WPBA: Care Assessment Tools (CATs)

In ST1 and ST2, only CbDs are done. In ST3, other CAT formats are available. For more information on CbDs please visit the case based discussion page. 

The minimum requirements are: 

• ST1: 4 CbDs (a minimum of two for each 6 monthly Educational Supervisor Report (ESR) 
• ST2: 4 CbDs (a minimum of two for each 6 monthly Educational Supervisor Report (ESR). 
• ST3: 5 CATs (which can include CbDs). There are no set numbers for each different type of CAT and CATs are only available in ST3. 

The numbers required are pro rata for less than full time trainees.

CATs can be assessed by either an approved GP Educational Supervisor (ES) or an approved, appropriately trained, and updated GP Clinical Supervisor. Each assessment should last a minimum of 30 minutes with subsequent debrief time. The assessments are recommended to be completed within a protected tutorial.  

CATs should cover the full range of the capabilities. This will provide a triangulation of grades for each capability across a range of different assessment methods. GP registrars should have been assessed in all the capabilities using a formal assessment tool at least once in their training. A maximum of four capabilities and 2 Clinical Experience Groups should be linked to each CAT so that in-depth reflection and meaningful feedback is given for each. Separate assessments can be used if the assessment covers a larger number of either. 

While it is not mandatory to have a CAT for each Clinical Experience Group, a range of types of assessment and information will need to be provided in the Portfolio to show exposure to, learning from, and competence in caring, for the range of Clinical Experience Groups across each training year. 

By the end of ST3 GP registrars must be assessed as being competent or excellent for the capabilities assessed (as illustrated by the competent/excellent descriptors) and graded at or above the level expected of a GP registrar working in the current clinical post. 

If following completion of the prescribing assessment in ST3 an additional prescribing CAT is used to address outstanding learning needs, this can count as one of the five required CATs during ST3. However, the total number of completed CATs should demonstrate the breadth of the capabilities and clinical experience groups.

There are different approaches that can be taken when choosing the content for the assessment. Consider and decide which approach should be used before the assessment:

• Reviewing consecutive patients/interaction/results including a whole surgery to give a picture of overall performance.
• Reviewing a random selection of contacts looking through one particular ‘lens’, or possibly two e.g. appropriateness of the diagnosis or decision-making or documentation, use of coding and consultation length.

GP registrar self-selection is likely to yield cases perceived as being ‘successful’ where the ‘right’ outcome was reached. GP registrars may also naturally choose specific patient populations or capability areas. It can be helpful to vary the approach to case selection (and the lead i.e. GP registrar or GP trainer) for assessment throughout the training year to ensure there is an accurate representation.

Generally, a retrospective approach looking at contacts is taken, but occasionally a mix with prospective approach might be appropriate e.g., a proportion of blood results/documents filed and some awaiting review and actioning.

When undertaking a CAT, it is recommended that the supervisor ensures the GP registrar sees a range of patient types, conditions and mix of urgent and unscheduled care and routine appointments. It is an opportunity to address any actions that need to be planned in response to the balance of work across the Curriculum and the clinical experience groups.

It can be helpful if the GP registrar and supervisor jointly choose three to four Capabilities ahead of the assessment to focus on. It is also recommended that the supervisor ensures the assessment maximises educational opportunities and guides the GP registrar to the most suitable Capabilities. 

Ahead of the assessment, the Capability descriptors should be reviewed, and questions suggested (if appropriate) to become familiar with what needs to be demonstrated for the various grades. Specific feedback for each Capability is required with agreed plans for each following the discussion. 

Outline of how the assessment is completed

• The GP registrar briefly describes the case(s)/results/documents.
• The supervisor asks the GP registrar questions in a way that allows the GP registrar to demonstrate the highest level they can, based on the Capability descriptors.
• Questioning continues with the supervisor postponing answering any questions from the GP registrar until the feedback section.
• The three to four Capabilities previously agreed are discussed with time for the GP registrar to add anything else they wish.
• It is essential for both the supervisor and GP registrar to consider the Capability descriptors during the discussion.
• Once the case(s)/results/documents and Capabilities have been fully critiqued and discussed the supervisor collates developmental feedback into themes to give to the GP registrar and moves to the feedback section.
• It can be helpful to ask the GP registrar to say which grade they feel they have demonstrated and to give their own feedback first.
• The supervisor gives a grade and provides feedback. Feedback should focus on what was demonstrated well and what the GP registrar should aim to demonstrate in future learning events or assessments.
• The grading and discussion should be captured in the Portfolio.