The Clinical Skills Assessment (CSA)

The clinical skills assessment (CSA) assesses how a doctor integrates the application of clinical, professional, communication and practical skills. The CSA Component is distinctly different from previous MRCGP modules and feels like a busy morning surgery with thirteen life-like primary care ten-minute appointments. You stay in a consulting room whilst a different assessor each case observes you consulting with standardised "patients", all expertly role-played by professional actors. The venue for this simulated surgery is currently in Croydon until at least 2012.

These Case Cards are a useful resource for preparing for the CSA exam. They are available via the College - please go to:

RCGP Case Cards

One pack currently cost £22.50. The Dorset GP Centre has Case Cards available should you wish to look at them before purchasing.

More detail on the clinical skills assessment.

Recent CSA Results

Wessex has a proud tradition with regards to Trainee success at MRCGP, but for a number of reasons we have to review how we ensure this continues. The large majority of Dorset ST3s sat the latest CSA exam in Feb-March 2011, but unfortunately there were three unsuccessful trainees.

There are new CSA standards, we do have an increasing number of trainees whose medical qualifications were gained outside of the UK and there has been difficulty filling Wessex GP rotations in 2009 and 2010. As a training community we need to reflect on this and are already being proactive in looking at future exam sittings.

To date the VTS three year training programme has tried to avoid being an ‘exam-feeder’ course and this is an important principle to maintain. We all want to see confident and competent newly qualified GPs who are capable of starting work in the real world whilst retaining enthusiasm and a quest for lifelong learning. Of course, the exam is discussed and remains prominent on the ‘wants’ list of all ST3s. We do run an annual CSA ‘taster’ afternoon every December in addition to the residential Communication Course and strongly encouraging the ST3s to see enough real-life patients as well as start CSA revision groups.

At the next biannual Trainers meeting on Wednesday October 5^th we will run a ‘CSA Practice’ day for ST2’s, with a view to raising awareness of role-playing, CSA assessing and also to provide the ST2’s with some feedback and identify potential concerns well in advance of the obligatory ‘hoop-jumping’ in ST3. We would like to be able to repeat this exercise later in 2012 for the ST1s with, thereafter, a once yearly practice CSA late in every ST1 year.

Some of the relevant issues were highlighted at a presentation in October 2010 - http://www.dorsetgpcentre.com/gp_trainers/trainer_meetings/btm_-_6th_oct_2010.

The Deanery is aiming to ensure the early identification of trainees in difficulty but is also providing the following support;

GP Patch Office – early problem sharing and involvement of the Associate Dean, Dr Clare Wedderburn.

Wessex Faculty MRCGP 3 day CSA Revision Course – the bulk of the funding is already paid by the Deanery for every ST3 and all ST3s should be encouraged to attend the November Course.

Intensive CSA Communication Course – available for any Trainee unsuccessful at CSA, starting April 2011 and will be run, if needed, within a few weeks of any CSA diet.

1-1 CSA Coaching – for Trainees with particular difficulties or have been unsuccessful at CSA on more than one occasion. This is accessed via the Associate Dean and/or the GP Head of School

Professional Support Unit – accessed via GP Head of School, Dr Richard Weaver http://www.wessexdeanery.nhs.uk/professional_support_unit.aspx

The Clinical Skills Assessment (CSA) from the viewpoint of a GP Educator

The CSA is best taken half-way through the standard ST3 year (February - March sitting) but this requires you to start your preparations early. Whilst thirteen challenging,10 minute appointments under observation is at first a daunting task for anyone wanting their CCT it is a very realistic surgery and very achievable with some fore-planning.

Your surgeries at your training practice are your ideal preparation but you need to also arrange small groups with your peers to practice CSA role playing. Doctors traditionally don't like being asked to role-play but it is important to remove this emotional block. On the day the actors are so professional that it really does feel like real-life with all the emotions of a day to day encounter.

