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

SPECIFIC GUIDANCE FOR IMGs (click to open me)

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 MeetUpwww.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.

SOME DVD VIDEO AND WORKBOOKS TO CONSIDER

  • 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