MRCGP - A registrar's guide to the CSA

Videos, home visits and a decent diagnostic set are all part of the thorough preparation that will leave you confident and relaxed on the day of the CSA examination, writes Dr Leke Asong.

Go through your consultations with your trainer after a joint surgery to see where youscore highly
Go through your consultations with your trainer after a joint surgery to see where youscore highly

The mere thought of the clinical skills assessment (CSA) is daunting for most GP registrars, but this does not have to be the case. With the right mind state and preparation, the CSA can be attempted with ease and confidence.

According to the RCGP, the CSA 'is an assessment of a doctor's ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice'.

The CSA is marked under three domains: data gathering, technical and assessment skills; clinical management skills; and interpersonal skills.

Most vocational training schemes will have an induction week where you will sit in with various GPs in the practice. Use this time effectively.

Although every candidate is trying to score on the same criteria, every doctor has their own individual style. You may model your style on one of the partners, or just develop your own.

I know one highly efficient GP who starts the consultation by ticking off the reminders for the quality and outcomes framework before coming to the presenting complaint.

However, for the purpose of the CSA, I would recommend shying away from this particular approach. It does not pay to start by measuring patients' BPs and asking for their weight before you know why they have come to see you.

Shadow the community nurse, social worker or other members of the primary care team.

Video consultations
Start videoing your consultations early - even though you may squirm when watching yourself.

Thank goodness my course organiser told us this.

Ask your trainer to provide a thorough critique of your consultations. See what you score well on, and work to improve the areas you score less well on in subsequent consultations.

My trainer helped me immensely with analysing my videos and consultations after a joint surgery.

10-minute consultation
With practice, you will be able to gauge a 10-minute consultation. Go through the focused history, speedy and smooth examination, and present the patient with options.

Glance discreetly at the clock on the back wall; don't let your gaze fall on it consistently throughout the consultation. Another thing to be aware of on the day is the examiner in the room; try to ignore him or her to avoid panic.

Don't miss out on home visits. Be polite, ask if you can come in, and have your bag equipped. Examine the patient in a comfortable area and always present options for treatment.

Practice cases with colleagues after work or when free over the weekend. Alternate after each case, being an examiner in one and a candidate in another (see CSA practice cases box).

CSA practice cases

Preparation course
Last but not least, book a CSA course. Attending a course has many advantages. You will meet other candidates sitting the same exam. Even a casual chat with a colleague on a course can be useful. You can compare your standard with others, and ask for feedback from course organisers.

There are many courses advertised. One way to pick a course is to talk to someone you know who has a similar learning style to yourself, and see which one they recommend.

Remember that you are required to bring your own diagnostic set. Buy these items well in advance. I assumed my practice would have many spares lying about, but I was wrong.

I managed to pull together all the equipment except a thermometer - my trainer had given me a mercury thermometer. I had to buy one at a local chemist.

The day before the exam, rest and stay relaxed but refreshed.

On the day
It seems obvious, but allow yourself ample time for travel to the CSA centre. I thought I had. Forgetting it was a week day, I set out to the station and there was a long queue for tickets.

I finally got my ticket, ran for the train and attempted to board, but was told 'The doors are now closed'. 'I have an exam ... ' I said, frantic as I watched the train moving away. Luckily, I made it on time, but with palpitations. I skipped coffee, so as not to make things worse.

Once in the CSA centre, stay relaxed. You are going to see similar cases to those you have seen all through your GP training. Take a seat in your consultation room and familiarise yourself with it. Once the bell goes, smile and radiate confidence. You will sail through those 13 cases.

Learning points

1. Consider your consultation style and what you want to achieve in 10 minutes.

2. Start videoing your consultations early in your training and watch them back with your trainer.

3. Do not forget to gain some experience of home visits.

4. Consider booking a CSA preparation course.

5. On the day, stay relaxed and be confident.

  • Dr Asong is a GP locum in Nottinghamshire. Dr Asong passed the CSA in October 2007 
  • This topic falls under section 2 of the RCGP curriculum, 'The General Practice Consultation',

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