Dr
Ravi Parekh
ST3
GP trainee & ACF
Throughout my years in GP VTS training the
three letters C, S and A have been hanging over my head like a grey cloud.
There seemed to be an incredible hype and fear surrounding the exam with
rumours flying around, to the extent that I was surprised on the day to see
that the examiners were actually real human beings and not monsters!
I thought it might be useful to share some
of my experiences in preparing for the exam, and the actual day itself for
those who will be sitting the exam in the future. As medics, we are all very
familiar with exams and I am sure each candidate understands which revision
technique works well for them– so I must emphasise this is my experience and by
no means the “right” or “best” way to approach CSA.
Preparation…
The most important thing that helped me in
preparing for the CSA was practise, practise and more practise. Amongst the
ST3s in our VTS we formed a revision group, initially gathering once a week (after VTS
teaching seemed to work well) for one or two hours going through cases. We
increased this to twice weekly about a month prior to the exam. The cases are readily available in resources
which you can buy or rent. I found the CSA Case Workbook Mock Exam by Ellen
Welch very useful with cases which appropriately reflect the level required.
The cases available on the Bradford VTS website were expertly written and very
realistic to cases that were seen in the exam. The CSA practise cards from the
RCGP were also very useful at making me think how I would explain basic
concepts. Many practises may have these available to use or borrow which can
save you money.
We tried to ensure a minimum of three
people so we had a patient, doctor and observer/examiner. Looking back, I think
it was important to ensure that we were all comfortable with everyone being
open in their feedback whether that was positive or negative. There is a real pressure
to always be nice and not hurt your friends’ feelings; however I feel being
open and constructive was the best way to get the most out of these sessions.
In
terms of courses, there is a handful to choose from all costing around £300 -
£400. I attended the London MRCGP course in Lambeth. Personally I found it to
be an excellent confidence builder and a chance to get an idea of the standard
expected, which perhaps is more difficult without a course. However, these
courses are not cheap and may not be suitable for everyone. It might be useful
to consider if you are the type of learner / personality type that would
benefit from these intensive courses, and whether you would want to spend this extra
money.
I did find it difficult to know the level
of theoretical knowledge that would be expected for the exam and therefore how
to split my revision between practical revision and bookwork. I found the
majority of the knowledge expected in the exam, I was already using on a day to
day basis in my GP surgery. Remember this is a clinical exam and majority of
the marks are around how you take a history, examine, explain and negotiate
with the patient rather than how well you have memorised a NICE guideline.
The day itself…
As with most clinical exams, I find the
nerves and apprehension is the worst part. On the day the college do very well
to try and keep you at ease and as relaxed as possible. You will be given a
morning or afternoon session with specific detailed instructions of timings and
equipment to bring. There are also videos on the RCGP website which are useful
to give you a “walk through” the exam centre.
After arriving and registering, candidates
are lead to an exam briefing to give you an overview of the day and answer any
questions people may have. Refreshments are provided throughout the day. You
are allocated your own individual clinic room with a locker inside, which will
be your home for the whole of the exam. This is a nice contrast from medical
school OSCE days, running around from room to room and forgetting your
stethoscope along the way! It also allows you to get comfortable in your room
and helps settle the nerves. The actors and examiners then rotate around the
rooms.
The patient details and relevant
information are located on your own personal i-Pad which allows you to scroll
through all the cases from the beginning. In addition you also have a white
board and marker to make notes. There is a large digital timer directly in
front of you to let you know how many minutes you have left in each
consultation. In total there are thirteen cases and you will have a break after
seven cases.
Overall, remember that the pass rates for
the exam are usually between 80-90% and the exam is there to test you on what
you will be doing daily in your GP surgery. Try to ignore much of the anxiety
around the exam, practise your consultation skills and focus on what went well
in each station.
I hope this is of some use and good luck!
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