Dr. Safiya Virji
The MRCGP CSA examination is a challenging exam. Dr Safiya Virji sat and passed the exam on her first attempt with one of the top scores in the country. In this article she shares some tips on preparing for the CSA exam.
An important step in successfully passing the CSA is to make a decision early on which sitting to go for, and actively work towards being thoroughly prepared by this time. I made the decision six months beforehand. I had just started my ST2 placement in GP and took this opportunity to practise various consultation styles until I found one that suited me and came more naturally to me.
I ensured that I was videoed frequently from very early on and did not let the embarrassment of watching myself on the screen stop me from getting vital feedback from my trainer. I was always conscious to encourage my colleagues to give constructive criticism so that I had identified specific points to improve over the coming weeks. I also gradually reduced my consultation times; starting at 20 minutes and gradually working down to 10 minutes about two months before the exam.
I found joint surgeries with my trainer and other partners at the surgery extremely beneficial. Not only can you see alternative ways of phrasing things, but it also gives you a chance to see how you are inclined to perform when you don’t know who or what is going to come through the door and you are being watched. Conducting these on a weekly basis meant by the time the exam came, I was already comfortable with the scenario of being watched conducting consultations I was not familiar with, so was less nervous then you would expect in such a weighty exam. This enabled me to perform to the best of my abilities when it really counted.
It is important to use all opportunities as exam practice. Every patient you see is an opportunity to practise explaining a diagnosis in layman’s terms or to ask about what they think may be causing their presenting complaint. Anything that goes wrong in your consultations is worth jotting down and discussing with your trainer afterwards. It could be the phrasing, or it could be bad choice of questions. I found the more that went wrong, the better I was getting, as I was prepared for all eventualities.
I was also part of the on-call rota and working on emergency patients with a seven minute consultation time from about four months before the exam. This in combination with the GP out of hours (OOH) gave an excellent opportunity to practise for the exam. I took the opportunity in OOH to ensure every patient I saw was observed by the trainer, timed and feedback was given.
I read a selection of case books including:
MRCGP – Practice Cases, Clinical Skills Assesment – Raj Thakkar
CSA Scenarios – Thomas M Das
Consultation Skills for the MRCGP – P Naidoo & C. Monkley
Get Through MRCGP: Clinical Skills Assessment – Bruno Rushforth (this was the best book for role play in my opinion)
I tried to use these for role plays with colleagues at least for a one hour session a week, increasing this to 2-3 hours a week in the last month before the exam. However, I also read these books in my own time to learn how simple presenting complaints can often have an unbelievable amount of depth, and how missing out one vital question can lead to missing the underlying point of that consultation.
Regarding examinations, I watched videos on how to do the examinations thoroughly yet quickly, and used my own equipment to perform these multiple times on family and friends in the week before the exam so examinations were fresh to hand if necessary.
In preparation for the exam, I set myself a target to complete all consultations within 8 minutes. Strict time management a month before the exam meant I was used to working at a fast enough pace that would ensure I would not over run in the exam, even with the unexpected cases which take a few seconds longer.
I ensured I was always trying to examine the patient by 5mins, and always kept a note of the start and finish time of each consultation to ensure I was always working to time.
In the exam, on several occasions I was still conversing with the patient when the bell rang. However, it seemed I covered enough material at the end of the 10 mins to score well on each station.
One month before the exam I went on several courses, one of which was the Emedica CSA preparation course. I found the course useful as it tackled preparation slightly differently to other courses. The group for practice was very small (just 6 candidates per group). This meant there was time to focus on each trainee independently and specific feedback was given on their performance. By the time you go on any course, you have usually had experience of the simple well known cases, but the scenarios at the Emedica course were slightly more complex than average which meant you were prepared for the more challenging cases in the real exam.
Some of the cases in the CSA do throw you so having some practice at performing under pressure can mean the difference between a pass and fail. The feedback on the course was very useful as it was not based just around what was done well, but more on what needed to be improved on in order for you to pass, and pass well. For me, this approach was more beneficial as I always maintained the attitude that by taking constructive criticism on board, I was far more likely to pass as all my flaws would be ironed out by the time the exam came round. After the course, further reading material and links were provided, including videos of common examinations. This was very helpful as though it is not a huge part of the exam, when it does come up, it is essential they are performed fluently and effectively so that the correct diagnosis is made.
Having sat the exam before all my colleagues, I was not exposed to many horror stories about the exam. This meant I was optimistic when exam time came. A combination of this, alongside minimal nerves and trying my best to apply a structure that worked for me when things were going to plan, and adapting my consulting style when I needed to be flexible, plus a happy face, lead to my passing with a score of 106/117. And I forgot to mention, when I sat the exam I was 38 weeks pregnant!
In summary, the my key tips to help you pass the MRCGP CSA exam are:
• Give yourself enough time to prepare – I started 6 months before the exam
• Use all opportunities as CSA practice opportunities – surgery, OOH, on call
• Be observed as much as possible – joint surgeries and video surgeries are both helpful
• Actively seek constructive feedback – and use it to develop your technique
• Create an effective structure that works for you and apply it as much as possible
• Get used to working under time pressure – being comfortable with 10 minute consultations really helps
• Don’t let stress on the day change your attitude toward exam consultations – keep calm and carry on
One last point, once you have finished with one patient, don’t analyse or get upset in the exam, move your focus onto the next one and give it your best!
Dr Virji passed the MRCGP CSA exam on her first attempt, and scored 106 marks out of a maximum of 117 – this is in the top 3% of scores.