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Thank God the CSA’s over – apart from the flashbacks…



I was planning to write this immediately after sitting the CSA two weeks ago, but I was so convinced that I had failed that I didn’t want to formalise my thoughts about it in writing.

It’s not even the extra revision that having to re-sit would entail that was so fearsome – it’s the financial implications of paying another £1,550 to sit the exam, and paying for another night in a hotel and another train journey.

For the last two weeks I’ve had what I and my study group have named ‘CSA flashbacks’. These involve waking at 5.30am shouting: ‘A rash! I forgot to ask if he had a rash!!’. Whilst in Tesco, I find myself remembering an actor yawned at one point– causing sudden trauma in the frozen food aisle, panicking that was that a cue. And I had missed it!! Were they tired and depressed? Were they suicidal? I didn’t ask!!

I wondered if I was too informal with the actors – I even forgot for a nanosecond I was in an exam, and shared a joke with one actor. I’ve been over and over it in my mind wondering if the examiner thought I was trivialising the patient’s problem, or didn’t find me funny.

People in the year above us told us CSA was like a normal surgery. Well, if that exam circuit was like a normal surgery in my practice, I would have transferred from general practice to another discipline long before sitting that exam.

Simple cases left me feeling like I missed something – I found myself asking the actor twice if there was anything else they were worried about. Surely the examiners must be worried about my practice if a straightforward ENT problem turned out to be a brain tumour but I hadn’t ‘got it out ‘ of the ‘patient’?

By the same token, the hard cases felt very hard. Being quizzed by an actor on the details of a condition I’d only met before in passing was unpleasant.  As I changed in the toilets afterward I could hear a gaggle of girls chatting about what a relief it was that it ‘wasn’t too hard’, which didn’t improve my mood…

But as it turns out, I passed with the second highest score in the deanery. Turns out questioning about a rash wasn’t too important after all.

You can also read about our other GPST3’s experience of passing the CSA here.

Dr Julie Fry is a GPST3 in Cheltenham.