The Consultation Observation Tool
The Consultation Observation Tool (COT) has
been designed to be used by trainers as an evidence-collecting
instrument to support the more holistic judgements made about
GPStRs at the six monthly and final reviews when the GPStR is in
primary care. The mini-CEX tool (link to mini-CEX page)
will be used for this purpose in a hospital setting.
What is
the Consultation Observation Tool?
How is the Consultation Tool
applied?
How
many? How often?
FAQs
Resources
What is the Consultation Observation Tool?
The starting point for this assessment is
either a video recorded consultation or a consultation directly
observed by the trainer. In either case the observation should
generate discussion and feedback for the GPStR and yield evidence
which will be recorded in the ePortfolio. It is likely that more
evidence will be generated from consultations with greater
complexity.
The selected consultations are rated according
to a set of criteria which have been developed from the experience
with Summative Assessment and the MRCGP consultation skills module.
These criteria are built into the ePortfolio.
How is the Consultation Tool applied?
The GPStR records a number of consultations on
video and selects one for assessment and discussion, or the GPStR
and the trainer agree on a prospective patient encounter which will
be the subject of direct observation. In either case the patient
must give consent in accordance with the guidelines for consenting
patients.
Consultations should be selected across a
range of patient contexts and over the entire period of training
spent in general practice and should include at least one case from
each of the following categories:
- Children (a child aged 10 or under)
- Older adults (an adult aged more than 75
years old)
- Mental health
Time is set aside for both GPStR and trainer
to view the consultation together during which time the trainer
rates the evidence which they observe against the competence
framework and COT criteria. The trainer then formulates a global
judgement for the overall consultation and offers formal feedback
on the consultation with recommendations for further work and
development by the GPStR.
Top
How many? How often?
The requirement is for a minimum of six COTs
or Mini-CEX in each of ST1 and ST2, (ensuring there are three
before each six monthly review), and 12 COTs in ST3 (six before
each six monthly review). The minimum requirement applies whether
or not the GPStR is in full time training. If the GPStR spends some
of their final year in hospital posts, then the point at which COTs
take over from Mini-CEX may vary.
One consultation should be viewed at a
time.
FAQs
Q. Won’t the GPStRs select the videoed
consultations in which they think they did well?
A. Yes, probably, but this doesn’t
matter. If they are able to discriminate between good
and poor consultations then they are showing
professional development. However, GPStRs should not be encouraged
to spend a lot of time videoing different consultations. They need
to understand that this is not a pass/fail exercise but just part
of a wider picture of competence which they are building up.
Q. Are there any restrictions on the
length of consultations to be videoed?
A. It is inadvisable for a consultation
to be more than 15 minutes in duration, as the effective use of
time is one of the performance criteria.
Top
Resources
nMRCGP DVD: The COT. A Guide to the
Consultation Observation Tool. Available from the RCGP bookshop and from the
Wessex faculty office. £25, with discounts for RCGP members and
associates. Discounts for bulk orders from the Wessex faculty
office.
Downloadable resource:
COT: Detailed Guide to the Performance Criteria.