CSR, iESR and ESR guidance

Who carries out the CSR?

The Clinical Supervisor is responsible for writing the report although it is appropriate and usual for the CS to discuss the CSR with colleagues to inform the final report. In addition to this gathering of information from colleagues it is expected that the CS will have carried out at least one of the mandatory Workplace Based Assessments personally (CBD/MiniCEX/COT) prior to each CSR. Where there are concerns about your progress and there is more than one experienced CS working in the department or practice, it is appropriate, and good practice, for there to be more than one CSR written for a single period of training.

It is your responsibility to arrange a meeting with your CS to ensure the report is completed before the end of your placement and in time for your ESR meeting.

What is the reference point?

The CSR is used in both primary care and non-primary care. It is therefore important that the reference point is one that will be recognised in both settings. Two versions of the CSR have been written - one for non-primary care posts and a second version for primary care posts. The Clinical Supervisor in a non-primary care CSR is asked to make a comparison of your performance with the expected performance of a GP trainee at that level of experience in that post. The assessment form, therefore, asks the CS to make a judgement (after recording their comments) of whether you are:

• Significantly Below Expectations
• Below Expectations
• Meets Expectations
• Above Expectations

The Clinical Supervisor in a primary care post is asked to make a comparison of your performance with the standard expected of a trainee at the end of ST3 (a newly qualified independent GP). The grades match those in the ESR and the form asks the CS to make a judgement of whether you are:

• Needing Further Development - Below Expectations
• Needing Further Development - Meeting Expectations
• Competent
• Excellent

What does the form review?

Each of the seven questions covers a particular area of practice, for example Professionalism. There follows a description of how this is likely to be observed in the working environment. Professionalism, for example, includes being respectful, diligent, and self-directed in your approach to patients and others and to your own learning needs, developing resilience and making appropriate ethical decisions. Each question will automatically be linked to specific Capabilities in the Portfolio (e.g. Maintaining Performance Learning and Teaching, Maintaining and Ethical Approach, Fitness to Practice).

Capability descriptors have been written to support the grading and feedback for each question. See below for non-primary and primary care posts.

The CS is also asked to make an assessment of the level of supervision required compared to the expected level of performance for a GP trainee at this stage. There are 4 levels of supervision and if more supervision than would be expected is required, or you cannot be left without supervision, then an additional comment box will appear asking for further details.

Finally, in line with all other specialties there is a question about whether you have been involved in conduct, capability or Significant Events and what the outcome has been.

Short Posts (for example 3 months or less)

It is particularly important that a CSR is completed if you have been in a short post so that there is an assessment of engagement and learning in the post. (It would also be expected that there should be pro rata assessments (CBD/ MiniCEX/ COT) for these posts)

Being both ES and CS

There are occasions when the same person will be your Clinical Supervisor and Educational Supervisor. The CSR is a summary of the observations of the supervisor on your performance under the various Capability headings. It is an opinion based on observation, debriefing, tutorials, etc. The ESR, in contrast, is a summary of the information from different sources of your performance, recorded in your Portfolio. It is appropriate for the ES to quote as evidence along with other evidence the assessment made by the CS (even if the ES also completed the CSR).

If the CS is also your ES in a primary care post then the CSR does not need to be completed unless the evidence within the Portfolio does not give a full enough picture and information in a CSR would provide this missing information, or you and your supervisor feel it is appropriate. In these situations, the CSR should be completed irrespective of whether the CS and ES are the same person.

Communication between the CS and ES

The CSR is one of several sources of evidence used by the ES to reach a judgement about your progress. While it has been designed to provide useful structured information, it is no substitute for dialogue between the Clinical and Educational Supervisor. If there are known concerns about your performance prior to the start of a post it is appropriate for your ES and/or the Training Programme Director to ensure that the CS is aware of the concerns and for the ES to remain available for advice. It is good practice for you also to be aware of these conversations and their overall content.

