The CSA with Confidence

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TIP 1: you have got to practice!

I see so many trainees in the last 2 months before the CSA exam taking lots of time off to “read” books and read CSA cases and the marking sheets to brush up on.

THIS IS NOT A GOOD WAY OF LEARNING FOR THE CSA EXAM.

Why? Because the exam is not only testing your knowledge. It’s testing your performance too. And examiner isn’t going to ask you to write down how to explain, say COPD, to a patient or verbally recite what you have read. No – instead, they’re going to want you to explain it in semi-live conditions with a patient actor. They are marking you on YOUR PERFORMANCE. So it seems illogical to use a study method which does NOT help you with your performance. Wouldn’t you agree? Reading books is just helping you with your memory and knowledge. And yes, the CSA has a strong clinical knowledge component – and we must NOT belittle that, but equally do not belittle the PHYSICAL PERFORMANCE from you that is required. For instance, you might be able to explain COPD in your head, but can you do it face-to-face with a real person? Will you stumble over your words? Answer = you will not know if you don’t practise! And you will never get feedback on how you are doing if your revision idea is sat in a room with a CSA book all alone.

So practise is the key and there are many ways to practise. And you need to practice with others so that they can give feedback to you to help modify your behaviour towards a more desirable way. But I will say something – seeing lots and lots of patients during real surgeries will automatically expose you to the type of things that will come up in the CSA exam. And if you slow down a little an pay attention to what you are doing in real surgeries (and by that I mean taking some times to practising some core CSA skills with real patients and making a list of clinical topics you’re not good at and reading up about them there and then), you will do a lot better than just reading books and becoming a book worm.

So, real practise is the key. This link takes you to a page which tells you all the different ways of practising for the CSA. Do as many ways as you can to make it lively and FUN! www.bradfordvts.co.uk/mrcgp/csa/csa-practice-methods/

Here are some more video clips talking about the importance of practice.

TIP 2: Don't know what the management plan is?

Quite a number of trainees get stuck if they have the slightest notion of not knowing the knowledge or the clinical management plan about something. As a result the rest of the consultation goes wrong because this “negative thought” preoccupies their mind so much that it interferes with the rest of the consultation.

BUT IT NEEDN’T BE. Here are some tips…

First of all, just because you don’t know the right clinical management plan SHOULD NOT stop you from taking a good history, a good examination, making and explaining the diagnosis. Remember, Clinical Management is just ONE arm of the trio of things they assess in the CSA. You can still get full marks for Data Gathering and InterPersonal Skills. And remember, you don’t have to pass all three components (Data Gathering, Clinical Management, InterPersonal Skills) to pass the CSA case.
Be honest that you don’t know but say it in a way that does not make the patient lose faith in you. “Mmmm to be honest, it’s not an area I am familiar with but I tell you what I can do, I can speak to the specialist about you and I’ll call you back and discuss it with you. How does that sound?”
And remember, just because you don’t know the exact clinical management plan does not mean you should give up hope. Other than give a medicine for something, is there anything else you can offer (Physio, Counselling, Dietician, etc.)

Look at this clip and see how Dr Anu handles the management in plan in this case of premature ejaculation. Notice in particular, just because she doesn’t know the clinical management in detail, at least she still offers other help like RELATE counselling and so on.