CSA Practise Tools
- Consultation video analysis sheet (CSA style)
- CSA practise scoring sheet for observers
- CSA performance criteria (generic descriptors) & grading
- CSA template for writing your own
An intro to CSA
- An introduction to CSA (powerpoint)
- An introduction to the cases in the CSA
- CSA on 2 sides of A4 for trainers
- Guide to how the CSA is marked
- CSA cases and confidentiality – everyone must read this
Structuring your CSA consultation
- CSARam’s ‘5+5’ CSA consultation method (helps with time-efficiency)
- CSA – managing the 1st five minutes (YouTube video clip by Matt Smith)
- CSA – managing the 2nd five minutes (YouTube video clip by Matt Smith)
- CSA consultation model to help with time-efficiency
- CSA consultation model by Dr Ross
- CSA consultation model by Flannagan
- CSA consultation model by Flanagan as a flow diagram
Scripts and Phrases for your Consultation
Generally, we don’t recommend memorising scripts and phrases because a conversation between two people naturally flows when they respond to what each other has just said. Scripts and phrases can make the consultation look artificial or contrived. However, we’ve provided them here because we know some trainees would like an ‘idea’ of the kinds of things to say. Please develop your own phrases and remember to contextualise them according to the specific situation you are in.
- Scripts for Ideas, Concerns and Expectations
- Scripts for Psycho-Social-Occupational Enquiry
- Scripts for Explanation (Diagnosis)
- Scripts for Formulating a Management Plan
- Scripts for Checking Understanding
- Red Flags for the CSA
- Ram’s top tips for the CSA – part 1
- Ram’s top tips for the CSA – part 2
- Ram’s ‘on the day’ rules for the CSA
- What Yorkshire CSA Examiners Say…
- The RCGP’s ‘Case Cards’ resource
- Trainers – help your trainee pass CSA by tisi.doc
- CSA Preparation – by Tomson and Rughani
- CSA guidance – how to succeed
- CSA – how not to fail (powerpoint with slide notes)
- CSA – the way I did it 1 (an IMG trainee’s perspective – from 2010)
- CSA – the way I did it 2 (another trainee’s perspective – a high scoring trainee in 2013)
- CSA – guidance from trainees who have done it
- CSA myths and tips (YouTube video 11mins)
- ‘Arghhh, I’ve failed’ – how to make effective use of your feedback
Examiners’ Feedback Statements
- CSA feedback statements from the RCGP (brief)
- Examiner’s feedback statements – why people fail (brief)
- Examiner’s feedback statements – why people fail (detailed)
- 2010 CSA Examiners’ Feedback
- 2011 CSA Examiners’ Feedback
- 2012 CSA Examiner feedback from Yorkshire
- 2015 Examiner’s feedback from RCGP course
- CSA summary reports (RCGP)
Please buy through our book links below. Amazon gives us a small percentage which isn’t much but helps keep our costs down and keep Bradford VTS free for you.
If you have poor consultation skills, you are unlikely to pass the CSA. Therefore, having some sort of consultation framework is important (although which framework you choose to use from the variety out there is less important). Try and work on these as soon as you start doing a GP post (whether in ST1 or ST2) and continue to revisit and build upon in ST3. Look at the book links above for some fabulous ones that will help you build on your communication and consultation skills.
- First of all, understand what the CSA is all about – how it works and what it is trying to test. A lot of this information is available on this webpage. More information is available on the RCGP CSA pages.
- Form a CSA study group early on with some of your colleagues. Around about 6-8 members per group is about right. Try and get a diverse membership so that different members can provide unique and different perspectives on things.
- Some of you may want to do additional practice in pairs. If that’s the case don’t just stick to giving direct feedback to each other after practising a case. You all have video cameras – go further by videoing your performance and reviewing it together. We often can’t see how we really perform when we are in the process of performing and our memories are often unreliable too.
- Candidates who have got their primary medical qualification abroad (i.e. international medical graduates) – PLEASE do not form a CSA group full of other international medical graduates. You need to mix in with those who graduated from the UK to widen your cultural perspective on specific cases. That’s not to say you can’t have other international medical graduates in your group; all we are saying is to make sure there is a balanced mix of different people in your group. Some international medical graduates can often get it fixed into their heads what they think will get them through the exam – and often, these notions are completely wrong. But what is worse is when they pass that same advice onto their colleagues. But if you were part of a diverse group, then you’d be able to check those notions out.