Download the forms

• CSR for primary care posts in ST1 and ST2 (DOCX file, 58 KB)
• CSR for primary care posts in ST3 (DOCX file, 59 KB)
• CSR with word descriptors for non-primary care placements (DOCX file, 865 KB)

Documents

• CSR guidance (PDF file, 191 KB)
• Guidance for Clinical Supervisors on Completing Assessments (PDF file, 568 KB)

Clinical Supervisors Report (CSR) – FAQs

When do I need a CSR completed?

You will need to have a CSR completed at the end of each non-primary care placement.

You will also need a CSR completed in your primary care placement if:

1. Your named Clinical Supervisor is different from your Educational Supervisor (ES)
2. The evidence in your Portfolio does not give a full enough picture of your progress and information from a CSR could provide this missing information or
3. Either you or your Supervisor feel it is appropriate.

The CSR provides important evidence about you to your ES and must be completed prior to your Educational Supervisor Report (ESR).

What happens if I didn't complete my post due to absence or if I had to move post unexpectedly?

In this situation the ARCP panel will need to determine whether a short post (less than 3 months) can count towards your overall training time, A CSR (and also pro rata WPBA) is especially important in helping the ARCP panel reach this decision.

Who should complete my CSR?

Your named Clinical Supervisor in both non-primary and primary care posts should complete your CSR. If your Clinical Supervisor is also your ES in your primary care post then ideally another Clinical Supervisor in the practice should complete the CSR if it is required. If this is not possible then your ES should also complete the CSR.

If I work less than full time in a one-year hospital placement, will I need a CSR after 6 months to use in my ESR?

Yes.

I have only spent a small amount of time with my Clinical Supervisor. Can I ask another Clinical Supervisor to complete my CSR?

No. Your named Clinical Supervisor must complete the assessment. However, your Clinical Supervisor is expected to seek the views of colleagues prior to completing the report.

Why are there three different versions of the CSR?

One is for use by hospital based Clinical Supervisors for trainees in non-primary care placements. The second is for use by GP Clinical Supervisors in primary care placements during ST1 and ST2. The third is for use by GP Clinical Supervisors in ST3 GP placements. The key difference is that in hospital placements you are assessed against the expected level for a GP trainee at this stage in training, but in primary care placements you are assessed against a trainee at the point of Certificate of Completion of Training (CCT).

The only difference between the two GP primary care forms is that the one for use in ST3 includes a fourth ‘Level of Supervision’ grade of ‘requires no supervision in their clinical role’.

Does every section of the CSR need to be completed?

Yes.

I disagree with comments on my CSR. How can I get it changed?

It cannot be changed. If you wish to clarify a matter it is suggested you discuss it with your Clinical Supervisor and ES. If you wish for your comments to be recorded, you should write them as a reflective log entry and add to ‘Supporting Documentation’ and ask your ES to reference them in Educator Notes or in your ESR.

If level 1 or 2 of ‘Level of Supervision’ is ticked, why is referral to the Training Programme Director or Associate Dean required?

In this scenario the local Training Programme Director or Associate Dean would be expected to make an assessment of your training needs and, if necessary, arrange appropriate support and write an educational plan. An ARCP panel may need to be triggered.

What is the difference between “significantly below expectations” and “below expectations”?

Please refer to CSR with word descriptor for non-primary care placements. At the bottom of the page, there is a description of a trainee performing significantly below or below expectations for each section.

I am a Clinical Supervisor and I have significant concerns about my trainee’s performance. Do I need to wait until the end of the post before completing the CSR and highlighting my concerns?

You should not wait until the end of the post to highlight if your trainee is performing significantly below expectations. You should contact your local GP Training Programme Director or Associate Dean and share your concerns. They may ask you to summarise your concerns in writing and may ask you to do this by writing an early CSR.

I am a Clinical Supervisor and I have highlighted significant concerns about a trainee’s performance in the CSR. How can I be certain these will be acted upon?

An Educational Supervisor’s report should be written every six months. This will involve reviewing that trainee’s CSR. However, if you have significant concerns you should contact your local GP Training Programme Director or Associate Dean.

Content last updated: 18 June 2022

When is it appropriate to complete an interim ESR?

