CSA

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Top Tips and Guidance

Examiners’ Feedback Statements

Scripts:
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.

Other tips

HOW CAN I PREPARE FOR IT?

  • 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
  • Check out the Pennine Scheme’s YouTube site for some excellent demonstrations of consulting with patients.
      1. In this clip, Matt Smith explores important points to cover in the first 5 minutes of the consultation.
      2. In this clip, Matt Smith explores important points to cover in the second 5 minutes of the consultation.
      3. To see all of the Pennine Scheme’s YouTube video resources, click here.

These are the 3 areas you will be tested on:

  1. In Data Gathering, they are testing communication skills AS WELL AS clinical skills like clinical examination; around 3 stations will involve clinical examination.
  2. Clinical management includes synthesis, diagnosis, appreciation of co-morbidity, flexibility and sharing management options with the patient.
  3. 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

SOME DVD VIDEO AND WORKBOOKS TO CONSIDER (click to open me)

  • There is a fabulous teaching resource set by Marie McCullagh and Ross Wright:   It’s called ‘Good Practice: Communication Skills in English for the Medical Practitioner’.   For more information, click here.   To buy it, click here (and click on the green book icons)
  • London Deanery have produced two video resources that are pretty good
    • ‘Words in Action’ - a resource to aid to communication skills training.  The DVD uses real consultations recorded in the multi-cultural London borough of Lambeth to examine closely and systematically what goes on in conversations with patients who speak limited English, or who have a very different style of communicating from their GPs.
    • ‘Doing the Lambeth Walk’ - a companion resource aimed at doctors new to UK general practice. The DVD and accompanying booklet encourage practitioners to reflect on how they use their communication skills in English, manage the consultation and share decision-making with patients. It will help practitioners ‘tune in’ to the different ways in which patients speak and develop the skills needed to prevent and repair misunderstandings.
    • Each costs £5 but buy both for £8.50 (incredibly cheap!).    To order your copies, please contact Dale Burton at dale.burton@londondeanery.ac.uk or phone 020 7866 3123 or complete the slip below and return to Miss Dale Burton, 2nd Floor, London Deanery, Stewart House, 32 Russell Square, London WC1B 5DN
  • Particularly good books for starting to learn about communication skills are:
    • The Doctor’s Communication Handbook by Peter Tate
    • The Inner Consultation by Roger Neighbour
    • The Naked Consultation by Liz Moulton
    • Skills for Communicating with Patients by Silverman, Kurtz and Draper (one of the best books, but better read after one of the above three)
    • You can order any of these here

SOME SCENARIOS TO BE PREPARED FOR

DOCTOR BEHAVIOURS

  • Breaking bad news
  • Motivational interviewing
  • Proxy consultations
  • Confidentiality

PATIENT BEHAVIOURS

  • Aggressive patients
  • Manipulative patients
  • Negotiation Patients who request a test
  • Patients who want antibiotics
  • Non-compliant patients
  • Somatising patients

PATIENT PROBLEMS

  • Joint pains
  • Non-specific abdo pain
  • Backache
  • Diarrhoea
  • Dyspareunia
  • Tired all the time
  • Cystitis
  • Relationship break up
  • Anxiety/panic attacks
  • Recurrent sore throat
  • Non-specific chest pain