Introduction to the exam and how to introduce yourself!

Welcome to my podcast about the CASC exam! In this episode I give an overview of the CASC exam, how it's marked and give some key tips to approaching the exam. I also talk about one of the most important parts of the exam - your introduction! You have to introduce yourself at every station and this is the first impression the examiner will have of you, so make sure it counts! After listening to this episode, I recommend you spend some time practising introducing yourself out loud! Hope you enjoyed the episode, feel free to message me if you have any questions or feedback! Here is the transcript: Speaker 1 (00:00) Hi and welcome to my podcast about the CASC exam. My name is Natalie Ashburner, I'm a CAMHS psychiatry registrar working in the UK. And you are most likely thinking about or have signed up to take the CASC exam. So this series of podcasts is all of my best tips and hints about how to pass the exam. Thank you for signing up to my exclusive content. Speaker 1 (00:32) Please have a look through and recommend me to your friends. And of course, if you're interested in one to one or group tuition, please contact me and I'm happy to do that for you. Now, you might be tempted to kind of skip ahead and get to some of the more sort of interesting kind of fleshy information podcast, but I would really recommend that you do give this one a listen. And the reason is because I truly think that the CASC is not an exam about knowledge, it's not about knowing everything about every condition and it's very much about the communication, it's also about the way you approach the exam. And I believe that my way of thinking about the exam is what really helped me to pass and is what helps other people to pass. Speaker 1 (01:26) So I've got some really important kind of key hints and tips that are more general about the exam, but actually are probably the most important things that I'm going to say, more important than the specific detail or particular stations. Because the aim with the CASC exam is that you could walk into any station, even a station that you know absolutely nothing about, and pass it. And I'm going to tell you how to do that. And that's because it's very much about the approach and it's not about what you know. So I guarantee that by the end of this podcast, you will know how to approach the exam and you would be able to go in, even if you didn't know anything about it, and pass that station. Speaker 1 (02:14) Okay, so the CASC exam, just to give you a little bit of background, so it's the final membership exam for the Royal College of Psychiatrists. It's an OSCE style exam of 16 roleplay stations and it is made up of these 16 stations which are split into two circuits, one in the morning and one in the afternoon. Each station lasts for seven minutes, so you're in with the patient for seven minutes, but you get a warning when you've got 1 minute left. And in the morning you have the predominantly explanation/management style stations where you get four minutes of reading time and then seven minutes for the station. In the afternoon, you have the history and examination stations where you get 90 seconds of reading and seven minutes for the station. Speaker 1 (03:06) Now, in the past, they used to have these linked stations where there was one that was like the history examination and the other one was the management and they were linked. So it's the same case, they got rid of those, which is better for you because obviously if you didn't do well in the first one, you weren't going to do well in the second one with the old system. And instead they give you lots of information, which is essentially the information you would have gained from that first station doing the history. So now they give that to you for the explanation stations. That's why you get more reading time, because you often have more to actually read through. Speaker 1 (03:43) So, as I've already kind of alluded to, there are three types of stations history taking, examination, which includes mental state, risk and capacity and explanation. And you have five history taking, five examination and then six explanation to make up 16 overall. Now, anything could come up, anything to do with psychiatry, but obviously, I mean, people get really bogged down and get really worried about the very specific or obscure strange kind of stations that may be on topics that they don't necessarily know a lot about. I wouldn't say to disproportionately spend your time looking up those kind of topics because actually the common things are the stuff that comes up most often in the exam. You're most often doing mental state examinations, depression, psychosis, you're explaining commonly used medications, common conditions.that kind Speaker 1 (04:39) Okay, so it's not a really obscure exam, although they do come up every now and then. But you should expect that you will get a wide range of different specialties and different types of stations. And if you read my written post, there is a further breakdown of the exact makeup of the stations and what topics are covered in how many different stations. So you can also get all of that information from the Royal College website, which I recommend that you do. I recommend that you