xxsat2011

CASC tips please

36 posts in this topic

I found the oxford course waste of money and waste of 3days

What communication skills are we talking about

The people running the course except for Mel are foreign graduate whose skills are no better than ours

One is Indian,one is Romanian,one is Nigerian

Except for these 4 whose feedback makes sense

I don't even believe the others are psychiatrist,ones I had in mock

I didn't fail a single station

But if I was the examiner,I would have given serious fail for some of my attempts

My Neuro exam was hopeless,had no clue of my structure

My risk assessment in morbid jealousy was incomplete,didn't mention children or depth into previous history

In my view one needs to have a lot of money to go to these 3day courses

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Resuscitating this old thread...

 

I don't think it's really fair to criticise a course because the examiners are IMGs. I agree that it is useful (I would say even necessary) to have some UK graduates among the examiners (and UK born/raised actors), but having IMGs as trainers was a motivating factor for me, as it took away that feeling that "only UK graduates can make it" that many try to instil.

I certainly have seen many SpRs and consultants who are IMGs and are excellent communicators with their patients/family. In my view, in order to learn how to perform you need, 1) to learn the basic facts/theory; 2) to observe someone doing it well; and 3) to receive specific feedback to help you improve. Sometimes an IMG consultant/SpR will be better at 3 (giving feedback) than a UK graduate, sometimes not... that will depend on whether they are really interested in helping the candidate pass and whether they are confident in giving the right feedback (some trainers are overly concerned with political correctness and don't want to risk being labeled "racist").

 

However, I do think it is important to have local people helping with your practice, particularly to point out expressions that may be used out of context or with unusual words (I do that all the time and need to be correcting myself) or other things like body language, tone of voice, eye contact, etc. 

 

By the way I agree that Mel for Oxford course is great. She is one of the few consultants I have seen giving really useful feedback - not just to me but to other people in my group when I did the course. We could see her cringe when a candidate did something really bad, and she did not shy away from saying exactly how bad it was, and how to improve it, sometimes even doing it herself to illustrate her point. I had one consultant like her when I was an SHO, and it's a shame it was only one while the others usually gave overly "nice", poor feedback, 

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Here are my ten cents which I posted under a different thread. I have excluded the course related discussion from this thread which can be found in the link provided. I believe reading standard textbooks was very very important for me and I have listed down all the material I read before the 2015 attempt. 
 
 
Thank God, Thanks to Almighty God, I have passed in the 11th attempt. I want to thank the webmaster and all Psychclub members for their enormous support throughout and I'll always be there to help my friends as and when needed. 
I am grateful to my elderly dad, my wife and my mentor who were of enormous support to me. I am particularly thankful to all course organizers for their hard work into the courses.
 
COURSES
A review of courses can be found here:
 
Apart from COURSES [READING TEXTBOOKS FROM COVER TO COVER]:
 
This is the real bit which worked for me and that was the reading bit. One of the Pakistani clinicians, Dr. S. M. Ahmed asked me to do that and that was a through study. Not of the course materials but of the actual textbooks. I deliberately missed my September 2014 attempt as I wanted to finish off the textbooks. 
 
The advantage of reading textbooks, is that:
 
A. Textbooks will cover all aspects of Psychiatry and therefore will cover all seen, unseen, and possible stations. The course material will cover only the stations  covered during the course. 
 
B. The knowledge from textbooks will be authentic and you will go with more confidence that you have the knowledge from the primary source and not from the secondary source which is the course materials. All course materials are good but they have to be read AFTER you have core knowledge from the books. Seshni's book is good esp for questioning style but I would still suggest reading textbooks before Seshni's book as you will be getting knowledge from the primary source and then from other excellent resources. 
 
C. This is a very big misconception that people have knowledge if they passed the Paper A and B or Paper 1, 2 and 3. Preparation of theory revolves around learning MCQs and theoretical knowledge around that. The only book I read from end to end for written papers was Dr. Gosall's Doctor's guide to Critical appraisal. All other books I read were for the reference sake only and not end to end. I also consulted course materials and online resources for written papers. 
 
I would have never passed if I did not read the following textbooks end to end solely for CASC:
 
1. Green ICD-10 with all the differential diagnosis and clearly numbered diagnostic criteria. Available free of charge pdf version on Google via WHO site. 
 
