Anyone preparing for CASPer?

[repede]

Who here is preparing for CASPer? And if you are, how are you doing it?

 

I'm probably going to do some reading up on Canada's health care system and medical ethics. It's kind of nerve-wracking thinking about it because it's the first year this is happening so no one really knows how it's going to be like... but I guess the point of it is so you can't prepare too much.

[LostLamb]

There is definitely a character limit. I ran into it several times when I participated in the beta testing in August.

[RyanMaverick]

Winging it FTW. They want those answers from the heart yo - they love that ****!

[medhopeful64]

Who here is preparing for CASPer? And if you are, how are you doing it?

 

I'm probably going to do some reading up on Canada's health care system and medical ethics. It's kind of nerve-wracking thinking about it because it's the first year this is happening so no one really knows how it's going to be like... but I guess the point of it is so you can't prepare too much.

 

Oh dear, do they test on Canada's health care system? could you recommend some good sites for this please? Thanks.

 

I'm reading Doing Right, and this CMAJ series book called bioethics at the bedside (someone here recommended it!)

[repede]

Oh dear, do they test on Canada's health care system? could you recommend some good sites for this please?

 

I really have no idea. I don't think anyone knows. But I wouldn't rule out the possibility, since most people seem to anticipate it to be some sort of a preliminary MMI. Check this thread for some good resources on the Canadian Health Care system. It might be a good idea to know what are the current problems with as well.

[small_town_girl]

I think my answers were about as long as my answers for the mcmaster ABS before hitting the limit....so that's what, 700?

I put it in my suggestions for them to tell us the limit, and/or have a way for us to track the number of characters. With the time limit, we REALLY don't have time reach the limit, and then go back and edit...

 

How much was the character limit? Massive? A little bit?

 

Or do you remember in terms of numbers? 500?

 

The thing I hate about character limits is that its difficult early on to gauge when you'll hit that limit. Obviously, near the middle, you get a feeling for how much you've written because you've probably hit the limit a few times.

[aqm]

limit from the samples seems to be 1024 characters (including space)

[teresachang]

Hi guys, I'm confused. I thought the Casper is more like a personality and HR type of tests. Does it test us on actual knowledge of ethics and healthcare?

 

If anyone has beta tested or can offer any insight, please post. Thanks!

[repede]

Hi guys, I'm confused. I thought the Casper is more like a personality and HR type of tests. Does it test us on actual knowledge of ethics and healthcare?

 

If anyone has beta tested or can offer any insight, please post. Thanks!

 

Check the McMaster page on CASPer. There's a sample video in which a patient is talking to a doctor and wants a procedure but it is very risky so the doctor refuses. As the video plays, questions are asked to you real time, such as "what would you do?" "Is the physician doing the right thing?"

[future_doc]

Ethical and critical thinking under time constraints requiring one to be precise and concise, mirroring reality - the perfect test for each to show what they are made of.

[champ]

Ethical and critical thinking under time constraints requiring one to be precise and concise, mirroring reality - the perfect test for each to show what they are made of.

 

What do u suggest doing to prepare F_D?

[nosuperman]

Hi guys, I'm confused. I thought the Casper is more like a personality and HR type of tests. Does it test us on actual knowledge of ethics and healthcare?

 

If anyone has beta tested or can offer any insight, please post. Thanks!

 

It won't test you on factual data concerning healthcare. Think of it like a online MMI or check out the old Mac essay -if 3 sentences can be called an essay- questions. Note I wasn't involved with the beta testing, this is just how its been marketed from the beginning.

[teresachang]

Thanks for the clarifications. Does anyone have any suggestions on how we can prepare for the CASPER? besides reading up on current health care issues?

 

Thanks

[Theophilus]

http://casper.mcmaster.ca/demo/questionsamp.html

 

 

Sample Questions:

 

* Q1: You must make your decision now. What is your answer? Why?

 

* Q2: Should insistence for this surgery relieve the surgeon of all liability? Explain.

 

* Q3: Should a patient be allowed to sue if the surgeon refuses to operate in these circumstances? Defend your response.

 

According to the video, I'm an expert in performing these surgeries that likely leave people paralyzed :S hehe

 

Wanna discuss this sample? What do you guys think?

 

I'm guessing that they will judge your answers based on how well reasoned, compassionate, and well put together they are, and not on how much bioethics we know etc. though I guess it would help coming up with an answer

[future_doc]

What do u suggest doing to prepare F_D?

