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CSA Prep Top Tips for the MRCGP CSA Exam Part 1
Dr Muhammed & Nazmul Akunjee

General tips and pointers about the MRCGP CSA exam

The Royal College has a CSA case bank of 700 MRCGP CSA cases of which at least 200+
require you to perform a focused examination
Do not try and attempt to memorise all of these cases as they are often reviewed and a subtle
change to an examination card may change the case completely. Rather, attempt to develop
general approaches or principles to categories of cases that can be adapted to whatever case
you encounter
The CSA cases are not necessarily what you would expect to encounter in a typical surgery
consultation. They have been designed to be challenging and varied and represent scenarios
that you could encounter as an independent GP
Cases change on a daily basis and are rarely repeated in a diet. Knowing what had come up
previously in your diet or the previous day will not help inform you what will come on your day
Ensure that you arrive early for your CSA exam as those who attend after the start of the briefing
will not be allow to enter; book a local hotel if you are coming from afar
Make sure you bring photo ID document i.e. passport or driving license
All phones and electronic device barring watches will need to be handed in at reception

Exam structure in the MRCGP CSA exam

There are 13 cases in total in your CSA exam with 7 in the first section followed by a 15 minute
interlude then the remaining 6 cases
You will have a few minutes at the start of the exam where you can read all the candidates
briefs. You will also get 2 minutes between each case to read the vignettes for the next CSA case
Cases are often alternated between difficult and easy not to overburden a candidate with a series
of difficult cases nor to disadvantage those who start off the exam with a particularly hard case
Of the 13 cases often 1 case (but not always) is dedicated to a telephone or home visit
consultation
Telephone consultations may be with an adult about a medical complaint. Be sure to safety net
more than you would probably in an normal face-to-face consultation as you cannot see or
examine the patient
Telephone consultations can also be with other health professionals, i.e. hospital consultant,
midwife, community matron, specialist nurse (diabetic), district or Macmillian nurse instead of a
patient
Be prepared that occasionally things can go wrong and the telephone may not work. In the past
due to electronic failure, consultations have taken place across an artificial partition but if such
incidents occur then usually the case will be removed from the overall assessment
You will be invited to another room to have a home visit, or even the telephone consultation
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CSA course cases Top tips for the MRCGP CSA exam - CSA prep 2013

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Consider scenarios in general practice where you can be called out for such an assessment i.e.
palliative care, unwell elderly patient

Your room in the MRCGP CSA exam

Each room has a video camera recording your performance however this is subsequently deleted
at the end of the day, unless under special circumstances, such as serious concerns are raised.
They are not used as part of your assessment or for appeals
There are large LED timers in each room that count upwards from zero to ten minutes at the end
of which a buzzer will sound. Avoid looking at the timers too often as this will be a cue to the
patient and examiner that you are conscious of time and makes your consultations appear
wooden
Each room contains a pack that consists of a prescription pad, sick notes, and common forms
such as investigation requests and blood tests. If a patient insists on having a prescription to take
away, do write it out and give it to them. You will be assessed for its accuracy so take your time in
completing all the relevant details i.e. name, dob, address, drug, dose, frequency and signature

IPad in the MRCGP CSA exam

Each room has an IPad that requires you to log in with your GMC number. It will prompt you of
the next case and inform you if you are viewing the wrong record
You are allowed to look forward to other case notes on the day; especially useful during the
breaks
Make sure that you scroll fully down to the bottom of the page in case there is more information
provided for the case than you first realised
Your IPad is synchronized with the examiners so that they can send you examination findings or
results (e.g. ECG) depending on what you assess or request for
Be prepared for the IPads not to work! Sometimes they may fail and the exam will resort back to
the old-fashioned paper based assessment

Examining in your MRCGP CSA exam

You will not be expected to examine every patient but treat the case as if you do
You will not know which CSA case requires an examination. Previously you may have had an
inclining as the examiner would have walked in with a card, now examiners will prompt you with
examination findings through the IPad wirelessly
On average you may be expected to examine on 4-5 cases out of 13
Remember that only a focused examination is required. Your examination should not exceed 2
minutes
Make sure that you watch the RCGP e-learning examination videos on how to perform a focused
examination
Read OSCEs books on how to perform system examinations and brush up on examination
findings and how to interpret them
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CSA course cases Top tips for the MRCGP CSA exam - CSA prep 2013

CSA scenarios with REAL CSA actors

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& CSA actors on your performance

When examining the patient, ensure that you inform them what you are examining and why.
Some examinations require some extra information i.e. PR exam, - e.g. I will need you to lie on
your side and bring your knees up to your chest. I will then insert a gloved finger into the back
passage
There are a few occasions where models or mannequins are used such as an artificial breast or a
pillow is used under the clothes to simulate a pregnant patient
You do not need to bring a sphygmomanometer as BP readings will be provided to you by the
examiner, but do request for them
Ensure you bring all the necessary equipment including a turning fork. Snellen charts are present
in all the CSA rooms
There is no spare equipment on the day. If you fail to bring yours the invigilators will be unable to
help you. Consider improvising and safety netting suggesting to bring the patient back to perform
that particular examination
Be prepared to use your equipment such as auroscope, ophthalmoscope or even a peak flow
The examiner will be observing how confident you are with the equipment. Results will be given
to by way of photos/pictures i.e. fundi
Equipment required include: latest BNF, BNF for children, Stethoscope, Ophthalmoscope,
Auroscope, Thermometer, Patella hammer, Tape measure, Peak flow meter and disposable
mouthpieces
BNFs must not contain any notes inside or hand written annotations but can contain bookmarks.

Paediatrics/Children CSA Cases

The RCGP have introduced children cases to the MRCGP exam to make the CSA exam reflect
real general practice
The CSA exam will include child actors who are aged around 10-12 years old who can roleplay
patients much younger than themselves i.e. 7 year olds
Consider how you would consult and speak to an adult i.e. mother as well as the child. Avoid
medical jargon and try simplify your explanations
Develop rapport with the child by asking: Hows school, Who is your favourite teacher? Who is
your best friend? Who is your favourite football team/player.
Ensure you prepare for common presentations for children such as URTI, tonsillitis and otitis
media. Also consider more unique presentations for a similar age group i.e. limp/hip pain,
nocturnal enuresis
Remember to bring your children BNF (BNFc) along with your adult BNF
You may be expected to see possibly 1 or even 2 cases on the day with real children.

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CSA course cases Top tips for the MRCGP CSA exam - CSA prep 2013