You need to have a review with your ES annually and at the midpoint of each year.

If you are progressing satisfactorily then you can have an interim review at the midpoint of the year rather than the full review.

When is an interim ESR not appropriate and the full ESR required?

If at your last ARCP you were given an outcome 2 or 3, the previous ARCP panel asked for a full ESR.

If you have been involved in a Significant Event which has not been resolved.

If your ES has concerns about your progress. This should include any of the following issues:

What will be assessed at an interim ESR?

It is important to assess whether you are producing satisfactory evidence across all the RCGP 13 Capabilities and Clinical Experience Groups as well as reviewing the overall quality of your Portfolio and checking that the required number of assessments have been completed.

Which ESR should be completed if a trainee has not done half of the mandatory assessments by the midpoint of the training year?

If you have shown a good level of engagement and done a little less than half of the year’s assessments by the midpoint, and there are no other factors which necessitate a full ESR then an interim ESR should be completed. If, however, you have done significantly less than half of the requirements this raises concerns about your engagement and progress. In this situation your ES will seek advice from the local education team and complete a full ESR.

Does it make any difference to the review needed if I am less than full time?

You need to have a full ESR each calendar year you are in training whether you are full or part time. All reviews in between these ESRs, can be interim ESRs as long as the stipulations detailed above are followed.

Who can complete my interim ESR?

Only your ES can complete an interim ESR.

• If concerns raised at a previous ESR have not been resolved
• There are concerns over the ‘Level of Supervision’ needed, or your performance in the WPBA tools. For example, more than the anticipated number of WPBA have been graded as you ‘needing further development – below expectations’ for this stage in your training
• There have been concerns identified about you relating to a lack of engagement in the Portfolio
• Concerns have been highlighted by the local education team or your supervisors in the 'Educator Notes' section of your Portfolio

Capability progression in ESR

For the six-monthly reviews, you’ll first conduct a self-assessment of your progress on the 13 capabilities. You will then be assessed by the educational supervisor. Quality of evidence is more important than quantity. In the early stages of training, it’s unlikely that you’ll be able to provide evidence of readiness to practise. But the review will form the basis of a learning plan, highlighting where you’re doing well and where more support is needed.

By the end of ST3, the educational supervisor will be looking to establish fitness to practise and readiness for completion of training through several sets of evidence in each capability area, collected from a range of settings and through different tools. Each portfolio will look slightly different, but it should provide a rich picture built up over three years.

• Workplace Based Assessment (WPBA) capability framework

Clinical experience groups coverage in the ESR

While it’s not the main focus of ESR, you’ll have opportunities to consider breadth of clinical experience groups coverage as well as progress in the capabilities. When reviewing your Trainee Portfolio, you and your educational supervisor can monitor how far you’re covering the range of knowledge described in the curriculum, in preparation for the Applied Knowledge Test (AKT) and clinical practice.

Completing trainee self-rating and educational supervisor capability grading for ESR

Capability areas

For each Capability the list of linked evidence should be reviewed. These can be opened and reviewed by clicking on them in your Portfolio. You are required to pick up to three pieces of evidence from the range available for each Capability.

Trainees in ST3 in full time placements are advised to include a minimum of 3 pieces of evidence per review to ensure there is an adequate amount of evidence to support their capability rating. Similarly, this is encouraged in ST1 and ST2 but it is recognised that some capabilities in non-primary care placements are harder to achieve and this may not be possible. Trainees in less than full time rotations need to include evidence which reflects the pro rata number of assessments and log entries for their percentage of training.

The evidence chosen needs to demonstrate your current performance within that Capability area.

It is preferable that a range of types of evidence from the learning log and work place based assessments is selected, though often logs alone may be used if these demonstrate a range of the descriptors.

Using the capability descriptors, the trainee states what these pieces of evidence show them doing and how they support the grade they have given. They should only comment on evidence within the portfolio not their opinion of anything that is not recorded.

As an ST1/2 it would be expected that they would be meeting the Needs Further Development NFD descriptors but may also have some showing competent.

