MRCGP CSA Preparation – Tips to help you pass the MRCGP CSA exam

CSA Preparation – Tips to help you pass the MRCGP CSA examMRCGP CSA Exam Tips
Dr. Safiya Virji

The MRCGP CSA examination is a challenging exam. Dr Safiya Virji sat and passed the exam on her first attempt with one of the top scores in the country. In this article she shares some tips on preparing for the CSA exam.

An important step in successfully passing the CSA is to make a decision early on which sitting to go for, and actively work towards being thoroughly prepared by this time. I made the decision six months beforehand. I had just started my ST2 placement in GP and took this opportunity to practice various consultation styles until I found one that suited me and came more naturally to me.

I ensured that I was videoed frequently from very early on and did not let the embarrassment of watching myself on the screen stop me from getting vital feedback from my trainer. I was always conscious to encourage my colleagues to give constructive criticism so that I had identified specific points to improve over the coming weeks. I also gradually reduced my consultation times; starting at 20 minutes and gradually working down to 10 minutes about two months before the exam.

I found joint surgeries with my trainer and other partners at the surgery extremely beneficial. Not only can you see alternative ways of phrasing things, but it also gives you a chance to see how you are inclined to perform when you don’t know who or what is going to come through the door and you are being watched. Conducting these on a weekly basis meant by the time the exam came, I was already comfortable with the scenario of being watched conducting consultations I was not familiar with, so was less nervous then you would expect in such a weighty exam. This enabled me to perform to the best of my abilities when it really counted.

It is important to use all opportunities as exam practice. Every patient you see is an opportunity to practice explaining a diagnosis in layman’s terms or to ask about what they think may be causing their presenting complaint. Anything that goes wrong in your consultations is worth jotting down and discussing with your trainer afterwards. It could be the phrasing, or it could be bad choice of questions. I found the more that went wrong, the better I was getting, as I was prepared for all eventualities.

I was also part of the on-call rota and working on emergency patients with a seven minute consultation time from about four months before the exam. This in combination with the GP out of hours (OOH) gave an excellent opportunity to practice for the exam. I took the opportunity in OOH to ensure every patient I saw was observed by the trainer, timed and feedback was given.

I read a selection of case books including:
nMRCGP – Practice Cases, Clinical Skills Assesment – Raj Thakkar
CSA Scenarios – Thomas M Das
Consultantion Skills for the new MRCGP – P Naidoo & C. Monkley
Get Through New MRCGP: Clinical Skills Assessment – Bruno Rushforth (this was the best book for role play in my opinion)

I tried to use these for role plays with colleagues at least for a one hour session a week, increasing this to 2-3 hours a week in the last month before the exam. However, I also read these books in my own time to learn how simple presenting complaints can often have an unbelievable amount of depth, and how missing out one vital question can lead to missing the underlying point of that consultation.

Regarding examinations, I watched videos on how to do the examinations thoroughly yet quickly, and used my own equipment to perform these multiple times on family and friends in the week before the exam so examinations were fresh to hand if necessary.

In preparation for the exam, I set myself a target to complete all consultations within 8 minutes. Strict time management a month before the exam meant I was used to working at a fast enough pace that would ensure I would not over run in the exam, even with the unexpected cases which take a few seconds longer.
I ensured I was always trying to examine the patient by 5mins, and always kept a note of the start and finish time of each consultation to ensure I was always working to time.
In the exam, on several occasions I was still conversing with the patient when the bell rang. However, it seemed I covered enough material at the end of the 10 mins to pass well on each station.

Having sat the exam before all my colleagues, I was not exposed to many horror stories about the exam. This meant I was optimistic when exam time came. A combination of this, alongside minimal nerves and trying my best to apply a structure that worked for me when things were going to plan, and adapting my consulting style when I needed to be flexible, plus a happy face, lead to my passing with a score of 106/117. And I forgot to mention, when I sat the exam I was 38weeks pregnant!

