MRCGP Clinical Skills Assessment (CSA)

The CSA is a high-fidelity skills assessment based largely on the familiar and well-proven OSCE format providing an external, objective assessment of clinical skills at a standardised, pre-determined level of challenge. The validity of the CSA resides in its realistic simulation of real-life consultations. Patients are played by trained and calibrated role players, and cases that are written and assessed by working GPs. The format of the assessment also allows for systematic sampling from the curriculum, using a selection blueprint.

Each candidate is allocated a consulting room and has 13 ten minute consultations.

CSA consultations

The CSA focuses on testing the following areas of the GP curriculum:

• primary care management: recognition and management of common or important medical conditions in primary care
• problem solving skills: gathering and using data for clinical judgement, choice of examination, investigations and their interpretation and demonstration of a structured and flexible approach to decision making
• comprehensive approach: demonstration of proficiency in the management of co-morbidity and risk
• person-centred care: communication with patients and the use of recognised consultation techniques to promote a shared approach to managing problems
• attitudinal aspects: practising ethically with respect for equality and diversity, with accepted professional codes of conduct
• clinical practical skills: demonstrating proficiency in performing physical examinations and using diagnostic and therapeutic instruments

Use of children in the CSA:

A paediatric case has routinely been included in the daily case mix (palette) of the CSA since its inception. This has hitherto only been achieved through a third party, usually a parent presenting with concerns about their child.

Cases involving child role players, accompanied by their parents, have been included in the palette selection process since November 2013. Although there will be a paediatric case each day, this will not necessarily involve the use of a child role-player on every occasion.

Some new cases will test paediatric examination. There will be no need for candidates to prepare in a different way as the learning outcomes are unchanged.

Additionally, please note that the British National Formulary (BNF) for Children has now been added to the list of equipment that candidates are required to bring into the CSA examination.

The CSA is delivered in a paper-light format. Candidates have electronic patient lists and case notes and examiners record their marks electronically. Please consult the following document before you attend your examination.

• Candidate information on the use of iPads in the CSA [PDF]
• More about the format and content of the CSA [PPT]
• More about the GP curriculum 

There are a finite number of places available for each examination session so regrettably we cannot guarantee that all applications will be accepted. Furthermore it is possible that we may not hold examinations on each of the dates published, as the scheduling will depend entirely on the number of candidates who have applied.

Regrettably we cannot allow you to choose a specific date for your examination. We will assume that you’re available to attend on each of the dates published within the session that you wish to apply for, but if you foresee insurmountable problems in attending on any particular days, or at a specific time, you should state these when completing your application and we will try to accommodate your request. We cannot however guarantee that this will be possible in every instance.

After you apply

You will receive an email acknowledging that your application has been successful. This email will also provide information about when you are likely to be advised about the date and time of your examination. In most instances this will be approximately 7 to 10 working days after applications have closed.

Fees must be paid when you apply.

• MRCGP examination fees

CSA examination dates 2019 - 2020 

All dates may be subject to change. Appropriate notice of any changes will be given at the earliest opportunity. Please note that CSA exams are not held on Sundays.

Owing to the continuing effort to contain the COVID-19 spread, all MRCGP examinations are cancelled until further notice.

*Owing to unexpected demand, the October 2019 examination session has been extended by a further three days to include 7, 24 and 25 October in addition to the dates published above. The results of the examinations held on 24 and 25 October will be released on 1 November, and for all other days on 15 October.

A limited number of spaces will be reserved in the December 2019 CSA session for those who are unsuccessful in the October 2019 examination and who have been unable to re-apply before 24 October.

**A limited number of spaces will be reserved in the February 2020 CSA session for those who are unsuccessful in the December 2019 CSA examination.

***A limited number of spaces will be reserved in the May 2020 CSA session for those who are unsuccessful in the April 2020 CSA examination.

Apply online during one of the booking periods shown in the table above.

Please note: There are a limited number of spaces available for this session and applications will be accepted on a first come-first served basis. Therefore, you should make your booking at your earliest opportunity.

• Apply for MRCGP
• MRCGP examination fees
• Candidates with disabilities and requesting reasonable adjustments

Notify the RCGP of a disability 

Frequently Asked Questions about reasonable adjustments

CSA candidate information document

All candidates should read the full candidate information pack before sitting the CSA.

• CSA Information for Candidates [PDF]

Candidate Briefing

Before the start of your examination you will receive a briefing from the Senior Marshal. Below is the presentation that will be presented on the day.

• Candidate Briefing [PDF]

More resources for CSA candidates

It's also helpful to review sample cases, guidance on how the CSA is marked and other resources.

