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.

Changes to the MRCGP CSA Exam

The RCGP has announced important changes to the number of cases and marking of the MRCGP CSA. From the September 2011 sitting of the exam, all 13 cases will count compared to the previous 12 cases + 1 pilot case. The way that the overall marks for the exam and the way a Pass or Fail for the overall exam is decided will also change.

In previous sittings, examiners marked each candidate in 3 domains, and then awarded one final grade based on their overall impression of the performance for that case. The grades were – Clear Pass, Marginal Pass, Marginal Fail, and Clear Fail. Only the grade for the overall impression for each case counted towards your exam result. To get an overall pass in the CSA, candidates needed to get a pass in 8 or more out of the 12 assessed cases.

From September, the examiners will not give a separate grade based on the overall performance. Instead, the grades given for the 3 domains (Data gathering, Interpersonal Skills and Clinical Management) will be converted to a numerical value, with the total score for each case being the total score from each domain.

The pass mark will no longer be fixed, but will instead be set each day using the borderline group method, which has previously been used to set the pass standard for the PLAB OSCE examinations.

The Emedica CSA Preparation Course includes teaching on the new mark scheme. Each course only takes 6 GP registrars, allowing each candidate to have 4 mock CSA practice cases. There is detailed 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.

Further reading:
RCGP information on the changes to the CSA.

New rules for MRCGP AKT and CSA examinations

New rules on the timing and number of attempts for both MRCGP AKT and MRCGP CSA exams are coming into effect for trainees starting a GP rotation from August 2010 onwards. The new rules are:

MRCGP AKT – Maximum 4 attempts in total (previously no maximum). Can sit the exam in ST2 or ST3 year (previously able to sit the exam in any year of training). No time limit for a pass remaining valid (previously a 3 year limit on validity).

MRCGP CSA – Maximum 4 attempts in total (previously no maximum). Can sit the exam in ST3 year or later (final year of training) – no change. No time limit for a pass remaining valid (previously a 3 year limit on validity).

The rules do NOT apply to those already in training, the old regulations continue to apply. You can read the full details of the current MRCGP regulations on the RCGP website.

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

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