top tips for mrcgp csa exam

Top Tips for your 
MRCGP CSA exam part 2
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

CSA preparation – How to best prepare for your MRCGP CSA exam

  • Give yourself plenty of time to prepare for your exams. People often leave 1 month to prepare for the exam which is insufficient. At least 4 months is needed to prepare for the CSA exam
  • Practice in groups as practice makes perfect
  • Consider practicing in different groups (ideally 2 or a maximum of 3)
  • If practicing in groups, when you are neither the candidate nor the actor, simulate being the examiner. When observing consider how you would have approached the same case
  • Avoid practicing with the same 1-2 friends. Often you can learn a lot from your peers but by practicing with the same group that will limit what you can learn from each other and can result sometimes in bad habits being shared
  • Consider practicing with people who have struggled in the exams before. Such relationships are mutually beneficial. They may benefit from a ‘fresh pair of eyes’ on their consultation skills whilst you may benefits from tips about the structure of the CSA exam and from their own personal experiences
  • If you cannot find anyone to practice with contact neighbouring VTS course directors for people who are in a similar position or practice over the phone or via Skype
  • Consider practicing with a recently qualified doctor who had just past the MRCGP CSA exams
  • Consider asking your trainer to practice challenging cases with you. Often experienced GPs have numerous patients they had seen that had been difficult to manage
  • If you encounter a colleague whose trainer is experienced in the CSA and offers extra training ask permission from both your trainer and theirs if you are allowed to join their study group
  • Speak to the Practice Manager about other areas of general practice such as complaints procedures, data protection requests
  • Practice with a framework to data gather information in 5 minutes, perform an examination in 2 minutes and formulate a management plan in 3 minutes. This will offer you more time for management if an examination is not required
  • Consider attending CSA courses that use medically trained actors. Often practicing with friends who are medically trained will prevent them from highlighting medical jargon that you may use especially if you practice with them often. This will not be able to create the exam pressure of simulated patient and would be rather artificial
  • Consider practicing with friends who are not medically trained along with CSA case books
  • Do review your video consultations to see if you have any troubling nuances that can unnecessarily prolong the consultation or appear unnatural such as saying: ‘OK,’ or ‘hmm’ repeatedly. Also some people have a habit of repeating their explanation several times to improve patient understanding. This is unnecessary in the exam situation and can waste valuable time
  • In daily practice at work, try having your consultations at 12 minutes so that you can simulate 10 minutes exam consultations with 2 minutes to document them on to the computer. Do not feel pressured into moving to 10 minutes if you do not feel ready
  • Make sure you get into a habit of asking the patient’s ideas, concerns, expectations, psychosocial history in a natural manner and not in a formulaic one
  • Get feedback from your patients at the end of your consultations whether you had explained things well or had in fact confused them
  • Often registrars get lumbered with the ‘duty doctor’ role and see only acute presentations such as cough and colds. Ask your trainer if you can hold ‘QoF clinics’ or share patients from their list (with their permission). Often patients with chronic conditions are more complicated and tend to migrate towards the long term regular doctors
  • Use your out of hours (OOH) sessions as an opportunity to practice telephone consultations. Have your sessions monitored by a trainer who gives you constructive feedback.


General MRCGP CSA Exam consultation tips

  • Do not follow a rigid formulaic approach for asking ICE or the patient’s psychosocial history. Be flexible in your approach and structure and make the consultation more of a conversation. Ask these questions when it feels natural to do so
  • Do not approach CSA cases as if each one has a hidden agenda. React only to what is presented to you. Often ‘hidden agendas’ are not very hidden and are easily revealed if you challenge the patient’s verbal and non-verbal cues
  • Do not make premature judgements about what the case is about in your first few minutes. Candidates often make the mistake of believing they have grasped the nub of the CSA case dismissing any further information given by the patient and then forcefully pursuing their own agenda. The actor will not bring you back if you do this
  • If appropriate, enquire about red flag symptoms so that you exclude serious conditions and demonstrate safety in your consultations
  • If you choose to summarise back to the patient, only summarise the salient points briefly as it can be quite time consuming. Consider summarising back when you are stuck or not sure what the case is about to ‘buy time’ and as a prompt to the patient that you do not fully understand their complaint. This also may allow the patient the chance to correct your history taking or add something you may have missed
  • Check understanding only if it is appropriate, especially if you think the patient appears confused once you have attempted to explain things. Inappropriate checking of understanding can be laborious and time consuming
  • If you do check understanding reverse the phrase to put onus on yourself for the poor understanding. ‘Is there anything that I have said that I could have said more clearly?’ or ‘I am sorry, if I confused you. Do you want me to go through it again?’
  • Ensure that you negotiate a management plan with the patient rather than list all options. Going through all options will waste valuable time particularly if the patient is only interested in one treatment option
  • After sharing the management plan with the patient do not be afraid to offer your opinion or recommendation. Patients consult doctors for advice and direction not to pick their own treatment. You could say: “After what you have told me about your symptoms, I would recommend...’
  • If you offer leaflets to the patient ensure that you explain its content as this will improve compliance with the advice. Do not pick up plain white A4 sheets and offer these as improviso leaflets. Tell the patient to wait in reception and to pick the leaflets up from there when you have printed them out
  • Offer health questionnaires as an adjunct to the making a diagnosis rather than the sole means to making a diagnosis i.e. phq9
  • Ensure that you safety-net your consultations where appropriate to show safety in your consultations and offer the patient an open or time fixed appointment to come back for assessment or discussion with you if things do not improve or worsen.

A crash course in preparation for your MRCGP CSA exam
By Nazmul Akunjee & Muhammed Akunjee