really read their guides on there inside out. Speaker 1 (05:17) You should know it all, exactly what's written on there because they've got a lot of information. They've even got videos of mock kind of stations, example stations that you can look at. The mark scheme is on there and the blueprint and the curriculum, the syllabus is on there as well. So really there's a lot of information about this exam that the Royal College gives out itself in terms of key resources. I've also done a post about this, so have a look there. Speaker 1 (05:46) But I would really recommend the RCPsych Maudsley Trainee guide to the CASC. It's made by the Royal College, they published it, so it has to be obviously pretty accurate to the exam. It's also the most recent book and resource that's been made and it's very detailed, so I do recommend that. And if you're an RCPsych member, you can get it free. So how do you pass this exam? Speaker 1 (06:13) Well, you don't have to pass every station, although obviously that would help. You only have to pass twelve out of the 16, but you also have to pass an overall pass mark which is called a borderline regression score. So for each station, these stations are marked out of five. So there's three to five domains and each domain is marked out of five. Okay? Speaker 1 (06:37) And on top of that, the examiner gives you a global judgement score. So there are some descriptors that you can read on the Rcsych website, but essentially it's broken into excellent pass, borderline, pass, borderline fail, fail and severe fail. And so basically those domains which are scored down to five are then compared to the global judgement scores. And all of those candidates who had a judgement score of borderline, what they do is then they look at what mark those people got, so what they were scored out of five for each domain and that's used to figure out the pass mark. So it's basically the pass mark is decided by the borderline candidates and the pass mark for the exam is the average of each station pass mark for that day. Speaker 1 (07:34) So each day also has a slightly different pass mark because obviously they're sort of different. Not all the stations are of the same kind of difficulty. So you need twelve out of 16 stations as well need to be passed. The idea behind that is they think you should pass about eight out of ten of the history and examination and four out of six of the management, because the management are a bit harder. If you got two or more marks that are a severe fail, then they will look at your marks overall and you might still fail even if you had actually passed twelve out of 16 stations and passed the overall mark score. Speaker 1 (08:15) But to be honest, that's unlikely to happen. So there are some really key topics which I'm going to be talking about in later podcasts in a lot more detail. But communication, as I've said before, that is the key thing for this exam. And also empathy in every single station you need to put empathy in and I suggest that you add it right at the beginning and again, I will go into more detail about that later on. The third thing that you really need to do is practise as much as possible. Speaker 1 (08:48) It's one thing knowing things in your head and it's another thing saying those things out loud in a way that a patient is going to understand. And that's where people fail, okay? In my experience, it's not because they don't know things. What it is, is because they don't know how to take that knowledge that they know that's right there in their head and put it into words so that they can actually explain something to somebody and get their point across in a clear way. Okay? Speaker 1 (09:15) There are some key things that you do need to learn in terms of kind of content, and I've talked about those in some of my posts. It's things like criteria for diagnosis. So learning like the ICD criteria, learning about medication, the side effects, how it's monitored, how it started, effect on pregnancy, things like that, about the different psychotherapies, because that's often something that we don't tend to know as much about and obviously you need to be able to talk about it confidently. You also need to know about things like psychiatric emergencies and kind of physical health conditions that can be caused by medication or that are sort of linked otherwise to mental illness. And you do need to learn a few statistics. Speaker 1 (10:01) It's not many, but you just want to know for each condition, how common is it in the kind of genetics stations? You want to know what is the likelihood of inheriting this disorder for the perinatal ones. You want to know what's the likelihood of the baby getting a certain complication caused by medication or something like that. So you do need to know a few figures, but it's not a lot. So essentially when you're thinking about this exam, you're thinking about these stations. Speaker 1 (10:44) You need to approach them all in the same kind of way. Okay? So the first thing to think about when you're just without even picking up a textbook or even looking at any CASC resources is your introduction. Every single station you are going to walk in and obviously the patient and the examiner is going to make an instant judgement of you. So obviously it