There are plenty of exam preparation books with suggested cases and "marking schedules" which you can buy cheaply from the cohort of ST3s who have newly qualified! However, it is also very easy to quickly create your own role plays by anonymising a recent patient encounter you or your trainer had, summarising the nub of the case for perhaps a receptionist to role play and then get your trainer to observe you and define what went well and what could have been done better. If you write these comments down they form the basis of a "marking schedule" little different from a live CSA case and can then be used in your small groups. Remember that real cases will have been dreamed up and produced from exactly this sort of starting point.

Ten minute consulting is a challenge to all doctors but remember that the exam cases are much more defined and focussed than many real life encounters. Histories are clearer, there is no previous encounter with you, case notes are brief (but often contain useful information) and there is no computer to use nor notes to write up legibly afterwards. All in all this makes ten minutes acheivable.

A structure which ensures perhaps 3 minutes for data-gathering and examination, 3 minutes for summarising, identification of any patient concerns and sharing of management options as well as 3 minutes for making a decision and explaining it beofre checking understanding will leave you 1 minute "spare"!

There is much to learn and experience in the ST3 year above and beyond passing the CSA, but as it is an essential part of your CCT why not start one fairly short but 10 minute consultation length surgery once a week from mid-November. It will help you!

Finally, make sure you book early on the 3 day Wessex Faculty CSA Preparation Course which is heavily funded for Wessex AITs by the Wessex Deanery.

The Clinical Skills Assessment (CSA) from the viewpoint of an AIT

By Dr Andrew Boyd, ST3 in Wessex from August 2009 - July 2010

The CSA – a trainee’s perspective

There is some evidence from the RCGP that sitting the CSA at the latest possible opportunity (i.e. May of the ST3 year) yields the best results, but the general consensus amongst my peers was that the Jan/Feb sitting provided the best balance of experience with a ‘second chance’ later in the year if the candidate had a shocker on the day!

With an exam that costs the same as a decent second car, you’ll be wanting to minimsie your chances of being one of the minority that fails. My top ten tips –

1) Book your exam session well in advance as the more popular sessions fill rapidly.

2) Start practicing early! Perhaps 3 months before the exam date, so that by D-Day you’re super confident.

3) Practice in groups. You can’t ‘revise’ for this exam on your own! Although very few people enjoy role playing, the quicker you get into the swing of it the quicker you’ll get used to it. It’s not that bad, particularly if you…

4) …Set some ground rules. Start and finish times for the sessions, constructive feedback only, and limited time to role play and then discuss each case.

5) Use the Wessex case cards. They’re good at the end of a group session when everyone’s role-played out. Buy them second hand, or split the costs between you to keep the price down.

6) Read the feedback on the RCGP website - http://www.rcgp-curriculum.org.uk/docs/CSA%20Candidate%20Feedback%20Suggestions%20v%208%20SRMSJAC%20100908.doc – it highlights the areas where candidates are weakest.

7) Get at least one book of cases between you, preferably more. True, they’re all less than keenly priced but they hold their value reasonably well. nMRCGP Practice Cases: Clinical Skills Assessment by Raj Thakar is pretty good.

8) Get your hands on a registrar or newly qualified GP who’s been through the exam and ask them to talk through the revision process and perhaps facilitate your first group session.

9) Scrutinize with due care and attention the ‘information for candidates’ section on the RCGP website, particularly when you need to be at the exam centre, and what you need to bring. People have been turned away because they forgot their relevant I.D - you have been warned!

10) Treat the actual exam as you would a real-life surgery – be realistic about what you can offer patients. And when, inevitably, a case goes less than perfectly, try not to panic, you’re allowed to fail up to four cases.

Good luck!!

MRCGP

The Clinical Skills Assessment (CSA)

Recent CSA Results

The Clinical Skills Assessment (CSA) from the viewpoint of a GP Educator

The Clinical Skills Assessment (CSA) from the viewpoint of an AIT

Loading Email Form...