Audio-COT

General Practice has evolved, 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 provides an additional tool to enable the assessment of your telephone consultation skills, which complements the existing components of the WPBA. The Audio-COT uses the same methodology and process of completing the assessment as the COT, but is used in a different setting. The Audio-COT counts towards the total number of COTs you need to do in each training year. 

How the Audio-COT works

Your supervisor will review a number of your telephone consultations during your rotations in primary care, either via direct observation of a telephone consultation or via an audio recording. Your supervisor will discuss the case with you and give you feedback. An Audio-COT assessment is then completed as evidence and documented in your Portfolio.

Selecting consultations for an Audio-COT

You can either be observed directly undertaking a telephone consultation (using a dual headset, for example) or via a recording of the discussion (both patient and doctor).

Complex consultations are likely to generate more evidence. The telephone consultation used for an Audio-COT should typically last between 10-15 minutes.
Telephone consultations should be drawn from your entire period of GP training, reflecting a range of patient contexts. 

Telephone consultations can be complex. It is therefore recommended that Audio-COTs are completed during the ST3 year of GP training. During your primary care placements in ST1 and/or ST2 we would recommend you are assessed following face to face consultations. However due to the increase in telephone consulting this may not be possible and the COT requirement for that placement can include the assessment of your telephone consulting. In ST3 it would be expected for trainees to demonstrate their competence in consulting both in face to face consultations and on the telephone. There is no set number for how many of each are needed.

Telephone consultations are undertaken in both the Unscheduled care / OOH setting as well as in the GP setting and you are encouraged to undertake assessments in both clinical environments.

Telephone consultations can either take the form a telephone triage call or a full telephone consultation. For this reason, not all areas of assessment may be covered in all telephone calls. Supervisors are encouraged to mark ‘not observed’ for those descriptors that are not assessed.

It is natural for you to select telephone consultations in which you feel you have performed well; the ability to discriminate between good and poor consultations indicates professional development. However, you are reminded that the Audio-COT is not a pass/fail exercise. The assessment is part of a wider picture of your overall practice and presenting recordings that you feel perhaps did not go as well as you had hoped may result in greater 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 an Audio-COT may not be submitted for the RCA as it has already been used as evidence for WPBA. 

Patient consent

The patient must give consent to the telephone consultation either being listened to by a second doctor or being recorded, in accordance with the guidelines for consenting patients. Please see the separate patient consent document for further information on gaining informed consent for audio recording the consultation below.

Collecting evidence from the consultation

Your supervisor will review the consultation with you, relating their observations to the WPBA Capability framework and Audio-COT performance criteria - see below. Your supervisor will then make an overall judgement and provide structured feedback, with recommendations for further development. You are encouraged to reflect on the telephone consultation through a separate learning log entry.

Capabilities

The Audio-COT has been mapped to the RCGP Capability statements, which in turn will link to work place based assessment evidence in the Educational Supervisor Review.

Trainee rating and overall assessment

Trainees are rated for each area within the Audio-COT as ‘not observed’, ‘needing further development’, ‘competent’ or ‘excellent’. Your supervisor is rating you against detailed performance criteria. ‘Competent’ refers to the standard that would be expected of a GP trainee on completion of their training. A global judgement is made at the end of the assessment tool regarding the safety of the telephone call.

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Audio-COT - FAQs

What is an Audio-COT?

General Practice has evolved, and it is likely that you will carry out more and more consultations 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 provides an additional tool to enable an assessment of your telephone consultation skills, which complements the existing components of the Workplace Based Assessment (WPBA). The Audio-COT uses the same methodology and process of completing the assessment as the COT, but is used in a different setting.

When should I complete an Audio-COT?

Audio-COTs are undertaken in primary care placements. They contribute to the total COT requirement for each training year.

During your non-primary care posts the mini-Clinical Examination Exercise (miniCEX) tool is used rather than the COT to record consultation observations. 

Do I have to have a certain number of COTs which are face to face and a certain number of Audio-COTs?

No, ideally these should not just be solely face to face or audio consultations and a mixture of the different types of consultations would be recommended.

It is recommended that in ST1/2 you are assessed on face to face consultations, but if this is not possible then a telephone consultation can be used

Why use the Audio-COT?

The Audio-COT is a time efficient way of assessing your telephone consulting in a real practice setting and so it is a complete and realistic challenge. It allows you to get feedback on your performance from an experienced clinician about a real patient/scenario, in real time.

Who can assess an Audio-COT?

Either your approved GP Educational Supervisor, or approved, appropriately trained and updated GP Clinical Supervisors can assess Audio-COTs.

What is the process to complete an Audio-COT?

The process is similar to completing a face-to-face Consultation Observation Tool (COT) in the GP setting. GP Supervisors will naturally review a number of your telephone consultations throughout your training in a GP setting, either via direct observation of a telephone consultation or via an audio-recording. To complete an Audio-COT, your GP Supervisor will review the consultation with you, relating their observations to the WPBA capability framework and Audio-COT performance criteria. Your GP Supervisor then makes an overall judgement and provides structured feedback, with recommendations for further development. An Audio-COT assessment is then completed as evidence in your Portfolio (see below for further information about how the form is completed). 

