The clinical skills assessment

The clinical skills assessment tests your ability to integrate communication and practical skills, explains Dr Chris Elfes.

The clinical skills assessment (CSA) part of the new MRCGP examination is the most unfamiliar element for trainers and candidates alike. The intention is to produce an exam that reflects modern general practice, with realistic clinical scenarios that have been evaluated for their validity and reliability. The scenarios are chosen to test the learning objectives in the new GP curriculum.

The purpose is stated to be an 'integrative skills assessment'. This means testing a doctor's ability to integrate and apply clinical, professional, communication and practical skills appropriate to medical practice. The old MRCGP was criticised for not having a consultation skills component.

What to expect
When you reach the assessment centre, you need to check-in, bringing proof of identity, and will then be spoken to by a senior college assessor who will explain where you have to go and help with any last-minute queries.

There will be 13 cases of 10 minutes each, with two-minute breaks between them. You will be allocated a consulting room, where assessors and actors, who role-play as your patients, will come to you. The consulting room will contain charts, for example peak flow charts, tongue depressors and kit specific to a case only. You will need to bring your own medical equipment - usually that which is found in a doctor's bag.

Each case will consist of instructions for the actor and assessor as well as case notes for you. These will include the relevant medical history, current medication, social habits and possibly details of the last consultation or a letter from secondary care.

Role-players will act as patients with certain symptoms, describe their signs to you when you ask to examine them or pass you a written card that documents the examination findings you request.

The assessor will sit out of your line of view and will not interact with you unless required to do so, for example if you request information that the actor can not provide. A buzzer will sound after 10 minutes and the actor will immediately stop role-playing.

The CSA will initially be held in Croydon, Surrey, although a dedicated centre is planned for the new college premises in central London within the next three to five years. Three-to-four-week sittings will be held in February, May and October each year, beginning this October.

What is assessed
The cases will be marked in three domains - data gathering, clinical management and interpersonal skills - and they will be graded as clear pass, marginal pass, marginal fail or clear fail. The assessors will mark each domain separately and then give an overall grade for each case.

Cases can only be from general practice, matched to the curriculum statements (see box, left). They will cover a selection of acute, chronic and undifferentiated presentations, along with psychological/social cases and cases based on health promotion. The role-players will be a selection of men and women of a range of ages. One or two cases will demonstrate diversity and a few cases will probably involve a clinical examination.

To get a clearer idea of the clinical scenarios you might face, think of your last surgery. As we get to know the marking domains, we can guess at what will be in them.

Dr Elfes is a GP trainer, MRCGP examiner and nMRCGP assessor in Swanage, Dorset.


Preparing for the CSA

  1. The nMRCGP is still developing and so watch out for further updates on the RCGP website, through your trainer, local deanery and the GP publications.
  2. Look up the curriculum statements on the RCGP website, and thoroughly read the sections on common and important conditions. Cases are likely to be based on these.
  3. There are three domains in the marking schedule so use this knowledge to consider how cases are likely to be assessed.
  4. Reflect on day-to-day cases in which you are involved and discuss them with your trainer and colleagues.
  5. Demonstrate your ability to engage with patients, using recognised interpersonal skills, such as enquiring about their health beliefs and incorporating these into your explanations.
  6. You are already practising in general practice and this exam tests exactly that.


You will be tested mainly from the following areas of the RCGP's new curriculum for GPs:

  • Primary care management: recognition and management of common medical conditions in primary care.
  • Problem-solving skills: gathering and using data for clinical judgement; choice of examination, investigations and their interpretation; demonstration of a structured and flexible approach to decision making.
  • Person-centred care: communication with the patient and the use of recognised consultation techniques to promote a shared approach to managing problems.
  • Comprehensive approach: demonstrating proficiency in the management of co-morbidity and risk.
  • Attitudinal aspects: practising ethically with respect for equality and diversity, with accepted professional codes of conduct.
  • Clinical practical skills: demonstrating proficiency in physical examinations and using diagnostic/therapeutic instruments.


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