Emma

I‘m really scared I don’t want to travel to London How will I pay for it ? How will I pay for the re-sit? I’ll never be prepared for it/good enough How do I book it? Where do I start revising Do I need to go on more courses? Have I given myself enough time to revise?

Should reflect a typical surgery session in general practice.

It is a pain going to London It is expensive It is scary BUT They are not trying to trick you Everybody is very pleasant and they try to put you at ease. Get into the swing of it really quickly

“Test a doctors ability to gather information and apply learned understanding of disease processes and person-centred care appropriately in standardised context, make evidence-based decisions, and communicate effectively with patients and colleagues.”

Problem-solving skills Person-centred care Clinical practical skills Primary care management Comprehensive approach Attitudinal aspects

RCGP website 8 separate sessions – Oct to May Book session rather than individual sitting/slot Pay at time of booking (£1642) Slots randomly allocated after booking

Purpose built building in Euston 30 Euston Square, London NW1 Euston Mainline and Euston Square tube station 5 mins away on foot Arrive by 9:00 or 12:15 for am and pm sittings Usually leave around 1pm and 5pm respectively Getting there: Train or Drive Parking available at Euston Station but expensive

Arrive, sign in, show your ID ( passport or photo driving licence) and hand in your mobile Put in a room with everyone else- given a brief Informed how to use the iPads Once briefing over you are taken to your floor Locker inside the room for valuable safe keeping, have to lock up, and leave keys outside Remain in same room for whole exam unless home visit.

On desk will be an iPAD with all the cases for that session as well as other things you may or may not need Buzzer rings to mark start and end of consultation 2 minutes between each case Break of minutes after 7 cases, water coffee and tea. At the end they will knock on your door and then you may leave Could well include home visits / telephone consult and child actors

BNF (adult and children) Stethoscope Ophthalmoscope Auroscope Thermometer Patella hammer Tape measure Peak flow meter and disposable mouthpieces (N.B. These must be EU standard)

13 cases Marked on the 3 domains of data gathering, clinical management and interpersonal skills. Each domain has an equal numerical score Marked as clear pass ( 3), pass ( 2), fail (1) and clear fail (0) Total 9 for each case- 117 overall Examiner also marks whole case as pass, fail or borderline For borderline cases score is added and averaged Based on this they will integrate the scores and produce the pass mark – around 72 +/-3

Worst bit was the waiting / night before in hotel Nothing came up which you wouldn’t expect in a normal surgery in fact probably a lot more straight forward i.e patients only had 1 problem Be yourself Don’t panic even if you feel you muck up a case If you don’t know something admit this to a patient (as you would in real life) Don’t waste time writing prescriptions/ sick notes N.B they are now introducing stations where by you have to prescribe the medication and hand the script to the patient.

What went well Get a revision group together- minimum 3 Have a consultation plan – and practice. (books can be a good source for this) Videoing and Practising cases with trainer Cases- look at topic domains and write your own Suitable accommodation (including Euston building itself)

What went less well Books cases fairly complicated and not all have marking schemes Make sure you don’t all have the same ones!! Panic revising, made things worse! Watching the RCGP csa DVD. Trying to guess how good others in your circuit might be Just focus on you and the exam What I would change Discuss difficult everyday cases with colleagues Don’t talk about it once you are out

Taken from RCGP document ref below Out of those who do not pass: Out of the three domains, Clinical management is the domain that candidates scored the lowest in. Interpersonal skills being the second lowest scoring domain ICE, cue handling

I split my time between practising the consultation / scenarios and learning the topics. Making sure I tried to be as up to date as possible with my clinical knowledge helped to improve my confidence Nice CKS useful for up to date knowledge on presentation, red flags and management Write knowledge summaries from cases seen in real life / or ones simulated with revision group Using revision books to learn the red flags, what I should be asking (structure), driving rules etc..

Revising the consultation Revision groups Practising with NON medical people To practise daily by pretending every pt is a CSA case Lots more practising... Splitting your time between routine cases (diabetes / COPD) and weird / wonderful cases (meningitis contact, child abuse)

Follow the patient – (follow the cues) It can be so tempting to go down your outlined plan for the case, but I found that by following the cues, the consultation flowed better and you got to the nub of the consultation far quicker. Patients may take you by surprise buy being bossy / shy / schizophrenic / demanding / shouty... Find your own style of consulting that works for you, and be your self in the exam The exam is not the time nor place to try something new If they say no, it means no! Don't go chasing too deep after hidden / ulterior motives, if a patient says no to a direct question, then don't waste any further time going down that route.

Do what you would normally do in a surgery The role players will help direct you, and want you to pass Don’t try to second-guess the case.. Remember you’re the patient’s advocate!