goes around saying make sure you look smart and presentable and the best that you can on the day, make sure you smell nice and things like that, but also work on your introduction. Speaker 1 (11:22) So I always say that I find it the easiest thing ever is just to have the same introduction for every station because then you have less to remember. Okay? If you're trying to do a different introduction, you might fluff it up, you might get it wrong, it's more to remember. You'd be nervous. So if you just keep practising the same thing over and over, that's going to be your introduction. Speaker 1 (11:44) That's the best way to do it. So for example, my introduction is always, hi, my name is Dr. Ash Berner, I'm one of the psychiatrists here. That's literally all you really need to say, but yeah. Hi, my name is Dr. Speaker 1 (11:58) Ash Berner, I'm one of the psychiatrists here and I'd like to ask you a few questions or and I've heard you've been having a difficult time recently and I'd like to ask you some questions. Is that okay? So obviously I would then tweak this for most of the stations. The one where I say, Hi, my name is Dr. Ashburner, I'm one of the psychiatrists here. Speaker 1 (12:23) I've heard you've been having a really difficult time recently and I'd like to ask you some questions. Is that okay? That was my standard introduction to nearly every station. And the reason for this is you've already put empathy in before they've even opened their mouth. Okay. Speaker 1 (12:38) You already come across like a kind, caring person who's interested in what the person is about to say. Okay? There is the odd occasion where that doesn't really fit with the situation. So, like, they haven't been having a difficult time recently. Sometimes it's like an explanation station where the person's been stable for a long time and then you might just say either, I'd like to ask you some questions. Speaker 1 (13:05) Is that okay? If it's one where you're going to be asking, or if it's one where they've got some concerns, you could say something like, I've heard you've got some questions for me and I'm happy to answer those, or I heard that you have some concerns and I'm here to answer those. So something like that. Okay, but you're pretty much saying the same thing every time. Obviously, you then also need to plan what your next thing you're going to say is. Speaker 1 (13:31) So a lot of people, they've got the introduction down, they come in, they're confident, they say it, and then they're like, oh, mine goes blank. So make sure that you've planned your next question that you're going to ask, okay? And this is a good thing to do in your preparation time, but to give you some ideas, especially if it's a sort of history or something like that, you might say something like, could you tell me a little bit about what's been going on recently? Or if it's a management station, you might say something like, could you tell me a little bit about what you understand to be the situation? Or what do you understand about what's happened so far? Speaker 1 (14:10) These are just some really key generic sentences that you can say, okay? So start to say these, start to work these into your practise, okay? Just getting these really generic kind of questions and sentences that you want to use because otherwise you will get to the exam and you'll just be like, blah, blah, blah. I don't know what I'm saying. Okay, so you will be nervous. Speaker 1 (14:35) You want to make it straightforward as possible. You want to have that information on the tip of your tongue. You want to have practised so many times that it just flows. Okay? And you want to be confident because people trust a confident person. Speaker 1 (14:49) And that is going into that station, delivering that introduction. And the best thing about this is if you are confident with it, it doesn't matter what's happened in the station before, you might have absolutely just bombed. You might have just made a complete mess up of it, feel like you've done really, really badly, but that's why you need to have this learnt introduction, this knowing what you're going to go in there and say, because it doesn't matter. Then you could be a complete mess about to cry, but at least you'll remember what your introduction is, okay? And it's like, why we practise life support loads and loads of times because in the situation you're going to be stressed. Speaker 1 (15:30) You're going to have a lot of adrenaline and it needs to be almost automatic, and that's the same in this case. So don't sort of avoid practising the introduction because you think, oh, yeah, introduction, I'll do that. No, practise it. Okay. So I think I'm going to leave it there for this podcast today. Speaker 1 (15:53) I want to try and keep them all to around 1520 minutes so it's easy for you guys to listen to and kind of short and to the point so you can listen when you're, I don't know, walking around, walking to work or driving in your car, commuting, that kind of thing. So this was a little introduction to the CASC itself and then talking about your introduction in the exam in your stations. How are you going to introduce yourself? So after this, please go away, practise your introductions, and I will see you on the next episode. Thanks, bye.