Patient Instructions

Name of Patient:

Mrs Serena Dziel

Description of the patient & instructions to simulator:

You are a 37 year old lady who has recently moved to the UK (3 months ago) with your new
born child to be with your husband.

Your child is now 4 wks old. You have come with your 4 week child to have a chat with the
GP as you recently had a visit from the HV with regards to immunisations but you did not
understand what she has said. Your husband is at work.

Ideas - you know very little about immunisations as there is no formal schedule in your rural
part of ‘Farlandia’.

Concerns - you are scared it may harm your baby

Expectations - You want clarification about the aims, schedule, risks and benefits about
immunisations

Normal delivery with no complications during pregnancy or birth.

No other children

No FH of other problems

Child is fit and well

You have reasonable grasp of English, your husband understands English better.

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Doctor’s (GP ST) Instructions

Name & age of patient

Serena Dziel 37 yr old lady

Summary Card
PMH:
DH:
Allergies:
BP/BMI/ ?smoking and alcohol hx:

Case Notes - Last few entries in records:

No other information available as patient is new to practise.

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CSA EXAMINATION CARD

Patient Name:

Examination findings:

Not applicable

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 CSA Case Marking Sheet
Case Name: Immunisation case Case Title:
Context of case
 immunisations risks and benefits
Assessment Domain:
1. Data-gathering, technical and assessment skills
Positive descriptors: Negative descriptors:
 Reason for attendance  Closed questions
 Understanding from health visitor  Not exploring underlying health issues
 Understanding of immunisations  Not taking obstetric and neonatal history
 obstetric and neonatal history

Assessment Domain:
2. Clinical Management Skills
Positive descriptors: Negative descriptors:
 Explain immunisations in simple  Use of jargon
language
 Not knowing immunisation schedule
 Know immunisation schedule
 Not explaining benefits of immunisations
 Be aware of risks
 No f/u offered
 Offer leaflet with translation
 Follow up with interpretor or
husband

Assessment Domain:
3. Interpersonal skills
Positive descriptors: Negative descriptors:
 Patient centered approach  use of jargon
 Simple language  Lack of empathy
 Explore ICE  Closed questions
 Chunk and check
1.

Other aspects e.g. time keeping, consultation

structure, comment on consultation skills etc
Positive descriptors: Negative descriptors:
 Time keeping 
 Follow up 

Grading: Clear pass = 3, Marginal Pass = 2, Marginal Fail = 1, Clear Fail = 0 2.

Data Gathering Score = Clinical Management Score =

Interpersonal Skills Score = Total for case = (max = 9)
General
Feedback/Comments

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 GENERIC INDICATORS FOR TARGETED ASSESSMENT DOMAINS – Crib Sheet

1. DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS: Gathering & using data for clinical judgement, choice of examination, investigations &
their interpretation. Demonstrating proficiency in performing physical examinations & using diagnostic and therapeutic instruments

(Blueprint: Problem-solving skills, Technical Skills

Positive Indicators Negative Indicators

 Clarifies the problem & nature of decision required  Makes immediate assumptions about the problem
 Uses an incremental approach, using time and accepting uncertainty  Intervenes rather than using appropriate expectant management
 Gathers information from history taking, examination and investigation in a  Is disorganised/unsystematic in gathering information
systematic and efficient manner.
 Data gathering does not appear to be guided by the probabilities of disease.
 Is appropriately selective in the choice of enquiries, examinations & investigations
 Fails to identify abnormal data or correctly interpret them
 Identifies abnormal findings or results & makes appropriate interpretations

 Uses instruments appropriately & fluently

 When using instruments or conducting physical examinations, performs actions in
 Appears unsure of how to operate/use instruments

a rational sequence  Appears disorganised/unsystematic in the application of the instruments or the conduct of
physical examinations

2. CLINICAL MANAGEMENT SKILLS: Recognition & management of common medical conditions in primary care. Demonstrating a structured & flexible approac
to decision-making. Demonstrating the ability to deal with multiple complaints and co-morbidity. Demonstrating the ability to promote a positive approach to health
(Blueprint: Primary Care Management, Comprehensive
approach)

