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When should I start joining a CSA Study Group?

1st month of a 12 month GP ST3 post

  • Read up about CSA basics – what’s it testing, how it all works, visit the RCGP CSA pages etc.
  • Informally chat to other ST3s who have done the examine.  

In the 2nd month

  • Start reading a consultation book – this will help you identify consultation microskills you need to improve.  
  • Gradually start practising some of the consultation micro-skills with real patients.  A microskill is a small segment of a consultation skill – like exploring a patient’s ideas or explaining the diagnosis or management plan to them.    
  • Also start doing COTs as these will help build skills for CSA.  
  • And get your trainer to sit in with you at least once a month in your surgeries to give you feedback.  We call these ‘Sit and Swap’ surgeries.

6 months BEFORE the exam

  • Join a CSA study group.  
  • Get those CSA books and start meeting with others and practising at least on a weekly basis.   
  • Start doing some real heavy CSA work and practice by deciding on a CSA framework and using it in your everyday consultation with patients.
  • Do some CSA practice with your trainer too.
  • Ask your trainer to rate some of your COTs in CSA terms too so you can see how you are doing.
  • Chat to ST3s who have done the CSA – and get some tips and hints from them.

Is joining a CSA group really important for success?

In short, YES!

You have to get out there and practise – it’s the best way of achieving the level communication, clinical and interpersonal skills required to pass the CSA.  The number of GP trainees I see that try to memorise stuff from CSA books is beyond belief – it’s crazy to rely heavily on books because what is being tested is not just what you know but what you say, how you say it and how you perform and interact with the patient.   Good ‘performance’ can only be gained through regular practise, not through reading a CSA book!   

For a simple analogy: imagine that you’re going to be a passenger in a car that is setting off from Leeds to Birmingham (about 90 miles).  Tell me which of these two drives would you like to take you?  Driver A believes he is a good driver because she has read the highway code and has memorised a book called ‘how to drive safely’; but he has never stepped inside a car.   Driver B has not only read the relevant books but has actually practised loads of times with a qualified driver.  


So, who will it be?   

  • Can you see why just reading a whole load of CSA books is not going to help you pass the exam?  
  • Driver B is the better and safer bet out the the two.
  • The CSA exam is a PRACTICAL exam and that means you need to PHYSICALLY PRACTISE.  

By the way, the real answer in the real world is that you wouldn’t go with either driver because neither is qualified!  Hope that made you chuckle.
So, one of the best ways to practise is to form a CSA study group early on.   

In this video, Dr Rahman emphasises the importance of study groups 

Any tips for running a CSA group?

First of all, look for a CSA group.   And if you can’t find one to join, then FORM one.   This is easily done at Half-Day-Release: simply announce that you want to join or form a CSA study group and ask if anyone can offer or is interested.   This is no time to be shy!  If you’re too scared of joining a big group, why not start off in pairs with someone.   But later on, please pluck up the courage to joing a larger group. 

In terms of the structure of your CSA group…

  • Around 6-7 members per group is about right.    
  • Try and get a diverse membership so that you get a breadth of diverse and differing opinions when dissecting a case.   
  • If you’re an IMG, please do not form a group full of other IMGs.  You need British-born colleagues to help you understand the social culture and etiquette in this country.

In terms of the process of your CSA group (i.e. the way it runs)…

  • Start meeting up about 4-6 months before the exam.
  • At the very first session, set some group rules (see below)
  • To start off with, meeting up about once a week.
  • 2 months before the exam, meet up twice a week.
  • Each CSA session should last 1.5-2 hours.

Vary the way you do each session to make them come alive.

