Dealing with relatives

Dr Mahibur Rahman

This article was first published in February 2005 and is reproduced with the kind permission of Hospital Doctor, who retain the copyright.

Talking to the families of your patients can be one of the most difficult parts of your life as a doctor, but you can make it one of the most rewarding. It is part of everyday life for junior staff to be asked to discuss a patient’s care. Although this may set off panic alarms inside your head, there are a few key things that can really help, whether you are breaking bad news or just updating the family on management plans.

Be prepared

You need to be fully aware of all aspects of the current situation before beginning a discussion with a family – incorrect information can produce problems later on. Arrange a time (even if it’s only five minutes later), and go over the case notes to remind yourself of exactly what has happened, what is happening now and what is going to happen. If you are breaking the news of a patient’s death, make sure you know as much about the events surrounding the death as possible (cause, time, people present etc.). Consult with other members of the team (especially nursing staff). If possible, ask someone to hold your pager while you deal with the relatives. Make sure you get permission (where appropriate) from the patient to discuss their care with relatives.

Set the scene

It is essential that any discussions take place in a suitable environment – ideally a quiet side room or office where you won’t be disturbed. Holding a discussion around the bed is very rarely a good idea. There should be adequate seating for everyone. Standing when you are talking to someone can give the impression that you don’t have much time, and need to rush off somewhere else. Try to bring a member of the ward staff with you – someone who can stay afterwards and explain or reinforce anything that you said.

What to say

elderly-personHonesty is one of the factors that relatives value the most when dealing with doctors. They need the truth to make their personal adjustments to their plans. Make sure that you do not stray from the facts, and if you are unsure about something, NEVER make it up. Instead, offer to find out and leave the details with the ward staff, or arrange another meeting.

…and how to say it

At all times, be polite and patient. Remember that the family will be under great strain. Explain things in language that the relatives can understand, avoiding medical jargon as much as possible. The relatives are much more likely to understand “your father has had a stroke”, than “the CT scan has shown an ischaemic CVA”. Where the family have a grievance about anything do not be defensive and never raise your voice – this will make the situation worse. An apology a day keeps the lawyers away.

Say it again, Sam

You may have to explain things more than once, and relatives sometimes have their own ideas about what is going on. Allow them to air their concerns. Always ask if they would like you to go over anything, and offer them a chance to ask questions. The wording of this is very important – saying “is there anything I haven’t explained clearly?” is better than “is there anything you didn’t understand?”. Although having essentially the same meaning, the first does not demean the relatives in any way, where the second might be taken as an insult to their intelligence.

And in the end

Finally, leave a means of contact if they want to follow up your discussion – this can be by leaving a message with the ward clerk or a member of the nursing team, or via your pager (only give this out if you genuinely don’t mind relatives bleeping you – it is usually better to call them so that you are properly prepared for any conversation).

You will find that family members are often very grateful for the time you take to discuss their relative’s care. And doing this well will give a huge boost your job satisfaction.

Summary

Here are some of the keys to successfully dealing with relatives.

  • Look and speak the part
  • Make sure you know the case well – read over the notes carefully
  • Turn off your phone and hand over your bleep so you aren’t disturbed
  • Use a quiet room with adequate seating
  • Explain the facts clearly, avoiding medical jargon
  • Offer to go over diagnoses and management
  • Leave time for relatives to ask questions
  • Offer to find out things you don’t know
  • Make notes and record what was said in the patient’s notes

Salaried GP Posts – Advantages and Disadvantages

Dr Mahibur Rahman

Many doctors spend a large part of their careers working in a salaried capacity. For some doctors, it is the first step on the path to a partnership, for others, working as a salaried GP bring the benefits of working in general practice without the extra responsibility, time and uncertainty of partnership. Here is a comprehensive guide to some of the advantages and disadvantages of working as a salaried GP:

Advantages

Stability

As a salaried GP, you will have a stable work environment, being able to develop a working relationship with members of the team. You will be able to plan your finances as you will have a fixed monthly income. You should have a structured working week, making it easier to plan social engagements, childcare etc. Having a regular workplace also makes it easier to access CPD, to take part in audit and significant event analysis – all of which are important as part the appraisal and revalidation process.

