The Consultation Observation Tool (COT)
Trainers use the Consultation Observation Tool (COT) to support holistic judgements about your practice on primary care placements. COT is one of the tools used to collect evidence for your Trainee ePortfolio, as part of the Workplace Based Assessment component of the MRCGP exam.
How the Consultation Observation Tool (COT) works
Your trainer reviews a number of your patient consultations - either video recordings or by direct observation. You’ll use the resulting discussion and feedback as evidence for your Trainee ePortfolio.
Selecting consultations for COT
Either record a number of consultations on video and select one for assessment and discussion, or arrange for your trainer to observe a consultation. Complex consultations are likely to generate more evidence.
Consultations should be drawn from your entire period of GP training, reflecting a range of patient contexts. You can include consultations in different contexts – for example, a home visit.
You should include at least one case from involving:
- children (a child aged 10 or under)
- older adults (an adult aged more than 75 years old)
- mental health
It’s inadvisable for a consultation to be more than 15 minutes in duration, as the effective use of time is one of the performance criteria.
When you’re selecting a recorded consultation, it’s natural to choose one where you feel you’ve performed well. This isn’t a problem: the ability to discriminate between good and poor consultations indicates professional development.
But don’t spend a lot of time recording different consultations. COT isn’t a pass/fail exercise: it’s part of a wider picture your practice.
The patient must give consent, in accordance with the guidelines for consenting patients.
Collecting evidence from the consultation
You’ll have time to review the consultation with your trainer, who will relate their observations to the WPBA competence framework and COT criteria. The trainer then makes an overall judgement and provides formal feedback, with recommendations for further development.
When you use the COT
You’ll require a minimum of six COTs in each of ST1 and ST2. If you’re in full-time training, make sure you do three before each six monthly review.
In ST3 you’ll need 12 COTs (six before each six monthly review, if you’re in full time training).
Observations in secondary care posts
During secondary care posts you’ll use the Clinical Evaluation Exercise (miniCEX) rather than COT to record consultation observations.
The point of transition between COT and miniCEX may vary if you spend part of your final year in hospital posts.
- Clinical Evaluation Exercise (miniCEX) [internal link]
COT forms and guidance