I am sharing the CSA EXAM FEEDBACK 2011 given by our RCGP.

It was for the CSA Exams taken during the period from September 2010 to May 2011.

This Feedback is designed to help both GP Educators and candidates in their preparation for the CSA.  Areas addressed include examination statistics, specific candidate issues and feedback from the case management group. 

1) Examination statistics 

3590 candidates took the CSA between September 2010 and May 2011.  Most candidates appear to choose to attempt the CSA for the first time in the February/March diet, which ran for a record 25 days this year. 

Pass rates per diet are:

Diet	September 2010	November 2010	Feb/March 2011	May 2011
All Candidates	45.7%	63.4%	75.2%	64.1%
All first time takers	62.1%	76.6%	79.8%	77.9%
First time takers-UK graduates	82.0%	92.4%	92.0%	93.3%

 

UK Graduate/Non-UK Graduate Variation across 2010/2011diets 

Blue- UK Graduates          Maroon – Non UK Graduates

 

September                                                                                     November-December

                                                     

February-March                                                                                               May

                                                          

 

These statistics suggest that Non-UK graduates as a group do not perform as well in the CSA as UKgraduates.

This is similar to the differential performance seen in the AKT and in most otherUKpostgraduate examinations.

The RCGP with the support of the Royal College of Physicians and the Royal College of Paediatrics and Child Health is seeking a cross speciality review of this issue, with the aim of identifying common themes that might aid educational programmes.

A joint research project between the RCGP, King’s College London andCardiffUniversitiesis underway looking at the communicative aspects of candidates’ performance in the CSA.

The CSA Core group is offering a programme of individual supportive visits to Deaneries with low CSA pass rates.  Programme Directors from these Deaneries are particularly welcome to visit the CSA exam in action. 

A detailed annual report on examinations held during 2010/11 will be available later in the year. 

2) Specific Candidate Issues

A very comprehensive document on behaviours observed in passing and failing candidates is available on the RCGP website.

Click our article for further reading – General Comments on Candidates Behaviour in CSA. 

a) Clinical Management

 It is worth reiterating that this is the domain that causes candidates most difficulty. Clinical management should be grounded inUKmedical practice, linked to recognised algorithms or modes of practice as suggested by NICE, SIGN, or other national guidelines.  Candidates should be able to demonstrate problem-solving skills, with a range of reasonable management options to problems presented that are tailored to and acceptable to the patient.

Poor candidates may have an insufficient knowledge base to be able to think of a range of such management options, or may not be able to integrate and apply their knowledge to the situation in hand. Sometimes they do not appear to have a full understanding of the dilemma/problem presented, or its implications for the patient.

Some candidates put off making decisions, because they believe or have been told that there is always a ‘correct’ answer to a clinical or ethical dilemma, and they are afraid to  ‘get it wrong’.

This is not the case.  They simply need to demonstrate a justifiable patient centred approach to the problem.

Teaching strategies that may help with the clinical management domain include:

• Ensuring that trainees are consulting comfortably at 10 minute intervals well in advance of their CSA attempt
• Ensuring as wide a surgery case mix as possible.   In particular, ensuring access to hands on management of chronic disease cases such as diabetes and asthma, which are often the preserve of the practice nurse, and maximising the use of OOH sessions for the individual management of medical emergencies
• Assessing individual patient management plans in detail during joint surgeries, video analysis, debriefs and case based discussions.

b) Misconduct

It is necessary to remind all candidates at this point that it is forbidden to remove any material whatsoever by any means from the CSA centre.  This includes notes or copies made of any material during the course of the test.  The penalties for candidates who disregard this warning are described in a document entitled Guidance on the Conduct of Assessments and may result in disqualification.

3) Feedback from the case management group

 The CSA case bank contains approximately 550 live cases, which are used to generate the palettes of 13 cases used in the CSA.   Each CSA case has a different focus.  Great care is taken to ensure that each day of the CSA has palettes of similar challenge based on the past performance of the cases.

Providing feedback on individual CSA cases would not be practical given the number of cases in use.  However, it is possible to provide global feedback on cases based on their Curriculum area and we hope you will find it a useful basis for preparation.  We intend to provide this information on a rolling basis that will eventually cover all the Curriculum areas.

This feedback should provide candidates with ideas for cases that they can role-play with colleagues, enabling them to focus on the challenges present in such cases.

Care of Children:

In general, these cases represent a slightly lower level of challenge within the CSA, although the range of challenge is wide.

Many of these cases are consultations with the parents only (simply because children cannot take on the roles required).  A number of these cases involve teenagers where some of the challenge lies in being able to successfully generate a therapeutic rapport with the patient, assessing Capacity and explaining the problem in a manner understandable to someone who hasn’t achieved full adulthood.

There is a wide range of cases within this group:

• Concerned parents seeking advice about commonly encountered childhood problems including constipation, bed-wetting, coughs, earaches and UTIs.  Candidates need to be able to assess the nature of the problem, explain their thoughts in terms of likely diagnoses and offer advice and management that reflect good clinical practice.
• Children and teenagers with behavioural problems including ADHD and autism, and eating disorders.  Candidates need to be able to make an accurate assessment of the problem based on current guidelines and then suggest safe and reasonable management options.  Other emotional problems include anxiety, school refusal and concerns about bullying.
• Situations in which there may be reasonable cause for concern in relation to child protection.  Candidates need to be aware of the details of Child Protection guidelines so that they can provide safe assessments of the problems and offer correct advice.

Cancer and Palliative Care:

 In general, these cases represent a medium level of challenge within the CSA.

Typical cases include:

• Patients presenting with symptoms in which malignancy is a possibility.  Candidates need to be able to safely assess these symptoms, identify likely important diagnoses and manage the situation with sensitivity in accordance with current guidance.
• Patients returning from investigations to be told that the results are abnormal.  Candidates need to be able to explain the nature of the abnormalities and to potentially break the bad news that malignancy is a possibility, explaining the options in relation to future management.
• Patients with advanced disease needing palliative care.  Candidates need to be able to identify and manage commonly encountered symptoms/problems in palliative care in line with current best practice.
• Patients with advanced disease considering the options of ending their life. 

Cardiovascular Problems:

In general, these cases represent a slightly harder level of challenge within the CSA.

Typical cases include:

• Patients presenting so that their cardiovascular risk can be assessed.  Some are the worried-well; others may have significant risks that they are ignoring.  Candidates need to make a professional assessment of the risk and explain their thoughts in a clear and understandable manner to patients.  The explanation of risk is a challenge all candidates should focus upon as it is an area of the consultation often done poorly.
• Patients with hypertension, peripheral vascular disease, arrhythmias, angina and heart failure.  Candidates need to be able to diagnose and manage these common problems, mindful of the challenges created by patients with poor compliance, side effects of drugs and difficulty in understanding key concepts, such as the fact that they may be seriously ill. 

I hope that you have found this report helpful. Hearty Thanks a lot to CSA Core Group, July 2011.

Now, Please go and start your CSA Practice!

Remember –  Consistent Practice makes Consistent RESULTS!

To Your Success,

Hema xoxo.

 

FURTHER READING:

MRCGP CSA CANDIDATE FEEDBACK – JANUARY 2012.

COMMENTS ABOUT CANDIDATES’ BEHAVIOUR IN CSA.

THE NEW CSA STANDARD – SETTING SYSTEM