According to the RCGP, this is the area that most people lose marks in. To understand why this might be, and how to avoid it, continue reading below.
Reasons Why : candidates don't score as highly in clinical management
There are many reasons why candidates may not do as well in this area. Highlighted below are some of those reasons, including ways to help you overcome them.
One reason candidates don't do so well in this section is due to difficulties with time management. You're never going to score well in 'clinical management' if you run out of time. This is why it's very important that you structure your consultations in such a way as to leave you plenty of time (at least 3-4 minutes) to discuss management.
2: Lack of knowledge
Lack of knowledge on how to manage conditions is likely the largest contributor to poor performance in this heading. This is why it is of utmost importance that you stay up to date with current guidelines, and know how to manage common conditions within General Practice. It is not enough to simply know one or two management options, as often the cases will be designed to eliminate those options, to test how well you know the subject. For example: A case with a tennis elbow may be intolerant of opiate analgesia, has a past history of gastric ulcer (therefore can't have NSAIDS), and may have already tried a forearm band and had private physio. You therefore need to know what more can be done to manage this condition, otherwise you're at risk of becoming unstuck in the exam.
Highlighted below are some useful resources for up to date management advice:
3: Poor Explanation / Option Sharing
Often candidates may know how to manage the condition, but to score top marks, you need to be able to present that information to the patient in a way that helps them make an informed decision. We will cover this in a bit more detail below
Option Sharing : in progress..
1: Making sure you have options to share!
Before we even go into how we share options, it's important that you have options to share. It's known that during cases in the CSA, several options may be taken away from you (patient allergic, or already tried some of them without success...) so you need to know at least 4 management options for all conditions. One of the best way to practice this is with your trainer during debrief sessions - where they can help you out if you're struggling to come up with enough options. If you're unable to come up with 4 options, brush up on your knowledge using the above links.
2: There may not be more than one option
It is important to note that there may not be more than one option in SOME cases. For example a child with possible meningitis, a cancer referral or someone who is acutely unwell who needs a 999 call. For these cases, don't waste time trying to think of lots of different options, just discuss with the patient why there is only one recommended course of action. Then help them explore any concerns / expectations surrounding the chosen course of action, for example - what might happen next, do they need to inform any one, organise any temporary care for relatives / pets, and so forth....
3: Gift Wrapping
For most cases within the CSA there will be more than one management option, it is therefore key to discuss these options with the patient, to help empower them to make an informed decision regarding their condition. This does NOT mean simply listing all possible options to the patient. Remember, that they are there to seek your advice and expertise, and not to simply be given a long list of possibilities without having any guidance as to which may be best option for them.
This is where 'gift wrapping' come into play. Gift wrapping is a term coined to explain a strategy where by Doctors may make one option sound more appealing to patients, to help them in decide on a particular course of action. An example may be that when explaining options to an individual who has tennis elbow, instead of simply listing all possible management options; "simple analgesia, home exercises, physiotherapy, elbow straps and steroid injections or specialist referrals", we might say that "in your case, you've tried simple pain killers, and home exercises, so physiotherapy and a tennis elbow strap might be a good place to go to next as the former can help speed up healing and the latter can reduce symptoms. Steroid injections, whilst they may help with symptom relief, can prolong the condition, therefore it might be best to wait until we've tried other measures first." In this quick example you can see that the options are still listed, but one or two of them are 'gift wrapped' to make them seem more attractive. This technique can be very helpful in guiding patients through the plethora of management options present in some cases.
Explanations : coming soon..