CSA preparation for overseas trained doctors the way I did it.

(Dr Sarabjeet Gujral, G !rainee, "radford #!S$

%irst and fore&ost thin', there is no discri&ination 'oin' on in the e(a&ination hall.
I a'ree that there has been a tal) about no videos in all the roo&s and bein' the only
post 'raduate e(a&ination with one e(a&iner inside a closed roo&. !he &ost
i&portant is to 'o in with a positive &ind.
It is e(tre&ely i&portant to ai& passin' all the *+ cases. !his will not let you rela(
while preparin' for the e(a&ination and will &a)e you feel confident on the day of
e(a&ination.
,y e(perience co&es fro& discussin' how to prepare for the e(a&ination with
trainee candidates passed fro& -orthwest, west .or)shire, south .or)shire and west
&idlands. Also &y preparation 'roup included / trainees fro& south .or)shire.

A) Books ands video.
I went throu'h each 0 every boo) and video available to prepare for CSA and I can
fairly say which boo)1video provides what and what could be the order of use of
various boo)s. !his is &y personal jud'e&ent about boo)s and video (yours &i'ht be
different$.
riority and use of boo)s and videos.
CSA Scenarios for the new ,2CG by !ho&as Das
provides a list of cases for the CSA and further G life. -ot really co&plete
In &any specialities there is a clear lac) of cases. for e( ophthal&olo'y.
Details of treat&ent not 'iven, which is certainly needed. 3verall 'ood case
list but lac)in' in )nowled'e.
Get !hrou'h -ew ,2CG4 Clinical S)ills Assess&ent (Get !hrou'h Series$ 5
this lovely 'reen boo) can be the base of how to start to prepare. Sa&e
su''estion a'ain prepare in 'roups. 3ne beco&es the patient and one doctor
and another observer. I wish this boo) had &ore cases in it.
Also note down the state&ents used by this author while consultin'. It is 'ood
idea to use the&. Also 'ives so&e of the odd cases which are not covered
anywhere else.
-,2CG ractice Cases4 Clinical S)ills Assess&ent by 2aj !ha))ar (AS
test boo)$ 5 e(cellent boo)5 prepares you for chronic disease &ana'e&ent.
"read and butter of G land and so&e of the cases of CSA. A'ain to prepare it
in 'roup.
!hird is the boo) of -aidoo, co&es in three colours.
Green [Consultation Skills for the New MRCGP: Practice Cases for CSA
and C! "#lus $%$) & is the best also 'ives &oc) cases which are helpful.
!he &ost a&a6in' thin' of this boo) is the video. If I have to reco&&end one
thin' for overseas doctors it would be this video. 7e will tal) about this
further in second part of this tal). 2e5watchin' this video a'ain on the very
last day &i'ht put you in the ri'ht fra&e of &ind.
*
Red [Cases and Concepts for the new ,2CG /e4 Clinical S)ills Assess&ent
(CSA$ and Case5based Discussion (CbD$8
Blue [Cases and Concepts for the new ,2CG4 Clinical S)ills Assess&ent
and Case5based Discussion4 CSA and CbD4 CSA and CbD for the -,2CG
,ost of the cases are sa&e in red and blue boo)s.
9ssential -,2CG CSA reparation and ractice Cases (,asterpass Series$.
!his boo) can be discussed if you can find ti&e. "ut full ti&e G trainees
usually stru''le to find ti&e to cover all the boo)s. If possible read it as there
are so&e cases which are not 'iven in other boo)s.
ennine #!S website 5 http411www.pennine5'p5trainin'.co.u)1csa5case5
scenarios5written5by5our5'psts5for5their5csa5wor)5'roups.ht&.
7e found these cases useful to discuss but &any of the& are covered in other
boo)s already discussed. A'ain could be covered if you can find ti&e.
!here is another boo) in the &ar)et now5 -otes for the ,2CG4 A
Curriculu& "ased Guide to the A:!, CSA and 7"A seen only after the
e(a&ination so doesn;t )now about it.
#ID93
D#D of cases provided with the 'reen -aidoo boo). !he &ost useful of all
the video available. 2eally useful for content, style of consultation.
Concentrate on the lan'ua'e used (this is particularly i&portant for overseas
doctors$.
I feel that this should be the fra&e of &ind when we (overseas doctors$ wal)
in the e(a&ination hall. It is probably worth to watch a'ain on the day before
the e(a&ination.
2CG video5
Series II
is &ore relevant for the e(a&ination. It covers unusual types of scenarios li)e
District nurse station, an(ious relative, toleratin' uncertainty.
It is useful to )now about these cases as they co&e fairly co&&only in the
e(a&.
Series I5
After watchin' it I felt li)e the e(a& is about tic) bo( to cover various points.
7ell definitely not li)e that in actual e(a&ination. .ou can &iss &any points
and still easily pass but should not &iss any si'nificantly relevant point.
!he &ar)in' pattern shown in both these video is &ore opti&istic then the
actual e(a&ination. As per these videos you need terrible blunders to actually
fail the e(a&ination which is certainly not the case.
Don;t watch these 2CG videos in the last &inute (&y personal feelin'$
/
Courses- I have done 2.
2CG course
It is useful to )now as to how e(a&ination centre and roo&s loo) li)e. It ta)es away
your an(iety. It is a / day course. 3n days two */ cases discussed each trainee
does one. All the other candidates are watchin'.
!he e(a&ination actors are not sa&e as actual e(a&inations
I felt that the course doesn;t pitch to the actual level of e(a&ination. Also felt that
they &a)e you feel opti&istic. Actual e(a&ination is probably &uch &ore difficult.
<-A C3A=9S5
Good course and covers reason why people fail. Good advice about what to prepare
and what to wear for the e(a&. I feel it is useful for a lot of reason.
Cases covered by this course pitches at the level of e(a&. Good variety of cases.
7hat to wear is a useful advice. She also tells you about how to behave in the
e(a&ination hall.
9 ,edica5
-ot done it but have spo)en to people who have done it. ,ost of the trainees ran)ed
this course as 'ood.
PR'PARA!(N ) CAS'S
5 Gynaecolo'y cases 5 Can be a disaster if you are a &ale trainee and not well
aware of the fact that there is a 'ood share of 'ynae cases in the e(a&ination.
3n as)in' a lot of &ale trainee doctors post e(a&s said that they were not
well prepared for the wo&en health cases. Could be another reason of why
hi'her pass rate of fe&ale doctors.
,ale trainees don;t nor&ally see a lot of these cases in the real world and can
be suddenly flooded by the& in the e(a&ination. I selectively pic)ed up
'ynae cases fro& all the boo)s and practice the& with other trainees.
Another reason to have a &i( of &ales and fe&ale trainee in your study
'roup.
5 I&portance of 'ood clinical )nowled'e. !his cannot be replaced under any
circu&stances. CSA is not a Co**unication skills assess*ents +ut a
clinical skills assess*ent. !here is a ban) of &ore than >?? cases now and
will probably be &ore in the future.
Cases are pic)ed up rando&ly by the co&puter. !hese cases are rando&ly
divided between all the 2CG Curriculu& State&ent @eadin's therefore
they have a 'ood &i( of cases and can not reflect real life in any case.
In &ost of the cases they will loo) for an appropriate &ana'e&ent plan as
well.