Employment rights

As an employee, you have significant rights. First, you have entitlement to sick pay, a minimum amount of paid annual leave, paternity / maternity pay and leave and unpaid time off for compassionate leave. After working for 2 years in the same employment, you also gain full employment rights including the right to redundancy pay. Usually your past NHS service would be recognised towards this as long as you have not had a break in service. Employment rights are one of the biggest advantages of being an employee.

Fixed commitment

As a salaried GP you should have a job plan outlining your duties, and your work time commitment should be fixed. If the practice suddenly needs extra cover, while your employer can request that you do an extra shift, you do not have to accept, and they cannot demand that you provide the extra cover. Your main commitment will be to clinical work, and many doctors prefer this – managing other employees, dealing with the upkeep of the building, keeping an eye on the accounts will not be your responsibility.

Disadvantages

Pay

Salaried GP pay is very variable throughout the UK, and even between practices within the same region. The review body recommended range for salaried GP pay for full time doctors (working 9 sessions) is currently £55,965 and £84,453 (2016 figures). These figures apply to doctors working for GMS practices or for PCOs directly. PMS and APMS practices are free to offer any salary they wish. Average pay for salaried GPs in the UK working in either GMS or PMS practices in 2013-2014 (last available actual figures) was £54,600. This figure includes those GPs working less than full time (i.e. less than 9 sessions), which make up a large proportion of salaried GPs.

In some cases, if there is a shortage of applicants, or if you are taking a salaried role with additional responsibilities, pay can be much higher, or include a “Golden Hello” – an incentive to take a post in a specific area. In the current climate of GP shortages though, you may be able to negotiate a good overall package, especially if you have additional skills that can bring the practice extra income (such as fitting coils and implants, offering joint injections etc.). In many cases, actual take home pay for a full time salaried GP may be similar to a full time partner in a practice with below average profits once you take into account deductions for NHS pensions and indemnity.

Lack of Control

As a salaried GP, you will have less control on the direction of the practice or the services offered. You may also have less flexibility in terms of how much leave you have or when you take it, compared to working as a locum or a partner. Over time, some doctors find that the workload expected of them can creep up, with additional time and responsibilities expected that are not always reflected in additional income.

Summary

shutterstock_98508338Like any job, there are both advantages and disadvantages to working as a salaried GP. Hopefully this article is a good starting point to thinking about how whether working as a salaried GP is for you.  Please feel free to contact us with any queries you may have about your career – we will always do our best to offer advice and support.

Please post a comment and share your tips and advice for newly qualified GPs.

Developing a career as a Portfolio GP

Dr Mahibur Rahman

You may have heard the term “portfolio GP” more frequently over the last few years. This is an umbrella term used to describe any GP that has multiple jobs or that does multiple types of work within their working week. Most portfolio GPs have a primary job – this could be a partnership, a part time salaried position or being a locum GP, with one or more additional jobs in their portfolio.

Many GPs develop a portfolio over time almost by accident – what starts as a one off extra session working in a prison for example can become an interesting part of the regular working week.

The range of additional jobs that you might develop an interest in as part of your portfolio is huge – from developing a specialist interest, to taking on a management role as part of the CCG. Some of the more flexible additions to a portfolio can include:

  • Medical Education
  • Forensic Medical Examiner
  • Prison Doctor
  • GP with Specialist Interest (GPSI)

In this article I will discuss some of these options in a bit more detail.

Medical Education

There are various ways to become involved in medical education, from the occasional teaching and supervision of medical students on placement at the practice to becoming a GP trainer or Training Programme Director. Teaching can be very rewarding, as well as acting as a stimulus to refresh your own knowledge and to keep up to date.

Teaching Medical Students and Foundation Trainees

Most medical schools require doctors that will be teaching students on placement to attend a short training course (often over 1 or 2 days), and then to attend annual training days. Beyond this, you will not need to have any formal medical education qualifications. For teaching Foundation trainees, most deaneries require a similar amount of training.

Clinical Tutor

Many medical schools recruit qualified GPs to become clinical tutors to facilitate small group teaching, or teach clinical and communication skills for undergraduates at the medical school. Having experience in teaching will make you a more attractive candidate, and medical schools often offer further in house training as well as support to complete a postgraduate certificate or diploma in medical education. Time requirements are usually 1-2 sessions a week.

