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CASC - exam advice, tips

Discussion in 'CASC - GENERAL DISCUSSION' started by Johnson, Dec 13, 2015.

  1. Johnson

    Johnson Member

    First time in a casc station - I talked about cricket with a patient as he was a keen cricketer , now with alcohol problems
    First time a examiner gave a smile [ not sure good /bad]
    Will update after the results on this particular station

    Its not only ticking the box for ICD 10 criteria for alcohol dependency syndrome, but also listening to the patient

    Update on 21 Feb 2016
    I passed both the stations (linked) in January 2016

    This is my research station

    I am thinking of changing my style next time
    Consider to pick up CUES [ one way to do this is practise practise practise - come up with your own scenarios and ask the role players /friends to have their own cues and see whether you picked on them......I think we all have the knowledge of alcohol dependency
    Last edited: Feb 22, 2016
  2. Johnson

    Johnson Member

    Coping mechanisms
    when someone is alcohol dependent, can ask why they drink, for someone

    "is it to block out the reality" ( this sentence from a tv programme regarding homeless people)

    Social circumstances
    Known to charity organisation
    Last edited: Jul 16, 2017 at 12:50 PM
  3. Johnson

    Johnson Member

    Try to tweak the scenarios during the practise sessions.
    Sometimes we practise the same again and again and want to be sleek and could be carried away in casc
    This happened to me in the casc station in Jan 2016 with conversion disorder

    Tweak common stations and keep practise
  4. Johnson

    Johnson Member

  5. Johnson

    Johnson Member

    My friend who passed casc told me when talking about treatment decisions in casc stations (examples lithium, treatment resistant depression, speaking to angry relative)
    Give time for the patients to discuss with their family
    Give options of treatment
    Medication information leaflets
    and follow up (telephone/face to face to discuss the decision)

    One of my friends passed casc watching videos many times and writing down phrases and attending mocks
    Last edited: Jul 15, 2017 at 7:13 AM
  6. Johnson

    Johnson Member

    Most collateral history taking stations I fail even though I feel I have done well - I am missing something
    Is it consent from patient ?
    The same for all mental state examination !!!

    Update 16 July 2017
    Now I thought I will verbalise that " I would like to see the patient myself..."
    Last edited: Jul 16, 2017 at 12:49 PM
  7. Johnson

    Johnson Member

    I failed cognitive examination station

    I did to the word MMSE - as I was told in a course
    On reflecting started to read - a very useful book " Maudsley handbook of practical psychiatry 4e" pg.69

    " A MUST READ CASC preparation book" esp. MSE and cognitive examination [ this is important as in certain CASC station - it says perform a cognitive examination or MSE

    If you do only MMSE - a sure fail in casc station, no wonder I kept failing when I thought I did well, this is also important that some of us think we did well, but fail that station....I am sure we all have heard of it....

    Cognitive examination is not just MMSE

    Now 6e is out and Simon Wessley - co author /edited " does it ring a bell"

    https://www.esharingbook.com/index.php?threads/casc-books.91/ [ 13 July entry]

    Last edited: Jul 15, 2017 at 6:41 AM
  8. Johnson

    Johnson Member

    Sometimes I was not sure how to introduce, so far did as " I am one of the psychiatrists " changed to " I am a psychiatrists in...."
    Reflecting and was advised
    - When reading the scenario for the station - say what its mentioned there , like " I am a SHO in A&E" etc..

    I would suggest to listen to videos [ not to watch] while driving with a good mobile internet [EE has introduced car mobile internet...]
    Last edited: Jul 15, 2017 at 6:51 AM
  9. Johnson

    Johnson Member

    when I thought I did well but later failed [ same stations in 2 casc exams ]

    Reflecting [ not sure whether i did say or not, but will try in my next casc and see what happens - research minded but paying a heavy price, some learn the easy way and some learn the hard way, for me the latter...]

    In LD stations [ 2/3 casc exam has come] - speaking to mother - I would like to see the patient asap [think of abuse]

    In alcohol where wife asks husband to go for help [ 2/3 casc exam ] - speak to his wife [ think of domestic violence]
    speaking to mother about autism - see the child etc.......

