How the Consultation Observation Tool (COT) works
During training you are encouraged to video record and then review your consultations as these are an essential way of improving your consultations.
There are four types of COT using the same form and COT criteria:
- In person (live)
- In person (recorded)
- Virtual consultation (live)
- Virtual consultation (recorded)
The audio-COT is for telephone consultations and uses a different form. Please see the audio COT section below for further details.
Any consultations you video record will require the patient’s consent. A sample consent form is available below.
The choice of consultations should cover the full breadth of Clinical Experience Groups and be in different settings, such as surgery consultations, home visits and Unscheduled urgent care / Out of Hours.
When you are selecting a recorded consultation, it is natural to choose one where you feel you have performed well. Complex consultations or consultations that you found challenging are more likely to generate learning.
Please note that WPBA and RCA are independent components of the MRCGP Tripos and therefore evidence submitted for one assessment cannot also be used for the other. All recordings submitted for the RCA should not be utilised for evidence for WPBA. Similarly, a consultation that has previously been assessed e.g. as a COT or Audio-COT may not be submitted for the RCA as it has already been used as evidence for WPBA.
Collecting evidence from the consultation
You will review the consultation with your supervisor, who will relate their observations to the WPBA Capability framework and COT or Audio-COT criteria. The performance criteria for face to face consulting can be found below and for telephone consulting within the Audio-COT section. Your supervisor will grade each section of your consultation, make an overall judgement on your performance and provide formal feedback with recommendations for further development.
When to use the COT
COTs are only completed in primary care placements. MiniCEXs are completed during non-primary care placements. The total number of COTs required in ST1 and ST2 will therefore very much depend on your placements. A total of 4 MiniCEXs / COTs /Audio-COTs are required in both ST1 and ST2. The COT/Audio-COT is used solely in ST3.
Download the form
Consultation Observation Tool (COT) FAQs
COTs are done in all primary care placements.
In ST1 and ST2 when you are in a primary care post you will need to complete 2 COTs for each 6-month placement. Some areas of the UK have 4 month primary care placements in ST1 and ST2. It is recommended that 2 COTs are also completed in these posts. A total of 4 COTS / MiniCEXs are required in each training level in ST1 and ST2.7 COTs are required in your ST3 year. For trainees working less than full time these requirements will be pro rata.
You are required to complete half of the annual number before each six-month review in ST3.
No, there is no set requirement of the different types of consultations you experience in Primary Care. Ideally a mixture of the different types of consultations would be recommended, and at least one needs to be a face-to-face consultation with you and the patient in the same room.
COTs can be assessed by either an approved GP Educational Supervisor (ES) or an approved, appropriately trained, and updated GP Clinical Supervisor.
Over the three-year training programme, it is expected that you will submit COTs related to most of the Patient Experience Groups. However, your Educational Supervisor will be able to give relevant advice to you in the context of the rest of your Portfolio.
No. However, brief, low challenge consultations will be unlikely to give adequate opportunity to demonstrate your ability; and overly long consultations may lack structure. It would be expected that COTs are generally 8-15 minutes long.
Yes. The Educational Supervisor makes a recommendation to the ARCP panel based on all workplace-based assessment and the overall content of your Portfolio.
No. Your Educational Supervisor makes a recommendation to the ARCP panel based on all of your workplace based assessments and the additional evidence you have submitted in your Portfolio. Progress varies from trainee to trainee but you will need to demonstrate competence by the end of training. It would be expected that for each area the trainee has been graded as “ Competent for licensing” at least once across the year and that overall the trainee is graded as “At the level expected of a GP trainee working in the current clinical post” in their last review.