2. Two Volume Oxford Textbook of Psychiatry from end to end while thinking about CASC stations and ignoring the molecular and receptor level discussions if you have already passed the writtens. Focusing more from the textbooks what is relevant to the CASC, I dsicovered while reading the NOTP, that even most of the MCQs for the written papers came from NOTP and I was finding reference from online resources which was right but was not the ideal thing. 
 
3. Maudsley Prescribing Guidelines from cover to cover. Believe me many stations come from MPG such as QTc intervals, hyperprolactinaemia, lithium, prescribing in pregnancy, Psychopharmacology for elderly etc. etc, 
 
4. Any good book for Clinical examinations. Course materials, Seshni's Book or Andrew Iles' PASS THE CASC book may cover physical examinations. 
 
I also read 
 
5. Dale Dubin;s book on Interpretation of EKG
6. Fish's Psychopathology 
and 
7. Sim's symptoms of Mind. The later three are not essential but you should have clear idea about reading ECG from any good ECG book. 
 
 
COMMUNICATION
Communication a very important part of CASC. Well taught by Oxford Course, College course, Eastern Psych Course and partly by Revisenow course esp in the stations covered by Dr. Gosall himself. Superego course also entails communication videos as a part of their course. 
 
Universal Checklists with Clusters
The idea given by CASC Exam Practice course which is non-existent now. I'll share my universal checklists along with clusters for individual stations on request in the forum. The idea of dividing the checklist into clusters i.e. clustering and helicoptering by Oxford course was super. 
 
HOPE AND CONSISTENCE WITH PATIENCE
I am generally a very impatient person, but at least for CASC purposes I was stubborn to pass this. I had to redo all writtens after seven unsuccessful attempts and there were another 4 attempts after redoing the written papers. One of the CASCERS, Naveed who passed in 2010 in 3rd or 4th attempt used to say "if you can pass one station, you can pass 12 as well". It depends on how much enthusiasm and patience you have. If you have it, keep on redoing it untl it clicks. I was more desparate than most of the people in this forum, after I failed ten times but I was a bit stubborn to keep trying. If you don't have that stamina, the world is open and Canada option is there. Even staying as associate specialist or getting CCT from alternate routes, is also not the end of the world. This exam is very very very very strict and  a bit unfair as well, but is doable if you are determined and if you are mentally prepared to go for innumerable attempts like me and preparing well for each and every attempt until it clicks. 
Edited by Afterlife
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Hi Afterlife,

 

congratulations, I am really happy for you! Well done for your perseverance and motivation.

 

I absolutely agree with your advice with regards to reading books. For me, Oxford handbook, Maudsley guidelines and communication skills books (by Roger Neighbour and Peter Tate) were incredibly helpful. I commend you for reading the Oxford Textbook cover to cover - not many of us would be brave enough to do that!

 

I hope more people who succeeded post their advice here, to make this forum an even more helpful resource for the exam.

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Hi Afterlife,

 

congratulations, I am really happy for you! Well done for your perseverance and motivation.

 

I absolutely agree with your advice with regards to reading books. For me, Oxford handbook, Maudsley guidelines and communication skills books (by Roger Neighbour and Peter Tate) were incredibly helpful. I commend you for reading the Oxford Textbook cover to cover - not many of us would be brave enough to do that!

 

I hope more people who succeeded post their advice here, to make this forum an even more helpful resource for the exam.

Thank you dear

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Afterlife is an amazingly helpful person, maybe one of the most helpful on this forum.

But on this topic I respectfully disagree.

Textbooks complicate CASC preparation and I think are completely unnecessary for CASC.

CASC is not a knowledge exam, the key is knowing how to pass the exam.  Pick a good course, commit to it, and make sure you know the material inside out.  Most of the people I know who fail repeatedly overcomplicate the exams by over preparing, reading multiple course sets or textbooks, then confuse themselves and fail.

Whereas some people pick a single course, focus on it, prepare for weeks instead of months, and get through.  Of course, luck is an important part, but overall I would say textbooks are great for improving knowledge and clinical performance, but for the exams, stick to the material from a single good course.