- Our training programme (and most other schemes) will run mock CSAs twice a year to help you get practice and help you become familiar with what is expected. You must avail yourself of this opportunity.
- There’s a DVD out by the RCGP called: A guide to the Clinical Skills Assessment (CSA). For all doctors teaching or preparing for the new Clinical Skills Assessment (CSA) of the MRCGP. It costs around £20. Go to their website to purchase it: www.rcgp.org.acatalog
- Practice CSA scenarios: there are many books around (look at our Amazon link above) and many freely available on the web. There’s loads of Practice CSA Scenarios from the Pennine Scheme (click here).
These are the 3 areas you will be tested on:
- In Data Gathering, they are testing communication skills AS WELL AS clinical skills like clinical examination; around 3 stations will involve clinical examination.
- Clinical management includes synthesis, diagnosis, appreciation of co-morbidity, flexibility and sharing management options with the patient.
- Interpersonal skills include, communication, respect for others, professionalism and other behavioural indicators.
And finally, always safety net (ask your trainer if you don’t know what this means).
Some cases require examination: bring your normal doctor’s bag & equipment with you
It’s a well known fact that medical graduates who qualified outside of the UK have higher failure rates in the CSA than those born over here. This isn’t that surprising because in addition to clinical skills, the exam also tests communication and interpersonal skills. This means that when you are consulting with patients in the UK, you need to understand what they say in the context of UK culture. It also means having a good understanding of how everyday spoken English language works. If you are an international medical graduate (IMG), it’s very likely that you have a deep understanding of the societal habits, culture and nuances in language of the country you grew up in – more so than any graduate from the UK could possibly understand. Likewise, a UK graduate is more likely to understand British culture and the subtle differences in English language better than most IMGs. This means that a British graduate is more likely to pick up importance little things which the patient yields during a consultation than an IMG. Therefore, if you want to increase your chances of passing the CSA – get to know some British born trainees and practice cases with them.
Tips to help you become familiar with UK culture and everyday spoken English…
- Try and watch British based TV – especially soaps. In British soaps, actors will use colloquialisms, slang and other terminology and phrases which you will not have been taught at school. This is important because patients talk in everyday English and not textbook English.
- Try joining some sort of group in the UK. For instance, if you are a new mum, why not join your local new mums’ group (do a search on the net). Mix with people born in this country, chat to them and start becoming familiar with spoken everyday English. There are loads of different types of groups in the UK. If you are trying to lose a bit of weight, consider Slimming World or Weight Watchers – not only to help you lose that weight but to get you conversing with others. A good app for meeting up in groups is MeetUp: www.meetup.com which helps groups of people with shared interests plan meetings and form offline clubs in local communities around the world. Another great site is StreetBank: Streetbank puts you in touch with your community, bringing neighbourboods closer and making the world a bit nicer. www.streetbank.com.
- Start doing these sorts of things right from ST1 – don’t wait until ST3 because it will be too late by then! You cannot do a crash course in UK culture and English expressions; instead, it’s a lengthy but steady journey.
Tips with preparing for the CSA
- When your forming CSA study groups – join a study group with a mixture of trainees (i.e. some of whom are born in the UK and some abroad). Please do NOT form a study group purely with other IMGs – because you need to understand the cultural norms in the UK and the meaning of certain expression – another IMG’s interpretation of this might not necessarily reflect reality nor the truth!
- If you have failed the CSA, do NOT form a study group purely consisting of other’s who have failed the CSA. How will you pass if no one in your group can reliably offer you any advice for passing if they haven’t passed themselves. This is dangerous territory – stay away. The only way this will work is if you get an expert facilitator to help direct your group (i.e. someone who really understands the CSA – like a CSA examiner, a GP educator or a colleague who has passed with flying colours). If a group of you can’t get a good facilitator – make sure your group has a diverse range of people (i.e. has some British born trainees to guide you).
- Do not struggle with preparing for the CSA all by yourself. There are so many aspects to every clinical case – and you’ll become naturally aware of these if you start exploring CSA cases with a group of others. But if you do it all by yourself or with just one other colleague, it’s likely you’ll develop a one-track mind that is more likely to result in failure.
- Breaking bad news
- Motivational interviewing
- Proxy consultations
- Aggressive patients
- Manipulative patients
- Negotiation Patients who request a test
- Patients who want antibiotics
- Non-compliant patients
- Somatising patients
- Joint pains
- Non-specific abdo pain
- Tired all the time
- Relationship break up
- Anxiety/panic attacks
- Recurrent sore throat
- Non-specific chest pain