Linked Stations in the CASC
The introduction of linked stations in the June 2008 CASC onwards represents a more complex way of assessing advanced clinical and management skills. Whilst it can be thought of as being an OSCE and PMPs combined, you will need to think a little more strategically about how you approach each station.
Whilst the College haven't yet released much detail about the new exam, it should be reasonably easy to predict the kind of stations which may come up. Remember, the CASC is assessing individuals at the level of the old 'long case' and so the clinical skills required will be more advanced. Below are some possible stations. It is important to note that these are not necessarily representative of the linked stations that will arise. The College have yet to post examples. However, it is possible to recognise that after three years of training, you should be able to deal with these sorts of scenarios.
Linked Stations in the CASC
The following table contains stations that illustrate the scenarios that might arise in the CASC. For previous stations from the CASC exams, please go to the past CASC stations page.
|Station #1 (Clinical)||Station #2 (PMP)|
|Assessment of young woman with eating disorder (anorexia nervosa). Hypotensive and low BMI. Establishment of diagnosis; assessment of comorbidity. She also wants to become pregnant.||
Discuss management of her eating disorder and her possible pregnancy with consultant colleague. May include consideration and criteria for inpatient admission.
Discuss with relatives the diagnosis and likely management, with an emphasis of family factors that may be relevant.
|You are asked to conduct an assessment of a young man in police cells. He has a history of psychotic illness and aggressive behaviour, paying particular attention to aspects of risk.||
Complete sections of a court report which are in a short-answer question style. For example:
"Is this man sane and fit to plead?"
"Identify key triggers to his offending behaviour"
"Would you recommend a mental health or criminal procedures disposal?"
"What conditions might you place on a community sentence?"
|You are asked to assess a man with a history of psychotic illness who has been non-adherent to his prescribed medication. He is rather agitated and irritable. During the interview he reports that the devil has been commanding him to abuse his nephew who is under the age of 16.||Discuss with consultant your history, mental state, and management of the case. Risk and child welfare issues paramount.|
|You are reviewing a young woman with a history of rapid-cycling bipolar disorder which has been generally unresponsive to lithium and valproate/ semisodium valproate. Her mood is starting to elevate and although not clearly manic, she is elated and pressured in her thinking. She wishes to come off her medication and start a family.||Discussion with consultant relates to the management of (rapid-cycling) bipolar disorder as well as perinatal issues related to the treatment of an unstable bipolar disorder.|
|You are asked to see a man with newly-diagnosed bipolar disorder who works as a nurse in the hospital. He is elated, slightly grandiose, and his insight is deteriorating. He believes that he doesn't need supervised for potentially risky procedures and says he knows more than the doctors anyway.||Discussion with consultant. Consider issues of detention, management, and future employment.|
|You are asked to assess a man who is irritable, preoccupied and convinced that his wife is having an affair. It is probable that he has delusions of jealousy/ Othello syndrome. He expresses anger towards his wife. He allows you to speak to her but does not want you to tell her he 'knows' she has been unfaithful.||You must obtain additional information from the man's wife and also discuss your likely diagnosis with her. Issues of confidentiality important, and you will be expected to address issues of risk with her.|
|You are asked to assess a 75-year-old man with a history of recurrent depression. On assessment, he has marked cognitive impairment which is not attributable to treatment. You are guided heavily towards a probable diagnosis of Alzheimer's disease.||You have to explain your findings to the son (who is the main carer). He believes that his father's difficulties are simply a recurrence of depression and he has read about 'pseudodementia' on the internet.|
|You are reviewing a CMHT patient who has been increasingly difficult to manage in the community over the last few weeks because of agitation, irritability, loss of insight, and impulsive behaviour. You don't have his notes but his keyworker (a social worker) has brought him up for assessment. Some of his symptoms are consistent with hypomania/ mania.||
You have to discuss your findings with the social worker and consider admission (if indicated). The social worker is of the opinion that his presentation is due to personality disorder rather then mental illness.
You will be expected to address issues of diagnosis and may be required to challenge the views of another professional, justifying your position.
|You have been asked to review a middle-aged man in a medical ward. He has recently experienced a heart attack but wants to discharge himself. The consultant physician feels that he shouldn't go home and wants you to consider detaining him in order to prevent him from going home.||
You must offer feedback on your assessment to the physician and explain your decision on grounds for detention.
The station involves aspects of assessment of mental state, previous psychiatric history, and legal basis of detention and treatment.
You will be expected to deal with consultant physician who may not share your views and so diplomacy is being assessed.
|You are reviewing a young man prior to discharge. You should assess his current mental state, his understanding about the medication he is on (this is given to you) and you are to suggest follow-up arrangements to him on the basis of the information you obtain.||You must discuss the follow-up plans with the patient's mother (who is his main carer). She is concerned about him being discharged. She may divulge information (such as a previously unknown history of aggression) which you have to integrate into your management plan.|