The CSA with Confidence
WHY PEOPLE FAIL THE CSA
DOWNLOADS & LINKS
An introduction to the 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
- 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
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
- 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
- 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
These scripts and phrases may help you with your communication skills. Generally , I don’t recommend memorising scripts and phrases because a conversation between two people should flow naturally – in other words, a conversation where each person responds to what each other has just said – and most of the time you cannot second guess what the other person will say. So – beware of scripts and phrases – they can make the consultation look artificial or contrived and the CSA examiners are very good at picking up things that sound artificial. For example, don’t explore Ideas, Concerns and Expectations (ICE) just because others have told you it is a good thing to do in everyone. Do it because you are genuinely interested and because you think it will be helpful. The same goes for the psycho-social-occupational (PSO) exploration of the impact of an illness.
On the other hand, scripts and phrases can provide you with a starting point by giving you some idea of what to say. They sound better if you can modify them so that they fit with your personality and style.
Examiners’ Feedback Statements
There’s a lot you can learn from Examiners’ feedback statements on previous exams. They highlight common difficulties and failures – which you can learn from!
- 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)
An intro to the CSA
First of all, if you don’t properly understand how the CSA works or what it is testing, then it is unlikely you will succeed. Think about it for a moment – if you truly understand the marking schedule, then actually you have the ‘answer’ sheet which should guide you how to pass. So step one to passing is going back to basics and truly understanding what the CSA is about and what it is testing.
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).
More information is available on the RCGP CSA pages.
Develop your own framework (i.e. structure)
Reading a consultation book or two will definately help you get some of the cores communication skills to consult effectively with patients. Although some people are naturally good at patient-centred consultting and others less so, the good news is that these skills can be learnt. Yes! Even if you are not good at consulting in a person-centred way, with practise you can learn to be as good as those who are naturally good. Of course, the key word here is practise!
Some good consultation books are…
- The Inner Consultation by Roger Neighbour (a great starter esp for ST1s).
- Skills for Communicating with Patients by Silverman et al (one of the best foundation books around – a definite worthwhile read).
- The Doctor’s Communication Handbook by Peter Tate (another foundation book).
- The Naked Consultation by Liz Moulton (covers a variety of tricky scenarios – another definite worthwhile read).