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Recorded Consultation Assessment (RCA)

NEXT LIVE RCA WEBINAR EVENT

PRE-RECORDED RCA TRAINING WEBINARS

  • These collection of 4 training videos (about an hour long each) have been highly rated by previous trainers and trainees.    These training videos are good for BOTH trainees and their trainers.   Trainees – you will truly understand what the RCA examiners are looking for.   Trainers – you will understand how to help your trainee and assess their videos more reliably with an RCA construct.   (Trainees – point your trainers to this page).
  • The information has been collated from a group of RCA examiners – not just one!   And they contain examples of how to do things (including Ram role-playing with himself.)

PASSWORDS NEEDED FOR THE FOLLOWING
(click pink button below to pay)

Data Gathering + InterPersonal Skills

Clinical Management + InterPersonal Skills

The RCA Marking Sheet – part a

The RCA Marking Sheet – part b

You will receive a password via email after payment.    
Any problems, email bradfordvts@gmail.com 

RCA posts

UPDATE: RCA webinars now available online!!!

Online courses with Dr. Ramesh Mehay

THE BRADFORD VTS RCA WEBINARS

Bradford VTS has produced 6 hours worth of material to help educate you about the RCA.   These have been derived from the successful series of RCA webinars that have been run.   

  • To make them easier to watch, we have broken them down into six 1-hour tutorials.
  • There are two 1h tutorials in webinar 1 & 2 and one 1h tutorial in each of webinar 3 & 4.
  • RCA webinars 1 and 2 focus on the 3 domains – Data Gathering, Clinical Management and InterPersonal Skills.  Webinars 3 and 4 look at the marking sheet in detail – and the subcomponents which make up these 3 domains. 
        • RCA webinar 1 focuses on Data Gathering and Interpersonal skills.  
        • RCA webinar 2 focuses on Clinical Management and Interpersonal Skills.
        • RCA webinar 3 – focuses on each of the Data Gathering subcomponents as detailed in the marking sheet.
        • RCA webinar 4 – focuses on each of the Clinical Management and Interpersonal Skills subcomponents as detailed in the marking sheet.
  • We have edited these videos so that “unfocussed chitter-chatter” is removed.
  • We have annotated the video clips to help emphasise and help you understand things.
  • There is a lot of other information in all four webinars – especially practical hints and tips.   
  • And there are demonstrations on how to do certain skills. 

We strongly recommend watch all 4 webinars.    If you are unsure, at least consider watching webinar 1 and 2 first. 

Data Gathering + InterPersonal Skills

Clinical Management + InterPersonal Skills

The RCA Marking Sheet – part a

The RCA Marking Sheet – part b

Their is a £33 charge for each video, which in the grand scheme of things is not much.  But proceeds to help to fund the Bradford VTS website and continue the good work we do.

Some Feedback

What people are saying

Q

Ram's RCA Top Tips & Help Files

The information below is available as a pdf file in the Downloads section above or here:  rca desk prep sheet by bvts.pdf

Before the Surgery

A notice to say that you are doing recorded consultations & DO NOT DISTURB.

DOWNLOADABLE FILES

Advise your admin staff what sorts of things to book and what sorts of things note to book.  Tell them exactly what sort of consultations are considered too simple consultations – remember, they are not doctors and they cannot second guess you.  So make a list of things that aren’t good like hayfever, stye of eye, otitis media.  And don’t just do this the once.  Do it every before every surgery with all admin staff working that day on front desk – and keep doing this until the whole team has been covered.  Allow them to ask questions – it is a sign they really want to help you.  Here’s a small list of things not to book in with you.  Please build a list yourself.

  • Haemorrhoids (piles)
  • Simple eye problems – conjunctivitis, stye
  • Simple urine infections
  • Sick Note requests
  • Medication requests
  • And in particular – patients asking for a review appointment – a review of something a GP has previously seen them with.