GP Trainer

The requirements to become a GP trainer vary by deanery, although there are some requirements that are fairly common throughout:

  • MRCGP – either by examination or via portfolio
  • Training in teaching – either a trainers’ course or a postgraduate certificate or diploma in medical education.
  • Experience – the minimum post CCT experience varies from 2 years to 5 years.

There are also requirements that need to be met in relation to the training practice. A trainer would usually need to put aside the equivalent of 2 sessions a week to allow time for supervision, tutorials and ongoing workshops for trainers.

Training Programme Director

Programme Directors (formerly known as VTS Course Organisers) have responsibility for organising the regular teaching for Speciality Training schemes, as well as supporting trainers. Programme Directors are usually appointed via deaneries, and again requirements vary across the county, although most require experience of teaching and a formal postgraduate qualification in medical education at diploma or Masters level. Many Programme Directors are experienced trainers. The time commitment required is usually equivalent to 2 sessions a week or more. In many areas with larger training schemes, there are multiple Programme Directors for the same area.

Prison GP

Working as a GP in secure environments may seem daunting, however it can have many benefits. There is currently a huge shortage of GPs in the prison service, so the rates paid are usually very good. The work includes GP style clinics and ward rounds for inmates – you will usually be well supported with an experienced nursing team, and guards are nearby (they can be in the room on request in some cases). As well as acute illness and ongoing management of chronic disease, there is a high proportion of patients with mental health issues and drug misuse problems. Undertaking the RCGP Drug Misuse certificate can be useful to give you more confidence in dealing with this aspect of the work. If you are not sure if this is for you, contact your local prison and talk to the lead clinician – in most cases they will be happy to show you around the unit and offer some induction and training. There is also usually some need for on call cover, although this varies at different units.

Portfolio GP

Forensic Medical Examiner

Forensic Medical Examiners (formerly Police Surgeons) work with police forces to provide assessment and treatment to victims of crime and persons in custody. Many FMEs are GPs that work with the police as an additional role. The work can be interesting and varied, and will include assessment and treatment of injuries, minor illness, sudden illness in custody, and assessment of victims of sexual assault. Most FMEs work as part of a group of doctors that provide cover for one or more police stations day and night. A lot of the time you may be able to be on call from home, with extra fees payable for each visit to the station. Another aspect of the work of the FME involves giving evidence in court.

GP with Specialist Interest (GPSI or GPwSI)

A GPSI is a GP that has gained additional skills allowing them to offer services that have tradionally been offerd in secondary care. They can range from ENT or minor surgery to dermatology, sexual health or musculoskeletal medicine. Usually, there is a process of accreditaion that will require relevant additional qualifications and experience and then getting signed off by a consultant to state that the practitioner is capable of independent practice. Once accredited, a practice may be able to bid for work from a CCG that will allow them to accept referrals from other practices within the area. Having a special interest can make you more attractive to a practice, and a practice offering a successful GPSI service can bring in valuable extra income. There are dozens of possible special interests, and so we will look at this in more detail in a separate article.

Variety is the spice of life

These are just a few examples of some of the options you might build into your career as a portfolio GP. I know GPs that work as civilian medical practitioners on military bases, work as team doctors for sporting clubs, are involved with the air ambulance or emergency services One of the great things about being a portfolio GP is that working in different roles can help keep you stimulated and reduce the chances of burnout. I find that for me, it really is true that “a change is as good as a rest”!

Dr Mahibur Rahman is a portfolio GP and the author of “GP Jobs – A Guide to Career Options in General Practice”. 

MRCGP AKT Exam – High Yield Topics from the October 2012 Exam

MRCGP AKT Exam – High Yield Topics from the October 2012 Exam

Dr Mahibur Rahman

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.Child Health

As some of you may be finalising your revision for the January 2013 MRCGP AKT Exam, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the October 2012 MRCGP AKT exam:

The top score was 93%
The mean score was 74.3%
The lowest score was 40.7%
The pass mark was 69.8%
The pass rate was 71.6%

Scores by domain:

Clinical medicine – 76.1%
Evidence interpretation – 69.8%
Organisational – 64.1%

High Yield Topics

The examiners’ report from the October 2012 diet of the MRCGP AKT exam highlighted the following key topics:

