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Independents' Day

How Spock can help you to pass CSA and do a good job interview

Dr Una Coales focuses on how to combat subjective bias to deal with both a job interview and a re-sit CSA. One tip, think like Spock!

Dr Una Coales focuses on how to combat subjective bias to deal with both a job interview and a re-sit CSA. One tip, think like Spock!

With the CSA results due out next week, many GPs will be anxiously waiting for their results. For those who pass, it means preparing for a job interview. For those who fail, it means revisiting their own nightmare. Unlike other College examinations, the CSA does not have an examiner shadow to reduce subjective bias, so marking at each of the 12 + 1 pilot stations is done by one examiner for each case. So, my tips:

• Dress for success. The politically correct response is that it should not matter what you choose to wear, as you are marked on your clinical ability and not your dress sense. The truth is that we humans form instant subjective opinions within seconds of meeting a stranger. Do you sit up straighter for a professionally-dressed patient? Dress in a suit for a week and see if your patients and colleagues treat you any differently. It is an eye-opening experience. In the old MRCGP exam, one might be asked to define professionalism. After all, we doctors hope to be regarded in the same league as barristers and bankers? Would you expect to consult with a barrister who is dressed in a woolly jumper and tweeds, especially if your life is at stake?

• Still not convinced? Read ‘Blink' by Malcolm Gladwell, a worldwide best-seller. In the blink of an eye, 13 GPs and 13 actor patients will decide whether they like you and 13 GPs decide whether you are a clear pass, marginal pass or fail candidate.

• Smile and pass. Frown and fail. In 1955, Professor Albert Mehrabian, a renowned US educational psychologist, published that communication was 55% nonverbal, 38% paralinguistics and 7% content. So what we do with our face, hands and body posture matter. In 1872, Charles Darwin published the book The Expression of the Emotions in Man and Animals, also discussing the significance behind facial expressions and communication. So what should our facial expressions reflect? Our joy at being a GP, so smile! Unless you are breaking bad news.

• Paralinguistics you say? Okay that means tone, pitch, rate, accent, etc. So get yourself a tape-recorder and listen to your own voice. A study in the USA showed that surgeons with harsh vocal tones were sued the most and that there was no correlation between being sued and competency. So much for patient satisfaction surveys! So we ensure our tone is soft, our pitch is not high (like a nagging wife), our rate is measured (not pressured), and our accent is neutral (must sound educated at the very least!). One tip is to read a passage and omit all the vowels. Yes that's right, stress the consonants and magically sound posh!

• Don't pray! We all know how desperate you feel! Having observed countless trainee and established GP consultation videos as well as mock Simulated Surgery and CSA role-plays, there is one position your hands must never assume – ‘the praying mantis!' This is the hands clenched together gesture which means ‘please I pray, get me out of here!' The crossed arms gesture is also very defensive. So ensure your hands and arms are open.

• Avoid excessive blinking, sweating, touching one's nose and wandering eyes which are all non-verbal cues that a person is lying and untrustworthy. Think Bill Clinton! So powder your face. Dry off those palms. Maintain eye contact at all times. And keep your hands below your shoulders.

• Are you an ‘ummer'? When nervous, your heart starts to beat faster and faster as your amygdala becomes hijacked with emotions of intense fear and dread. You start to ‘um' repeatedly. And if that does not make matters worse, when your heart rate reaches 146 beats per minute, you become petrified with fear (stage-fright) and cannot utter a single word, much less remember your own name. So what can one do? You will have a bottle of sparking water on your table, so drink and try deep breathing exercises during your 2-minute intervals and rest period. Habituate the response by practicing role-plays. Think ‘Spock' and activate your neocortex (logic and reasoning).

Powder your face. Dry off those palms. Maintain eye contact at all times. And keep your hands below your shoulders. Dr Una Coales About Dr Una Coales

In 1993, as a US surgeon, I sat my first ruthless UK postgraduate exam, the PLAB exam with its 5-modules, fail one module, re-sit all policy. I made a promise to write a book on this exam if I ever passed!

As I progressed through most of the UK postgraduate exams (including the masochistic FRCS exams), I wrote exam books along the way to help colleagues. In 2002, as I sat the MRCGP exam at the Royal Horticultural Hall amidst 400 GPs, I wondered what exactly had I revised over 6 weeks as nothing seemed relevant to the actual MCQ paper in front of me.

There were no RCGP courses or books on the Simulated Surgery module and not surprisingly, the RCGP published pass rates between 56% and 60%. These GPs (who could not video-tape) needed help and so between 2004 and 2009, I have been teaching all 5 modules of the old MRCGP (MCQ, written, oral, video and simulated surgery) and now solely on the new MRCGP exam (AKT and CSA).

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