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Surviving (and hopefully passing) CSA

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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