For the pre ARCP ESR evidence from any time in that year, even if it does not appear in this review, can be cited.

The ES or CS may have stated, in the learning log comments or assessments feedback, why they were linking the log to set capabilities or grading the assessment as they did and if they have done this, quoting the capability descriptors. Their comments can be selected to be moved into the trainee self rating. Trainees should make it clear in their log which of the capabilities they feel they are addressing, so the ES can make appropriate comments.

In order to have a good range of evidence to use it is important that all of the capabilities have at least one log linked to it in the review period. More logs allow for more of the capability descriptors to be evidenced and a higher grade awarded. It is important to demonstrate the capabilities across the range of Clinical Experience Groups but not all have to be demonstrated in each one. How many is possible will depend on the post under review.

Ratings

ST1, ST2 and ST3 who are not due to CCT

The new ESR outcome options for ST1, ST2 and ST3 who are not due to CCT in this review period will be as follows:

• Making progress above the expected rate
• Making progress at the expected rate
• Making progress below the expected rate
• Making progress significantly below the expected rate

ST3 trainees who are at their currently due CCT date

The new ESR outcome options for ST3 trainees who are at their currently due CCT date will be as follows:

• Competent/Excellent in WPBA requirements as evidenced by this ESR
• Progress below the expected rate in WPBA requirements as evidenced by this ESR

Word descriptors for ESR outcomes

The following descriptors are not designed to be used as a checklist but as a guide to support and justify ES decision-making. For example, if the trainee has one piece of evidence that sits in a below/significantly below area on the descriptors it doesn’t mean that this rating is automatically given, conversely not all areas of concern need to be present to give that rating either.

If the trainee is graded as significantly below expected rate or below expected rate a pop-up box will come up to remind the ES to consider involving the TPD/scheme performance team as the trainee may require additional support or an earlier panel. 

Making progress at above the expected rate has been included to keep this in line with the assessments where a rating of above expectations is an option. It also recognises those trainees who are doing especially well.

ESR outcome options for ST1/2 and ST3 trainees who are not due to CCT at this time

Making progress above the expected rate – compared to trainees at the same stage of training

• CSR areas rated as above expectations
• Assessments have been graded as working above the level of a GP trainee working in the current clinical post.
• All mandatory WPBA have been completed.
• Many capabilities are graded as Needing Further Development – Above expectations.
• Evidence of adult and child safeguarding /BLS
• Regular engagement with the Portfolio and proactively engages with the supervisor, arranging and being well prepared for meetings.

Making progress at the expected rate – compared to trainees at the same stage of training

• CSR areas graded as meeting expectations
• Assessments are graded as at the level of a GP trainee working in the current clinical post.
• Capability areas are graded as: Needing further development – Meeting Expectations. (Depending on the capability, if a capability is harder to achieve in non-primary care placements and has been rated as below expectations, this may be acceptable in this context, - for example community orientation in ST1/2)
• All mandatory WPBAs are completed or a plan on providing those outstanding, up to a maximum of two
• Trainee has engaged with the Portfolio and engages with the supervisor in an appropriate time frame.
• Evidence of adult and child safeguarding level 3 /BLS

Making progress below expected rate – compared to trainees at the same stage of training

Engagement concerns:

• Incomplete number of assessments/ CSRs – maximum of 2 areas missing
• Repeated late entry/sharing of log entries
• Missing mandatory evidence – BLS/safeguarding
• Educator notes relating to lack of engagement

Performance concerns:

• CSR highlights requires more supervision than would be expected.
• WPBA areas graded in some but not all assessments as below the expectation for a trainee working in the current post.
• Needing further development – Below expectations in up to two capability areas
• Concerns around knowledge gaps highlighted in assessments/reports/educator notes, but sufficient to impact on patient safety.

Professional concerns:

• Evidence of concerns within the trainee’s professional behaviour as evidenced in assessments (MSF for example), log entries, CSRs, ESRs and educators notes, for example honest and integrity, time keeping, evidence of difficulty in accepting feedback.