DOWNLOADS

If you get a good system in place for others to follow – this will help with time efficiency in the consultation.   Clearly, you want to spend most of the consultation talking about the clinical problem and its management – not on administerial stuff like waiting for a photo to come through or organising an appointment for them or waiting for them to find a private room!   So, get reception staff to prep the patient – things like…

  1. Consent  
  2. photos for rashes
  3. T-shirt and shorts for MSK probs 
  4. Find a private room 
  5. Somewhere to prop up the phone
  6. reminder – this is a 10 min consultation.

In terms of items 2-6, get a practice system in place – it will be good for the other doctors too!   Get  reception staff to do this not you – but train them up so they do it adequately.   Why the reception staff?  Because RCA examiners want to ensure you have not had too much prior contact with the patient and “briefed them up”.  Besides, it saves you time.

If you select simple cases for the RCA consultation, you won’t get many marks.  In fact, many simple cases only score 3 marks (1 for DG, 1 for CM and 1 for IPS) – because it is difficult to score more than this because the very nature of simple cases does not help you demonstrate high order consulting and clinical skills.   So, get the other doctors in the practice to help you.  Remember, the doctors working that day with you are unlikely to be familiar with the RCA.    So, tell them what it is about and tell them what sorts of cases are good for you and which ones are not.    

  • New presentations not reviews or follow ups.
  • No simple ones.  
  • Give clinical examples.
        • Haemorrhoids (piles)
        • Simple eye problems – conjunctivitis, stye
        • Simple urine infections
        • Sick Note requests
        • Medication requests
        • And in particular – patients asking for a review appointment – a review of something a GP has previously seen them with.
  • Will they be happy for you to swap one of your easy ones for their more complex ones (I can’t see them saying no).

DOWNLOADS

Look at on-call list.  Select NEW Cases.   Do NOT pick follow-ups or reviews.  Select challenging cases not simple ones.

10-15 mins Before the Call

Sometimes, admin staff will put on the screen some idea of what the call is about e.g. “swollen leg”.   If this is the case, then think about differentials and clinical avenues to explore. Jot them down on a blank piece of A4 to help organise your mind.   DO NOT MAKE EXTENSIVE NOTES – it will distract you.  Just 1-2-3 word notes.  And space them out onto the blank sheet of A4.  Don’t just scrawl them in a little tiny corner!

DOWNLOADS

GPN = GP Notebook.     Don’t spend too long here.  Only 5-10 mins.  Remember,  you know most of this clinical stuff.   The reason I am asking you to SKIM READ through something like GP Notebook or CKS is simple to help you PICK OUT THINGS YOUR MIGHT FORGET or to simply HELP ORGANISE YOUR BRAIN so that the consultation is done in a structured, comprehensive and safe manner.   After all, this is what the RCA examiners are looking for – that you are structured, comprehensive and safe – they are more interested in this than you covering every single minute detail.  

So, skim-read things like

  • Differentials or Clinical Systems to explore
  • Essential Hx for above
  • Red flags not to miss
  • Latest Guidance (CKS/GPN)

But remember – the aim is to to fill in your gaps, not to review what you already know!

LINKS

You may find it helpful to make notes before you call the patient after you have looked at their medical records and reviewed the clinical topic on something like CKS or GP Notebook.      Things you may wish to make a note of are things like

  • Clinical Systems or Differentials to Explore, e.g. for SOB “explore heart, lungs, anxiety”
  • Clinical History bits not to forget, e.g. for SOB “don’t forget PE/DVT”, for depression/anxiety: “don’t forget suicidal risk assessment”
  • Red flags not to miss, e.g. “Don’t forget meningitis”
  • The latest Clinical Management advice.

The whole point of jotting things on an A4 was alluded to earlier in point 1 above: 

  1. To help organise your mind OR
  2. To help you remember things you might forget.

Remember, you are not making notes on things YOU ALREADY KNOW, but rather to make notes on areas you might forget about or simply to provide a structure for your mind.   The key is NOT to make your notes too wordy or list’y.   Keep very brief – one or two words is best.  Not sentences.  Otherwise, you will focus on your notes sheet rather than the consultation, and your consultation flow will be ruined, and you will miss essential bits of the talk as the patient speaks (i.e. you will miss verbal and non-verbal cues). And use a new sheet of A4 for each patient.