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OK. Thanks a lot Babauckland.

If reading course materials is required (which is a second priority) SPMM materials are the best PROVIDED you read A. The materials from the latest course

As well as

B. The online pdf material

The reason is that if you read only the most recent course, you only cover recent stations and if you read only the online print out of the course you miss out the recent stations, so both are essential (as a second line strategy).

For me personally speaking, I attended 30 courses before reading books and read their course materials but it did not click until I read the textbooks.I also did loads of practice but it was only partially helpful. After reading textbooks I attended 6 more courses making a total of 36 along with another spell of one to one practice and then I passed. Reading textbooks definitely boosted my confidence and reduced my anxiety levels. My main problem was lack of confidence and some sort of either over calmness or over anxiety in the exam. This time I was full of working and functional anxiety and curiousity about the person sitting in fron of me. Why, where, how, what, how much, why you, why now etc questions helped a lot.

That is on a personal note otherwise suggestions by babaukland are also very helpful but I would like to add that please read both comprehensive set of spmm notes for past stations in addition to the recent notes in order to pass. Ideally they should give a copy of comprehensive notes to everyone attending the course but due to some reason they (spmm) sell the comprehensive and most recent notes separately. Seshni's book is also good but lacks technical details. If you are using that book, books can be consulted for additional reference.

Your input is much valued babaukland and I don't disagree as people have passed by acquiring different strategies. Thanks a lot for that.

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Heartiest congratulation and well deserved success. You are an example of perseverance and patience. I do not know how you got that. Well done.

OK. Thanks a lot Babauckland.
If reading course materials is required (which is a second priority) SPMM materials are the best PROVIDED you read A. The materials from the latest course
As well as
B. The online pdf material

The reason is that if you read only the most recent course, you only cover recent stations and if you read only the online print out of the course you miss out the recent stations, so both are essential (as a second line strategy).


For me personally speaking, I attended 30 courses before reading books and read their course materials but it did not click until I read the textbooks.I also did loads of practice but it was only partially helpful. After reading textbooks I attended 6 more courses making a total of 36 along with another spell of one to one practice and then I passed. Reading textbooks definitely boosted my confidence and reduced my anxiety levels. My main problem was lack of confidence and some sort of either over calmness or over anxiety in the exam. This time I was full of working and functional anxiety and curiousity about the person sitting in fron of me. Why, where, how, what, how much, why you, why now etc questions helped a lot.

That is on a personal note otherwise suggestions by babaukland are also very helpful but I would like to add that please read both comprehensive set of spmm notes for past stations in addition to the recent notes in order to pass. Ideally they should give a copy of comprehensive notes to everyone attending the course but due to some reason they (spmm) sell the comprehensive and most recent notes separately. Seshni's book is also good but lacks technical details. If you are using that book, books can be consulted for additional reference.
Your input is much valued babaukland and I don't disagree as people have passed by acquiring different strategies. Thanks a lot for that.

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OK. Thanks a lot Babauckland.

If reading course materials is required (which is a second priority) SPMM materials are the best PROVIDED you read A. The materials from the latest course

As well as

B. The online pdf material

The reason is that if you read only the most recent course, you only cover recent stations and if you read only the online print out of the course you miss out the recent stations, so both are essential (as a second line strategy).

For me personally speaking, I attended 30 courses before reading books and read their course materials but it did not click until I read the textbooks.I also did loads of practice but it was only partially helpful. After reading textbooks I attended 6 more courses making a total of 36 along with another spell of one to one practice and then I passed. Reading textbooks definitely boosted my confidence and reduced my anxiety levels. My main problem was lack of confidence and some sort of either over calmness or over anxiety in the exam. This time I was full of working and functional anxiety and curiousity about the person sitting in fron of me. Why, where, how, what, how much, why you, why now etc questions helped a lot.

That is on a personal note otherwise suggestions by babaukland are also very helpful but I would like to add that please read both comprehensive set of spmm notes for past stations in addition to the recent notes in order to pass. Ideally they should give a copy of comprehensive notes to everyone attending the course but due to some reason they (spmm) sell the comprehensive and most recent notes separately. Seshni's book is also good but lacks technical details. If you are using that book, books can be consulted for additional reference.

