonary arteries
Though his pulmonary veins
Though his stomach
Example resp disease
17 year old develops chest pain and SOB after swim. Hyper reonance an decreased breath sounds on the right side
Single most likely diagnosis is….AsthmaPneumothoraxPulmonary embolusLVFPulmonary haemorrhage
Example extended matching question
List of possible options
3 or more scenarios
Most appropriate option should be chosen
Options can be used several times or not at all.
EMQ food and drinkfor each food listed select the single most appropriate drink
Asti spumanteShirazBaroloCeylon teaChablisChiantiChilled vodkaMexican beerSherrySauternes
Coq au vin
Crème brulee
Kipper
Nuts
Oysters
Snapper
Wild duck
Cucumber sandwiches
EMQ e.g. certificationFor each patient described pick the single most applicable certificate
Med 3
Med 4
Med 5
Med 6
RM 7
SC 1
SC 2
Private cert
See pt with back pain off work 7 days needs cert from the day he sees you
Pt on long term sick for 6/12 and has a questionnaire prior to all work test Wants a cert…
Regarding data…
Quantitative, qualitative, meta-analyses and systematic reviewsHierarchy of evidence – as in NICEEssential stats – mean, median, mode, normal distribution, confidence intervals, p values, ARR and RRR, NNT and NNH, sensitivity and specificity, positive and negative predictive values!!! Oh and forest plots, funnel plots, scattergrams and homogeneity and heterogeneity!
Feedback to candidates.
Their result – overall score, the pass mark, their performance in each of the three areas.
Pass is overall and not for each of the three areas
General feedback to Deaneries also placed on RCGP web site.
The practicalities..
150 test centres -first come first served.Register and phone to book inDemonstration tutorial – www.pearsonvue.com/rcgp/ AKT does start with short tutorialSecurity identity checks, invigilated, once in cannot leave, no phones, notepads.Confidentiality document signed. No late entries. Test forms downloaded on day of test. Never the same on consecutive days.
Revision strategies..
Small revision groups- share workloadPractice timed MCQs Exam website has samples syllabus and feedbackHow to read a paper Trish Greenhalgh, RCGP website materialTime management – is everythingSkip difficult onesGuess at the endCover test – answer before reading options.
Trainers can help by..
Broad an experience as possible
Target areas of need e.g. medicolegal
Question clinical decisions and look for evidence
Use clinical evidence
Cover Stats and critical reading
Familiarise with algorithms.
CSAFormat of exam
What candidates must know
Venue, examiners, cases
Candidate experience
Exam preparation and timing
Format
3 parallel circuits trice daily13 simulated patient stationsCases last 10 minutesCandidates stay in own room as a real surgeryRole player accompanied by an assessor throughoutPrescription pads, certificates, test forms provided.
Timing and security
Circuit lasts 3.5 hours.
15 minute break
Case 10 mins 2 min break and so on
Monitored during break –no talking!!
Separate am and pm candidates
Confidentiality agreement signed
Candidates must….
Not be late!!
Remember ID
Bring Drs bag and BNF – clean!!
No mobiles = disqualification
Read patient record thoroughly
Own food and drink – no canteen.
Examiners
260 many are GP trainers
Hands on Drs, team player, not prejudiced.
Selection and training in place
Idea is good representation form Primary Care
QA of assessors and role players to ensure fairness.
Remote cameras in place.
Cases
600 written
Change daily
Reflect spectrum of General Practice
Designed to fill 10 minute slot
Costs a lot of money to run.
Scope
Wide clinical scopeDiffering contexts all from GPRange of ages including children by proxyEthnicity and disabilityBreaking bad newsEmotional problems, depression. May have a body part to examineConsultations with health professionalsNo manikins or models - almost
Trainers should cover…
Telephone consulting
Home visits
Different ethnicities
Disabled patients
Difficult patients
Uncertainty
Pitfalls…
Jumping to conclusions too soon.
Mechanistic consulting – irrelevant stock phrases
Forgetting examination skills 33% need hands on examining- remove clothing!!
Looking for non-existent hidden agenda
Rigid, Dr centred consulting.
Standard expected..
That of GPR at end of 3 years. Safe for independent practice. Feedback form candidates – fair, centre fit for purpose, actors realistic, reflects real life experience, stressful,CSA exam fees are high!!Feedback to candidates – pass – excellent or fail, number of cases passed, which cases failed, formative feedback statements. Fed into E Portfolio.
Key messages for registrars
Revise from curriculum statements
No assumptions based on previous candidates experience.
Read the case paperwork
Manage time
Structure consultations
Trainers can help by..
Allow Reg to experience wide variety of cases.
Short practice swaps
Use the COT as a way of assessing
10 minute consulting in practice a must.
Use info on web site – dummy cases
Wessex DVD RCGP book coming
Marking schedule for CSA
Each vase is marked in three domains Data gathering examination and assessment skillsClinical management skillsInterpersonal skillsOverall grade only counts. 8 passes to get through – no compensation. One bad mistake does not fail, cover all domains in all cases, watch the timing.
Data technical and assessment
Positives
Clarifies problem
Accept uncertainty
Use of time good
Systematic approach to information gathering
Selective choice of enquiries, examination and investigations
Identifies abnormal findings
Uses instruments well
Appropriate interpretation of information
Negatives
Immediate assumptions made
Interventional
Data gathering not related to probablilty of disease
Fails to identify abnormal data or interpret it.
Unsure re instruments
Disorganised unsystematic
Clinical management skills
PositivesRecognises presentations of common problemsPlans reflect natural history of common problemsFeasible appropriate management optionsAppropriate assessment of riskRefers appropriately co-ordinates care with team membersManages risk, safety nettingManages multiple problemsEncourages improvement rehab recoveryEncourage patient participation
Negatives Does not consider common conditions
Patient not made aware of risks or different possible approaches
Inappropriate decisions
Referral inappropriate
Follow up not planned
Co-morbidity not considered
No problem list No prioritisation
No enhancement of patients coping strategies.
Interpersonal skills
PositivesExplore patients agenda
Alert to verbal and nonverbal cues
Explores impact of illness on patients life
Works in partnership
Psych and social info elicited
Responds to pt preferences feeling and expectations
Shared management plan
Respect. Inclusive.Open Non-judgemental Sensitive to pts feelings
Consent consent confidentiality
NegativesMisses patient perspective
Misses verbals and non verbals
Misses psychosocial context
No empowerment
Inappropriate language
Little understanding
No compassion
Own views paramount
Prejudiced Patronising. Paternalistic.
Embarrasses patient.
Candidates comments
Cases favoured chronic conditions
Real interesting enjoyable!!!
So lets try some cases and see if we agree!!
Group rules
Idea is to get a feel for the casesNot to judge colleagues performanceNeed one patient one registrar and one observer. Timing- 10 minutes to do, 10 to chat then change over cases if time!Use generic indicators sheet to assist. Confidentiality please.
2 cases to try…
Mrs Smith
Cleaner mid 50s married
C/o fluid retention bloating
In reality just getting fatter
FH NIDM brother and CCF Father
Wants water tabs and tests
Bloods 2 weeks ago normal
Mrs Jones
mid 50s smoker
C.Of increased sob at rest and on exertion
No chest pain or ankle oedema
BP controlled with ACE
Father had lung cancer
Worried she may have something serious
Wants a CXR