The Consultation Observation Tool (COT) and Audio-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 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.

COT forms and guidance


General Practice has evolved, and more and more consultations are being carried out by phone. Different skills are needed to carry out a consultation safely and appropriately on the phone from those needed for face-to-face consultation.

The Audio-COT form that has been developed would be expected to be used for at least one COT in ST3, and further ones would be encouraged. A total of three Audio-COTs can contribute towards the overall total of COTs required in ST3.

Audio-COT would not be expected as part of the minimum numbers of COTs in ST1/2. The AudioCOT is encouraged in ST1/2 whilst in a GP placement but it will not count towards the overall total number of COTs in these training years.

The Audio-COT guidance, assessment form and consent form can be seen below.

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