How is the CSA marked?

In the past to pass CSA you needed to get 8 clear or marginal passes out of 12 cases. The marking schedule has now changed. For each case you are given a mark between one and four on the three exam domains (data gathering, clinical management and interpersonal skills) and then an overall mark. One = clear fail, two = borderline fail, three = borderline pass and four = clear pass. The marks are then added up and you get a percentage score for the CSA exam.

The pass mark is set by averaging the score of candidates that CSA examiners have said are borderline. The RCGP then applies some magic number mystery stuff (borderline group method) to these average pass marks and a pass mark for the exam on that day is produced (this is what Richard Adams says if we have got it right!!)

In the past you could pass the CSA with 8 borderline passes and doing badly in the other cases. For example if you got 8 borderline passes, three borderline fails and two clear fails under the old system you would pass. Under the new system you would score 57% and fail. Richard Adams, our local tame CSA examiner, says that the pass rate is 60 - 70% (although the score to pass in the September CSA was 76%).

For each case you can get 16 points ( 1-4 per three domains, and 1-4 on the overall score). In order to pass, if the pass mark is 70%, you need to get on average 12 per case = 3 per domain overall.

So, in order to pass you need to do reasonably well in all the cases - if you do poorly in a few and get some ones and twos, you will fail. Which maybe one of the reasons why it is more difficult to pass.

Not wishing to panic you, but to prepare you need to do COTs and COTs and COTS, and be the doctor at HDR!

Autumn CSA results .....

Not sure whether you have seen it or not but in Yorkshire only 10 out of 20 candidates who took the CSA this time passed. In DWP our pass rate was higher than this with three out of four candidates passing. This pass rate is a lot lower than in previous sittings of the CSA. The RCGP was reported as saying that this was because the quality of candidates was lower than in previous sittings - the doctors sitting it are more likely to have failed CSA before and undertaking remedial training and we know that the more times you take it the more likely you are to fail ....

Marking of the CSA has changed this time; all the cases count, an overall mark is given and the 'the borderline group method' of marking is now used. I have read the RCGPs explanation of how the marking scheme works click here for a link to the RCGP website but I would not like to have to explain how it works to anybody ....!!

So ... in order to make sure you pass first time do lots of COTs, volunteer to play the doctor in the CSA cases at ST3 HDR and click here to download what the RCGP says about what you should do to avoid failing.

Learning Log Entries - how many?

At the Pontefract Trainers Workshop yesterday we discussed the issue of trainees who have not started to engage with the ePortfolio. This mainly concerned new doctors to the scheme who are in ST1. What the trainers meant by 'not engaging' is not making regular entries on their ePortfolio or have only made a small number.

Of course there is no dictate from on high about the number or frequency of entries you should make. The only advice is that your ePortfolio should show a progression in your learning over the entirety of your training programme. Not very helpful if you are after advice about a specific number of entries or advice about how frequently you should make these entries. From my perspective the time to start doing something about inadequate ePortfolio entries is NOW rather than new May, just before an ARCP panel.

So ... how many and how often. I would expect a minimum of two entries per week, every week. So that means that we would expect you to have made twenty entries in your ePortfolio by now. If you haven't then the time to start is NOW rather than in May when if your ePortfolio entries are inadequate you face the long, long walk up the hill to an ARCP panel meeting in Leeds ... And we know you don't want to do that!

No free lunch ....

At the hospital trainees whole day teaching sessions we have had an interesting debate on whether doctors should accept gifts from the pharmaceutical industry - post it notes, pens and lunchtime sandwiches etc etc. In the group I facilitated I was really surprised how much support there was for accepting these promotional gifts as most of the doctors in my group thought it did not affect them and that they could clearly distinguish between marketing and education.

The debate has resurfaced with some discussion on the Google group about drug company sponsored educational meetings. The meeting was about neuropathic pain and was sponsored by Pfizer. Pfizer of course make Lyrica - which has global sales of $2.8 billion dollars in 2009 - click here for Pfizers 2009 Financial report. In 2009 sales increased by 10% compared with 2008.

If you look at comparative costs a 28 day course of Lyrica (pregabalin) 50mg costs the NHS £96.60 compared to £4.99 for an equivalent dose of gabapentin (300mg). The increase in Lyrica sales have happened despite authorative advice that 'in patients with neuropathic pain, there is no statistically significant difference in clinical response rates between TCA, anticonvlusants and SNRIs' - click here for the link to MeReC Rapid Review published by the National Prescribing Centre.

The reason why Pfizer have been so successful is because of their effective marketing campaign. It is estimated that in the UK there are 8,000 pharmaceutical representatives to promote their products to 60,000 NHS doctors - not a bad ratio, and that big pharma spends £10,000 per doctor on promotional activities. To read more click here for a link to No Free Lunch - which is a website that aims to expose the activities of Big Pharma in the NHS.

So next time you accept a drug rep sandwich please remember there is no such thing as a free lunch!