The CSA is a comprehensive and intense examination of your clinical skills. Emedica’s Dr Mahibur Rahman shares his secrets to help you pass.
What does it involve?
The CSA is based around a simulated surgery format, with 13 consultations. You will have two minutes to read the case notes for the patient you are about to see before a buzzer sounds. The notes for all patients are displayed on a tablet on your table.
Once the buzzer sounds, the patient will knock, and you will have 10 minutes for your consultation. After 10 minutes, another buzzer signals the end of the consultation, and the patient and examiner will leave, regardless of how far into the consultation you are. There is a short break after the first seven consultations.
Some cases may be based around a home visit – in these cases you will be taken to a different room that has been setup to simulate this. You may also have a telephone consultation – telephones are available in each consulting room.
What to expect
The cases at each sitting of the CSA are chosen to cover a wide range of disease areas and a variety of case types – acute illness, chronic illness, cases with social and psychological aspects as well as cases that involve ethical or medicolegal issues. Every sitting of the exam will include at least one child health related case, and at least two cases will include testing of safe prescribing. There are several hundred different cases within the CSA database, so it is impractical to try to prepare for every possible case.
How is it assessed?
There are three domains assessed in each case in the CSA, with each carrying an equal number of possible marks. The domains are:
- Data gathering, technical & assessment skills
- Clinical management skills
- Interpersonal skills
Data gathering, technical & assessment skills
This domain is assessing your ability to take a concise, systematic and relevant history – both exploring the relevant symptoms and risk factors, and excluding the relevant rare but serious conditions by asking about red flag symptoms. It also assesses your choice and ability to perform the correct examinations. In some cases, your ability to use equipment as part of your data gathering will also be assessed – e.g. an otoscope, ophthalmoscope, or peak flow meter.
Clinical management skills
This domain assesses your ability to synthesise the data you gather and to come up with a sensible working diagnosis or differentials. It also assesses your decision making skills and ability to manage the patient holistically in line with current best practice. You may have to manage patients with multiple problems or co-morbidities as well as show an ability to promote good health and manage risk appropriately.
This domain assesses your ability to communicate appropriately and effectively with the patient, demonstrating a patient centred approach. You should be able to take on board the patient’s health beliefs and preferences, and to explain things using language that is understandable. Where appropriate, you should involve the patient in decision making.
How to prepare
Make sure you leave enough time to prepare. You want to start planning your revision and practice around six months in advance of the CSA.
You can revise by looking at the core clinical topics from the GP curriculum and by seeing patients regularly and reading around the cases you see.
The best way to prepare is practice – lots of practice! There are different types of practice that can help you to develop your own consulting style while ensuring that you are able to demonstrate the skills and competences needed to pass the CSA. Here are some of the things that you can do to help you prepare:
See lots of patients
Seeing patients in surgery day to day is the most effective way to develop your own consulting style and to improve your knowledge base. Try to get comfortable with 10-12 minute consultations before you sit the CSA – in the exam, you cannot have a few extra minutes to finish off – you will be marked on what you achieve in the 10 minutes consultation (although you do have 2 minutes to read prior to each case).
Arrange joint surgeries
Video your consultations
Doing joint surgeries with your trainer will allow you to get valuable feedback on areas of weakness as well as a chance to discuss alternative ways to manage problems.
Videoing consultations and then reviewing them yourself (and with your trainer) will often highlight things that can otherwise be missed. You may pick up small cues that you missed, or realise that your questioning style could be improved. You will need consent from patients – design a form and make it clear that the videos will only be used for training purposes and will be destroyed after a short period of time.
Join a study group
Form a study group with other registrars that are preparing for the CSA and try to meet regularly to practice. It is a good idea to start this early – six months before you plan to sit the CSA. As you get closer to the exam, try to meet more frequently, increasing to two or three times a week in the last couple of months before your exam. Meeting in a group of three will allow you to get a good amount of practice in a short amount of time, with useful feedback – you can each rotate being the patient, being the candidate and being the examiner. Try to be honest when giving feedback, and to avoid being defensive when receiving feedback. Watching others consult can also give you an insight into different ways to approach the same case.
Attend a course
Many registrars find attending a focused CSA preparation course useful as part of their revision. Ideally you want to be in a course with a small group that provides as much practice with individual feedback as possible. Experiencing mock CSA cases with professional role players can help you get a feel for the real exam, and honest feedback can help you understand your weaknesses and develop a clear plan to improve them prior to the real thing.
Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He has been the medical director of Emedica since 2005 and has taught more than 20,000 delegates preparing for GP entry exams, MRCGP and on GP careers.
Download our MRCGP Revision Guide
To aid your preparations for your MRCGP AKT and CSA assessments we’ve produced a detailed revision guide filled with all the information you need to know, including:
- Exam overviews
- Sample questions
- Sample cases
- Revision tips
- Revision checklists
Download your revision guide
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