The Clinical Skills Assessment (CSA)

This is the element of the new MRCP examination that most GP speciality registrars seem to spend more time worrying about than any other! - and for good reason. It is a tough OSCE-type assessment, with a pass rate for first-time applicants of around 78%. It costs a lot of money to take (currently £1481 for Associates in Training).

When to take it?

Unlike the AKT, candidates must be in their ST3 (final) year of training to take the CSA. There is a temptation to try it as early as possible (perhaps thus giving plenty of time for further attempts!) - this should be resisted, as there is no substitute for time and experience in primary care to get you into shape (see below). All learners on the West Essex programme do 18 months in general practice now, so generally will be consulting at 10 minutes per patient by the beginning of ST3, and a few will be good enough to pass the exam in September. It seems a pity to scrape through then however when a much better mark would be achieved in February/March!


In our view the best preparation for the CSA is to:-

  • acquire a sound knowledge of consultation models and skills, with regular formative feedback/analysis on your consulting from a good trainer, and
  • see as many and varied a number of patients in general practice as possible, consulting with 10 minute slots.

At the very least, you should be thoroughly familiar with Roger Neighbour's "The Inner Consultation", and "Skills for Communicating with Patients" by Silverman, Katz and Draper - these are both superb books to be regarded as mandatory study.