Mastering the Psychiatric Long Case – Passing the Observed Clinical Activity (OCA) Exam

The OCA which is a new version of the long case is about converting theory into practice, which requires you to develop a navigational system to guide you through the complexities that arise in patient management. It also requires you to look beyond diagnoses and adopt a problem solving approach.

Here are some tips to help you start this journey.

APPROACH THE OCA WITH COMPLETE CONVICTION

Give it your best shot. As Thomas Jefferson said:

Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude.

This may be an internal assessment but you won’t realise how important preparing for the OCA is until you become a Consultant psychiatrist. It becomes even more important if you plan to private practice. Without effort into preparation, you are depriving yourself of the chance of being good at your job and that will cost you in the long run.

DEVELOP YOUR PSYCHIATRY INTERVIEW SKILLS

The most important part of the OCA is the interviewing technique and the formulation (data synthesis) without which it is next to impossible to develop a management plan. This alone accounts for 60% of the OCA.

MAKE FULL USE OF YOUR CLINICAL WORK

Approach cases in your clinical practice like OCA cases. Aim to vary the type of case; e.g. acute case, chronic case, eating disorder case, dual diagnosis etc. Psychiatry is a rich field and the ability to decipher complexities in a range of patients makes it (likely) the most stimulating discipline in medicine.

DEVELOP YOUR FORMULATION SKILLS

The aim is to be able to formulate any case that you are confronted with in 10 minutes thinking time. Reserve the other 10 minutes for management. This requires a structure (template) and knowledge of the biological, psychological, social and cultural models for each psychiatric condition. This should then be followed by a succinct time specific narrative that requires presentation skills underpinned by a presentation template. Real world clinical practice is busy and the ability to formulate and develop management plans in 20 minutes or less is a valuable skill to develop.

Click here to learn more about formulation.

DEVELOP STRATEGIC MANAGEMENT PLANS AND COMMUNICATION SKILLS

Present the management plan in a structured manner and have a sound knowledge base about medications, psychological treatments and social treatments for each psychiatric condition.

There is an art in presenting management so that you prime the examiner to ask you the questions that you want – and  believe me it works!

Be aware of issues for Indigenous and migrant populations and answer questions succinctly. A competent knowledge base will equip you to answer any questions the examiner asks you along with evidence based treatments.

 

FOCUS ON THE PERSON

The most powerful tool to passing the long case is  summarized well in the quote by William Osler-

Ask not what disease the person has but, rather what person the disease has.

This requires you to think outside diagnoses and think about the complexities of the person. Then and only then can your management plan be tailored to your patient.

We hope this is helpful. Don’t forget to drop us a line if you’ve got any extra tips.