A registrar survival guide ... for the CSA

Be prepared
Get to the clinical skills assessment (CSA) examination venue in Croydon in good time. Bring any medical equipment or books, such as MIMS, that the RCGP advises you to bring.

You are also expected to bring your normal doctor's bag. Check that your medical equipment, especially if battery operated, is in good working order.

Listen to the examiners' brief
The examiners will brief you before the exam commences. Follow their instructions. Expect to be told to treat the exam as a locum session with 13 patients booked into your clinic. When the bell rings, the patient and examiner will enter your room, and at the second bell, they will leave. There will be a two-minute break between patients to allow you to use the rest rooms.

Read the patients' medical notes
Use the two-minute break to read the patient's notes. You may be provided with a sheet of paper containing a summary of the patient's problem list, medication, hospital letters or test results. This may give you a clue to the patient's reason for attending the clinic.

Interact with the patient
The examiner accompanies the patient. Ignore the examiner and engage with the patient - be patient-centred. Take a focused history and, if necessary, perform a targeted examination. Explain your findings, diagnosis and management plan to the patient in clear, jargon-free language. Invite the patient to ask questions and clarify any outstanding issues. If the patient looks unhappy at any point, ask them for their ideas or solutions. Marks are awarded for your data gathering (history and examination), clinical management and interpersonal skills.

Be time-conscious
You have 10 minutes for each patient. Try to remain logical and systematic in your approach. If you become flustered, take a moment to collect your thoughts. It may be useful to summarise the patient's ideas, concerns and expectations out loud to help you take stock. Remember that you are not expected to perform a full examination; a targeted examination will suffice.

Compose yourself for the next patient
Bear in mind that this is an exam, so expect a mix of low- and high-challenge patients. When the patient leaves the room, try not to ruminate on what you could have done better but compose yourself for the next patient.

Dr Prashini Naidoo is a GP in Oxfordshire and author of 'Cases and Concepts for the new MRCGP - CSA and CbD'

Essentials checklist

  • Proof of identity.
  • Medical equipment in a doctor's bag.
  • A mix of listening and questioning skills.
  • A mental check-list of pre-prepared questions.
  • A watch for time-keeping.


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