I repeat – PLEASE PLEASE PLEASE remember to keep these notes brief.    If you make them detailed, you will be more concerned with your notes sheet than the patient and you will miss what they say and the consultation will lose its natural flow.   So, in order to prevent this…

  • Write 1-2-3 word things down.   
  • DO NOT write down everything you need to cover.  It will confuse you and you mind will become distracted and lose focus in the “here and now”
  • Just jot down things that you might forget or things to help organise your mind.
  • Perhaps a maximum of about 5 items.
  • Space them out over the whole of the blank A4 sheet.  
  • Use a brand new blank A4 sheet for the next patient.  You don’t want to clutter the next patient with the previous patient’s notes do you!

DOWNLOADS

2 mins Before the Call

Set the timer or clock on your desk.   At 5-6 mins, move to Clinical Management!

  1. The last 3 consultations
  2. DH
  3. PMH
  4. Letters
  5. Blood/Test Results

To quickly refresh and remind you of things not to forget or to structure your thinking.

This will enable you to talk with your body and hands freely (even if the patient can’t see you).  Speaking with your body and hands affects the way you speak.

This may sound silly but trust me, it will get your brain into the right frame of mind. It really works.  Just try it.   Don’t spend too long here.  Just enough for you to feel good.  This 10 second exercise makes you positive and welcoming.  This increases the chances of success in the consultation.

  • Think of a person you love, a favourite place/holiday.
  • Think about them or it for 10 seconds.  
  • When you notice that you naturally smile thinking about them, then you are ready to place the call. 

 

Beginning the Call

Here are some examples.   Try and see if you can make one of your own that fits in with your personality.

  • A good example:
  • “Hello my name is Dr XXXX.   I am one of the GP trainees nearly at the end of my training.   I want to thank you for agreeing to this recording which is for my final assessment.  I will check again at the end of the consultation to see if you are still happy for me to use it. Is that okay?”
  • If you have a speech impediment:
    “Hello my name is Dr XXXX.   I am one of the GP trainees nearly at the end of my training.   I want to thank you for agreeing to this recording which is for my final assessment.  I will check again at the end of the consultation to see if you are still happy for me to use it. Before we start, I just want to let you know that I have a bit of a speech problem – I stammer, so please bear with me.  Is that okay?”
  • If you have a strong accent:
    “Hello my name is Dr XXXX.   I am one of the GP trainees nearly at the end of my training.   I want to thank you for agreeing to this recording which is for my final assessment.  I will check again at the end of the consultation to see if you are still happy for me to use it. Before we start, I just want to let you know that I know I have a very strong accent.  So if there is anything you do not understand or if I confuse you, please stop me and let me know – I will not be offended. Is that okay?”

Try and use 14Fish to do the recording – because their consent process is really easy, smooth and comprehensive.  It means you don’t have to do much other than the “opening statements” listed in the point above.  If you are using iConnect, then you will have to do the consent process in full.  And if you show the consent process on your recording, it has to be done properly or there is a risk that your consultation recording can be rejected and you get no marks no matter how good that consultation is!   So, if you talk about consent – make sure you do it properly on iConnect.  Don’t worry about time running out – your 10 minutes only starts after the consent process at the point at which you say “How can I help you” or “What would you like to talk about today?”

DOWNLOADS

During the Call

Only look at the clock occasionally.  I would suggest that in a consultation, you should only have to look at the timer 2-3 times.  No more.   The first thing you are looking for is the mid-point where you need to start moving from Data Gathering to Clinical Management.   After that, your are looking for the 2 minute mark where you need to wrap up, safety-net, follow-up and close.

Remember, you should be moving from Data Gathering (DG) to Clinical Management (CM) at the 6 min mark for 10 min consultations (7 min if you have 12 mins).  HOWEVER, don’t wait for this point to arrive, though.  Instead, start wrapping up the DG a minute before (i.e. 5 min for 10 min, 6 min for 12 min).  So, look for the 5 min mark (10 min consultations) or the 6 min mark (12 min consultations).

