5 POWERFUL WAYS TO MAXIMISE YOUR CSA PRACTICE
Dr. Aman Arora – Arora Medical Education
Practicing CSA cases with colleagues is one of the main forms of preparation for the CSA exam. This exercise can be efficient, beneficial and lead to exponential growth in confidence…OR…it can end up hammering in bad habits, being done ‘for the sake of it’ and generally being a waste of valuable ST3 time.
These 5 thoughts are developed from personal experience of having prepared for the CSA myself, as well as from seeing 1000’s of trainees prepare for the CSA over the last 6-7 years.
1) Record your CSA case practice.
You’ve all likely recorded your real life consultations and watched them back at some point – and probably learned a fair bit about how you consult. Recording and play-back can be an extremely valuable growth tool – but consider extending this to recording your cases in CSA study groups. Lets face it – our mindset is often different to real life when we are preparing for CSA (anxiety, stress etc), and you want to see what you do in THAT mind space….What mannerisms do you display? Which words do you use? How clearly do you explain things? Which cues do you miss? It is so important that you recognise your good and not-so-good points in your ‘CSA zone’ – often remarkably different to those when consulting in real life…. Alongside recording your real-life consultations, there is often no better way to do this that recording and watching your own cases back after a study group session.
2) Critically self-reflect.
So often we base how successful study group sessions are solely on how many cases we get through. Of course number of cases are important but it is vital to get as much as you can from each case. Self-reflection of performance AFTER the session, for example on the drive home, is where the magic really happens. Rather than switching off, go back through each case that you did yourself and break it down in your mind. You may have thought it went well at the time and would probably have forgotten it completely, but become a little self-critical. Did I actually ask all the red flags that I should have? Did I know what the guy did at work or find out if his symptoms affected it? Did I come back to the alcohol like I said I was going to? Did I really involve him in the second half, or did I take over for 3 minutes?...Only through this detailed process of self-critique, when you are on your own and not under pressure to move straight onto the next case, will you realise where YOUR improvement points are…Without doing this you may make the same omissions and errors next time too.
3) Practice back-to-back.
At our courses I’m often amazed when it is the first time that someone has done more than one case back-to-back. We ensure that you get this experience, as it is vital to see how you cope when cases go wrong…. A really common scenario that I often hear about after a CSA exam: “the first case was so difficult and I completely messed it up - the rest of the exam was affected by that”. This only happens if you haven’t practiced how to move on from a case that went horribly wrong. Please take some time to string some cases together when you practice – it is only through practice that you can figure out how to move on from a case that you know went terribly…Advice is often given to ‘just forget the last case and move to the next’ – actually having the skill to do this in reality takes practice…again and again and again…
4) Be challenging when acting.
I remember practicing with friends - everything was nicey-nicey. ‘Actors’ were all friendly, sometimes information was given too easily and feedback was always based mainly on the medicine. ‘Should you have given this drug or that?’, ‘was that referral based on the current guidelines? etc. Of course these are all very relevant but two things were usually lacking….Firstly I had not experienced the other challenges that the exam can test such as emotion, communication difficulty etc, and secondly there was not enough appreciation or discussion on areas other than ‘clinical’, such as whether the ICE was addressed or whether practical suggestions for the patient’s work issues were explored…So when you practice with friends or colleagues, 1) aim to challenge each other in areas other than making the medicine difficult and 2) make sure you discuss the other vital aspects of the CSA afterwards.
5) If attending a course, go early rather than late.
Attending a course is not necessary for everyone and many pass the CSA without attending a course. However if you do attend a course, book on early if you can. When people attend our course often they leave saying they wish that they’d attended earlier – we cover a huge amount of challenging and raw material on the day (32 cases in 1 day ensures hundreds of learning points) and most people need time to process, reflect and practice what they have picked up. There are also many who deliberately choose to come nearer to the exam however (we do get many attend in their final week!) but ideally I’d suggest 2-4 months beforehand if you had an open choice….The other thing I’d suggest is that if you do attend a course, consider attending with your study-partner or group (most courses have a discount for group booking). Practicing in a group after a course can be so much more beneficial if those practicing are on the same wavelength as you!
- Record your own cases in study groups.
- Critically reflect on your cases after the session.
- Get used to the pressure of back-to-back cases.
- Challenge each other when being the actor.
- If you attend a course consider attending earlier rather than later and if possible, with study group members.
Of course you will practice heavily for your CSA when seeing patients at work – inevitably a huge part of your preparation. Everyone will develop their own practice styles, both at work and when in a study group, but bear these in mind when you next try some cases with colleagues.
Study group practice is for most a vital part of getting ready for the big day – make sure each minute of this practice counts.
We cover these points in depth at our immersion 1-day CSA courses.
Our CSA video tips on YouTube also cover many of these points as well as others.
And if you’re sitting the CSA any time soon….GOOD LUCK!!