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:

• 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.