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Hema Here!

Does prior knowledge of CSA cases help you pass the examination? 

I came across this vital information in our RCGP site and I thought it will certainly help you to pass your CSA exam.

It has come to our attention that a number of CSA ‘live’ cases are being circulated through the AiT community. These have been created by trainees who have taken the CSA or trainers who have collected them, promoting them as being helpful in preparation for the examination. The purpose of this document is twofold:

1. to warn you against rehearsing cases that you think are part of the case bank and likely to come up, and

2. to guide you into thinking constructively about the type of cases you are likely to meet in the CSA.

We would like to point out that candidates are asked specifically NOT to reveal the cases they have seen, and that copyright of these cases resides with the RCGP, who reserve the right to refer anyone found to be fraudulently using RCGP cases to the GMC, as we regard this as a form of cheating.

The risks of using ‘live’ cases.

There are now over 400 cases in the CSA case bank, with new cases being written and piloted throughout the year. The chances of seeing a case that you have heard about already are slim, and if you wish to prepare all 400 cases prior to the examination to a passing standard, that is likely to become a solid basis for your consulting skills in general practice anyway! It is also worth mentioning that while candidates could take away the clinical presentation of a case, they will not have the case specific marking schedule and will, therefore, not have much idea about the focus of the case, and what the examiner is looking for in the consultation.

We would like to warn you of the dangers of assuming you know a case from prior knowledge. We are aware of an instance recently where candidates sitting a paediatric gastroenterology case confidently and repeatedly made the wrong diagnosis. This in itself was interesting to the examiners, who spend some time at the end of each day discussing the case they have been marking.  It became even more interesting when the role players pointed out that they had played a different paediatric case the previous week that was similar enough to the present case to cause candidates with prior knowledge to mistakenly assume it was the same case. In addition, as we are now aware of the tendency of some candidates to try to memorise and rehearse cases that they know are within the CSA case bank, we frequently tweak cases so that the persona and clinical context remain the same, but the focus of the case or the diagnosis is changed.

So can we advise you on preparing for the CSA?

We would recommend that you see plenty of patients in your surgeries, getting down to 10 minute appointments as soon as you can. Reflect on these consultations and how you would deal with them in an examination situation, and you should find that your preparation enables you to tackle the examination with confidence. Using hot reviews with your trainer to do this would be a useful exercise. Mark yourself according to the CSA case marking domains of data gathering, clinical management and interpersonal skills. COTs are also a good way to practise for the CSA.

It is not considered cheating to try to predict the type of case that might appear in the CSA – this is part of the sensible preparation for any examination. To do this, you need to consider how the examination is structured and what type of ‘generic’ case is selected from the case bank for each day of the CSA (the cases change every day). The selection blueprint is published, and forms part of the CSA Introduction presentation on the RCGP/CSA website (here).

You may like to consider how you would consult if presented with the following types of cases:

1    Cases based on the curriculum statements

All cases are blueprinted to the curriculum statements. Many of the clinical statements have a box at the beginning of the statement, with lists of common conditions seen in general practice in that clinical context. It is likely (but not definite) that the ideas for cases will be drawn from these lists. Ideas also come from the different domains sub-headed in the curriculum statements.

2    The CSA case selection blueprint

This blueprint is published (see above).

       a)  Cases with a clinical examination

Think about the type of clinical examination that will be possible in a CSA-type examination that uses role players. Some examinations are not likely to occur on the role player, but might be expected by demonstration on a manikin or model (for example a breast examination or PR examination). Some examinations are not likely to occur because they will become too uncomfortable for the role player if repeated 26 times (especially if this done without consistent regard to the role player’s comfort!). You can probably make your own list of such cases.

However, where a clinical examination might be expected, make sure you are ‘slick’, focussed and look as if you know how to use your diagnostic instruments appropriately. During a CSA consultation, if you feel a clinical examination is appropriate, you should go ahead with it – the examiner will stop you if he/she has a card with the examination findings on it, or if he/she does not want you to proceed.

       b)  Age specific cases

There is likely to be at least one paediatric case and one case that involves care of elderly people. Think about the type of case that is feasible in the CSA – how might a case involving a baby be presented? Likewise with elderly patients – what common conditions might present?

        c) Cases involving issues of diversity

At least one of the cases will involve an element of diversity. This could be anything related to diversity – ethnicity/ cultural issues, age, physical disability or learning difficulty. For these cases, the diversity issue is the focus for the case, and how you deal with the patient (hopefully with tact, understanding and respect), will have a bearing on the mark you receive.

       d)  Acute and chronic presentations of illness

Think about the types of cases you are seeing in your general practice, and imagine how they might present in a CSA-style examination. 

3     Cases involving team working

GPs no longer work in isolation, and knowledge of teams in Primary and Secondary Care

and how to use them effectively is one of the competency domains for both WPBA and

the CSA.

Think about the types of team member who might ask to have a word with you during a

busy day at the surgery. What sort of problems might they bring you? How would you

respond in a manner that shows you are a good team member, knowing your areas of

expertise and respecting that of others. In some instances you might be expected to be

a good team leader. Can you demonstrate that you know when to assume the correct


4     Telephone triage and home visit cases

Occasionally you might be presented with a telephone triage or home visit case.

Telephone triage has increased in frequency in general practice quite dramatically, and is

also an important feature of Out of Hours medicine. Use your OOH experience to think

about the types of cases you have dealt with, and how they might present in the CSA.

Some calls will be for the caller, but some might be by the caller on behalf of the patient

who is too sick/ elderly/ young to call you him/herself.

Finally, remember that the cases are all taken from everyday general practice. Each one

has to be discriminating to be worthy of a licensing examination, so you are unlikely to

get a patient who only asks for a repeat medical certificate for an ongoing chronic

condition, or for a straightforward repeat prescription. If this appears to be the request,

look for an additional presentation or connected agenda that you might have missed.

(Written for RCGP by Kamila Hawthorne, July 2009)

Thank you so much Dr Hawthorne!

Now, You know what informations you need to know to pass the CSA.



To Your Success,

Hema xoxo.



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