 

Other than the suggestion immeidately above, I suggest the best form of preparation is no preparation. You are coming to the table with an agile and ethical mind, having the ability to think critically and solve problems in a timely manner. Just be sharp and up to the task, i.e., have a good night's sleep, a regular meal and you are fit to go.

[MA246]

http://casper.mcmaster.ca/demo/questionsamp.html

 

 

Sample Questions:

 

* Q1: You must make your decision now. What is your answer? Why?

 

* Q2: Should insistence for this surgery relieve the surgeon of all liability? Explain.

 

* Q3: Should a patient be allowed to sue if the surgeon refuses to operate in these circumstances? Defend your response.

 

According to the video, I'm an expert in performing these surgeries that likely leave people paralyzed :S hehe

 

Wanna discuss this sample? What do you guys think?

 

I'm guessing that they will judge your answers based on how well reasoned, compassionate, and well put together they are, and not on how much bioethics we know etc. though I guess it would help coming up with an answer

 

I'd be interested in discussing this for practice. This is how I would answer (its not the best but I did it quick so that I could maybe simulate the real deal?.. I hope it doesn't suck):

 

(1) My answer to the patient would be that at this point in time I cannot perform the surgery. Despite there being an inherent risk of paralysis due to the type of surgery being performed, the patient also has certain cardiovascular complications that are potentially fatal if the surgery is performed. Assessing each individual's health prior to surgery is necessary to ensure that the benefits could outweigh the risks, and unfortunately, in this case, the risk of death due to his cardiovascular health is of deep concern. Recognizing the patients hardships, I would kindly recommend other surgeons that could offer a second opinion. Even though I have the highest success rate, there are others who are also skilled and successful that may, perhaps, offer an alternate assessment.

 

(2) I do not believe that insistence of surgery can relieve the surgeon of all liabilities. The patient is in a stressful situation due to his back pain, and as such, may come to a different immediate conclusion than he would if he were to contemplate the long-term potential risks of the surgery (especially given his current cardiovascular health and the risk of death). Thus, it is the surgeons ethical duty to make the best decision for the patient given his experience in this field. Although clearly difficult, sometimes refusing surgery and/or referring the patient to an alternate surgeon is the best option one can make.

 

(3) I do not believe that a patient should be allowed to sue if there are alternative surgeons that could very well perform the surgery. If this were to occur, then there is a risk of surgeons performing surgeries under duress. This situation would compromise the integrity of the medical profession as well as the long-term health of patients. An example of the latter would be a possible increase in post-operative complications as well as a possible increase in surgical fatalities. However, understanding that refusing surgery places patients in difficult situations, some viable alternatives should be presented to individuals who truly express a conflicting opinion than that of the surgeon.

[aqm]

For the last question (allowed to sue) I would say yes, the patient must/can sue.

 

A informed consent does not relieve the surgeon of his/her actions. He/she should still be held accountable for medical malpractice if complications arise after informed consent has been obtained. This ensures that the notion of 'informed consent' is not abused by the medical community by protecting doctors and allowing them to make errors that may lead to complications besides those that were discussed while obtaining the consent. Hence, in order to protect the public and hold the medical community accountable for their actions, a patient should be allowed to sue the surgeon, particularly if the breach in conduct resulted in a complication that was not discussed when obtaining the informed consent.

 

 

 

What do you future doctors think?

[future_doc]

MA246, I like your approach. With respect to no. 2, it is the surgeon ehtical and legal duty. In exercising his discretion, the surgeon;s professional opinion is that the surgery is too risky, and he is entirely within his rights not to operate, indeed, he is duty bound not to given his professional opinion.

 

With respect to no. 3, I believe the question is not well thought put in the sense that the patient is allowed to sue anybody on earth if he finds a lawyer willing to take the case. THe wuestion should have been how to do rate the chances of success of legal proceedings taken by the patient against the surgeon, justifying your answer. The patient would need to demonstrate damages suffered, falt or negligence of the surgeon and causaility. I do not think the reqwuisite elements are there for the patient to make a successful case against the surgeon. Indeed, if the surgeon were to operate notwithst anding his professional opinion that the risks were too great, in such a case, the surgeon would be undertaking an unacceptable professional, ehtical and legal risk. Surgery is not like buying burgersw to which you are entitled on demand. Professional training, experience and judgment is invovled.

