Cultivating General Practice in the Garden of England
The Consultation Observation Tool (COT) has been designed to be used by trainers as an evidence-collecting instrument to support the more holistic judgements made about GPStRs at the six monthly and final reviews when the GPStR is in primary care. The mini-CEX tool (link to mini-CEX page) will be used for this purpose in a hospital setting.
The starting point for this assessment is either a video recorded consultation or a consultation directly observed by the trainer. In either case the observation should generate discussion and feedback for the GPStR and yield evidence which will be recorded in the ePortfolio. It is likely that more evidence will be generated from consultations with greater complexity.
The selected consultations are rated according to a set of criteria which have been developed from the experience with Summative Assessment and the MRCGP consultation skills module. These criteria are built into the ePortfolio.
The GPStR records a number of consultations on video and selects one for assessment and discussion, or the GPStR and the trainer agree on a prospective patient encounter which will be the subject of direct observation. In either case the patient must give consent in accordance with the guidelines for consenting patients.
Consultations should be selected across a range of patient contexts and over the entire period of training spent in general practice and should include at least one case from each of the following categories:
Time is set aside for both GPStR and trainer to view the consultation together during which time the trainer rates the evidence which they observe against the competence framework and COT criteria. The trainer then formulates a global judgement for the overall consultation and offers formal feedback on the consultation with recommendations for further work and development by the GPStR.
The requirement is for a minimum of six COTs or Mini-CEX in each of ST1 and ST2, (ensuring there are three before each six monthly review), and 12 COTs in ST3 (six before each six monthly review). The minimum requirement applies whether or not the GPStR is in full time training. If the GPStR spends some of their final year in hospital posts, then the point at which COTs take over from Mini-CEX may vary.
One consultation should be viewed at a time.
GP DVD: The COT. A Guide to the Consultation Observation Tool. Available from the RCGP bookshop and from the Wessex faculty office. £25, with discounts for RCGP members and associates. Discounts for bulk orders from the Wessex faculty office.