nMRCGP - Preparing registrars for the CSA

The role of the trainer is crucial in helping registrars pass the CSA, writes Dr Kamila Hawthorne.

The clinical skills assessment (CSA) is an examination of clinical consulting skills. Many GP trainers have not had experience of preparing for, or taking, such an exam, and may feel that they are poorly prepared to mentor and supervise the preparation of their GP registrars.

This article is intended as a guide to trainers on how they can help their registrars to prepare for the CSA.

Discuss the requirements of the CSA with the registrar and ensure they understand models of consulting (Photograph:jason heath lancy)

Consulting models
Start early in preparing your registrar for the CSA. Discuss the requirements of the CSA and check that the registrar understands the theoretical basis and models of consulting in general practice.

Discuss the pros and cons of the various models and use informal role play or examples from patients you have seen together to illustrate the points you make.Let your registrar watch you consulting, so that he or she can learn from your experience and example.

Use the curriculum
Use the curriculum statements wisely in your preparation, with the core statement 'Being a General Practitioner' as your base. All CSA cases are linked to learning outcomes in the curriculum statements.

Within the clinical curriculum statements, most have a box at the beginning called the 'Knowledge Base'. This will give you an idea of the types of cases that might come up.

Cases will be based on aspects of clinical consulting, but some clinical areas that do not have corresponding curriculum statements may still come up, so try to think broadly.

Lead up to the CSA
Nothing can replace clinical experience, so encourage your registrar to see lots of patients.

Have your registrar consult in 10-minute appointments as rapidly as possible. It helps them get used to the 10-minute cases of the CSA. Putting in some 'catch up' gaps in their surgeries can help them initially.

Use the consultation observation tool from the ePortfolio to help registrars analyse their consulting. It is a useful method of checking performance.

The RCGP website contains a number of useful documents about the CSA, its format and content. The PowerPoint presentation on the website includes slides that describe what the examiners are looking for in each of the three marking domains:

  • Data gathering: history taking, review of results or letters and focused clinical examination if appropriate.
  • Clinical management: a clear, safe and clinically appropriate management plan, with safety netting and follow up if appropriate.
  • Interpersonal skills: using communication techniques to gain an understanding of the patient's ideas, concerns and expectations, relating these to the management plan, sharing options and checking the patient agrees and understands.

There is also a document on feedback about performance in the CSA. This is very useful for first-time candidates, as they can learn from others' mistakes.

Useful hints and tips

The following can all help your registrar prepare for the CSA.

  • Shared surgeries: watch the registrar consulting, either in shared surgeries or videos of their consultations.
  • Explanation: in teaching sessions, have the registrar to practice giving explanations to patients. You can run through a whole surgery with the registrar, going over the various explanations to patients that might have been needed in that surgery.
  • Role play: although generally disliked, it is a wonderful way to broaden the experience of your registrar and to expose them to clinical encounters that are usually seen by the established partners.
  • Clinical examinations: check the registrar is clinically up-to-date and can competently perform the various possible clinical examinations that might come up in the CSA.
  • Guidelines: the management of cases in the CSA are based on current guidance, drawn from the usual GP sources such as NICE and SIGN.
  • Small group work: encourage your registrar to meet regularly with others preparing for the CSA. They can focus on guidelines and help out with role play.
  • nMRCGP examiner: if you know one locally, ask him or her to run a workshop at the local half-day release course for GP registrars. They can help to demystify the process, explain points of procedure and give tips on exam technique.

CSA courses
CSA courses are not obligatory. However, they can remind candidates of good consulting practice, help them get a better understanding of the process of the examination and how to approach it, and give an opportunity to measure themselves against their peers.

The RCGP-accredited courses are standardised and run by nMRCGP examiners in a number of faculties across the UK.

They are designed by experienced examiners to cover the essential issues as well as the nuts and bolts of the CSA and include case-based practice and role play.

They confer the most benefit if taken some time before the candidate sits the CSA, so that alterations in consulting behaviour have a chance to settle in and become part of 'natural' consulting. Stylised consulting behaviour is quickly picked up by examiners.

The final two weeks
In the last two weeks, your registrar will need practice, final polishing of performance, and reassurance.

Do as many shared surgeries as you can and talk about your consulting behaviour as well as the registrar's. Discuss the arrangements for the exam itself - the documents and equipment needed, and travel arrangements.

Once the exam has been sat and your registrar is back in the surgery, spend time debriefing. The registrar will find it a great relief to talk about it, and you will learn more about the nature of the exam, which you can use to help your next registrar.

  • Dr Hawthorne is a GP in Cardiff, and on the CSA Core Group of the nMRCGP
  • With thanks to Drs Johnathan Cobb and Sally Hemmens (both experienced case writers and CSA examiners)

Learning points

1. Start preparing the registrar for the CSA as soon as they join the practice.

2. Use the RCGP curriculum to ensure relevant clinical areas are covered.

3. Observe the registrar consulting and allow them to sit in with some of your appointments to watch you.

4. Debrief after the assessment.


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