CSR, iESR and ESR guidance

Clinical Supervisors Report (CSR)

Educational Supervisor Report (ESR)

Interim Educational Supervisor Report (iESR)

Personal Development Plans (PDP)

Clinical Supervisor’s Report (CSR) 

The Requirements 

The Clinical Supervisor’s Report (CSR) is a short, structured report completed by your Clinical Supervisor in each post.  

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's Report (ESR). 

Every section on the CSR needs to be completed.  

The CSR is an opportunity for you to receive feedback about your performance and the conversation with the CS that accompanies it can be particularly useful. The CSR is also a valuable source of evidence for each Capability in the Educational Supervisor's Report and for ARCP panels. 

The latest version of the CSR was rewritten to: 

  • Make a clear link between each section and the relevant GP Capabilities. 
  • Ensure that all the GP Capabilities are covered in the report. 
  • Introduce an overall assessment by the Clinical Supervisor (CS) of the level of supervision that you have required. 
  • Make the report shorter and easier for busy clinicians to complete. 

For trainees working less than full time in a one-year hospital placement, a CSR will still be required after 6 months to use in the ESR. 

More about the CSR

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.

Anyone assessing a Workplace Based Assessment is required to sign in to the Trainee Portfolio. Assessors will need to create a (free of charge) FourteenFish account if they don't already have one.

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.

If a Clinical Supervisor has significant concerns about a trainee’s performance, they should not wait until the end of the post to highlight these and should contact the local GP Training Programme Director or Associate Dean and share their concerns. They may ask you to summarise your concerns in writing potentially via an early CSR.

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 

For further information, please see the CSR for non-primary care placements. which also includes links to the word descriptors and further guidance for completing a CSR in non-primary care placements.

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).  

If you don’t complete a post due to absence – or any other reason – the ARCP panel will need to determine whether a short post (less than months) can count towards your overall training time.  

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

 There are 3 forms below - 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’. 

Documents 

Educational Supervisor’s Report (ESR) 

Workplace Based Assessment (WPBA) builds up a qualitative picture of your performance in training. The evidence you collect in your Trainee Portfolio is reviewed at six-monthly intervals by the educational supervisor. 

Purpose of the Educational Supervisor’s Report (ESR) 

ESRs provide feedback on your overall progress and identify areas where you need more focused training. 

Reviews are informed by the evidence you collect through the WPBA tools, along with ‘naturally occurring evidence’ from elsewhere in the Trainee Portfolio (for example, the Learning Log). 

You’ll then agree a learning plan, and the outcome of the review will be recorded in your Trainee Portfolio. The educational supervisor gives an ESR outcome for the ARCP panel to consider. 

Towards the end of training there’s a final review, and the educational supervisor makes a recommendation to your deanery ARCP panel regarding your overall capability. The ARCP panel makes the final judgement on whether you’re competent for licensing, based on the evidence in the ESR and your Trainee Portfolio as a whole. 

More about the ESR 

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.

Anyone assessing a Workplace Based Assessment is required to sign in to the Trainee Portfolio. Assessors will need to create a (free of charge) FourteenFish account if they don't already have one.

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.

If a Clinical Supervisor has significant concerns about a trainee’s performance, they should not wait until the end of the post to highlight these and should contact the local GP Training Programme Director or Associate Dean and share their concerns. They may ask you to summarise your concerns in writing potentially via an early CSR.

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 

For further information, please see the 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.

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).  

If you don’t complete a post due to absence – or any other reason – the ARCP panel will need to determine whether a short post (less than months) can count towards your overall training time.  

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

 There are 3 forms below - 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’. 

Documents 

Interim Educational Supervisor’s Report (iESR) 

The Interim ESR is based on the full annual ESR but reduces the burden of assessment for the Educational Supervisor. 

You will meet with your ES at the 6-month point of your training year and together review your progress since your most recent ESR, and the training requirements which will need to be completed before your next annual ESR. (It is recognised ST1 trainees will not have a previous ESR). 

The ES should ensure that there is evidence of appropriate progression in each of the Capabilities across the Clinical Experience Groups appropriate to your placements and stage of training. 

The Interim ESR is a formative process to support you and try to and ensure you are on track to achieve ‘satisfactory progress’ at your next ARCP. 

The ESR is prepared in the same way for either ESR. You will need to complete a self-rating and add evidence for each Capability, complete and update your PDP and add up to 3 action plans. 

Your ES can decide whether this is to be a full or interim ESR at any time during the review period and can switch from one to the other if required. In an interim ESR, the ES can still decide to grade and give evidence for each Capability, but this is not mandatory. 

The interim ESR is only appropriate to use between annual ESRs and when there is no ARCP scheduled within the next two months. A full ESR would be expected every calendar year. 

An Interim ESR should NOT be done when: 

  • The last ARCP panel outcome was a 2 or 3 
  • The panel asked for a full ESR at your last ARCP 
  • The trainee has newly identified or previously declared Significant Events (GMC threshold of potential or actual serious harm to patients, complaints or other investigations which have not been resolved since their last ARCP i.e. any declaration made on the last Form R (or SOAR in Scotland) which is outstanding. 

The sign-off for the Interim ESR is slightly different to that of a full ESR. If the supervisor has any sufficient concerns and selects any outcome other than "satisfactory", the portfolio will prompt to switch to a full ESR, where the ES will then be required to grade and evidence each capability and give the full ESR grading at the end. 
Examples where concern may be raised include: 

  • 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. 
  • There have been concerns identified about your lack of engagement in the Portfolio 
  • Concerns have been highlighted by the local education team or supervisors in the 'Educators notes’ section of your Portfolio.

Should an Interim ESR be completed in error or where the Deanery have subsequently requested a full ESR, the ES must request an interim ESR roll back and then switch to a full ESR and complete this as normal with the trainee.

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.

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 

Personal Development Plans (PDP)

Personal Development Plan (PDP) information has moved to our WPBA assessments menu.