Psych CASC / OSCE · Professional — teaching and supervision skills
Give challenging educational feedback to a registrar — CASC communication station
MRCPsych/FRANZCP-style CASC: educational feedback, alliance, underperformance, patient-safety framing, and learning plan negotiation.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading. You are a psychiatry consultant / educational supervisor meeting a registrar for mid-term feedback. [1][5]
Candidate instructions. Your registrar is hardworking and well liked. Observed assessment shows a disorganised MSE; risk documentation after self-harm cases has been incomplete. They are rostered for independent overnight emergency cover tomorrow. Give feedback that is specific and non-humiliating, explore their reaction, agree a learning plan, and address patient safety regarding overnight cover. Do not collude with “everyone gets a pass,” and do not invent legal or college form section numbers. [1][2][4]
Candidate scenario
The registrar says: "I thought I was doing fine — last term everyone said I was great. Are you saying I am failing? I need that night shift for my hours, and if this goes on my record I will never get a job. Just tell me I am okay and I will try harder." They appear anxious, defensive, and tearful. [4]
Marking domains
- Warm, professional opening; educational alliance preserved
- Specific behavioural feedback (MSE structure; risk documentation examples) not character attack
- Explores reaction to feedback (R2C2 reaction step)
- Links to patient safety without catastrophic shaming
- Clear plan for observed practice / deliberate practice goals
- Addresses overnight independent cover honestly (restrict or senior support if unsafe)
- Documents need for written concerns; avoids failure-to-fail collusion
- Checks understanding; offers support (restorative function) and follow-up time
- Avoids inventing statute/form codes [1][2][4][5]
Reveal assessor key
Open. Thank them for meeting. State purpose: mid-term educational feedback based on observed work, aiming to support growth and safe care. Signal respect for effort and honesty about standards. [1][5]
Content (specific). Describe observed behaviours: MSE lacked structure in domains X/Y on mini-CEX date; risk notes after self-harm omitted enquiry elements A/B. Invite their view. Avoid “you are careless” labels. [1]
Reaction (R2C2). Allow emotion; normalise discomfort; clarify this is formative coaching with safety implications, not character condemnation. Explore barriers (caseload, sleep, knowledge gaps, distress). [2]
Coaching plan. Agree 2–3 goals (structured MSE template; mandatory suicide enquiry fields; weekly observed assessments). Offer teaching (microskills-style bedside coaching). Schedule review. [2][3]
Safety / overnight. Explain you cannot endorse independent high-risk cover until competence is re-demonstrated; arrange senior support or adjust roster. Frame as patient safety and their protection, not punishment. [4][5]
Close. Summarise plan; check understanding; offer restorative support pathway if distressed; state you will document behaviours and plan factually. Express confidence that skills can improve with deliberate practice. [1][4]
References
- [1]Ende J Feedback in clinical medical education JAMA, 1983.PMID 6876333
- [2]Sargeant J, Lockyer J, Mann K, et al. Facilitated Reflective Performance Feedback (R2C2) Acad Med, 2015.PMID 26200584
- [3]Neher JO, Gordon KC, Meyer B, Stevens N A five-step "microskills" model of clinical teaching J Am Board Fam Pract, 1992.PMID 1496899
- [4]Yepes-Rios M, Dudek N, Duboyce R, et al. The failure to fail underperforming trainees in health professions education Med Teach, 2016.PMID 27602533
- [5]Kilminster S, Cottrell D, Grant J, Jolly B AMEE Guide No. 27: Effective educational and clinical supervision Med Teach, 2007.PMID 17538823