I will elaborate further below on each of these distinctive features. The mental checklist is a practical guide on the strategy of how you would need to approach the task; the rationale of that CASC station; the key skills which are being tested by the college and the salient aspects which you would need to concentrate on. The intention here is for candidates to synchronize this mental framework with their ‘preparation time’ before each station.
The communication skills guide is there to give you an idea of the possible scenario to anticipate and in some cases the ‘ice breaker’ needed to be surpassed in those ‘first 2 minutes’, which most examiners consider as one of the crucial factors in determining a pass in the station. ‘Develop rapport and show empathy’ is one of the communication skills I have repetitively used, and with the intention for this to be one of those take home messages. I will illustrate this using 2 references.
Empathy is defined as: ‘We call empathy (from the Greek word ‘feeling with’) or atunement to express a way a person can be in tune with the internal world of another, and is also connected to what has been called emotional intelligence.’ (Orsucci, Mind Force on Human attractions, 2009, p.23) And following that a description of showing empathy: ‘If you believe that the patient is as important as you are, you are mistaken. The patient is more important than you are. Your career depends on how well you can get on with patients, and make them feel good about you. Hence be sensitive and show warmth, empathy, concern and consideration for the patient’s feelings. Try to see how you would have felt if you were in the patient’s shoes. ‘(Michael, A OSCE’s in Psychiatry, 2004, p. 3).
I believe these both are excellent summations of the components of empathy and as we know it is perhaps one of the most important essential skills required as a psychiatrist. I believe, if you are able to master this, then I can assure you, you would have won half the battle needed to overcome any given CASC scenario.
The scenario then develops into a suggested approach or dialogues which vary from a structured format of questions which need to be probed; to discussing management of the various psychiatric conditions.
These dialogues should not be repeated verbatim, and the skill candidates should aspire to, is to integrate these dialogues to create a balanced mixture of open and closed questions. I would like to further emphasise that these should be used as a mere guide, and tailored according to the given scenario and given task.
In order to succeed in the CASC, I would recommend you to use the format given in the book to analyse every case that you see in your day to day work And needless to say ‘practice makes perfect’. So practice these in your examination groups, with consultants, registrars and other colleagues under the timed examination conditions. I hope trainees preparing for the CASC examinations will find this beneficial, not only for their examinations but also when carrying out assessments once they have successfully completed their examinations. This would also be an essential read for those core trainees only just starting afresh in their careers in psychiatry to equip them with the fundamental psychiatric interviewing skills.
As psychiatry does not come without its fair share of setbacks, I know from my personal experience the impact that these exams have not only on our family lives and work, but also the financial and emotional implications. Colleagues, the key ingredient are perseverance. If at first you don’t succeed, try and try again.
And finally my outlook on psychiatry training whilst incorporating my philosophical view on life, is that whilst it is important for us as psychiatrists to have the knowledge, and continually strive for learning, I believe that it boils down to this, which is the ability to communicate effectively with our patients, families, carers and colleagues, and to put our patients at the heart of everything we do to promote their ‘wellbeing and recovery’. I wish you all the best in your career and all the success in this CASC examination. My sincere gratitude goes out to you for reading my book.
Good luck!!
Seshni Moodliar
MBChB, MRCPsych
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