Follow a consultation structure because it will help provide a framework for your mind to loosely follow.   Frameworks help you cover things…

  1. in a structure way.
  2. in a comprehensive way.
  3. in a safe way – making sure all generic areas of a clinical consultation are covered and nothing big is missed.
  4. in a time-efficient way.

Use whichever consultation model fits in with your personality.   I’ve developed one specifically for the RCA – but feel free to ammend this to suit your personality or the way you think.

Ram’s RCA Consultation Model

  1.    ROLA: ROLA = Rapport (be nice, smile), warm Opening, Listen, (set the) Agenda
  2.    The Story & then Clinical History
  3.    PSO & ICE
  4.   Any preliminary examination worthwhile doing on phone/video?  (not always necessary, especially if you have decided you want them to be seen)
  5.   Verbalise diagnosis/differentials   – give your professional clinical opinion.  
  6.   Further Clinical Ex & Ix
  7.   Mx plan – drugs, referrals etc
  8.   FU & Safety Net (Ram’s EDF)   – (i) explain what you EXPECT to happen, (ii) explain symptoms/signs indicating a DEVIATION from the norm, (iii) provide specific FOLLOW-UP advice.

The Pivotal Moment: at around 6 mins for 10 min consultations (7 mins for 12 min consultations), move away from data gathering, state your impression, and move onto clinical Mx.  Phrases like…

  • “I’ll tell you what I’m thinking…..”  
  • “My recommendation is…
A good tip for Clinical Management: When you are ready to start explaining the diagnosis or clinical management plan, if the patient has shared with you any thoughts of their ideas, concerns or expectations – start with that first before you go on to explaining your own.  
e.g. ” Mrs. Smith, I have some good news for you.   I know you were worried about your headaches being a brain cancer and you wondered whether you needed a scan.   The good news is that I don’t think you do.   People with brain cancers will get a change in vision or vomiting or fitting episodes and you’ve not had any of those, which is great.  The other good thing is that on examining you, your brain and nerves seem to be working just fine.   I do have a good idea what I think it may be and what we should do.   Would you like to hear my thoughts?”   (NB How can she say no? LOL).

DOWNLOADS

What can you show on video?

This has recently been changed.   Now, it is permissible to show flesh on the video recording PROVIDING there is no showing of the private areas.   The private areas being the area where a male wears shorts, where a female wears a bikini and where a baby wears a nappy.   In other words, don’t show female breasts.  Don’t show the genital area.   Don’t show bums.  

I hope the diagram on the right helps.

The next LIVE RCA webinar with Ram

  1. Dates: Sunday 3rd January 2021
  2. Times: 530-8.30pm
  3. Cost: £65 
  4. Places are limited.
  5. If you would like Dr Mehay to run another one, email him on rameshmehay@googlemail.com and specify when you think would be a good time.
  • Practical Set Up Tips
  • Consultation tips and tricks
  • Complexity of cases – choosing the right ones.
  • Truly understanding the Marking Scheme and what the Examiners are looking for.
  • How to perform to get the marks.
  • Doing examinations.
  • Describing Clinical Management.
  • Top Tips in Data Gathering
  • Top Tips in Clinical Management
  • Top Tips in Interpersonal Skills. 
  • Demonstrations.
  • A marking sheet – for you and your trainer
  • Ask your questions session.
  • This plans to be an interactive set of webinars – not just me talking throughout.

Ramesh Mehay runs webinars when there is a need.   He doesn’t do them often but if there is a great need he will do them.    He has done two highly successful webinars to date.   Their success is because he covers things they don’t tell you – things not on websites.  And the other reason is because he demonstrates how to do things in a variety of ways.   He will show you ways that are acceptable and he will demonstrate things that trainees do which are not acceptable. 

So, if you want Dr Mehay to run an RCA webinar, please place your request through the comments box below.  Say which month.  Say which week of that month you would like it.  He will then try and pick a week that is good for the majority.

