Good practice for passing the CSA exam is to experience as many cases as you can. Try to develop a structured approach to consulting and practice it in your working day consultations so it becomes second nature. We advise starting early in your training so you have enough time to achieve the standard required before taking your CSA.
The CSA is a significant hurdle for GP trainees so please do not underestimate the challenge of consulting effectively. Effective consulting is a complex skill which requires dedicated practice. There are various resources available to help you assess your performance including your trainers, course organisers and schemes, use of video surgeries, joint surgeries, role play groups, the GP curriculum, videos of CSA scenarios (such as those published by the RCGP, those on the penine scheme VTS website, the dialogues in decision making resource on the NHS local website) and CSA courses. Try and get an assessment early on of your skills compared against the standard required to pass CSA so you have an understanding of your strengths and weakness. Focus on the different skill areas and use the resources mentioned to regularly assess your performance to ensure you are improving towards the standard required.
Role play groups are good way of practising your skills in a safe environment and we suggest forming practice groups with at least 3 people. One acts as the examiner, one the actor and one the candidate. Try to take the acting as seriously as possible and simulate realistic patient responses.
However good your practice group CSA courses are of great value in improving your consultation skills. They will be able to better replicate the exam scenario (with experienced role players, better replication of the exam environment, more realistic pressure and experienced feedback) and can provide you with a detailed assessment of your performance compared to the standard required to pass the CSA. They also allow you to compare yourself to your colleagues. As well as assessing performance experienced course organisers will help you to develop strategies to tackle difficult consultations, to optimise performance, and to provide useful practical advice (where to stay, how to get there, what the venue looks like, what happens on the day etc...).
There are two schools of thought regarding when to take a course. 1) take a course just before your exam to check you are performing well 2) take a course earlier in your training to assess your performance. We would recommend the latter option as it can otherwise be too late to rectify failings leading to an expensive mistake (also bear in mind that the number of attempts at the CSA is limited to three).
You may wish to attempt some of our sample CSA cases which are in the style of the exam by clicking on the 'practice cases' link above. The sample questions are referenced to the evidence source, and curriculum linked. If you would like to book on a mymrcgp CSA course click here.
Some Problem areas for candidates developing their communication skills
• Language and Phrasing
• Explaining Conditions
• Managing Emotive Cases
Some areas of communication demonstrated by candidates performing well in the CSA
• Meta-communication, ‘talking about talk’
• Definition and causality (which is/which means)
• Narrative structure: sequential organisation
• Referential cohesion
• Sunny-gloomy pairings
• Metaphor: conceptual rather then concrete
• Convergence in dialogue
• Intonation for explanations
Ref RCGP Research 2012/13
Some General Tips for Coping on The Day
• Only read one case at a time
• Try to think of red flags for every case
• Don't keep looking for hidden agenda
• Ensure you are patient centred
• Practice as many cases as you can
• Take a CSA course early to get an idea of how well you are performing in a pressured environment and how
you can improve.
• Use a consultation structure in your daily surgery to develop a slick and comprehensive approach
• If you are an international medical graduate it may help if you practice in groups with UK graduates to help develop
your phrasing and to get a clearer picture of your performance. UK graduates of all ethnic groups perform better on
average than non UK graduates.