  • DMARDs and inflammatory arthritides
  • Drug calculations
  • Oral contraception and LARC
  • Childhood development
  • Childhood immunisation schedule
  • Childhood screening programmes
  • Antenatal screening / antenatal care
  • Controlled drugs – prescribing, regulations, storage
  • Osteoporosis
  • Diabetes – diagnosis, management, interpreting diabetic blood results
  • Topical steroids for skin conditions

The MRCGP AKT is a comprehensive examinations, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

The highest scorer in the April AKT examination was Dr Razwan Ali. He attended the Emedica AKT course about a month before his exam. You can read his AKT Preparation Tips on our blog.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Further reading:
Complete October 2012 AKT Summary report

MRCGP AKT Revision – tips for effective preparation from a high scorer

GP Registrar Pay

 

MRCGP AKT Revision – Tips for effective preparation

Dr Razwan Ali

The MRCGP AKT exam is a challenging test of applied knowledge in a GP setting, covering clinical medicine, statistics and evidence based practice, and organisational aspects of general practice. Dr Razwan Ali passed the AKT on his first attempt with an overall score of 93.5% – this was the highest score in the April 2012 AKT exam. In this article he shares his tips to help you pass the AKT exam.

The first and most important point that one must appreciate when sitting the AKT is that it is a difficult exam; do not underestimate it. Almost all my colleagues that failed unfortunately decided to “cram” 2 weeks before the exam, a high-risk strategy that ultimately failed. I started my preparation  2 months before the exam, with  my weekends in the last 4 weeks taken up  with high-intensity revision.

It is worth remembering the structure of the AKT exam in relation to the 3 domains; 80% is clinical medicine, with organisational and evidence interpretation each contributing 10% of the marks in the exam.  Although these topics may take up a disproportionately longer time to cover and may at times seem quite dull to read, they can provide a real boost to your score. Moreover, once these topics are adequately covered by trainees, they tend to be fairly straightforward.

I tried to maintain a healthy balance between reading around topics and answering questions.  Simply repeating questions  may provide you with a false sense of reassurance as questions can be answered correctly by pattern recognition the second time round. Similarly, reading alone has its own pitfalls, as it does not allow you to assess whether you have truly absorbed the information you covered.

MRCGP AKT RevisionWith regards to the resources for the exam, I tended to favour online AKT examination websites over traditional text books which are often out of date with current best practice.  I used Passmedicine – this is cheaper and is of a similar if not more difficult level than the AKT exam. To supplement your statistical knowledge, you may wish to consider a basic text such as Medical Statistics Made Easy by Michael Harrison whilst the first few chapters of the Oxford Handbook of General practice provide an excellent foundation to the organisational/administrative aspect of primary care. Another important area to cover is the latest NICE/SIGN  guidelines on common topics such as asthma, diabetes, hypertension etc. as this is a common area for AKT questions.

AKT Revision Tips

  • Ensure you allow adequate time for revision – around 2 months.
  • Sign up with an online examination resource.
  • Pay due attention to statistics and organisational medicine.
  • A good AKT course can be invaluable to consolidate your knowledge.
  • Complete the online Pearson Vue tutorial to familiarise yourself with the computer system.

Exam tips for the day

  •  You have 180 minutes to complete 200 questions or 54 seconds per question.  Don’t dwell too much on one question. If you remain unsure, select an answer, mark it for review and come back to it later.
  • Answer every question even if it is complete guesswork. Remember the exam is not negatively marked.
  • Read the question carefully and thoroughly, appreciating discriminators such as most likely, least likely, diagnostic etc.

Useful resources

  • Oxford Handbook of General Practice.
  • Medical  Statistics Made Easy.
  • BNF Learn the first 36 pages, especially controlled drugs. Familarise yourself with common drugs and side-effects.
  • Memorise guidelines on fitness to drive (DVLA) and fitness to fly (CAA).
  • Familiarise yourself with NICE/SIGN guidelines on common topics; asthma, diabetes etc.
  • Be aware of RCGP feedback release from previous exams.

Dr Razwan Ali passed the AKT on his first attempt with an overall score of 93.5% – this was the highest score in the April 2012 – hopefully these tips will help you make the most of your AKT revision.