Making progress significantly below the expected rate - compared to other trainees at the same stage of training

Engagement concerns:

• Global failure to engage with the Portfolio
• Incomplete number of logs-less than half the required number 
• Incomplete number of assessments /CSRs – less than half the required number
• No up to date PDP present
• Missing mandatory evidence – BLS/ safeguarding etc
• Multiple educators notes on lack of engagement

Performance concerns:

• CSR highlights concerns over being unable to be left without direct supervision
• WPBAs consistently graded below the expectation of a trainee working in the current post
• Needing Further Development - Below expectations in 3 or more capability areas
• MSF scores of 60% or below compared to peers for either clinical or professional behaviour and/or significantly concerning individual comments
• Significant concerns around knowledge impacting on patient safety are highlighted in assessments/reports/educator notes despite guidance and educational input.

Professional concerns:

• Evidence of significant concerns within the trainee’s professional behaviour as evidenced in assessments (MSF for example), log entries, CSRs, ESRs and educators notes, for example honesty and integrity, time keeping, evidence of difficulty in accepting feedback.

ESR outcomes for ST3 trainees who are at their currently due CCT date

Competent in WPBA requirements

• All mandatory WPBA completed. Assessments completed towards the end of training are graded as competent
• All capabilities graded as ‘Competent for licensing’ or ‘Excellent’.
• Updated PDP completed, and may have included post training entries
• No concerns raised in the CSR (if completed).
• In date BLS / ALS with AED
• Knowledge and reflection of Safeguarding Adults and Children at level 3

Making progress below expected rate

Engagement concerns:

• Incomplete number of assessments.
• Mandatory WPBA / PDP not completed.
• Lack of in date BLS/AED
• No evidence of Safeguarding Adults/Children

Performance concerns:

• Number of WPBA overall graded as below the level of a GP working in the current clinical post.
• CSR (if done) grading as needing further development or requiring more supervision than expected in the clinical role.
• Any capability areas graded as needing further development.

Professional concerns:

• Evidence of concerns within the trainee’s professional behaviour as evidenced in assessments (MSF for example), log entries, CSRs, ESRs and educators notes, for example honest and integrity, time keeping, evidence of difficulty in accepting feedback

Action plans

After completing the capability grading the trainee will be asked to pick up to 3 capabilities that they feel they need to focus most on developing in the next review period.

For each of these they need to write what they aim to achieve, ideally relating to the capability descriptors.

The ES may add a further two of these if the trainee has not selected a capability that they feel is important for the trainee to address.

This is required even for final review ST3/4s as they need to plan further development in their post CCT pre-appraisal period.

What should the Educational Supervisor do?

The educational supervisor should read the trainee self-rating and review the evidence they have linked and decide if they feel that this does support the grade given. They also need to decide if this is a true representation of the trainee’s current level of performance as demonstrated within the portfolio. To do this they need to be aware of or review all the linked evidence. If the trainee has clearly stated what the evidence shows and how, using the capability descriptors, and they are able to justify the grade and the evidence linked supports this, the ES can simply agree, stating that they have confirmed this to be correct. If, however there is evidence that they feel supports a lower grade they need to link this evidence and state why this supports a lower grade. Similarly, if they feel that the trainee performance level is higher than they have graded themselves they justify this different grade using linked evidence and stating how this supports this revised grade. They are able to link up to an additional 3 pieces of evidence.

PDP review

Reviewing the PDP and helping the trainee write SMART entries is an important part of the ESR meeting and review.

Before each placement/post, as well as during it, trainees should think about what their learning needs are, relevant to that post and how to address these. For ST1s this can be done before or at their initial meeting with their ES and subsequently when completing their self-assessment review for their ESR. Trainees should propose at least one PDP idea that covers a learning need and make a SMART plan for achieving this. At the ESR the supervisor can edit these and also help the trainee create other relevant ones if needed.

PDPs are focusing on specific topic, skills or learning needs that the next post will require and help them achieve. They may well be about specific parts of the GP curriculum and are separate to the actions plans which focus on demonstrating progression in the capabilities.

More information about the PDP can be found below.