Clinical skills assessment

In the first of a regular look at the nMRCGP, Dr Daryl Goodwin explains how to pass the CSA.

The clinical skills assessment (CSA) is the most lifelike and fascinating part of the new RCGP membership and licensing process. It does just what it says on the tin - but candidates might not know what to expect.

The CSA will be conducted on one of three circuits at the RCGP's assessment centre in Croydon. The centre is easily reached by public transport; it is only 12 minutes to East Croydon from Victoria main line station.

Once there, you will go to the 19th floor (colour coded blue) to register and be briefed for the day by a marshal. Don't forget to take your photographic identification with you.

It is sensible to arrive in good time, but don't arrive so early for an afternoon session that the morning candidates are still having their coffee break, because you will then have to sit in 'quarantine' until your session starts.

You will be briefed about the assessment and told which floor you are on and which room is yours for the session - the 18th floor is colour coded red and the 20th floor is purple.

The consulting room
There are lockers for your possessions as you will only be able to take certain items into the consulting room. Don't forget to turn off your mobile phones and be aware that taking one into the consulting room might result in ejection from the assessment.

There will be paperwork on your desk about the cases that you will see. Read through these and make a mental note of what you think is significant information (and, if you're wise, where more information would be useful).

When the assessment starts a 'patient', or 'role player', and one assessor will enter the room. The role players have been selected and trained and will seem very realistic and credible.

You will have 13 consultations of up to 10 minutes with a couple of minutes break between each - everyone says how quickly it flashes by.

Each case that you see has been written, revised, quality assured, piloted, revised, quality and performance reviewed and further revised.

There is an ongoing commitment to maintaining high standards of quality and reliability so feedback is sought from the role players, assessors and you, the candidate. This is reviewed and taken into account in running the cases.

One of the cases is being piloted for future use - but you won't know which one, so do your best with each case. The pilot case does not count towards your result.

The mix of cases is selected to reflect different degrees of difficulty and the diversity of the UK population, and the wide variety of medical problems encountered in general practice.

All the cases are based on the RCGP curriculum statements so there should be no surprises because you will know in advance the intended learning outcome for all the statements.

Each case will have a focus or 'nub' in assessor parlance - the crux of the case - but overall performance in the case will determine your final grade.

The assessor will mark your competence in three key areas and award an overall grade. No single assessor can fail or pass you and their decisions are made independently of each other.

You may want to know how to prepare for this crucial assessment. The best advice that I can give is to see lots of patients in general practice and get used to 10-minute consultations.

This will not only endear you to your trainer and the practice, but will give you the experience and confidence to deal with the challenges presented in the CSA.

There are several preparation courses around the country, but only those which have RCGP approval are allowed to use that designation.

There are some useful books but the quickest and cheapest source of information is the RCGP website.

The assessors
Spare a thought for the assessors. They are working GPs who have volunteered to be selected and undergo further training.

The value is that there is a single standard and concordance around the whole of the UK, as the assessors come from all parts and contribute their local flavour and ideas to the assessment.

At the outset, some assessors thought it might be repetitive to see the same case played out several times, but they are fascinated by how different doctors take different approaches.

In summary, always prepare. Arrive in good time with your documentation at the Croydon venue. Read the case notes carefully, and consult and treat as you would do in real life, and then await the results.

Dr Goodwin is a CSA assessor and RCGP examiner, and a GP principal in Birmingham.

Contact Emma Quigley at GP Education on (020) 8267 4805 or email

Learning points
Attention to detail is key

1. Prepare by seeing real patients in general practice. Get used to 10-minute consultations.

2. On the day, arrive at the venue in good time and listen carefully to the briefing.

3. Read the notes provided about each patient and think about what extra information you might need.

4. Remember that your overall performance determines your final grade; no single assessor can pass or fail you.

The Royal College of General Practitioners is a network of over 35,000 family doctors. They work to encourage and maintain the highest educational, training and clinical standards in order to improve care for our patients. ; .

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