How to pass the MRCGP CSA: Understanding the new 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.

The RCGP changed the way the MRCGP CSA exam is marked from September 2010. We posted an update about this a while back, but wanted to go through the details of the new marking scheme in more detail.

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
Marginal Pass – 2
Marginal 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 marginal 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:

• 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 practice 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 performance early on, to allow time to embed any changes before the exam.

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.

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.

GP Specialty Training Payscales 2010-2011

These are the current payscales for GP trainees in effect from April 2010 – April 2011.  The GP Registrar supplement is currently 45%.

GP Specialty Training Payscales

You should start on the paypoint with basic pay that is closest to your current basic pay.  E.g. if your current basic is £29,500, you will move onto the StR Min scale, with a basic pay of £29,705 and so on. You will move onto the next point on the scale on the anniversary of your increment date (this should be on your last payslip).

When you are on paypoint StR3 or higher (shown in yellow above), you are entitled to an extra 5 days of annual leave – so you will get 30 days instead of 25 in addition to bank holidays.

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

GP Registrar Payscales 2009-2010

These are the pay scales from April 2009 – March 2010 (including the latest pay award).

GP Registrar Jobs

The current supplement for GP Registrar’s is 45%.

pay gpr

*These figures are estimated monthly take home pay net of income tax and national isurance. They have been rounded down to the nearest pound, and are based on a tax code of 647L.  As your pay may change during the tax year, the actual amount may differ.  You can get an accurate monthly calculation here (external link).  These figures do not include deductions for the NHS pension.

GP Registrar’s medical indemnity will be reimbursed less the amount they would have paid for an SHO job.

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 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