    In ideal world we would have done these naturally, but in casc world - VERBALISE to the examiner and I think casc might be about communication and being safe

    Perhaps this is where some of us go wrong, not having a holistic approach, as most of us do have the knowledge because people who fail casc repeatedly make good locums

    Lesson of the day
    speak/see the patient - if gathering collateral history from friends and family
    speaking to the patient - gather collateral history from friends and family before any decision making and ask for consent
    Perhaps in casc I was told if we don't say the right "WORD" - its a fail [not sure whether this is the case]
    Last edited: Jul 15, 2017 at 6:46 AM
  10. Johnson

    Johnson Member

    After taking cacs multiple times [I am thinking to hold the world record:cool: ]
    key learning points
    1. stick to the task
    2. its vital to differentiate between
    mental state examination
    cognitive examination
    psychopathology[ here depth is important ]
  11. Johnson

    Johnson Member

    In other forums candidates vent their frustation , which is understandable
    Candidates should be prepared to any stations [ new or old]
    All can't become consultants - then who will do the staff grade jobs [ I predict in future there will be less white doctors, working as SAS doctors, compared to now]
    This is the hard reality - we should get used to it - blaming or even speaking about it - I consider is just waste of our time
    As Asians, some are unlucky, not everyone
    the key thing is not losing hope- life is more than passing casc
    please maintain an uptodate eportfolio [I will be working on having our own eportfolio online] so as to become a consultant thro' ? Article 14 or to become a AC

    Lesson of the day
    Knowlegde matters to survive in any part of this world
    Blaming anyone is a waste of time
    Consider your self lucky working as a doctor [in any grade] in this country - as I was told by a senior colleague for whom I have great respect [ by the way he is English and also a professor ], these are his exact words
    " Johnson, its a privilege to work as a doctor in this country [ meaning UK] " After our conversation I was driving back home reflecting on this , and I thought " I couldn't agree more" for someone [me] who started the life in UK working in a Shell serving station, then as a carer for elderly, for people with intellectual disabilities etc.. and here is the best bit

    - All the investment done for 7 years for my under graduation in Russia was earned with my first year's salary in UK:)
    - I worked for 70 odd hours per week and earned less than £1500/month before, now as a doctor, I work 40 hrs/week and earn 4-5 times more:)[net income] and driving a nice car, so how could I disagree with my colleague.
    So I and my family are very grateful to UK
    But this doesn't mean I agree with the system, some of my seniors need to have a mature thinking, its sad to know some or the system hasn't moved on...
    Last edited: Jan 10, 2017
  12. Johnson

    Johnson Member

    My friend's journey thro CASC [ last attempt was Sep 2016]
    [any additions will be in green]
    4 attempts
    1st - passed 5 stations and below the aggregagte [ trainee ]
    2nd - passed 6 stations and below the aggregagte [ trainee ]
    3rd - passed 8 stations and below the aggregagte [ trainee ]
    4th - passed 11 stations and above the aggregate [ was doing a post as locum speciality doctor] [ lets analyse... ]
    what was different on 4th time
    1. Stick to the task means you would complete in the right time and even have time to summarise- MSE means MSE, cognitive means cognitive and psychopathology etc.. [ he told me now the result sheet exactly reflects the task he did for that particular station - knowing this it very important] [ the stations on result sheet we get reflects exactly the number of the station in the real casc exam- always start from 1st station starts from left to 8th station would be the last to the right - this is important as you have start station 4 in single which would be the last on the left - i hope i am making sense here ] [ he is gone one step ahead - speaking to the footballer's father on 8 September 2016 was about communication, which reflected on his result sheet - here listening skill might be tested - if you interrupt you fail - well its only a hypothesis ] [knowing these ins and outs are vital to improve and pass the casc for someone with multiple attempts]
    [failed in both 7 min stations where my friend summarized - perhaps missed to ask certain questions]
    2. General adult - this time he was doing a post in GA inpatient, but mentioned he wished he did this at least 2-3 months before taking the casc, as he found very very useful for casc preparation
    3. Relaxed - my friend did not attend any mocks prior to his 4th attempt [ but mocks are very useful ][ I heard some who passed expensive mocks failed in casc and vice versa]
    more to come....

    My bizarre :rolleyes: inferences [ only a hypothesis]
    If you are a foreign graduate

    1. PASS all written papers FIRST TIME WITH FLYING COLOURS [ meaning close to 100]. E
    ven if you have a slightest doubt - DO NOT TAKE IT.
    Last edited: Oct 6, 2016
  13. Johnson

    Johnson Member

    Recently I attended a free course run by English - not that common in UK [ I can't get my head around why did they run this course.....] anyway...
    I got the answer for a perennial question
    In UK its recommended to address a patient by their surname - Mrs Rogers, unless otherwise the patient insists
    CASC is checking skills and competencies [ no marks would be given for telling in the last minute that you will do this and that...]
    Try to follow the patient, which is more important that just ticking the boxes