[MA246]

Those are great points future doc. I think pointing out that anyone can sue, but its the strength of their case that is in question, is important to mention to balance out the argument. Great thoughts!

[dzimmerman]

I have to agree with a number of you as well. With regards to question 2 - of course the surgeon is still liable upon performing this surgery, especially so because he/she very clearly knew and explained the high risk associated with this particular patient and surgery.

 

And for question 3 - of course the patient is 'allowed' to sue the Dr for not performing the surgery, but the surgeon is well within their rights to refuse to perform a surgery they deem too 'high risk'. Happens all the time.

[aquadon]

 

(1) My answer to the patient would be that at this point in time I cannot perform the surgery. Despite there being an inherent risk of paralysis due to the type of surgery being performed, the patient also has certain cardiovascular complications that are potentially fatal if the surgery is performed. Assessing each individual's health prior to surgery is necessary to ensure that the benefits could outweigh the risks, and unfortunately, in this case, the risk of death due to his cardiovascular health is of deep concern. Recognizing the patients hardships, I would kindly recommend other surgeons that could offer a second opinion. Even though I have the highest success rate, there are others who are also skilled and successful that may, perhaps, offer an alternate assessment.

 

I think you might be treading a thin line recommending another surgeon for the same surgery (when clearly one has already been consulted). I would probably focus more on researching/recommending specialists for alternative treatment/pain management options, and addressing the other underlying risk factors (i.e. the cardiac condition) that make the surgery too risky. Sending them to another doctor who will likely say the same thing (or if they don't will put the patient at a high risk - and is probably not in the patients best interest) is a frustrating and financially draining process for all involved.

 

I liked your answers for 2 and 3 though. And I also thought your writing style was very clear and you picked up on lots of clues from the video. I think showing that you can remember pieces of the patient's history and use them to justify your decision will be key in CASPer.

[MA246]

Thank you for the great feedback aquadon! I really like the alternate treatment suggestion and I appreciate your line of thinking about the referral. With your approach, the surgeon would be demonstrating that his priority is indeed the health and well-being of the patient.

 

I have learned a lot from this thread; there are so many great ideas and everyone is so helpful

[DXO]

I have a different point of view for these questions.

 

1. Patient is competent and has decisional capacity. He has assessed his risk/benefit ratio and has decided that from his point of view, his benefits outweigh the risks. The physician may be advising that in light of medical indications that the treatment is not advisable, but the patient has the right to make his own risk/benefit judgement. Autonomy is an important ethical principle, and patients have the right to decide for themselves whether or not to undergo treatment. He and his wife have been fully informed, the conversation should be documented in the patient's medical history, and a form should be signed to indicate that the patient has provided the surgeon with his consent. The physician has fully disclosed the risks and benefits and should engage in a participatory-style of decision making by eliciting the input of the patient (and in this case, his wife).

 

2. No, the surgeon should not be relieved of all liability. The surgeon is still liable to perform all surgical duties without negligence, must arrange for appropriate aftercare, and should have informed the patient of all potential risks and benefits involved in the surgery. The conversation with the patient should be documented, and documented consent should be obtained by having the patient sign a form. If the surgeon is sued in the future, then the surgeon can bring the appropriate documentation to court.

 

3. The patient is "allowed" to sue in any circumstance. The conversation with the patient should be documented. If the physician is uncomfortable performing this elective surgery, then he should arrange for the patient to be seen by another medical professional for a second opinion and should ensure that the patient is not simply abandonned. (<--- not sure how I feel about this one)

[DXO]

I also think we need to be careful and not make paternalistic, unilateral decisions. This patient may be in pain, but he is not mentally incapacitated.

[MA246]

I also think we need to be careful and not make paternalistic, unilateral decisions. This patient may be in pain, but he is not mentally incapacitated.

 

I'm not an expert at all in this field, but if you research the ACC/AHA Preoperative Cardiac Risk Assessment chart, you can take note that if a preoperative assessment of a patient wishing to undergo non-cardiac elective surgery determines that the cardiac risk is too great, then one should "consider delay or cancel non-cardiac surgery."

 

Although there is no right or wrong answer to this question, I certainly don't consider cancelling the surgery as "paternalistic" or "unilateral." It was a judgement made based on a risk/benefit analysis, the best interest of the patient, and the surgeons expertise.

 

Either way, I liked your writing and felt that you did a good job of supporting your answer.