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CLINICAL skills assessment what's it all about?

After months of preparation and

piloting clinical skills assessment for the nMRCGP, Dr Mei Ling Denney can finally reveal what it's all about

Clinical skills assessment (CSA) is part of the nMRCGP, the licensing test for general practice. It will be available to registrars from October 2007. During the CSA pilots run in 2006, some registrars assumed that it was simply a test of communication skills in a clinical setting.

In fact, this is not the case. The aim of the CSA is to assess a doctor's ability to integrate and apply appropriate clinical, professional, communication and practical skills in general practice. The CSA is very much a test of your clinical skills, although it is firmly based on cases from everyday general practice.

Roleplayers will act as 'patients', but you will be observed and marked by experienced MRCGP assessors. A large number of these assessors will be the current MRCGP examiners, but there are also going to be a significant number of new assessors brought in from the deaneries.

Unlike the video, this assessment is able to provide a predetermined, standardised level of challenge to candidates. The assessors will be testing your abilities to gather information and apply learned understanding of disease processes and person-centred care, making evidence-based decisions, and communicating effectively with patients and colleagues.

A lot of development has been taking place on the CSA during 2006 – new cases have had to be written and piloted, recruitment and training of roleplayers and assessors is well under way, and much work has been done on the organisational aspects and data analysis. This is in order to make it a fair and consistent exam for the anticipated 3,000 to 4,000 candidates who will take it each year.

What candidates can expect

• Thirteen stations, all or most of which consist of simulated patient cases.

• Each case will last 10 minutes.

• Candidates are likely to remain stationed in a room while the roleplaying patients move round.

• The exam will run for a number of weeks, several times a year.

• The venue is as yet undecided, but will take place in an assessment centre in or close to London.

Although the CSA will include assessment of clinical and practical skills, an entry requirement will be undertaking an enhanced pre-certification process of key clinical skills.

Each case will be marked in three domains. These are:

• data gathering, examination and clinical assessment skills

• clinical management skills

• interpersonal skills.

The domains encompass the six areas shown in the table. A GP registrar will be expected to demonstrate professional attitudes and ethical behaviours, a person-centred approach, the ability to manage complexity, and also to tackle health promotion issues where appropriate.

There are four possible grades:

• clear pass

• marginal pass

• marginal fail

• clear fail.

At the present time, there is no merit grade.

If you're thinking of taking the CSA it is worth looking out for, and dealing with, some of the more complex cases found in general practice. You might ask your trainer to direct some of these your way.

Don't forget to think about time management, and make use of video in your consultations. This will help both you and your trainer to review your clinical and consultation skills, giving you the best chance of success in the exam.

Mei Ling Denney is a GP and trainer in Peterborough and a member of the MRCGP CSA Operational Group

domains for assessment

Data gathering and interpretation

• Gathering of data for clinical judgment, choice of examination, investigations and their interpretations


• Recognition and management of common medical conditions in primary care; demonstrating flexible and structured approach to decision making

Co-morbidity and health promotion

• Demonstrating ability to deal with multiple complaints and co-morbidity and to promote positive approach to health

Person-centred approach

• Use of recognised communication techniques that enhance patient's understanding of their illness and promote a shared approach to managing problems

Professional attitude

• Practising ethically with respect for equality and diversity in line with accepted codes of professional conduct

Technical skills

• Demonstrating proficiency in performing physical examinations and using diagnostic and therapeutic instruments

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