GP training: Preparing for the CSA exam

The CSA can be a daunting experience. GP trainer Dr Pipin Singh offers some advice on how to prepare, plus key pitfalls and how to avoid them.

One crucial aspect of preparing for the exam is to form a CSA group outside of work (Photo: iStock.com/AJ_Watt)
One crucial aspect of preparing for the exam is to form a CSA group outside of work (Photo: iStock.com/AJ_Watt)

The clinical skills assessment (CSA) aims to simulate a real life surgery and all cases are designed to cover a large proportion of the GP curriculum.

The cases will allow you to demonstrate highly specialised consulting skills in a safe and time efficient manner. The exam will test your ability to take a focused history, perform a focused examination and formulate a safe management plan, dictated by the patients ideas concerns and expectations.

The cases are based on real-life cases and are not designed to trip you up.

When to sit the exam

The CSA can only be undertaken in ST3. Think about when you wish to sit the exam and this will allow you to plan in advance how you wish to prepare for the exam. The bottom line is that seeing patients will give you the confidence needed to pass the examination.

Tips to prepare

When you know the date you are due to sit the CSA, discuss this with your clinical supervisor if in general practice or your education supervisor if in a hospital post.

If you are in a GP post, your may wish to consider the following to help you prepare and receive feedback

  • Joint surgeries with your trainer
  • Joint house visits
  • Joint telephone triage
  • Consultation observed tools (COTs). This will allow you to focus on your non-verbal communication alongside the verbal aspects of your communication. Audio COTs have also now been incorporated into the eportfolio.
  • Role play. Although a term installing dread amongst registrars, role play is an extremely useful tool in helping prepare for the CSA. Consider using your trainer to help with this or even any other registrars and another trainer if able. I often run joint tutorials with another trainer and registrar, allowing two people to observe and mark the consultation and one person playing Doctor and another patient.

It is a good idea to book onto your deanery’s CSA course. This is often run by active or former examiners.

Use the CSA marking schedule, available on the RCGP website, to allow you to familiarise yourself with the domains used by the examiners.

One crucial aspect of preparing for the CSA is to form a CSA group outside of work. This will allow you to regularly meet and practice a number of cases across the whole breadth of the curriculum, using various CSA case books or even cases you have seen in your own surgeries.

This is a invaluable way of preparing and allows you to practice different phrases and sections of the consultation over and over again. Remember to provide constructive feedback to your friends or colleagues.

On the day

  • Make sure you have read all the information provided by the RCGP ahead of the exam.
  • Try and arrive the day/evening before the exam.
  • Arrive at the venue in good time.
  • Familiarise yourself with the location of the exam and how long it will take you to get there from your residence.
  • Check the RCGP website for what medical equipment you need to bring.
  • If you feel a case may not have gone so well, forget about it and focus on the next case
  • Use the gap in between cases to familiarise yourself with the information provided for the next case.

During the exam

Strucuring the consultation

The structure of your consultation is essential for a successful outcome in the CSA and also in real practice. Cambridge Calgary is a widely accepted model of safe, efficient consulting, so putting this into practice from an early stage of your rotation is essential.

Ensure you familiarise yourself with the patient's history, medication list, last few consultations and letters before you see them.

Key pitfalls and how to avoid them

Avoid statements that sound formulaic
This is often seen when trying to establish patients, fears and concerns. Ensure you practice ways of phrasing these statements regularly while consulting and also with your trainer and CSA group to receive appropriate feedback.

Management plan
Registrars failing cases have often not generated a shared management plan. Ensure you leave enough time to reach this section of the consultation. It is imperative that you use the patient’s ideas concerns and expectations that you have established earlier on in the consultation to generate your management plan.

Time management
Stay focused on the time. Remember each consultation is ten minutes.

Examinations
Keep examinations focused and based on the history that you have established.

Focus on the patient
There are likely to be verbal and non-verbal cues provided throughout the 10 minutes. A missed cue may result in a failure to appreciate the ‘nub’ of the case. Use your COTs, role play and joint surgeries to recognise your ability to pick up on cues.

Above all there is no substitute for real life consulting and regular feedback on your consultation skills.

  • Dr Pipin Singh is a GP trainer in Northumberland

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