One month before the exam I went on several courses, one of which was the Emedica MRCGP CSA course. I found the course useful as it tackled preparation slightly differently to other courses. The group was very small (courses take just 6 candidates per day). This meant there was time to focus on each trainee independently and specific feedback was given on their performance. By the time you go on any course, you have usually had experience of the simple well known cases, but the scenarios at the Emedica course were slightly more complex then average which meant you were prepared for the more challenging cases in the real exam.

Some of the cases in the CSA do throw you so having some practice at performing under pressure can mean the difference between a pass and fail. The feedback on the course was very useful as it was not based just around what was done well, but more on what needed to be improved on in order for you to pass, and pass well. For me, this approach was more beneficial as I always maintained the attitude that by taking constructive criticism on board, I was far more likely to pass as all my flaws would be ironed out by the time the exam came round. After the course, further reading material and links were provided, including videos of common examinations. This was very helpful as though it is not a huge part of the exam, when it does come up, it is essential they are performed fluently and effectively so that the correct diagnosis is made.

In summary, the my key tips to help you pass the MRCGP CSA exam are:

• Give yourself enough time to prepare – I started 6 months before the exam
• Use all opportunities as CSA practice opportunities – surgery, OOH, on call
• Be observed as much as possible – joint surgeries and video surgeries are both helpful
• Actively seek constructive feedback – and use it to develop your technique
• Create an effective structure that works for you and apply it as much as possible
• Get used to working under time pressure – being comfortable with 10 minute consultations really helps
• Don’t let stress on the day change your attitude toward exam consultations – keep calm and carry on

One last point, once you have finished with one patient, don’t analyse or get upset in the exam, move your focus onto the next one and give it your best!

Dr Virji is a GP Registrar (ST3) in Oxford Deanery. She passed the MRCGP CSA exam on her first attempt, and scored 106 marks out of a maximum of 117.

The Emedica MRCGP CSA Course includes teaching on the new CSA mark scheme including the 2012 CSA feedback statements. Each course only takes 6 GP registrars, with a strong emphasis on practice with individual feedback. Practice sessions are donw in groups of 3, allowing each candidate to have 4 mock CSA practice cases. There is detailed, constructive 1 to 1 feedback after each case using the new marking criteria. Our mock CSA cases are done in a realistic setting with professional simulated patients and timed in the same way as the real exam.

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.

Pass the MRCGP: Preparing for the AKT exam

Pass the MRCGP: Preparing for the AKT exam

Dr Mahibur Rahman.

The MRCGP Applied Knowledge Test (AKT) examination has recently been made harder – the pass standard was increased after the January 2010 exam, leading to the lowest pass rate so far – 73% passed the exam in January (compared to a long term average of 79% passing).  The secret to passing the exam is effective preparation.

Here are some revision tips to help you pass the exam:

  1. Plan your preparation – to cover the syllabus for this exam while also working will take most doctors 2-3 months revision.  Make sure you allow enough time to cover everything properly.
  2. Remember the boring stuff – registrars tend to do less well at the organisational and evidence interpretation questions than in the clinical medicine questions.  These areas include questions on statistics, types of study, interpreting graphs and charts, practice management, medico legal issues, DVLA guidelines and certification.  20% of the marks come from these areas, and although they may be boring to study, they offer relatively easy marks.
  3. Break your revision into bite sized chunks – after about an hour, your concentration and recall drops dramatically, so you will retain more by revising in multiple short sessions with breaks in between rather than a few longer sessions.
  4. Focus on your weak areas – doctors often enjoy attempting questions on topics they are good at, as they feel good when they get a high score.  You should avoid this and instead spend more time in areas that you are NOT so confident on; as these are the subjects you are more likely to lose marks in.
  5. Mix reading with practice – a good way to cement your learning and be sure that you can apply what you have read is to do a mixture of reading around core topics and practice sample AKT questions.  Ideally you should practice questions to time, as the pace in the real exam is very fast – you have to answer around 200 questions in 3 hours – this is less than 1 minute for each question!

The AKT is a challenging examination, but it is also fair.  Hopefully these tips will help you on your way to a pass.  Remember – if you fail to prepare, you should prepare to fail!