• Introduction to the cases in the CSA [PDF]
• An analysis of passing and failing candidates [PDF]
• InnovAiT Podcast Number 16 CSA Special: The CSA special covers everything the GP trainee needs to know about the exam from the perspectives of all of the key players involved and includes their top tips. [Media]

Non disclosure agreement

CSA examination material is confidential and copyright to RCGP. By applying to take the CSA, you agree not to pass on information about any of the cases you will encounter. You'll also be asked to sign a non-disclosure agreement when you arrive at the centre. It is advisable that all candidates read the non-disclosure agreement carefully prior to their examination.

• Read the MRCGP Clinical Skills Assessment: non-disclosure, confidentiality and video recordings [PDF]

In any case, knowledge of leaked material is unlikely to help you. The following document describes why this is so as well as giving advice on how to prepare for the examination.

The CSA normally lasts approximately 3 hours. A morning exam is scheduled to start at 10.00am and an afternoon session at 2.00pm. The RCGP aims to follow these times as closely as possible, however delays, whilst regrettable, are sometimes unavoidable and you should take this into account, particularly when making travel arrangements for return journeys.

Travel to the venue may be slow especially in the morning rush hour and taxi or bus services can be very busy. It is your responsibility to ensure that you arrive in time for the candidate briefing.

Entrance to the exam centre will not be permitted before 8.30am. You should not arrive later than 9.00am in order to allow time for checking in.

Entrance to the exam centre will not be permitted before 12.00pm. You should not arrive later than 12.30pm in order to allow time for checking in. For the security of the examinations, you will not be admitted to the session if you arrive later than 12.45pm, when the morning session ends.

Please refer to your confirmation letter or e-mail to be sure which of these sessions you have been allocated to attend.

N.B. Once you have checked in, you will not be permitted to leave the candidate reception and briefing area and mobile phone use is strictly no longer permitted.

Equipment

You should bring your doctor’s bag containing the usual diagnostic equipment with you, including:

• BNF
• BNF for children
• Stethoscope
• Ophthalmoscope
• Auroscope
• Tape measure
• Peak flow meter and disposable mouthpieces (N.B. These must be EU standard)

Please note that there is no need to bring a sphygmomanometer

CSA Information for Candidates (194 KB PDF)

You'll be expected to adhere to a dress code when you attend your CSA Examination.

The Dress Code is available as guidance to postgraduate doctors undertaking licensing assessments as part of the MRCGP examination. It has been written in conjunction with Deanery guidance, and applies also to situations of recruitment to GP training, work based training itself and assessment. Please ensure you are familiar with this before sitting the exam. 

• CSA dress code [PDF]

Each case is marked by a different examiner. The examiner marks each case on three domains or areas - data gathering, clinical management and interpersonal skills. This creates an overall numerical mark for the case. Each domain carries the same number of marks. The marks for each case are added to create a final mark. Each of the 13 cases contributes equally to the overall score.

The pass mark is created using the borderline group method, which establishes the pass mark for each different daily mix of cases.

• Standard setting: the CSA from September 2010 onwards [PDF]
• Guide to how the CSA is marked [PDF]
• CSA grade descriptors [PDF]

• Frequently Asked Questions about the role of video in MRCGP Clinical Skills Assessment [PDF]

The result of your examination along with any formative feedback will be published in your ePortfolio on the date given in the table above.

• Guidance on interpreting CSA enhanced feedback March 2019 [PDF]
• Feedback on candidate performance in 2014-15 [PDF] 
• CSA Feedback Questionnaire March 2017 [PDF]

Please bear in mind that the nature of the training cycle means that candidate cohorts differ considerably. The results for a particular diet should not therefore be used to draw any conclusions about the likely pass rates for other cohorts.

View the MRCGP regulations and procedures for complaints, reviews, and appeals.

The Fraser Rose Medal is awarded annually to the candidate who, having completed all elements of MRCGP and in concluding their training before 31 August, has demonstrated outstanding performance to the MRCGP panel. The award is usually made at the RCGP’s Annual General Meeting in the following November.

With effect from September 2019 the Assessment and Curriculum Development Committee will recommend a nomination to the RCGP’s Awards Committee in accordance with the following criteria and processes:

1. Performance across all three elements of MRCGP will contribute to the short-listing process for possible contenders
2.  All shortlisted contenders should hold a CCT and full membership of the College
3. Trainees re-sitting any part of the licensing tripos will be precluded from the short-listing process
4. Five trainees will be short-listed in the first instance on the basis of their combined AKT and CSA scores
5. The performance of these five trainees will then be rank-ordered on the basis of their WPBA including their combined MSF and PSQ scores as shown in their ePortfolios
6. Additionally, each of these five trainees will need to have had all of their ARCP outcomes during training recorded as satisfactory, and there should be no evidence of any lack of engagement with training and/or assessment
7. All five trainees should have an active PDP (for the purposes of revalidation it is good practice for trainees to have an ongoing PDP at the time of CCT) and show completion of the learning in a timely fashion.

Revised September 2019