helpful hints for your revision
Revise with Others
We would strongly advise against revising alone for the CSA. Ideally a group with a minimum of 3 members is required. You can allocate roles to each person in the group, for example, one can be the doctor, another the patient, and the third an observer / marker. You can alternate roles with each case.
It is useful to include different genders and ethnicity within your group. This way, you can benefit from different expertise and experiences.
Aim to initially start meeting 3-4 months before the exam.
It is vitally important that you prepare for these meetings. We found it helpful if each member brought or created a case with a marking criteria, and perhaps a precis of the topic in question. Each week a different topic was chosen, to try and cover the curriculum.
Yes, this does sound obvious. However the more cases you cover in your revision, the more confident you will be in the exam. With practise, the structure of the consultation will become more instinctive, allowing you more time to focus on other aspects, such as cue handling and exploring ICE (ideas, concerns and expectations).
If you get a chance to take part in a mock CSA, or practise scenarios at your GP teaching, then be brave and volunteer - the more exposure you get to cases, the better you will become. Trainees are often afraid to put themselves forward to be the doctor - however it is better to get it wrong in a practice consultation than in your exam!
There are also things you can do on your own - please see below for further advice.
There is unfortunately no quick and easy solution to passing the CSA, it simply takes time.
Long road ahead
Its important to remember that you have a long road ahead of you, not only will you be revising in your free time, meeting up with others, reading up management guidelines etc... But you will have to do it on top of your normal job commitments.
A recommendation that worked well for us was sticking to 15 minute appointments until we had taken the CSA exam. Now I know what you're thinking - "shouldn't I be down to 10 minutes before the exam?" Whilst it's true that you have 10 minutes per patient in the CSA, there are several things you wont have to do in the exam, that you would in real life. e.g. in the exam you will not have to call the patient, wait for them to walk down to your room, refer them anywhere, print out leaflets, write out scripts (In the majority of cases) nor type anything up. In fact, in around 8 out of the 13 cases you wont even have to examine the patient. I therefore found that 15 minutes was the perfect amount of time for me to apply a CSA style of consultation to every patient who walked through my door. That way I could encompass a lot of my CSA training within my normal working day. The only caveat here is that you must time yourself so that you allow only 10 minutes per patient, and then have the remaining 5 minutes for admin / documentation.
Use your trainer / HDR sessions
Make use of your trainer. This can be achieved through many different avenues:
Many HDR programms also run simulated patients, or mock CSA's. These are a great way of attaining experience in doing consultations under pressure. Opportunities like these should be jumped on, as they will only stand to make you better, and increase your chance of passing the CSA
divide your time
Divide your revision time in three - initially spending roughly equal amounts of time devoted to each area.
1. Learning your medicine - you will feel far more confident if you know about the common conditions that may come up. CSA is obviously more than just a knowledge based exam, however for you to really be able to focus on the consultation skills, you will need a firm grasp of the basics: symptoms, signs, differential diagnosis, management options, medications etc... The last thing you want to be doing in an exam is misdiagnosing or mis-managing simple or common conditions. Not only will this lose you marks, but will also lower your self confidence.
2. Practising your explanations and management options. The first step here is making a list of common medical conditions, and writing out simple explanations for them. Useful on-line resources for this include patient.co.uk, or even NHS choices. Alternatively you can also find explanations attached to our CSA cases within. The next step involves practising your explanations / management options. This can be done with any one, even by yourself. You need this part of your consultation to be slick. Spending no longer than 1 minute explaining the condition, and a further 1-2 minutes giving out appropriate management options. You don't have time in the exam to be making up an explanation for a condition there and then - so make sure you practice!
3. Revising whole cases in a group. This is obviously really important, and the closer you get to the exam, the more you will likely meet up. Its recommended to start meeting up at least 3-4 months in advance, on a weekly / biweekly basis, increasing to 3-4 times a week a month or two before the exam.
Once you have spent a bit of time in each of the above domains, you will realise where your weaknesses lie. At that point you can focus more energy one one or two of the areas as needed.
Use online resources
There are lots of excellent on-line resources out there to help. Some recommendations include:
Pennine GP website - Here you will find links to lots of resources about the CSA, including plenty of helpful videos to help guide you.
Bradford VTS - excellent resource to aid CSA revision
Patient.co.uk - excellent for simplistic explanations of conditions
NHS choices - again excellent for simple explanations
NICE CKS - an excellent resource for evidence based management
Practise "clinical management"
The most common reason for failure is poor performance in "clinical management". Very rarely do people fail to deliver in data gathering or interpersonal skills. This poor performance will either be down to lack of time - they didn't get to that part of the consultation, lack of a decent explanation or lack of competent management skills.
Take time to learn about the common conditions, prepare good and quick explanations for patients. Read up and learn about how to manage common chronic / acute conditions, and practise option sharing. Good resources for patient explanations are linked above, or alternatively feel free to sign up and have a look at our examples.
Your own style
I can't stress this enough: You need to be you! Everyone has different consulting methods and styles, and whilst there is a lot that you can learn from others, including certain phrases, or ways they approach questions / difficult situations, you should not try to copy their 'whole' style.
We often found that someone in our group would have an excellent way of explaining something, or of taking a history etc... Then what would invariably happen is that others would try to mimic.
The problem we found was that people who spent their time focusing on imitating other candidates style ended up missing important information in the case. This occurred because they were not focussing on the patient and teh case at hand.
We found it was better to take specific phrases or words that appeared to work well, but not to try and copy their whole approach to the case. That way it is easier to remember one or two words, without derailing your entire consultation.
Yes, we all have to do this at some stage for COT's, and yes, we don't like it. In fact, I hated watching myself back on the projected screen, everything I missed or did wrong seemed so much worse. However, this step is vital in your development towards passing the CSA.
It is only through watching yourself back on the screen that you can identify all the cues you missed, the fidgeting you might do, or other habits you have that might impede your path to success. We would advise using your trainers when viewing back the videos, as they have a lot of experience in helping trainees identify areas of both excellence, and those that need development.
Practise the unkown
Let's face it, it doesn't matter how hard you revise, you are bound to come up against a case in the exam that is going to throw you. Either you wont know the diagnosis, or the management, or you may just be completely stuck at what you need to do next! It happens to all of us. So we need to prepare in advance for this.
Now, you might be asking - well how do we prepare for the unknown? It is a good question. Firstly, we found that the greater the variety of cases you were exposed to during revision, the less likely it will be that you might find yourself in such a predicament. So make sure to practice as many cases as you can.
Secondly, you can prepare by using some of our fictitious cases, which we have developed specifically with 'undiagnosable' conditions, or simply ones that don't exist. We wouldn't be expecting you to cure these people, but it can help you practise dealing with the unknown. Even if you don't know the diagnosis, or know how to properly treat a conditions, that shouldn't stop you getting at least some marks in that station. Read our "on the day" section for tips how to survive such consultations, as well as signing up to gain access to these practice cases.