5 Co&fortable with blan) faces. So&e of the actors in the e(a&ination are
really 'ood but so&e will co&e with blan) faces.
It is i&portant to practice with collea'ues as this will 'ive practice to deal
with patient actin' and also e(pressionless cases.
+
5 Co&fortable with the e(a&iner in the roo&. !his is really i&portant5 not
easy as it loo)s. 7e are used to see cases1video alone. !his is not sufficient. I
thin) at least after A sessions I felt co&fortable with &y trainer sittin' in the
roo&. It would be useful if you could do clinics with different trainers if at all
possible. ractice in 'roups is a'ain helpful. In e(a&ination the e(a&iner
will not be in front of you but will be always in your visual fields.
5 !oleratin' uncertainly. Does not &ean tou'h &edicine cases. !here is a 'ood
e(a&ple in 2CG video II about a case of &edical uncertainty. A tou'h 9-!,
3phthal&olo'y and &edicine case is not a case with uncertainty.
5 Difficult cases. the cases in CSA does not truly reflect real life as the case are
ta)en fro& the 'rid of G curriculu& headin's so potentially could include
difficult cases fro& unco&&on specialities. It is useful to have the clinical
)nowled'e under your belt otherwise it would be very easy to panic there.
If you don;t )now about the )nowled'e aspect of the case it is difficult to
)eep yourself cal& and concentrate on patient a'enda;s and what patient is
spea)in' as obviously you would be thin)in' about the differential dia'nosis
of the case and &i'ht &iss i&portant cues. (As per the previous trainees 5
"elieve &e it happens everyday in the e(a&ination hall$
5 G2ID of areas fro& the G curriculu& state&ent headin's. repare with the
'rid. Buestion paper can be fairly easily predicted. Cases fro& so&e
co&&on curriculu& headin's are always there (li)e there will always a bac)
pain case$. Gives you confidence if you )now the )nowled'e5 thin)s about
the possible unco&&on cases of &inor clinical specialities. 3(ford handboo)
can help with this to find unco&&on cases.
5 repare for real life as well. A 'ood preparation for CSA always prepares you
for real life. Goin' throu'h all the possible scenarios covers for all possible
cases both for CSA and for further practice.
5 9(a&ination scenarios. <sin' past trainees to help you. !hey can beco&e
your patient and practice with the& if possible will 'ive you a chance to
understand where actual cases can pitch. It is ille'al to as) for the
e(a&ination scenarios (&a)in' one scenario cost about C?? pounds to
2CG$. !he sa&e scenarios can be as)ed in &any different ways so )eep
your &ind open. :nowin' scenarios can be ris)y as &any candidates have
failed assu&in' thin's and &a)in' decision based on previous scenarios.
5 Gap between CSA and A:!5 the least this 'ap is &ore appropriate it is as
)nowled'e base of A:! is useful in CSA. !a)in' the A:! too early is not
very useful as we have to revise everythin' a'ain.
5 Chan'in' 'ears the &ost i&portant bit. It is i&portant to be patient centred
but careful with cases where there is a sic) note or inappropriate prescription
is an issue. .ou 'et this chance to show the difference between actual patient
centeredness and doin' what the patient says.
A
CONSULTATION AND COMMUNICATION
I 'ot a chance to prepare with other overseas doctors, so&e eastern 9uropean
candidates and so&e Caucasians as well. !hat really helped &e to see the
difference between overseas trained doctors and in particular Caucasian
fe&ale doctors who perfor& the best in CSA.
,any of these s)ills are helped by <na Coales.

