5 Magic Steps to Pass the CASC and OSCE Exams and Excel in Clinical Practice! – MRCPsych, RCPSC and RANZCP

You’re probably thinking: “Oh no, not another one of those articles on how to do this and that!” Ok I’ll be honest; the steps are not magic. But they have the potential to be magical depending on one’s definition. Firstly, you have to believe in what I’m about to share with you. Why? Because this has worked for me over several years and helped hundreds of others for exams and clinical practice!

What if I told you there are 5 steps that will take you to where you want professionally? Not only passing the exam but also excelling in your psychiatry career. Interested?

STEP 1- PASSION

When passion is mentioned people often wonder, “Why do I have to be passionate about giving an exam?” What’s passionate about that? You see, passing an exam is one step on the journey to becoming a psychiatrist.

Hopefully you are doing the exam because you are passionate about psychiatry and wanting to go on to do bigger and better things. If you’re not, I suggest you don’t read the rest because it doesn’t apply to you.

You will pass the exam – eventually everyone does. The more attempts you make at the test, the likelihood of getting a positive result increases just by chance (remember multiple significance testing in critical appraisal?).

But if you are passionate about psychiatry and want to become a clinically well grounded psychiatrist, read further. You will take on what comes next and use it in the best possible way. I can speak from personal experience as passion, lots of small doses of luck and meeting the right people has helped me add value to education and patient care through my businesses and investments.

The thing is; the examiners are your judges only for the exam. They play only a very short role in your life. Your real judge as a psychiatrist is your client, the patient.

If you want to make a real difference, psychiatric interviewing skills combined with knowledge are absolutely crucial. This is your role and you have to do it justice. I have outlined below what it really takes to develop the skills, but it all starts with a passionate approach!

STEP 2 – DEVELOP YOUR INTERVIEW SKILLS

This is one of the most crucial components of the CASC and OSCE exams and also the most difficult one to develop. In medicine for example, a cardiologist will show you the entire process of examination, first telling you exactly what to look for and then the Registrar or House Officer spends many years developing those skills of picking up diagnoses. The point is that the benchmark has been set by the senior.

In psychiatry we see isolated practice all the time, and very rarely do you have consultants that show you exactly what is to be done, why and how.

Yet this is exactly what is needed to become a good psychiatrist and this is exactly what the CASC and OSCE exam  is evaluating. One can spend hours attending courses, practicing and reading books but one has got to know what benchmark they aim to match; things that actually work in reality and therefore also in the exams.

The message is: You have got to ask your consultant to perform these skills in their entirety and then have a discussion. The consultant psychiatrist must be able to show you the entire process in a structured and time efficient way for it to be learnt.

Modelling is one of the most effective ways of learning practical skills. The benefits of efficient interviewing are most evident when you enter private practice or are doing out-patient reviews in community settings.

The streamlined nature of your assessment and management allows you to provide value to a greater number of patients and maximise your return on time invested.

STEP 3 – TIMING

Often candidates start practicing and thinking about the exam when they actually come closer to the exams, whilst all this could have been done every day in their clinical practice.

This, of course, links in with step 2, but unfortunately not many are shown a benchmark and therefore spend hours assessing people without probably ever knowing what is required.

So start early, don’t wait until just a few months before the exams to start learning the basics.

STEP 4 – PRACTICE

In order to understand the power of practice, one has to go back to the basics of memory. We know that when you first observe a process it goes from sensory memory to your Short Term Memory (STM).

STM is finite and is extended with chaining. To convert this into your working long term memory, what do you need?  Yes, you need rehearsal, repetition and connections to real life experiences to transfer that into long term memory where it gets stored indefinitely.

When you need to use this memory you retrieve it to make it part of your working memory so you can execute the task. It becomes part of you, without needing any active focus on the process.

To give you an example, think about driving. You don’t always remember how you get to work, you don’t think about the number of gears you changed, lights you passed, the turns you took. It’s all there at your ‘spinal’ level. The only way of getting it there at the ‘spinal level’ is by rehearsal. Threfore, the most powerful way of developing interview skills is by rehearsal, and this involves rehearsal with your visual, vocal and audio senses (sensory memory: iconic, visual and audio) all at the same time.

Let me be honest with you, it is very easy to sit on the other side and give someone feedback on the process and what needs to be changed. There are several courses out there where you can go and practice a mock CASC or OSCE, but this is only beneficial if you have practiced the skills before the mock course.

I know that because not only have I attended several courses, I facilitate training courses myself. You may view some good candidates, some not so good, with only verbal and written feedback taken home. That’s all great, but that feedback needs to be incorporated and rehearsed several times so that it becomes part of your interview and you don’t always have to think of the next question. You must know exactly what the benchmark interview looks like.

Most of the REAL learning occurs on the go. For example, if someone tells you a psychotic symptom you must have a list of questions that you ask as part of your working memory and the art is incorporating empathic statements so that it doesn’t sound like a checklist.

But if you do not have these questions at your disposal at the drop of the hat, you have to think, the anxiety comes across to the person viewing you and the empathy goes out the window!

The only way you will develop this is by practice and rehearsal, and guess what; it only needs to be done a certain number of times and you will then reach a stage where you can modify it, adapt it to different situations. When you reach that stage, you are well on your way to becoming a good clinician.

At this stage you’re probably thinking: “Yes, but what should I rehearse; how do I know what to rehearse, what if I am rehearsing the wrong things?” Correct, that’s why step 2 is so important!

STEP 5 – KNOWLEDGE

In clinical practice, the CASC and OSCE exams there is a finite amount of information required to treat the patient effectively. It’s all about prioritisation and strategic thinking.

So in any situation you must remember,what I call, buzzwords. This consists of a checklist of key words that are most important in each clinical scenario.

You can apply these to any case, and any presentation. What’s really good about it is that you can use it in your future ward rounds and clinical cases.  So when you are in a linked station for the CASC or OSCE you don’t have to fret because you have a structure to fall back on.

A colleague once told me that the best thing about having a structure to any task is that you can always fall back on it when things are difficult. He’s absolutely right; if your foundation isn’t strong, everything built on top of it will be shaky.

AFTER THE EXAM - EXPLORE AND QUESTION

As we all know, there is a big difference between the exam and real clinical practice. Medical and psychiatric illnesses are complex and require a sophisticated problem solving strategy to achieve good outcomes. Most important though is an attitude of exploring and questioning. Good psychiatric interviewing skills will set a strong foundation to move on to the next step; which is the art of formulation and strategic management. By this I don’t mean psychodynamic formulations but advanced bio-psycho-socio-cultural formulations that lead to a comprehensive management plans.

Psychiatry is a fascinating field. Like with any discipline, setting the foundations to scale up higher are essential. And it all starts with a focus on your interviewing skills. Master that and you’ll reap the rewards.

The discussion continues on this site, so stay tuned. In the meantime, good luck for the exams and your career in psychiatry!