‘an assessment of a doctors ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice’
(RCGP 2007)



- 13 cases


- 2 minutes between cases 


- 1 or 2 examiners observing the consultation      



- 10 minutes per consultation 


- Candidates stay   in   their   consulting   room   for   all

  cases excepting telephone and home visit consulations


- The total exam lasts approximately 3 hours 


- There is a break in the middle of the exam for refreshments 


- Three domains are assessed

- Data gathering, technical and assessment skills

- Clinical management skills

- Interpersonal skills


CSA courses are a good way of familiarising yourself with the standard and format of the examination.


For more information on CSA courses see the link labelled course.



Tax relief is available on exam fees: 


Trainees can claim their tax relief either by completing a form P87 or through their self-assessment tax return if they are already in self-assessment or the expenses they've paid amount to more than £2,500. Tax relief can be claimed for qualifying expenses incurred in the current tax year or any of the four preceding tax years. More information on how to claim can be found on the Gov.UK website and at the RCGP website



   - CSA MRCGP Summary Page

   - Information about the format and content of the CSA

   - eLearning for CSA communication skills

   - mymrcgp physical examinations for the CSA


   Popular CSA Resources

   - Fourteen Fish

   - RCGP CSA Course West Midlands

   - The complete CSA Casebook: 110 Role Plays and a Comprehensive Curriculum Guide

   - CSA Cases Workbook for the MRCGP

Inside the CSA venue



CSA Format

Top Tips for the RCA

1. Start early - start recording as soon as possible to get into the swing of it

2. Get the tech - speak to your trainers to make sure you have a webcam and are aware of the governance issues of recording and storing consultaitons

3. Get the right cases

Cases submitted should be of an appropriate level of challenge sufficient to demonstrate safe and independent practice. See Appendix 1
Pick cases that help you demonstrate their skills across a breadth of the curriculum
Ensure there is sufficient evidence in all 3 domains for the assessment
Reception/admin staff need to be ‘on board’ and know what is happening
Engage reception/triage clinician to only book appropriate cases
Simple triage consultations are unlikely to cover all three domains
Agree with your practice to ‘be selfish’ and pick appropriate cases off other clinicians list
Problems that are new are more likely to be suitable for submission
Get other clinicians on board and involved with swapping of appropriate cases
If individual GP surgeries offer pre-triage or electronic navigation prior to a consultation, ensure this isn’t detrimental to the consultation and use these systems to ensure appropriate case exposure
If possible, only book willing/consenting patients to maximise opportunity.
Make sure patients know that the call may come from a withheld or unrecognised number
Be creative in how cases are identified – ask nurses for any newly diagnosed hypertensives / diabetics; following up on letters can sometimes work well
4. Balance workload with catch ups to get and stay in the right frame of mind for recording and to allow adequate time to review notes.

5. Keep up to date with the RCGP guidance which is updated regularly

6. A do not disturb sign on your door can help prevent interruptions during recordings

7. Use a desktop timer to help keep track of time

8. Consider prompt sheets to help you remember key consultation elements e.g. consent, identity checks, assessment of impact, ideas, concerns, expectations

9. Make notes as necessary but don't let note taking or typing distract from the flow of conversation

10. Reference any relevant medical history in the discussion.  You should be asking contextually relevant questions but the examiner can't assess if questions are relevant if they don't have the context you therefore need to expose relevant history to the examiner by verbalising it.

11. Learn to assess the suitability of your consultation against this grid:














Inside the CSA venue



RCA Format

RCA Marking Grid

Cases which are of low clinical challenge will not provide sufficient opportunity for trainees to demonstrate capabilities.

Examples of cases of low clinical challenge:

Follow up of well controlled chronic disease with minimal changes to current management
Medication review with minimal changes to current management
Low diagnostic challenge e.g. viral warts
Health promotion consultation - limited opportunity to demonstrate data collection and diagnostic capabilities
Appointments to request expedition of hospital appointemnts - limited oppotunity to demonstrate data collection

and diagnostic capabilities