5 Difference between real life and CSA. .ou can never open a can of wor&s in
CSA. So&eti&es the other way round infor&ation is hidden and Duestion is
supposed to be as)ed in a certain way to 'et the infor&ation out. !his does
not often happen in real life. !here is a very little chance of Duestions li)e Eis
there anythin' else you want to sayF or Ehow is it effectin' your lifeF to ta)e
you off the trac) or open a can of wor&s (which you don;t )now what to do
with$ in CSA whereas in real life there will always be story followin' these
Duestions. Another reason why to i&press the actor. Actors are also hu&ans
li)e youG they will try to help you if they are on our side.
5 And E@37 IS !@IS A%%9C!I-G .3<2 =I%9F. Sin'le &ost i&portant
Duestion to as) in CSA. "efore preparin' for CSA I never as)ed this Duestion
in real patients. I found it a useful way of ta)in' history as it will obviously
brin's out psychosocial aspects and patient a'enda as well. It effectively cuts
down the need to as) a lot of other Duestions. And a'ain will hardly ever
open the can of wor&s in CSA. A'ain very useful to see Caucasian trainees
usin' this Duestion.
5 !ry not to say EI needF a very useful tip by <na Coales (a si'n of
inappropriate doctor centeredness$ which in &y case was further helped by
one of the local 'raduate by chan'in' it fro& EI needF to Ewe needF.
Althou'h I have seen it in couple of places in CSA preparation videos but it
is so&ethin' to drop if you use it.
5 E,ay IF instead if Ecan IF another useful advice fro& <na Coales. !his is
actually the traditional way of spea)in' to the patients. <na Coales
reco&&ends an old &ovie EDoctor in the houseF which I thin) is useful to
watch.
5 Dress H suit 5 7@.. I&portant to dress very s&artly in a nice shirt and suit
with a sil) tie. !his advice is 'iven by a lot of previous trainees. !he concept
behind is tryin' to i&press the e(a&iner and the actor li)e in an interview.
(!he concept of first i&pression of an interview$. 7ithout a 'ood
perfor&ance it &i'ht not &ean anythin' but will add to your confidence and
&i'ht just add to the first i&pression. -o har& in tryin'.
About >?I of the e(a&inees are s&artly dressed in the e(a&ination.

