nMRCGP - Prepare for the CSA experience

Dr Zohra Jafri describes how her consultations helped her prepare for the clinical skills assessment.

The clinical skills assessment (CSA) is structured to reflect the practical working experiences of an authentic surgery list, so it follows that the best preparation is seeing patients in surgery. Therefore, without conscious planning for the exam, in my day-to-day work and in familiarising myself with the consultation process, I gained valuable initial preparation.

My learning was augmented by undertaking video consultations early on in my registrar job.

Patients were happy to participate and the videos, along with short evidence-based presentations on the medical conditions, formed a basis for weekly tutorials. An additional suggested approach was to participate in joint surgeries with my trainer.

Constructing mock timed consultation scenarios is a useful way to prepare for the actual exam

A couple of months before I sat the CSA exam, I attended a revision course, which was held at the CSA examination centre in Croydon, south London.

While not essential, I personally found the experience invaluable. It was useful to gain feedback from examiners and candidates.

Mock consultations
Nearer to the time of the exam, my trainer constructed mock timed consultation scenarios.

This gave me an idea of the time restraints of the consultation. At the time that I sat the exam, I was seeing patients at intervals of 15 minutes, and I was aware that this was five minutes more than the timing in the exam.

The scenarios provided the opportunity to gain feedback of the consultation from the 'patient' as well as my trainer. I also participated in mock consultations during one of the VTS teaching sessions.

The days before
I spent the few days preceding the exam at work, seeing patients in surgery as usual, but paying particular attention to the length of consultations and reading around problem areas.

The RCGP website contains a list of instruments candidates should bring with them to the exam. The only thing I brought that was not on the list was a BNF for children, which was one of the few items that I did actually use.

On the day
Before the exam commenced, we were given a short presentation about how the exam would run and an opportunity to raise any concerns or queries.

Compared with other postgraduate exams I have sat, the atmosphere was noticeably relaxed. With regards to dress code, most candidates had gone for the smart work wear option.

The candidates were split into three groups and we were each assigned a particular room number within the group.

We were each given a locker for our personal belongings, and the only things that I took into the room were the items of equipment (having been transferred to the clear bag provided) and a drink.

In the room
The room looked new and bright (with a fairly good view over London, if you're interested) and was arranged like a typical consultation room.

There was a clock on the wall and a Snellen chart on the back of the door. On the desk there was a pile of blood test and radiology request forms and a prescription pad. In addition to this, there were also a few pieces of extra equipment (none of which I used).

Most importantly, there was an A4 file containing information on each of the patients whom I would be seeing.

There was a timetable that listed the patients in order, (seven patients followed by a break for coffee/toilet and then the six remaining cases). The patient information was arranged in order.

In general, there was one A4 sheet per patient. I familiarised myself with the timetable and the information provided for the first patient. To be honest, the information provided is fairly minimal. As I recall, it consisted of basic information (name, age) and a few lines about ongoing medical conditions, past medical history, social history and investigations.

Compared with a normal surgery, the information is clear, concise and presented in a user-friendly layout.

The consultations
Once the first buzzer sounded, the patient entered the room, followed by an examiner who sat in a chair out of direct view.

The consultation ran the same as in real life, bar the usual interruptions. On one occasion the findings were pictorial, so I would recommend being familiar with what may be found on, for example, fundoscopy.

When the 10 minutes was up, another buzzer sounded and the patient and examiner left the room. There was then a break of a few minutes to get over the last consultation and prepare for the next. Rather worryingly at the time, in 11 of my cases the patient was still seated and the consultation was in progress when the buzzer sounded.

Typical surgery
At the time, I felt that one case went very badly, and the majority I was not sure about. Overall, there was only one slightly surprising case. I felt I had spent most of the time during consultations communicating and a minimal amount of time examining. I also felt like I had told most of the patients to stop smoking, cut down on alcohol, eat healthily and exercise more - it really did feel like a typical surgery.

  • Dr Jafri qualified as a GP in August 2008 and will start in a salaried position in January 2009
  • This topic falls under section 2 of the GP curriculum 'The General practice Consultation', www.RCGP-curriculum.org.uk

Learning points

Organisation is the key

1. Organise tutorials, and mock/video consultations with your trainer at the beginning of the registrar year.

2. Review clinical guidelines (aim for one a day) and incorporate into tutorials along with current evidence.

3. Remember that every surgery session is preparation for the exam.

4. Although there are strict time constraints, try not to become too distracted with timing as this may interfere with the natural flow of the consultation.

5. Try to be yourself rather than using a formulaic approach.

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



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