  • Fo lots of role play of CSA cases using books for the actual cases to practise with.   
  • Use a fish bowl technique – where a patient and doctor role play in the middle surrounded by the rest of the group in a circle around them who observe and give feedback.  Always get one person in the group to represent the patient because doctors in groups often end up being nice about each other but not so nice about the patient.   The patient then gets all the blame for any poor performance on the part of the doctor.   Having a group member helps prevent this metaphorical ‘assassination’ of the patient. 
  • On other occasions, think about videoing the performance, and observe the videos in groups and see what you think.   The thing is we often don’t realise we are doing certain things because we cannot watch ourselves.  We don’t have a third eye.  However, the video can be the thing you need to provide that third self-reflecting eye.  See video as a window of CSA opportunity!   And don’t forget to do those COTs. 
  • There’s a whole variety of other methods you can play with
    1. just focusing on explanations of different diagnoses,
    2. working on specific micro-skills,
    3. using RCGP’s CSA cards and so on.

Setting Group Rules

 Setting group rules is incredibly important.   Just imagine for a moment – you’ve started up a new group.  None of you really know each other that well.   And some people  are likely to have a way saying things that will upset others.   And when that happens, group members start disliking each other.  Members may leave and at the very worst, the group might disband altogether.   Clearly we don’t want that to happen do we?    

One way to prevent that from happening is to set group rules.   Rules create ‘law and order’.  Sometimes they are necessary because everyone is clear right from the start what is permissible and what is not.   Group rules remind us that we need to speak and treat others the way we wish to be treated ourselves – primarily with dignity and respect.   In essence, group rules promote harmonious interactions and in that way your CSA group will run smoothly and the learning will be effortless and a joy at the same time.  Group rules, in effect, will ensure that your CSA session is focused on education and learning rather than on negative group emotions and scoring points against one another.


Here are some examples of common group rules you may wish the group to agree on…

  • Openness and Honesty
  • Respect/Valuing all perspectives
  • Confidentiality
  • Having an “Opt out” option
  • Owining statements eg through the use of “I” statements
  • Giving constructive criticism and supportive.
  • Punctuality/Time Keeping – restarting session promptly after tea breaks, etc
  • Having fun
  • Preparation – sharing advance material, honoring commitments
  • Commitment – doing tasks you said you’d do.
  • Mobile phones off? Or Only making calls during tea breaks.

In the beginning... focus on the story, not the timer

You have 10 minutes per case in the CSA.   But if you are just starting off, you should not worry about that.   So, if you’re starting out on your CSA practice, forget having a timer (by the way, you should be start preparing for you CSA at least 6 months before the exam date).  At this stage it is important that you focus on

  • developing your consultation framework 
  • learning how to follow the story (the patient’s narrative) 
  • taking a good enough history and examination
  • improving your explanations and 
  • learning how to formulate a joint management plan.

Later on, say 3 months before the exam, your consultation skills should be good enough.  It is at this 3-month-before-the-CSA-date that you can start getting the timer out and trying to do it all in 10 minutes.  And practice twice a week.

Getting feedback from others

There is a way to get effective feedback from others.     Actually, giving feedback is a skill in itself.   Your trainers and TPDs have had intense training into how to give feedback.  However, it is highly likely that none of your fellow trainee colleagues have.   So, here’s a way of getting the most effective feedback from them.   And by effective feedback – I mean feedback that you can do stuff with – truly be able to identify what you need to carry on doing and what you need to change.

Getting Effective Feedback…
  • Ask you colleagues to focus on your behaviour – i.e. what they can see and/or hear.    “I noticed that you said xxxx and I wonder how the patient would have taken that comment” rather than “You looked arrogant and harsh”.
  • Ask your colleagues to be specific: “Your explanation seemed rather complicated.  Could we have made it more simple?” rather than “The explanation could have been better”.
  • Ask them to give you suggestions: “So, when the patient looked at you funny, I wonder if asking her at that point what she was thinking or feeling at that point”.
  • Ask them to use the words “I wonder” or own their statements when offering advice.   “I wonder if it would have been helpful if you asked her what she thought of the management plan”, or “Personally, I would have have asked her how she felt about the management plan”.

Please leave a comment below if you have any words of wisdom to help others or if you have any questions you wish to ask…

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