Working as a locum GP – advantages and disadvantages

Dr Mahibur Rahman

Working as a locum GP is a common starting point for many newly qualified GPs, with some doctors choosing to work as a freelance GP long term. In this article we will look at some of the advantages and disadvantages of working as a GP locum.
Advantages

Flexibility

As a freelance GP, you can have more control over where and when you work.  If you wish to take time off during school holidays, or go for an extended trip, you are free to do so without needing authorisation from anyone else.  If you wish to spend 6 months working just a few sessions a week you can.  If you need extra money for a specific purpose, you could increase your working week temporarily.  If you do not like the way a particular practice works, you can choose not to book more shifts there.

Being self employed

As a locum, you are your own boss.  You can set your own rates, and most locums can earn more per day than most salaried GPs and some partners.  As a self employed contractor rather than an employee, you are also able to claim many more expenses against your tax bill, further increasing your take home pay.

A change is as good as a rest

Sometimes working in different environments, and being able to go in, deal with the patients then leave, without getting involved in internal politics or bureaucracy can be very refreshing.  It also allows you a chance to see different ways of working, to take examples of good practice from different places, and also to see what does not work well.  Working several sessions as a locum can give you a really good understanding of whether a practice would be a good place to work long term before committing to a salaried position or a partnership.

Income

As a locum, you can realistically make a £100,000+ a year working full time if you are willing to put in some hours covering evening and weekend shifts.  If you prefer not to work evenings and weekends, you could still earn over £75,000 per year working less than full time. Working 26 hours per week at a realistic average rate of £70 per hour with 6 weeks leave, 2 weeks bank holidays, and 2 weeks study / CPD time (total 10 weeks without any earnings) gives an income of £76,440.

Disadvantages

Uncertainty

One of the big drawbacks with working as a locum is living with uncertainty.  There is no guarantee that you will be able to work as many sessions as you would like, or that practices will be willing to pay the rates that you had hoped to charge.  In some areas there many trained GPs fighting for both salaried posts and locum sessions, while in others there is no shortage of work.  Agency locum rates have gone down in the last year in some regions.  You may not know exactly how much you will earn from month to month, or exactly where you will work from day to day.  For some people this is not really a big issue, but others find it difficult to cope with a variable income when they have large fixed costs to deal with each month (e.g. paying the rent / mortgage, bills, childcare, schooling costs etc.).  Some locums will, over time get most of their work from a few regular practices, so that you might have a fairly fixed amount to your income, with the variation limited to the number of additional sessions that are available each month.

Isolation

locum gpBeing a locum can be very lonely.  In many practices, you will arrive for your session, be shown to your room by the practice manager or a receptionist, see 18 patients in 3 hours, then leave, without seeing or talking to any other colleagues.

This can be a bit of a shock to newly qualified GPs who have had the regular contact that comes with being in a training practice, as well as the pastoral benefits of being in a VTS group.  If you are doing the odd sessions in many different practices, it can be difficult to build relationships with the team.

No employment rights

As a locum, you are a self employed contractor, so you do not have any of the rights a salaried employee would have.  This means no paid holidays, no paid study leave, no sick pay, no automatic increase in pay and no job guarantee / entitlement to redundancy pay.  Of course you can take this all into account when setting your rates and calculating how much you will have to work in order to make enough to meet all your expenses and still have a decent amount of time for holidays and study leave.  You will also need to make provisions to cover your expenses if you are off sick or unable to find work for some time.

Continuing Professional Development / Revalidation

Working as a locum GP can make it more difficult to engage in CPD – for example, you may not have the opportunity to attend weekly clinical meetings or journal clubs.  Some parts of revalidation are more challenging – e.g. taking part in complete audit cycles can be quite difficult if you are not working regularly in any one practice. The latest guidance does allow alternative quality improvement activities to account for this. As a locum, you will not get any paid CPD time or study leave, so need to account for the cost of courses or e-learning as well as the lack of income while on a course when considering your fees.

Travelling

In some areas, you may find that you need to be willing to travel quite large distances to ensure that you have enough work.  This can lead to increased expenses, increased tiredness and stress if you have to travel in peak times.

Summary

Like any job, there are both advantages and disadvantages to working as a locum GP. Hopefully this article is a good starting point to thinking about how this style of working might suit you.  If you are thinking of starting out as a locum and have questions, please feel free to ask via our Facebook group or post a comment below.

If you have been working as locum for some time, or recently started, please post a comment and share your tips and advice for new locums.

Elumnus – 2010 in review

The stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads Fresher than ever.