    Today I made a mockery of myself, as this was next day after my 2 week holiday from Sri Lanka, the examiner asked that I didn't pick up the cue " gifted" in a manic station. I was wondering, did he really say that......:confused:

    before taking the exam - relax [ movie, yoga etc..]
    Last edited: Jul 15, 2017 at 7:22 AM
    Haytham Mekki likes this.
  14. Johnson

    Johnson Member

    I spoke to a friend who has failed casc few times, who told me that she couldn't work out which stations she passed /failed

    I believe the first on the left is station 1 [ first 4 on one side and last four stations on the right side]
    my first casc - I couldn't get my head around - most says MSE - fail [ i thought that was not MSE]
    now I can point out even which one was communication, hence i passed 11 stations [ believe me its an achievement] this was only possible by sticking to the task
    Last edited: Jul 15, 2017 at 7:22 AM
  15. Johnson

    Johnson Member

    Some of the questions asked by an English consultant during reviews

    How are you feeling today?

    Do you feel depressed?
    How is your mood today?
    In term of happiness, out of 10, can you rate your mood?

    What do you enjoy doing in your spare time?
    What do you enjoy doing?

    Are you drinking plenty of fluids to keep your kidneys working?
    Are you eating alright?
    What is your appetite like?

    Did you sleep alright?
    How much sleep did you get?
    How is your sleep?

    Self esteem
    How do you feel in yourself?

    Have you ever felt bad about yourself?

    Suicidal thoughts
    Have you ever felt life worth not living?

    How is your awareness of time and place?
    What is the name of this place?

    Have you had any unusual thoughts, that you can’t understand or explain?
    Do you ever see things that aren’t there? like hallucinations
    Do you ever hear things that aren’t there? like hallucinations
    [example in a practise session the consultant was a patient in a psychosis, patient mentioned " the voices telling him to hurt others", later some point I asked "do they talk about you" to stick the third person hallucinations. The feedback was that I was not listening to the patient as I could have asked more about second person hallucinations and then asked " Does the voices ever talk about you"

    When did you have a normal bowel opening? [How is your bowel opening? ]
    Does anything trouble you?

    I have been marked many times to be formulaic in casc , some are marked here in red
    Last edited: Jul 16, 2017 at 12:59 PM
  16. Johnson

    Johnson Member

    Recently I am very privileged to have 1-1 sessions with a English consultant and in recent teachings and few I learnt on reflections [ these are only personal reflections as I have been marked several times to be formulaic]

    1. Consider to use words like "worries" instead of "concerns", "talk " instead of "speak"

    2. Any medical conditions like blood pressure, diabetes [ esp. important in pervasive conditions like asking Any medical conditions like epilepsy, diabetes.. instead of "do you have any medical problems"

    3. Most casc stations I have passed I have noted that I have been asking “any other symptoms” example in linked station for agoraphobia, l asked for symptoms of GAD, social anxiety, panic attacks etc.., similar in opioid and pregnancy – I spelled out most other drugs name like ketamine, magic mushrooms…. And this could apply for vice versa in ADHD station, when a mother [actor] says “ my son is always on the go…” and if pause, well don’t forget to acknowledge or show some empathy and ask “ you told me XYZ, anything else you or others might have noticed”

    4. Any family history of depression and anxiety [ in depression station] instead “any family history of mental illness”

    These reflections have taken 5 casc attempts , and certainly doesn’t mean I will be passing next time. But I am very pleased that I can put such reflections in day to day practise and this is the best part.
    Last edited: Jul 16, 2017 at 1:01 PM
  17. Johnson

    Johnson Member

    In some stations like I have noted some similarities, examples like
    Fire setting - exclude OCD, PTSD, EUPD, short duration
    Gender dysphoria - OCD, long duration
    BDD- OCD, EUPD, long duration

    Recurrent thoughts are common [ after routine questions, something I would like to ask in above stations ]
    "How much time do you spend thinking about them ?"
    "Are they distressing?"
    "What happens if you try not to have these thoughts?"
    "Was everything alright in your childhood or Would you say you were happy in your childhood"
    instead of " How was your childhood"
    [ I was always marked to be formulaeic in CASC exam, I thought it was worth the try to do it differently after all, as its only still my 6th attempt in Sep 2017. I say to myself "go Johnson go" "forget about £918" . I am happy at least someone might be pleased, I meant the College:mad:.
    Last edited: Jul 16, 2017 at 1:22 PM
  18. Johnson

    Johnson Member

    General feedback from a English consultant
    If English is not you first language, try to speak only in English for a period of time before CASC
    To read books/watch , esp. P.G Wodehouse works - Jeeves & Wooster

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