Dr Mahibur Rahman is the medical director of Emedica.  He is a portfolio GP and a consultant in Medical Education.  He has taught extensively on MRCGP and GP careers courses, as well as teaching GP trainers.  Details of the Emedica AKT Preparation course are available at http://courses.emedica.co.uk/acatalog/nMRCGP_AKT_Preparation.html

Emedica Alumni are entitled to a £20 discount – use this code when booking – alumniakt2010

Starting in General Practice

Starting in practice

Starting out in General Practice (whether in your ST1, ST2 or ST3 year) can be a challenging time. You have to deal with a completely different way of working compared to hospital medicine, new computer systems and electronic patient records and usually a lot more responsibility for your own patients. This article from www.gpst.info offers some advice on starting out.

Settling in

Apart from the obvious differences in setting and the range of patients seen, there are changes in the level of responsibility and autonomy you have. Although you will initially be seeing patients with your trainer, you will very quickly find you have your own booked surgeries, and you will largely be working independently (although with help close at hand whenever you need it). This can be both daunting and very satisfying – you’ll be amazed at both how much you do and don’t know! One of the most pleasant changes from hospital medicine is the continuity of seeing patients over a long period of time, and getting to know them. Most registrars also love the freedom of not having a pager after so long.

Practice Routine

You will soon find out that the work day is slightly different in practice compared to in hospital. No more starting the day with a long ward round and then working through the morning and perhaps a clinic in the afternoon – interspersed with trips to the ward to resite cannulas and complete TTOs. Instead, you are likely to have a morning and afternoon surgery, with plenty of paperwork in between, some home visits, the odd tutorial and regular practice meetings. You will soon find out which days you are on call (home visits etc.), and which clinics happen on which days (baby clinic, smear clinic, diabetic clinic, COPD clinic etc. etc.).

Working with the team.

Although you will be in your room seeing your own patients a lot of the time, you will find that in primary care there is a large team of staff with various skills and roles that you have to fit into. You need to find out how to make the best use of the resources available. Some of the members of the team include:

Practice Manager Very important. Will sort out your pay, training on practice systems, may be involved in sorting out study leave and rota. Normally involved in keeping an eye on progress with QOF points under new contract.
Receptionists Practices could not run without good receptionists. They will locate your notes, find results, and be responsible for letting patients know when you are going to be videoing for your assessments. Be nice to them!
Practice Nurse Most practices now have nurse led clinics for various things – CHD, COPD, Asthma etc. May also see patients with minor ailments, as well as dealing with removal of sutures, immunizations, and assisting in minor surgery.
Healthcare Support Worker Many practice employ a HCSW to take bloods, blood pressures and help the practice nurses with clinics etc.
District Nurses May be attached or directly employed by the practice, usually involved in care of terminally ill patients, community management of DVT, care of housebound patients.
Health Visitors Involved in child health surveillance, including developmental assessments, hearing assessments and home visits to children and new mothers.
Practice Secretary Where would you be without someone to type and send all your dictated referral letters? Probably still at surgery until late.
Other doctors Remember that your trainer is not the only one that you can learn from. The other doctors may be involved formally or informally, and should be able to offer help and advice when you are unsure of a diagnosis or when to refer.

Electronic Patient Records

One of the biggest changes in General Practice comes when dealing with patient records. Many practices are paperless (or paperlight), with almost everything done on the computer system. Whichever system your practice uses (EMIS, Torex, Vision, SystemOne), you need to spend some time learning how to navigate it. Keeping accurate and detailed records is essential – not only for your patients, but to help colleagues when they follow up your patient, and also for your own protection in case there is ever a complaint. Make sure that you are comfortable with how to enter consultations, examinations, how to check blood results and access letters from secondary care.

Finally, I recommend that you LEARN TO TYPE! The better you can type, the more detail you can provide in your notes without running late. Emedica have developed a simple, fun way for you to improve your typing skills. You can use this free typing package, called Meditype to practice typing (it has a practice module and a typing game to make it more enjoyable). You can have a go at www.meditype.org.