3)Clinical Assessment Skills & Competencies

ON 25/06/2020                                                                                          BY AFIZA AZMEE

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Resources I Used For CASC 

Question Bank & Notes

  1. SPMM

I only subscribed to SPMM for my CASC. I did not subscribe to MRCPsych Mentor or Birmingham Course because I was informed that this should be enough.

This subscription provided you with very good and comprehensive clinical scenarios across a range of core competencies (history taking, illness explanation, management, clinical examination). They also provided you with 74 CASC videos demonstrating how you are expected to perform in each of the CASC station.

 Books

There are two recommended books for CASC:

  • Pass The CASC – authored by Dr. Sheshni Moodliar

9780956994141

  •   Get Through MRCPscyh CASC – Melvyn WB Zhang, Cyrus S.H. Ho, Roger C.M Ho, Basant K. Puri

9781498707893

I have BOTH books but I only had the opportunity to finish reading Get Through MRCPsych CASC. I didn’t use the book Pass The CASC all that much even though I understand that the book is also very good. Time is  a great limiting factor, here. I also needed to study the SPMM notes and watch the videos provided by SPMM and therefore I only had time to go through one book only.

My suggestion is for you to choose either one of these books because based on my experience, you would not have the time to cover BOTH books on top of the SPMM notes and videos that you also must go through.

Guidelines & Leaflets

  • NICE guidelines
  • Maudsley guidelines
  • RCPsych Leaflet

CASC Course Training

There are a few options of CASC course that you could choose from.

  • Oxford CASC course – usually held in Singapore and KL.
  • CASC course organized by the Royal College of Psychiatrist
  • CASC course organized by Hospital Permai

I attended the one organized by Oxford in KL and had to pay GBP 595 (*gulp* convert the currency rate to Malaysian Ringgit… memang sakit hahaha). 

But it did provide me with an overall idea of what to expect in the actual exam and what are the examiners’ expectation on the candidates in terms of communication skill.

If you cannot afford Oxford Course, I recommend for you guys to attend the ones organized by Hospital Permai because it was free of charge. I didn’t go to this one because they had organized it so very near to my actual exam date at that time. (I think it was around 10-14 days before the actual exam, which was just not a very ideal time to be attending a course. You would want to spend that time studying and practicing, knowing that the exam is so near. CASC courses should be attended at least 4-6 months before the actual exam so that you will have the time to practice and apply the tips that you had acquired from the course throughout that 4-6 month of pre-exam preparation). Otherwise, it would have been perfect for me. Most of the participants who had gone to that course in Permai did not plan to  take the CASC until 6 months to 1 year later, so it made sense for them to go. But for us who would be having our exam in 2 weeks time, we decided not to join the course. Sayang… because it was free, sponsored by KKM. Even accommodation was provided for (nursing hostel of Hospital Permai). So I really recommend that you guys attend this free CASC course if you do not fancy spending so much money on Oxford CASC course. 

The CASC Syllabus

As  you well know, CASC consists of 16 OSCE stations testing your clinical and communication skills across a broad range of clinical topics. Anything can come up. But there are common tested stations that you should be aware of:

  • Psychosis/depression/Mania history taking
  • Risk assessments
  • Self-harm and agressive behaviour
  • Illness explanation and giving information about ECT, medication such as Lithium/Clozapine, side effects like hyperprolactinaemia/metabolic syndrome/NMS/Serotonin Syndrome
  • Dealing with difficult patient/relatives and managing challenging consultations
  • Clinical examination – neurological examination, cognitive assessment, Frontal/Parietal/Temporal lobe assessment, capacity assessment, MSE.

The Exam Format

The CASC is an OSCE-style clinical examination consisting of 16 stations altogether (5 stations on history taking, 5 stations on clinical examination, 6 stations on management/treatment). There is one circuit of eight stations in the morning and one circuit of eight stations in the afternoon. You only have 7 minutes to perform your task for each station. Yup, not a lot of time! And therefore, you must be very methodical in how you approach the clinical scenario. Always start with open ended question to get a feel of what this patient is presenting with and then quickly ask questions that would narrow the diagnosis down.

Circuit 1 (morning stations) consist of:

  • 6 stations on clinical management
  • 1 station for Examination
  • 1 station for history taking

For the morning circuit, you are given 4 minutes to read the instructions/scenarios and 7 minutes to complete the tasks.

Circuit 2 (afternoon stations) consist of:

  • 4 clinical examinations
  • 4 history taking questions

For the afternoon circuit, you are given 90 seconds only to read the instructions/scenarios and 7 minutes to complete the task.

To sit for CASC, I had to pay GBP 1462 – around RM8000. Yup, it was very pricey. But, it is worth it when you pass. So try to be fully prepared before deciding to take the CASC exam.

Preparing For The Examination

For CASC, you MUST have study buddies who could do the role plays for you. One buddy can become the patient, one buddy can be the timekeeper as well as the observer and you can be the candidate performing the task. Later, the patient and the timekeeper/observer can give you some feedbacks on what you do well and what you should improve on. You guys can take turns being the candidate/patient/timekeeper.

Aim to at least cover each topic/station at least two to three times before the exam. Have a schedule in how you want to ensure that all  the topics are covered a few times before the actual exam. Me and my colleagues practice almost every working day after we finished seeing our clinic patients. And we also came regularly to our study room in the ward during weekends to practice our CASC stations. Practice until your performance is effortless and fluid while keeping the time strictly at 7 minutes per station.

Try not to sound stiff and “checklisty” as you perform your task. Don’t appear aloof or as if you have a list of questions you must tick off when you are talking to the patient. You must try to mesh your agenda with your patient’s agenda while conducting the consultation. Be responsive to the patient’s concerns. There are a lot interviewing tips and techniques that would be taught to you when you attend the CASC course by Oxford or Permai. Try to practice them regularly while you are practicing your CASC stations with your study buddies.

Below is a video I find very insightful regarding dealing with an angry/upset patient. Rest assured, you WILL encounter one station in the CASC examination testing on how you deal with a difficult patient. I love the 6-steps formula that the video talked about when it comes to managing the emotion of your patient or their relatives. Do check this video out.

While practicing with your study buddies, (I know it can be hard but) try to be honest with your feedbacks to each other so that everybody can improve on their performance. I recommend that you practice your CASC stations with the seniors that had already passed their CASC. They would be able to guide  you on what you should improve on.

If you are the only CASC candidate in your center, you can try to practice via Skype with other candidates. I had done the same a few times. But I generally prefer face-to-face practice than using Skype. But sometimes, we do not have any other option and have to make the best out of the situation. So Skype is definitely an option!

I hope Allah will make it easy for all of you who are planning to take the CASC exam. Hardship and headaches while studying are expected. But you will be amazed at how much knowledge you have acquired by practicing CASC stations multiple times. You are at your most knowledgeable self while preparing for CASC exam, trust me. After the exam, you might forget some of the knowledge you have acquired but plenty of them remain with you, helping you into being a better clinician than when you had first started.

If you didn’t make it the first time or even the second time or the third time…. do not be disheartened. Consultants and specialists all over the world from other countries also failed this exam multiple times. And they are consultants! I had known one candidate who is pretty good and competent in his clinical skills but failed CASC 4 times. But he made it in his 5th attempt. Just persevere and continue your effort while praying hard that Allah will grant you success. Insya Allah, you will make it in the end.

I hope you guys are able to get some idea about CASC after reading this page. I wish all of you the best in your exam. May Allah reward your patience in pursuing His knowledge by bestowing upon you the best of success in this life and the hereafter. Amin. Much love and may Allah bless all of us.

 

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