Your input is much valued babaukland and I don't disagree as people have passed by acquiring different strategies. Thanks a lot for that.

I agree completely, I forgot to mention about old sets of notes but you are right.  

I took CASC twice, first time I used SPMM recent course notes, and got a few stations that I did not know how to handle.  But other people said they were in previous notes from SPMM.  So I got previous version of SPMM and found that they for some reason take out stations in each set of notes, and then add them in later.  

It's a very sad strategy but SPMM have always been a bit shifty when it comes to providing a fair and helpful course and prep materials.  Similar to when they stopped offering high yield notes unless you attend their written paper in person courses.

So yes, definitely, as many sets of SPMM notes as possible.  I can totally understand why reading textbooks might help deal with anxiety when someone already has the knowledge as afterlife showed often on here.

Personally even though I really don't like their business tactics I used SPMM only for every exam, after failing a written paper once by confusing myself and preparing with mrcpsychmentor and spmm.  

I know some people who passed CASC, even 16/16 stations, with very limited knowledge and I'm sure they have not even read the SPMM notes much less textbooks but I guess that's the luck.

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hello every body, i need some help if any body tried before the CASC course cognition of CASC?

 

Im preparing for CASC next september, any body motivated to practice on Skype?

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On 18/02/2014 at 23:51, mcmcmcmc said:

My general approach to the stations:

 

Again this is not advice, but only my account of what has worked for me.

 

When the exam started I got extremely anxious and forgot all checklists that I had learned from the Eastern Psych and SPMM notes. I could only keep in my mind a general outline of what I had to do in the station and ended up doing what I would do in my clinical practice.

 

My main challenges during my preparation for the exam were: keeping a structure; active listening and not missing cues; and not missing important information about risk and differential diagnosis. This is how I tackled this in the exam:

 

1. I started by greeting the patient by their last name and introducing myself by my name and role. Then I said a bit about what I knew of the situation, and said what I aimed to do. ("Hello Mr XXX, I am Dr XXXX, a psychiatrist. I understand that you have been referred by your GP because you have been feeling low, and I am here today to talk to you about your treatment")

 

2. Then I asked a very open question about their understanding of the situation.

 

3. For the history taking stations, I first asked the basics (what is the problem? when did it start? how did it progress? has you had any similar problem in the past? what was going on in your life around the time the problem started?), and then proceeded to ask questions to elicit important symptoms and exclude differential diagnoses.

If the patient said something that could be important for my risk assessment (risk cues), I asked them to clarify it immediately - I noticed, after having failed some risk stations in mock exams, that if you don't pick up a risk cue straight away, the examiner will think that you are not listening actively and will probably fail you.

 

4. For the explanation/discussion stations, I tried my best to keep things simple, avoid jargon (if I'm talking to a patient or family) and most of all go with the flow of the patient, answering their questions with the appropriate depth. First I asked what they already knew about the treatment, then I asked what they wanted to know, and then I proceeded to say what I thought they should know, if we had not covered it already (i.e. risk of agranulocytosis and blood test monitoring on clozapine, that kind of thing).

 

5. In the "angry family member"/"difficult colleague" stations (we had 3 of these on Thursday) I found that it really helped if I gave them some time to put their point across, without interruption. Then I said something like, "I can see where you are coming from" (and NOT "I know how you feel" - apparently people get even angrier when you say that!). I would then apologise on behalf of the team for any miscommunication or anything that had gone wrong.

In the station of the paediatrics nurse, who was a really unpleasant guy, I tried to gain his trust by saying "I know that you are really pressured on your ward, I can see that this is difficult, but I would really appreciate if you could understand that we have a duty of care to this young girl, and if she is discharged she has a risk of dying that is as high as the other patients on your ward with physical health problems".

I then praised the angry relative/professional for whatever they have done right and tried to make it as genuine as possible, i.e. "you are showing that you are really supportive to your father/son/etc by coming here today and speaking to me, I am sure your son/daughter/father/etc really appreciates this as well, and your support is very important for their recovery", or to the nurse, "your team are doing a great job with XXX on the ward, she is being very well supported, thanks for keeping her safe here whilst we arrange for a psychiatric bed, please contact me again for all the support you need" etc.

