A survey of CSA examinee’s preparation

Abstract

After passing the MRCGP Applied Knowledge Test (AKT), the main concern for most GPs in training is passing the Clinical Skills Assessment (CSA). ‘What should I revise, how should I prepare, how long should I prepare for, should I go on a course?’ etc. are common questions.

A group of ST2s in Northamptonshire were tasked with conducting a project to find what evidence or advice there was to guide GPs in training as to which preparation resources are the most effective for passing the CSA. To start, a scoping search looked for advice that was already available to GPs in training from unbiased sources.

Published advice

The RCGP website included some useful pointers and information, but there was no pooled or evidence-based advice. The RCGP recommend that one should prepare for the CSA with colleagues in small groups. An analysis of passing and failing candidates from the 2009 CSA (Rendel, Hawthorn, & Roberts, 2010) gave a great deal of insight into effective consultations and skills required to pass, but it provided no information about the resources that those candidates had used.

A search of Google Scholar© and PubMed© revealed just one article of relevance, this was a questionnaire survey done in the Northern Deanery (Dixon, 2003). It concluded that: ‘Study groups are perceived to be of greater value than vocational training schemes or trainers for the … oral components of the examination’.

A survey of CSA examinees preparation

It was felt that the sources above had not fully answered the question of how best to prepare for the CSA. As a result of this, a survey was designed and uploaded to SurveyMonkey©, which was then disseminated as widely as possible. The aim of the survey was to capture the experience of GPs and trainees who had sat the CSA in the last 5 years to learn how they had prepared and what has worked for each respondent. Box 1 lists the organisations that we would like to thank for helping us disseminate this survey.

Box 1.

Organisations that assisted us with disseminating our CSA preparation survey.

A total of 36 GP practices local to us who also had an email contact address on NHS choices

Durham & Tees Valley GP Training Programme

Northumbria GP Training Programme

Northern Ireland Deanery

GPonline

Pulse Magazine

Doctors.net

Various Twitter accounts

In total there were 252 survey responses; 146 (57.9%) from GPs and 106 (42.1%) from ST3s. As with all email and postal surveys, the research team had no control over those who chose to respond. As a result, there is the possibility of non-response or participation bias. However, some interesting findings emerged, but these can only be taken as associations and not causations. It is very difficult to fully answer all the questions on CSA preparation, but the authors hope this information helps to empower our colleagues’ decisions.

To see if the sample was representative, the CSA first attempt pass rate (79.4%) was compared with the average for the last 3 years published by the RCGP (80.5%). Therefore, in terms of pass rates at least, the sample did appear to be representative.

Results

With nearly 6000 pieces of data analysed the main outcomes that emerged were:

Group study (71%), books (38%) and in-practice learning (37%) were the most valued resources (responders top 3), while group study (47%), in-practice teaching (13%) and external course (8%) were indicated as the single most valuable resource in hindsight (Figure 1).

Valuing group study most highly made a responder 1.4 times more likely to pass the CSA at their first sitting.

Valuing a deanery CSA preparation course was associated with a 2.5 times increase in failing at first attempt (1.3 times for external course, i.e. RCGP/commercial).

Most responders prepared for 2–4 months (56%); interestingly spending less than 2 months compared to 2–4 months preparing was associated with a 6.0 times higher first sitting failure rate (Figure 2).

Figure 1.

CSA preparation resources by percentage valuing as ‘most important’.

Figure 2.

Time spent preparing for the CSA.

Similar findings emerged from the free-text responses, which are displayed in Table 1. The most common advice being ‘do small group practice’, ‘go on the RCGP CSA course’ and ‘use the Bradford VTS website’.

Table 1.

Summary of freetext CSA tips (n = 152).

Recommendation	Frequency of comments	Notes
Small group practice	66
Non-specific ‘practice’	23
Specific course	19	RCGP course frequently recommended
On-line resources	8	Bradford VTS website frequently recommended
Relax	7
Books	6
CSA case cards	6
Know guidelines	5
Start preparation early	5

Hindsight reflections are listed in Box 2. They most commonly included ‘do more small group work’, ‘start preparation earlier’ and ‘relax/do not worry’.

Box 2.

Hindsight reflections (n = 92).

• More group work (18 respondents)

• Start preparation earlier (13 respondents)

• Relax/worry less (11 respondents)

• Better clinical knowledge (5 respondents)

• Finish consultations on time (5 respondents)

• Go on a course (4 respondents)

• Don’t go on a course (4 respondents)

An email survey such as this is subject to biases, such as sampling, volunteer, non-responder, reporting and recall bias, which could have distorted the findings. For example, the better result outcome associated with valuing group study most highly could be secondary to stronger candidates engaging with this form of preparation better than weaker candidates. Likewise, weaker candidates might be more inclined to attend courses than stronger candidates.

Top tips for the CSA

Putting the survey results, together with the pre-existing evidence, the authors suggest the following top tips for CSA preparation:

Start revision early; at least more than 2 months before the examination

Study in small groups (3–5 varied people) and give frank, honest feedback; using books and the Bradford VTS website to facilitate this

If you want to attend a course, go on the RCGP CSA revision course

Relax and don’t worry.

Best of luck with your CSA preparation.

Footnotes

Acknowledgement

All authors work for and undertook this study under the auspices of Kettering GP Training Programme, Health Education East Midlands, Ruddington Fields, Nottingham.

References

Dixon

(2003) Candidates’ views of the MRCGP examination and its effects upon approaches to learning: A questionnaire study in the Northern Deanery. Education for Primary Care 14(2): 146–157.

Rendel, S., Hawthorne, K., & Roberts, C. (2009). An analysis of passing and failing candidates. Retrieved from www.rcgp.org.uk/training-exams/mrcgp-exams-overview/∼/media/77B0C1D899584B1C9DCA6AE392CD6EE4.ashx.