Abstract
GP trainers are a sensitive bunch and so caring registrars will want to look after them and guide them through the difficult times. One repeated source of stress in the life of a trainer is when their registrars prepare to take their Clinical Skills Assessment (CSA), and so, as a special New Year's gift to them, here are some tips on ensuring that they emerge from the process with their dignity and sanity intact.
Remind them that it's your exam
Some trainers I know would drive to Croydon to sit the CSA for you if they could. Such over-protectiveness does nobody any good and you may need to protect your trainers from this tendency. The best way to do this is to be organized. You really do not need to involve them in booking your exam, navigating the Royal College of General Practitioners (RCGP) website for advice on the CSA or setting up a study group with your registrar colleagues. Neither do you need them to sit on your shoulder reminding you to do all of these things.
Keep a sense of perspective
This year I saw my first ‘count down to Christmas’ advertisement in August. Like Christmas, the CSA comes around for trainers (at least) once a year and, while your trainers will appreciate the need to pay increasing attention to it as the time approaches, they will lose the will to live if you think and talk about little else for months beforehand. So try to relax. The CSA is a high stakes exam but it should not be the entire focus of your training year. In fact, as I explain below, placing undue emphasis on the exam itself can act as a barrier to your progress.
Do some work
The CSA basically tests whether you can spend 10 minutes with a patient and use that time effectively. Unsurprisingly, therefore, the best preparation for the exam is to practise doing exactly that, over and over again. The really good news is that there is absolutely no shortage of opportunity to do this in your practice. Trainers sometimes complain to me that their registrars use the approach of the CSA to justify taking their foot off the pedal at work while they ‘prepare’ for the exam. This is the opposite of what you should be doing, and, if anything, you should be ramping up the pressure on yourself at this time. Demand of your trainers that they make you see at least 13 patients during each 3 hour surgery as this is just what the CSA examiners are going to do to you in Croydon. Think twice before suggesting to your trainers that your time would be better spent going on yet another course.
Do not neglect your workplace-based assessments
The reason your trainers want to keep going with your Consulation Observation Tools and Case Based Discussions is that these are excellent tools to help you in assessing your progress towards the standards needed to pass the CSA. Similarly, registrars who make effective use of their log diary will be engaging in exactly the sort of reflection that will help them in dealing with the myriad of problems that will walk through the door during the CSA. As a programme director, it is noteworthy to me how strong the correlation is between the standard of our registrars' eportfolios and their success, or otherwise, in the CSA.
Develop a little skin thickness
The default position of most trainers is to be kind and so they can find it stressful to be critical of your performance. If they are met with upset or defensiveness, they may react by holding back their criticisms. Trust me; you do not want them to do this. If your trainer is telling you that you have a problem, then you almost certainly do. Put your energies into working together to get to the root of your difficulties rather than formulating elaborate justifications for them. Remember that the CSA allows you no opportunity to explain your idiosyncrasies to the examiners coming in and out of your room. Registrars I've worked with who have failed the CSA are sometimes genuinely bewildered by some of the feedback they receive but it is rare that their trainer shares the same feeling. So give your trainers a break and allow them not to be eaten up by the fear of upsetting you.
Do not moan at them (too much)
Most of us get worried and fed up as we approach exams and it can be natural for some of this angst to get translated into complaining about the unfairness of it all. Your trainers will be happy to put up with some of this, but if it is loud and endlessly repeated, they will grow weary of listening to it. Instead, try to be enthusiastic about the challenge. Most registrars who adopt a sensible preparation strategy find that they learn a lot about themselves and their job as GPs in the process. Feedback from the CSA shows that registrars find it a fair and relevant exam and so it seems reasonable that you approach it in this light. Enthusiasm is catching and you will want to infect your trainers with this rather than with cynicism and despair.
Do not over-protect them
You might worry about being a burden to your trainers or of letting them down. Providing that you follow at least some of the advice above, you can stop being anxious about this. If you free your trainers from unnecessary responsibilities, you will allow them to get on with what they are really good at, which is providing you with guidance and encouragement. If you are finding something troubling, then tell them. They can cope.
So that's about it. Oh, except that, when you get that nice certificate to hang on the wall, spare some thought for your trainer. By then, they will be back in action with yet another registrar who is asking them how to find a map of Croydon on Google.
All the best for the New Year!