5 "ro)en 9n'lish, 'ra&&ar &ista)es5 &any of the overseas doctors spea) very
'ood 9n'lish and therefore to so&e e(tent don;t a'ree that 9n'lish could be
a factor in their perfor&ance. Spea)in' 'ood 9n'lish is a crucial part of
CSA. articularly under pressure it is possible that we spea) bro)en 9n'lish
with 'ra&&ar &ista)es. I feel this in itself is sufficient to reduce our
perfor&ance fro& clear pass to a &ar'inal pass. Spea)in' s&all sentences
can be a 'ood alternative. ractice and )nowled'e will help your confidence
which will further help your perfor&ance.
C
5 Spea)in' less will also save you ti&e. A co&&on place where trainees
stru''le is e(plainin' co&&on ter&s for e(a&ple 'enetics, epilepsy, heart
failure etc. this is further hard if 9n'lish is not our first lan'ua'e. It is useful
to use websites li)e atient u), e5G to &a)e s&all sentences in lay&an;s
lan'ua'e.
5 Consultation in your own lan'ua'e5 raised &y &oral. I really felt &y
perfor&ance was si'nificantly betterG I was &ore fluent and perfor&ed
coverin' &ost of the aspects in less ti&e. !his 'ave &e ideas to wor) on the
lan'ua'e I was usin' with patient.
!his 'ave &e tre&endous confidence and i&proved &y s)ills.
5 9(a&iner sees you as a salaried1partner in the practice. Another of the
su''estion 'iven by <na Coales. If they want to e&ploy you they would
obviously want to see a confident doctor co&petent in &ana'e&ent and
co&&unication s)ills. A'ain s&art dress will help you in that. 7e should not
loo) li)e an under confident doctor and not very s&artly dressed with a
bro)en 9n'lish. 2e&e&ber it is a 'lobal assess&ent unli)e &any other
e(a&s in <:.
5 C<9 is there 55always best part of this e(a&. !he Cue is always there.
articularly if you are &issin' the trac) the patient will drop a cue. !hey
drop the cue two to three ti&es. If the patient repeats so&ethin' twice (e(
Ewhat about &y sy&pto&s doctorF$ please pic) up the cue, it &i'ht be the
nub of the case. I'norin' it &i'ht fail you. So&eti&es there is non verbal
cue5 li)e patient loo)in' upset. Ac)nowled'e and as).
5 -<" of the case. 3nly one nub per case. <nli)e real life patient in CSA will
try and ta)e you there, so listen to the&.
5 !hird party consultation5 easiest to do if appropriate you can always say
EI would li)e to see the patent before any further planF. 9asy 'eneral advice
&i'ht be sufficient to pass you. Could be a case of 2elative (chec) consents$,
D- as)in' for advice or educations, &u&1father of a child. Couple of video
In 2CG video volu&e II about it.
5 %or&at of as)in' Duestions. 7e all 'o in the e(a&ination hall with a s&all
for&at or seDuence of as)in' Duestion. .es it is i&portant to cover all of the&
but patient &i'ht not let you as) the& in seDuence anyway. !here are three
aspects which should not be for'otten5 IC9, sychosocial and 2ed fla's. Any
Duestion can co&e anywhere as lon' as you cover the&.
5 Don;t say5 EAre you happy for &e to e(a&ine youF &any of overseas doctors
does it. "elieve &e it sounds li)e a disaster.
I a& yet to see a local 'raduate as)in' this Duestion.
9(a&iners in royal colle'e co&&ent on it as well.
5 Don;t 'ive shoc) to patient (patient not e(pectin' and you are tryin' to
ad&it the patient, 'ently tell it. .ou could develop your own &ethod$
J
5 Appropriate Si'npostin' e(tre&ely i&portant e(5 passin' urine in bac) pain
cases. atient &i'ht just shout bac)5 Ewhat has bac) pain 'ot to do with
urineF.
5 -eed to )now your ar&a&entariu&. 7hat are the possible options of patient
disposalK So&e e(5 should I review you a'ain to&orrow. I will as) for an
opinion fro& the speciality re'istrar and 'et bac) to you. !his will also help
&ana'e uncertainty.
5 %ollow up very i&portant 7@. could be a passin' &ar).
5 *C &in before e(a&ination starts. !hey collect all the e(a&inee candidates in
a roo& where you wait for your batch to 'o.
!his easily ta)es *C5 +? &in. I hated it as it increased &y an(iety. Don;t tal)
about the e(a&ination. !al) to so&eone about so&ethin' else could be a
topic of your hobby.

5 I tar'eted for &ar'inal pass5 )ept the pressure of &e.
,ow did ( #re#are for this e-a*.
5 2o'er -ei'hbour advice5 3ne s)ill in one sur'ery session. Decide which one
you would be chec)in'. rint a list of cases and at the end chec)
7hat was the patient A'enda, what were their concerns, how is it affectin'
the&, red fla'sK 5 !ill you are doin' it at subconscious co&petence level.
.ou really need subconscious co&petence in these s)ills to pass the e(a&.
5 preparin' for all the points in the co&&unication and consultation section.
5 7hat wor)ed for &eK ractice of cases5 *C?5 /??. repared in three different
'roups.
5 J wee)5 al&ost everyday.
5 repared e(tensive for wo&en health and contraception. ,y wife is a
Gynaecolo'y trainee. racticed all possible e(a&ination scenario cases with
her. It was very useful for &e.
5 Loint sur'ery with trainers sittin' in the roo& at least A or &ore. 7ith
different trainers if possible. Another way is reDuestin' your trainer to
beco&e a patient for you.
5 Consultation with collea'ues.
5 !ips fro& passed candidates5 as &uch as possible.
5 Good luc).
M