  • We would be most grateful if you do not share passwords for things you have purchased on this website with your friends and colleagues.   This is for one main reason: Bradford VTS doesn’t get much money from external sources.  In fact, a lot of the funding comes out of our own pocket and contributions from kind people – mostly your trainers.
  • We try to keep the site as FREE as possible, and occasionally we ask for money for just the odd resource here and there.    We rely on this little bit money to help fund us.   We don’t ask for much as you can see – compare it to the 100s you pay for exam courses!    We hope you think we are fair and reasonable.
  • Also, we should let you know that sharing passwords may result in the online software blocking you if it sees another person is using a password that is only meant to be for you.    We would hate for that to happen to you.   Especially if you are looking forward to joining us on a password enabled Zoom webinar.
  • At the end of the day, Bradford VTS was created for one main reason – to simply share ideas, knowledge and skills so we can co-create to produce wonderful new things effortlessly.   Bradford VTS is made with ❤ by Dr Ramesh Mehay and others.  It is an unfortunate fact that most of our funding comes from GP trainers and very little from Trainees.  If you would like to change this, then please click on the contribution page here.

Marking RCA videos (for trainees & their trainers)

Please use a proper RCA marking sheet when assessing RCA consultations.   

I see many people do this: They look at the RCA recording in terms of 3headings – DG, CM and IPS.  They then decide how good it was in each domain by their rough gut instinct.   This is NOT a good way to assess RCA consultations.  This method produces high false passes that will not be mirrored by what the RCA examiners give.

Instead, use a detailed marking crib sheet – see rca marking sheets on the right.  This is the same sort of proforma the RCA examiners use.  In other words, YOU HAVE THE ANSWER SHEET provided for you.  If you follow it, there should be little chance of going wrong.

So, in summary, always use a detailed RCA marking sheet and not just guestimate from your inner gut feeling.   Look at the components of what makes a case pass and what makes a case fail for each domain area (DG, CM & IPS).  If you do this, you are more likely to be in synchrony with the RCA examiners.

A special message to GP trainees.

  • Some trainers will be reluctant to give you a mark out of 3 for each of the domains when watching and assessing your RCA consultation.
  • This is because they have been asked (by higher authorities) not to give marks as they are not trained RCA examiners and more importantly so that you, the GP trainee, does not blame them if you fail.
  • But equally, we appreciated that it is difficult for trainees to bench-mark themselves and know how good they are if they are not given an idea of marks.  Especially as trainees are relatively new to General Practice unlike their experienced GP Trainers.
  • I would therefore suggest, that if a GP Trainer does give you marks, please be understanding that they are giving you these marks to help align your level of analysis and marking with theirs – because it is more likely they will be closer to the examiner’s marks than yours.   
  • Also be mindful of the intention of the GP trainer who gives you marks – to help give you some idea to improve.  
  • So, if you fail, please do not blame your trainer.  The person who failed is you, because your skills were not up to scratch.  Your GP Trainer’s advice is likely to have pushed up your marks, even if you did not reach the pass mark.   You are more likely to have failed more badly if that trainer gave you no advice.
  • So, please don’t blame your trainer.  They truly want the best for you.  They want you to pass.   But whether you pass or not, depends on YOUR skills, not theirs.  The RCA is an assessment of the trainee, not the trainer.
  • If you do find yourself failing, thank your trainer for the help they have provided thus far, and discuss how to increase your chances of passing the next time around.   Listen to them and your TPDs. 

In no time at all, your 14 Fish account will be full of recordings.    As you and your trainer and reviewing them, it is important to have a good MARKING system right from the start to signal which recordings are really good for submission, which are okay, which one if you are really desperate and which ones are bad.

If you don’t have a marking system right from the start, you and your trainer will get into an awful muddle and you will find yourself lost.   Neither you nor your GP trainer will know which are good, which are bad, and which are somewhere in between.  So, follow my system as detailed in the next two columns.   Show this section to your GP trainer. 

By the way, PLEASE DO NOT DELETE ANY OF YOUR RECORDINGS NO MATTER HOW BAD YOU THINK THEY ARE UNTIL YOUR TRAINER HAS SEEN THEM  – because sometimes you will think it is bad but the trainer will think it is quite good in places.  This is because your trainer understands the RCA marking system better than you.  That is why they are a trainer after all.   And sometimes, you might have done so well in (say) Data Gathering in a lot of the other cases, that it is okay to include one which isn’t so great but is strong in CM and/or IPS.