How do I select consultations for an Audio-COT?

You can either be observed directly undertaking a telephone consultation (using a dual head-set for example) or via a recording of both sides of the discussion (patient and doctor).

Telephone consultations should be drawn from your entire period of GP training, reflecting a range of patient contexts. Telephone consultations can be complex, therefore completion of Audio- COTs is recommended during your ST3 year of GP training. 

Telephone consultations are undertaken in both the out of hours (OOH) and the GP surgery setting. You are encouraged to undertake assessments in both clinical environments. Telephone consultations can either take the form of a telephone triage call or a full telephone consultation.  For this reason, not all areas of assessment will be covered in all telephone consultations. GP Supervisors are encouraged to mark ‘not observed’ for those descriptors that are not assessed. It is advised that you complete at least one telephone consultation in the OOH setting and one in the setting of the GP surgery. 

It is natural for you to want to choose telephone consultations where you feel you have performed well. This is not a problem - the ability to discriminate between good and poor consultations indicates professional development. You are reminded that the Audio-COT isn’t a pass/fail exercise; it is part of a wider picture of your overall capability. 

Each Audio-COT should represent a different clinical problem. It is helpful to vary the types of cases that are assessed as an Audio-COT so that your capability is reviewed throughout the cases.

Is there a minimum or maximum length of consultation for an Audio-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.  Complex consultations are likely to generate more evidence. The telephone consultation used for an Audio-COT should typically last between 5-10 minutes. 

How long should the assessment last?

The assessor should give you immediate feedback after the telephone call (which would typically last 5-10 minutes) and then provide a contemporaneous report, rating you and capturing the feedback within the Audio-COT form on the Portfolio. When assessors have provided more detailed written feedback on the Audio-COT this has been very helpful evidence for the Educational Supervisor Report (ESR).

How do I gain patient consent?

The patient must give consent to the telephone consultation either being recorded or having a second doctor listening into the consultation, in accordance with the guidelines for consenting patients. Please see the separate patient consent document for further information on gaining informed consent for Audio-recording the consultation. 

How is the Audio-COT assessment captured?

Educational Supervisors and some Clinical Supervisors have access to your Portfolio. If this is the case, the supervisor can log on and complete the assessment. For those who do not have access to your Portfolio, you should send a ‘ticket’ in advance to the assessor, which will allow a direct link to the online assessment form.

To use the ticketed feedback system you need to generate a new ticket after which the ‘Generate a New Ticket’ page will appear. You should select the ‘Audio-COT assessment form’ and fill in the assessor’s details. An email will then be sent to the assessor providing the login code for the assessor to complete the ticketed Audio-COT assessment form.

 

What standard am I assessed against?

You will be graded in relation to the standard expected at certificate of completion of training (CCT). Competent refers to the standard that would be expected of a GP trainee on completion of their training. The GP Supervisor is rating you against set performance criteria. The grading scale includes the option of ‘not applicable’ which means that you did not cover the identified area, as it was not within the context of the case. This is different to ‘significantly below expectation and/or below expectation’, which means that either you did not cover the identified area to a competent level, or it was not demonstrated at all, and should have been. An overall assessment of performance is made at the end of the assessment. 

What feedback should I expect?

Your assessor should provide specific, constructive feedback both verbally and documented on the Audio-COT form, which aims to enhance your performance. The feedback will be used as evidence of your progress within ESR. The comments about each assessment area are important. Areas of strength and suggestions for development are both encouraged. 

Is the Audio-COT mapped to the 13 Capabilities?

Yes. The Audio-COT has been mapped to the RCGP capability (competency) statements, to allow the linking of workplace-based assessment evidence in the ESR.

Do I need to cover all the clinical experience groups?

Over the GP training programme, it is expected that trainees will submit a breadth of WPBAs relating to all the clinical experience groups. However, the Educational Supervisor will be able give relevant advice to individual trainees in the context of the rest of their Portfolio.

Does it matter what level of complexity is recorded for Audio-COT cases?

No, however it contextualises the subsequent grades. You would be expected to complete the breadth of complexities and bear in mind low complexity consultations will be unlikely to give adequate opportunity to demonstrate your ability.

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

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

Can the Audio-COT be used for online/skype style consultations?

The Audio-COT form could be used in other types of remote consulting where you are not consulting face to face in the same room as your patient in a GP setting (virtual consultations). Examples include the evolving digital audio/video consultations via mobile applications e.g. ‘Skype’ which are being introduced into the primary care setting. Please await further information on the extended use of the Audio-COT. 

How do I access the Audio-COT form?

The Audio-COT form can be found in the trainee Portfolio or downloaded via the RCGP WPBA website

How is the Audio-COT assessment captured?

If you have any queries about using the Portfolio, please contact FourteenFish via www.fourteenfish.com/support where you can find a “Submit a request” form.

Queries regarding training

If you have a query about the training then it is appropriate to contact either the trainee’s Educational Supervisor or the local GP Training Programme Director/Associate Dean to discuss these further. 

For any general queries about your GP training and assessment or the content of the WPBAs please contact the RCGP.

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