The Consultation Observation Tool (COT)

Consultation Observation Tool

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 assessor 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. For information about who can complete COT and Audio-COT, please see the guidance on who can act as an assessor for workplace based assessments.

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.

Patient consent

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 capability 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.

COT forms and guidance

COT - Frequently Asked Questions

When are COTs done?

COTs are done in all primary care placements.

How many are needed?

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/mini-CEXs are required in each training level in ST1 and ST2.

6 COTs are required in your ST3 year. For trainees working less than full time these requirements will be pro-rata.


Am I required to complete half of the annual number before each six-month review in ST3?


Who can assess a COT?

COTs can be assessed by either an approved GP Educational Supervisor (ES) or an approved, appropriately trained, and updated GP Clinical Supervisor.

Do COTs need to cover all the Clinical Experience Groups?

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 give relevant advice to you in the context of the rest of your Portfolio.

Is there a minimum or maximum length of consultation to be submitted for a COT?

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. 

Can I be awarded a satisfactory Educational Supervisor’s Report outcome if the overall rating for my last COT is ‘needs further development’?

Yes. The Educational Supervisor makes a recommendation to the ARCP panel based on all workplace-based assessment and the overall content of your Portfolio.

Do I need to have a minimum number of ‘competent’ ratings for each of the 12 capabilities?

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.

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