Crunchy numbers

Featured image

A Boeing 747-400 passenger jet can hold 416 passengers. This blog was viewed about 2,000 times in 2010. That’s about 5 full 747s.

In 2010, there were 8 new posts, growing the total archive of this blog to 9 posts. There was 1 picture uploaded, taking a total of 70kb.

The busiest day of the year was August 3rd with 200 views. The most popular post that day was GP Specialty Training Payscales 2010-2011.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

1

GP Specialty Training Payscales 2010-2011 August 2010

2

How to pass the MRCGP CSA: Understanding the new MRCGP CSA Mark Scheme October 2010
2 comments and 1 Like on WordPress.com,

3

Pass the MRCGP: Preparing for the AKT exam May 2010

4

New rules for MRCGP AKT and CSA examinations August 2010

5

GP Registrar Payscales 2009-2010 March 2010

We hope to have even more posts in 2011 – why not write an article for us and get published? We are looking for anything of interest for GP trainees – tips on passing the MRCGP AKT, ideas for how to succeed in the MRCGP CSA exam, suggestions for the e-potfolio and WPBA, or an update on working life as a GP registrar, salaried GP, locum or partner. This is YOUR blog, so please do get in touch!

Wishing you all a successful 2011!

The Emedica Team

How to pass the MRCGP CSA: Understanding the MRCGP CSA Mark Scheme

 

Pass the MRCGP CSA: Understanding the new MRCGP CSA Mark Scheme

Dr Mahibur Rahman.

You may have heard that the pass rate for the MRCGP CSA dropped recently, with only 46% of candidates passing the September 2010 sitting of the exam (the pass rate was around 80% previously). Many trainees have suggested that the high CSA failure rate is due to the new marking scheme.

With the previous method of marking, candidates received an overall mark for each case, and had to pass 8 out of 12 cases to get an overall pass in the CSA. With the new mark scheme, candidates do not “pass” or “fail” each case, but are instead given a numerical score for each of 3 domains in every case. The 3 domains are Data Gathering, Clinical Management, and Interpersonal Skills. The numerical scores are:

Clear Pass – 3
Pass – 2
Fail – 1
Clear Fail – 0

This gives a maximum score for each of the 13 cases of 9 (a clear pass in each of the 3 domains). The total score for each candidate is then calculated by adding up the scores from each case, and is out of a maximum of 117 (9 x 13 cases). This allows you to compensate for a poor performance in one case with a very good performance in another case.

The pass mark each day is set using the borderline group method, which allows for adjustment depending on the difficulty of cases on the day. In September, the pass mark ranged from 75/117 to 77/117. A candidate that had a pass in every domain in every case would score 78/117 and so would have passed the September sitting.

It is not possible to directly compare the two mark schemes without more data than is currently available on the individual domain scores for candidates in the old scheme. However, it does seem that with the new marking scheme, passing the CSA is significantly more difficult than with the old marking scheme, where a candidate could have had 4 clear fails and 8 marginal passes and still achieved an overall pass.

Some details of the new mark scheme were available on the RCGP website, but it seems that many trainees were not aware of the changes before sitting their CSA in September. The RCGP has published some further details about the new marking scheme, including answers to some frequently asked questions.

Given the more challenging CSA mark scheme, we recommend that trainees start practising for the exam earlier on. Some of the ways you can improve your technique are:

width="300"• Understand what the exam is testing – read through the RCGP CSA feedback statements and examiners suggestions on how to improve on each one – many trainees only read this if they fail the CSA and are preparing for a resit. If you can learn what makes people fail, you will know what to avoid.
• Set up a study group with other trainees and try to practise cases regularly – perhaps once a week from the end of your ST2 year
• Try to do joint surgeries with your trainer so you can get feedback on both the communication and clinical aspects of your case.
• Try to do some video surgeries – you will need to enlist the help of your practice team for this to work effectively. Ask the receptionists to let your patients know that you are videoing as part of your training, and ask for a consent form to be signed if they are willing to take part. Make it very clear to patients that these videos will NEVER be used for anything other than your training, and that they can change their mind at any time during the consultation. Watching yourself on video, or going through them with your trainer often helps to pick up communication issues that could otherwise be missed.

The CSA was always a challenging assessment, with the new mark scheme it is important that trainees get as much practice as possible, with honest, constructive feedback on their performanceearly on, to allow time to embed any changes before the exam.