top tips for mrcgp csa exam

Top Tips for your 
MRCGP CSA exam part 1
A crash course in preparation for your MRCGP CSA exam


The MRCGP course organisers have written some quick tips tools to help you pass your MRCGP CSA exam and aid you in your consultation skills. We recommend consider these tips when you are sitting your MRCGP CSA exam




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General tips and pointers about the MRCGP CSA exam

  • The Royal College has a CSA case bank of 700 MRCGP CSA cases of which at least 200+ require you to perform a focused examination
  • Do not try and attempt to ‘memorise’ all of these cases as they are often reviewed and a subtle change to an examination card may change the case completely. Rather, attempt to develop general approaches or principles to categories of cases that can be adapted to whatever case you encounter
  • The CSA cases are not necessarily what you would expect to encounter in a typical surgery consultation. They have been designed to be challenging and varied and represent scenarios that you could encounter as an independent GP
  • Cases change on a daily basis and are rarely repeated in a diet. Knowing what had come up previously in your diet or the previous day will not help inform you what will come on your day
  • Ensure that you arrive early for your CSA exam as those who attend after the start of the briefing will not be allow to enter; book a local hotel if you are coming from afar
  • Make sure you bring photo ID document i.e. passport or driving license
  • All phones and electronic device barring watches will need to be handed in at reception



Exam structure in the MRCGP CSA exam

  • There are 13 cases in total in your CSA exam with 7 in the first section followed by a 15 minute interlude then the remaining 6 cases
  • You will have a few minutes at the start of the exam where you can read all the candidates’ briefs. You will also get 2 minutes between each case to read the vignettes for the next CSA case
  • Cases are often alternated between difficult and easy not to overburden a candidate with a series of difficult cases nor to disadvantage those who start off the exam with a particularly hard case
  • Of the 13 cases often 1 case (but not always) is dedicated to a telephone or home visit consultation
  • Telephone consultations may be with an adult about a medical complaint. Be sure to safety net more than you would probably in an normal face-to-face consultation as you cannot see or examine the patient
  • Telephone consultations can also be with other health professionals, i.e. hospital consultant, midwife, community matron, specialist nurse (diabetic), district or Macmillian nurse instead of a patient
  • Be prepared that occasionally things can go wrong and the telephone may not work. In the past due to electronic failure, consultations have taken place across an artificial partition but if such incidents occur then usually the case will be removed from the overall assessment
  • You will be invited to another room to have a home visit, or even the telephone consultation
  • Consider scenarios in general practice where you can be called out for such an assessment i.e. palliative care, unwell elderly patient

Your room in the MRCGP CSA exam 

  • Each room has a video camera recording your performance however this is subsequently deleted at the end of the day, unless under special circumstances, such as serious concerns are raised. They are not used as part of your assessment or for appeals
  • There are large LED timers in each room that count upwards from zero to ten minutes at the end of which a buzzer will sound. Avoid looking at the timers too often as this will be a cue to the patient and examiner that you are conscious of time and makes your consultations appear wooden
  • Each room contains a pack that consists of a prescription pad, sick notes, and common forms such as investigation requests and blood tests. If a patient insists on having a prescription to take away, do write it out and give it to them. You will be assessed for its accuracy so take your time in completing all the relevant details i.e. name, dob, address, drug, dose, frequency and signature

  

IPad in the MRCGP CSA exam 

  • Each room has an IPad that requires you to log in with your GMC number. It will prompt you of the next case and inform you if you are viewing the wrong record
  • You are allowed to look forward to other case notes on the day; especially useful during the breaks
  • Make sure that you scroll fully down to the bottom of the page in case there is more information provided for the case than you first realised
  • Your IPad is synchronized with the examiner’s so that they can send you examination findings or results (e.g. ECG) depending on what you assess or request for
  • Be prepared for the IPads not to work! Sometimes they may fail and the exam will resort back to the old-fashioned paper based assessment


Examining in your MRCGP CSA exam 

  • Consider scenarios in general practice where you can be called out for such an assessment i.e. palliative care, unwell elderly patient
  • You will not be expected to examine every patient but treat the case as if you do
  • You will not know which CSA case requires an examination. Previously you may have had an inclining as the examiner would have walked in with a card, now examiners will prompt you with examination findings through the IPad wirelessly
  • On average you may be expected to examine on 4-5 cases out of 13
  • Remember that only a focused examination is required. Your examination should not exceed 2 minutes
  • Read OSCEs books on how to perform system examinations and brush up on examination findings and how to interpret them
  • When examining the patient, ensure that you inform them what you are examining and why. Some examinations require some extra information i.e. PR exam, - e.g. ‘I will need you to lie on your side and bring your knees up to your chest. I will then insert a gloved finger into the back passage…’
  • There are a few occasions where models or mannequins are used such as an artificial breast or a pillow is used under the clothes to simulate a pregnant patient
  • You do not need to bring a sphygmomanometer as BP readings will be provided to you by the examiner, but do request for them
  • Ensure you bring all the necessary equipment including a turning fork. Snellen charts are present in all the CSA rooms
  • There is no spare equipment on the day. If you fail to bring yours the invigilators will be unable to help you. Consider improvising and safety netting suggesting to bring the patient back to perform that particular examination
  • Be prepared to use your equipment such as auroscope, ophthalmoscope or even a peak flow
  • The examiner will be observing how confident you are with the equipment. Results will be given to by way of photos/pictures i.e. fundi
  • Equipment required include: latest BNF, BNF for children, Stethoscope, Ophthalmoscope, Auroscope, Thermometer, Patella hammer, Tape measure, Peak flow meter and disposable mouthpieces
  • BNFs must not contain any notes inside or hand written annotations but can contain bookmarks.

 

 Paediatrics/Children CSA Cases 

  • The RCGP have introduced children cases to the MRCGP exam to make the CSA exam reflect real general practice
  • The CSA exam will include child actors who are aged around 10-12 years old who can roleplay patients much younger than themselves i.e. 7 year olds
  • Consider how you would consult and speak to an adult i.e. mother as well as the child. Avoid medical jargon and try simplify your explanations
  • Develop rapport with the child by asking: ‘How’s school,’ ‘Who is your favourite teacher?’ ‘Who is your best friend?’ ‘Who is your favourite football team/player.’
  • Ensure you prepare for common presentations for children such as URTI, tonsillitis and otitis media. Also consider more unique presentations for a similar age group i.e. limp/hip pain, nocturnal enuresis
  • Remember to bring your children BNF (BNFc) along with your adult BNF
  • You may be expected to see possibly 1 or even 2 cases on the day with real children.


By Nazmul Akunjee & Muhammed Akunjee
13.05.2014