💡 How can I reduce mistakes in my exams - the context bucket.

- Part 2

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We were recently looking at James Reason’s “Three Buckets” is a model that uses three categories (🪣self, 🪣context, 🪣task) to assess the risk of us making mistakes. We can use the model to recognise the potential causes of mistakes in the SCA exam. In the 3 buckets model the more items in your bucket the higher the risk of an error. So, to be ready for the exam we need to empty our buckets. Today we will look at the Context bucket.

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Context Bucket 🪣

This bucket relates to environmental factors such as distractions, interruptions, lack of time, and poor equipment.

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Environment factors

• Unfamiliarity with the room you take your exam in.
• Unfamiliarity with running video consultations

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Time factors

• Inexperience performing twelve, 12 minute consultations back-to-back.
• Inexperience with the case mix (e.g., going from safeguarding to dermatology withinminutes).

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Distractions

• Misinterpretation of what examiners are looking for (e.g., over-prioritising biomedical detail over relationship building).
• Belief that cases contain “hidden agenda,” leading to prolonged data gathering and defensive decision-making.
• Unachievable expectation that consultations must be perfect to pass.
• Interruption from staff and device messages

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Strategies to “Empty” the Context Bucket

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• Find out which room you will be taking your exam in and practice regularly in it setting it up as you would have it on your exam day.

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• When practicsing select a mix of case types to echo the exam experience.

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• Get used to performing 15 minute consultations back to back in the surgery. If you can perform at 15 minutes in a day to day surgeries you are likely to  be ready for a 12 minute SCA consult which is typically a single problem consultation.

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• Develop a structured consultation getting to clinical management by  6-7 minutes.

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• Understand what examiners expect. Examiners are looking for kind, interested, safe candidates that understand the big picture of the condition and its impact on the patient.

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• Recognise that SCA cases are ‘typical presentations’ of conditions and are not set up to trick you with hidden agenda.

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• Put a sign on your door to prevent interruptions and turn your devices to do not disturb

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