 

6. Then in the last 60 or 30 seconds, I would stop asking any questions and just summarise my assessment. "Thanks for speaking to me. Just to summarise, we have discussed this young lady called XXX, she has been admitted yesterday following an overdose in the context of a psychotic episode, she was medically cleared but is currently at high risk of self harm. The plan for the short term is for her to do an UDS and stay on 1:1 observations whilst I try to arrange for an urgent transfer to a psychiatric bed; after this she will probably need antipsychotics and psychological therapy, as well as social support. Have you got any more questions for me?". I tried to keep this summary as short as possible, but containing relevant information, to show the examiner that I had elicited the relevant history.

I was not able to do this in 2 stations where the patient was very talkative (angry mother and peadophilia assessment) and in the physical examination (EPSE), but in general I think this is helpful to tick the examiner's boxes of: good time management; good communication; covering relevant points; concluding the interview confidently.

 

7. In the end of every explanation station, I would offer the patient/relative/carer some leaflets, and if it was a carer I would offer a carers assessment or support/counselling etc.

 

I left the exam 100% sure I had failed. I can be very hard on myself, and kept ruminating over the things I had missed on each station (you may have noticed this from my previous posts!). But I remember from Oxford course notes (the old notes, with the instructions for the examiner) that it said something like: "a good candidate may not be able to elicit all the information that is in the actor's construct, but will conduct a fluent assessment and obtain the relevant information whilst maintaining good communication. Conversely a poorer candidate may elicit many symptoms but in a checklist approach that does not facilitate engagement with the patient" (these were not the exact words, just the general idea!). So I guess they want a good balance between getting relevant information and maintaining good communication.

 

Some friends who revised with me did not attend any courses or mocks, did very little revision with course notes, and in our practice, they had difficulty in managing time and getting all the information that was in the checklist. They passed the exam in their first attempt.

What they had in common was a very "English" style of communication (one of them is not English but went to medical school in the UK), which in my view is:

being very polite

thanking the patient

smiling appropriately (of course smiling to a paranoid patient in A&E would not help much!)

praising the patient or carer (when appropriate)

eliciting and acknowledging concerns

showing empathy by empathic statements ("I can see where you are coming from", "it sounds like it was a really difficult time for you" etc) and appropriate body language and facial expressions (that varies from person to person but could be: slightly frowning when someone is talking about something really serious; leaning forward when listening to someone telling their story; nodding and saying "hmm" to encourage someone to keep talking etc).

Saying people's names is always helpful in establishing a rapport (i.e. rather than "your son has XXX and I will prescribe XXX", it sounds a lot more empathetic to say "Danny has been diagnosed with schizophrenia", for example).

 

Other things that most UK graduates do and seem to work well:

Going through the management of any kind of disorder using the biopsychosocial approach.

Management in the immediate, medium and long term.

Covering risk well (Psychiatry, as well as general medicine in the UK, is very risk-averse, so naturally the exams will follow that)

 

A couple more things that helped.... (I can hear some people telling me to shut up already! lol)

 

I found this checklist on a website a few months ago - it is kind of an explanation of why some people seem to be in the "borderline" of passing:

http://www.drscotthall.co.uk/wp-content/uploads/2011/12/criteria.pdf

Many of the things he mentions applied to me. I found it helpful to have these things broken down into specific problems, rather than vague statements such as "poor communication", "lack of depth" etc that many examiners write in the feedback sheets when I sat mock exams.

 

If you still have a long time until your CASC, I would recommend taking a week or so to read a classic book called "The psychiatric interview" by the American psychiatrist Harry Stack Sullivan. This is by no means a CASC book, but is a brilliant little book about communicating with patients. He emphasises the importance of active listening, responding to cues, giving the patient the sense that he is getting something out of your interview (i.e. respecting the patient's agenda and not just your own), etc. If you have been told by seniors that you have a "checklist approach" and that you are not "responding to cues" I would recommend this book - it helped me a lot in addressing these problems.

Hi 

 

i can see see this is a very old and useful post. The link u have mentioned : drscotthall doea not seem to be working. Any chance u have the pdf ?

 

thanks

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