As a GP trainee…

So, I have come up with the following suggestion. Once you have done your recordings, have a look at each one yourself. Remember to look at it from three angles – Data Gathering, Clinical Management and InterPersonal Skills.  What score would you give yourself out of 3 for each of the DG, CM & IPS areas. Now decide if the recording is one of two grades.

  • (+) Is it a possibility for RCA submission?  Then, under the TITLE of the Case, put a plus (+) before it.  For example “(+) Lady with headaches”
  • (-) Is it really bad?   If so, put a minus (-) in the title.  For example “(-) Man with knee pain”

And that’s it.  Now, your trainer can see at a glance ones which you think are okay and those which aren’t.   They can focus just on looking at the good ones and see if they are good enough.  

If by the end, there are not enough good ones, they might want to look at some of your bad ones in case you have been too harsh on yourself.  

 

As a GP trainer…

Start by looking at the ones the trainee has marked with a *.  These are the ones the trainee thinks are okay.  What score would you give out of 3 for each of the DG, CM & IPS areas? Now decide if the recording is one of 4 grades.  (Add the following codes to the title so you can see at a glance which ones are which grades).

  • (A)   means the case is great.
  • (B)   means the case is okay.   Use if, by the deadline date, the trainee is short of numbers.
  • (D)   means the case is borderline.   Use if desperate for cases near the deadline date.
  • (E)   means the case is bad.  Don’t bother using this one at all. 

And that’s it.  The absence of a C grade forces you to make a decision where the case is at – it moves you off from sitting on the fence.   If you do this progressively as you review your trainee’s recordings, in the end, near the submission date, you will be able to see at a glance which ones to cherry-pick and send off.  

A bit of fun...

Seriously, this is just for a bit of fun.   I thought it was quite funny.   But there are elements within this “doctor” that we see in trainees who submit for the RCA.  These things will result in a failure….

  • Asking closed questions right from the start. 
  • Being too formulaic – following a “formula of questions” rather than trying to open up the story and understand the narrative.
  • Not exploring deeper with the patient about their psycho-social circumstances.
  • A lack of empathy or genuine interest in the patient.

Anyway, watch and enjoy.

Do you have any good RCA resources that you have found?
Have developed a resource of your own?
Please email it to me to share with others via this page.

'Make GP Training Better Together'

The RCA - Recorded Consultation Assessment

Next Session: July 20th & 21st, 2020
7.15pm - 915pm (willing to change if the majority want a different time or date)
You have 1 month before submission
Now is the time to get trained up...

£75 to attend one or both sessions (there may be some duplication, depends on the audience)

(proceeds go towards funding www.bradfordvts.co.uk which does not recieve major funding from anywhere; keeping it free for you)
This session will totally focus on consultation skills.
It will not focus on things like uploading, getting consent etc which is covered well on the RCGP website.
I want to focus on CONSULTATION SKILLS that will help you pass.
Things like...
The Marking Sheet
Controlling the talkative patient
Time management
And other marking domains.

I would like you to know that I feel for all you wonderful trainees who are in a mad panic about the RCA.
So, to help, after a very successful first Zoom webinar (and I wasn’t planning on doing more), I have decided to run 2 more sessions.  
I am familiar with this sort of assessment.   I have been a GP for 21 years, Training Programme DIrector for 17 years and we had a similar assessment before the CSA.  
So, I kind of know what they’re looking for.  The marking scheme is not unfamiliar to me.

Would this suit you?  Email me if you want to attend.  rameshmehay@googlemail.com

Also, leave a suggestion of what sorts of things you want covering.

Dr Ramesh Mehay

What would you like me to cover in Sunday's webinar?

Please write in the comments box below all the things you would like me to cover.   I am thinking about a 90 minute session where you can (hopefully) interact with me.      Ramesh Mehay, Bradford

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