Positive Indicators Negative Indicators

 Recognises presentations of common physical, psychological & social problems.  Fails to consider common conditions in the differential diagnosis
 Makes plans that reflect the natural history of common problems  Does not suggest how the problem might develop or resolve
 Offers appropriate and feasible management options  Fails to make the patient aware of relative risks of different approaches
 Management approaches reflect an appropriate assessment of risk  Decisions on whether/what to prescribe are inappropriate or idiosyncratic.
 Makes appropriate prescribing decisions  Decisions on whether & where to refer are inappropriate.
 Refers appropriately & co-ordinates care with other healthcare professionals  Follow-up arrangements are absent or disjointed

 Manages risk effectively, safety netting appropriately

 Simultaneously manages multiple health problems, both acute & chronic  Fails to take account of related issues or of co-morbidity
 Encourages improvement, rehabilitation, and, where appropriate, recovery.  Unable to construct a problem list and prioritise
 Encourages the patient to participate in appropriate health promotion and disease  Unable to enhance patient’s health perceptions and coping strategies
prevention strategies

3. INTERPERSONAL SKILLS Demonstrating the use of recognised communication techniques to gain understanding of the patient's illness experience and develop
a
shared approach to managing problems. Practising ethically with respect for equality & diversity issues, in line with the accepted codes of professional
conduct.
(Blueprint: Person-Centred Approach, Attitudinal
Aspects)

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Positive Indicators Negative Indicators

 Explores patient’s agenda, health beliefs & preferences.  Does not inquire sufficiently about the patient’s perspective / health understanding.
 Appears alert to verbal and non-verbal cues.  Pays insufficient attention to the patient's verbal and nonverbal communication.
 Explores the impact of the illness on the patient's life  Fails to explore how the patient's life is affected by the problem.
 Elicits psychological & social information to place the patient’s problem in context  Does not appreciate the impact of the patient's psychosocial context
 Works in partnership, finding common ground to develop a shared management  Instructs the patient rather than seeking common ground
plan
 Uses a rigid approach to consulting that fails to be sufficiently responsive to the patient's
 Communicates risk effectively to patients contribution
 Shows responsiveness to the patient's preferences, feelings and expectations  Fails to empower the patient or encourage self-sufficiency
 Enhances patient autonomy  Uses inappropriate (e.g. technical) language
 Provides explanations that are relevant and understandable to the patient

 Responds to needs & concerns with interest & understanding

 Has a positive attitude when dealing with problems, admits mistakes & shows  Shows little visible interest/understanding, lacks warmth in voice/manner
commitment to improvement.  Avoids taking responsibility for errors
 Backs own judgment appropriately  Does not show sufficient respect for others.
 Demonstrates respect for others  Inappropriately influences patient interaction through own views/values
 Does not allow own views/values to inappropriately influence dialogue  Treats issues as problems rather than challenges
 Shows commitment to equality of care for all  Displays inappropriate favour or prejudice
 Acts in an open, non-judgmental manner  Is quick to judge
 Is cooperative & inclusive in approach  Appears patronising or inappropriately paternalistic

 Conducts examinations with sensitivity for the patient's feelings, seeking consent
where appropriate  When conducting examinations, appears unprofessional and at risk of hurting or embarrassin
the patient

CSA Grade descriptors

Key: Clear Pass -- Marginal Pass -- Marginal Fail -- Clear Fail

CP The candidate demonstrates an above-average level of competence, with a justifiable clinical approach
that is fluent, appropriately focussed and technically proficient.

The candidate shows sensitivity, actively shares ideas and may empower the patient

MP The candidate demonstrates an adequate level of competence, displaying a clinical approach that
may not be fluent but is justifiable and technically proficient.

The candidate shows sensitivity and tries to involve the patient.

MF The candidate fails to demonstrate adequate competence, with a clinical approach that is at times
unsystematic or inconsistent with accepted practice. Technical proficiency may be of concern.

The patient is treated with sensitivity and respect but the doctor does not sufficiently facilitate or
respond to the patient’s contribution.

CF The candidate clearly fails to demonstrate competence, with clinical management that is
incompatible with accepted practice or a problem-solving approach that is arbitrary or technically
incompetent.

The patient is not treated with adequate attention, sensitivity or respect for their contribution.

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Note: All three CSA domains must be assessed in order to make the final global judgement. The descriptors
in italics address interpersonal skills. The rest of the text addresses the other two domains.

The standard for “competence” is at the level required for the doctor to be licensed for general practice.