Consultation Observation Tool (COT)

The COT is an expanded version of the Mini-CEX and considers your consultations with real patients in real time during your primary care placements. It assesses the clinical skills and professionalism necessary for good clinical care within your consultations and this includes your performance of the more holistic judgments needed to consult in General Practice.

How the Consultation Observation Tool (COT) works

During training you are encouraged to video record and then review your consultations as these are an essential way of improving your consultations. The COT assessment can then be carried out using a recorded consultation; or you can arrange for your supervisor to observe you consulting directly. 

The assessment can be completed using face to face, video or telephone (audio) consultations. If a telephone consultation is being assessed then please use the Audio-COT assessment form and not the standard COT form 

Selecting consultations

Any consultations you video record will require the patient’s consent. A sample consent form is available below.

The choice of consultations should cover the full breadth of Clinical Experience Groups and be in different settings, such as surgery consultations, home visits and Unscheduled urgent care / Out of Hours.

When you are selecting a recorded consultation, it is natural to choose one where you feel you have performed well. Complex consultations or consultations that you found challenging are more likely to generate 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 a COT or Audio-COT may not be submitted for the RCA as it has already been used as evidence for WPBA.

Collecting evidence from the consultation

You will review the consultation with your supervisor, who will relate their observations to the WPBA Capability framework and COT or Audio-COT criteria. The performance criteria for face to face consulting can be found below and for telephone consulting within the Audio-COT section. Your supervisor will grade each section of your consultation, make an overall judgement on your performance and provide formal feedback with recommendations for further development.

When to use the COT

COTs are only completed in primary care placements. Mini-CEXs are completed during non-primary care placements. The total number of COTs required in ST1 and ST2 will therefore very much depend on your placements. A total of 4 Mini-CEXs / COTs /Audio-COTs are required in both ST1 and ST2. The COT/Audio-COT is used solely in ST3.

Download the form


Consultation Observation Tool (COT) - FAQs

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.

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


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

No, there is no set requirement of the different types of consultations you experience in Primary Care. 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.

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.
Page last updated: 12 October 2020

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