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Gearing up for your first Consultation Observation Tools

Registrars doing the nMRCGP should aim to have completed at least two consultation observation tools (COTs) by the end of November. Dr Mei Ling Denney gives advice on how to prepare

Registrars doing the nMRCGP should aim to have completed at least two consultation observation tools (COTs) by the end of November. Dr Mei Ling Denney gives advice on how to prepare

COTs are one of a number of assessments that registrars must undergo to enable their trainers to make judgements about their competence during vocational training.

Details of the COT, as well as the other nMRCGP assessments, are available on the RCGP website, which should be checked regularly for any updates.

Although it is similar to the MRCGP video assessment, there are nevertheless some important differences in the COT that registrars should be aware of:

? You can either prepare a tape of a video-recorded consultation or ask your trainer to sit in on a pre-selected consultation for direct observation

? Your trainer will now be assessing your consultation him/herself – you do not need to send it off to the deanery or RCGP

? There is no ‘pass' or ‘fail', as the function of the COT is largely formative

? At the end of the observed consultation, there is time allowed for discussion and feedback, which will be recorded on the e-portfolio, along with the grades given

? Each COT will contribute to the evidence collected by the trainers and clinical supervisors throughout the 3 years of training, and the final decision as to whether you will be ‘signed up'

Planning your COTs

During the final year of GP training (ST3), a total of 12 COTs must be undertaken. This is a minimum rather than a maximum number. You can start doing COTs at any time during your final year, but there are a few points to think about when planning timing of COTs.

? Usually, two COT consultations should be seen at each sitting

? There is an interim review at 30 months and a final review at 34 months; prior to each review, six COT assessments should be made

? Doing COTs early in your GP year is helpful in a formative way, but you are unlikely to be able to demonstrate competence in many of the areas without sufficient consulting experience

? It is recommended that more than one person assesses your COTs, so it is worth discussing this aspect with your trainer to aid planning

With the MRCGP video exam, a series of examiners made judgements as to whether a particular criterion was present or absent- the criteria themselves were not graded individually, but contributed to the candidate's marked that were totted up at the end of the day. The performance criteria have now changed, and there are now no ‘merit' criteria. The criteria themselves will be covered in a future article in Pulse.

During a COT session, your trainer will grade each of the items in one of four ways:

I (insufficient evidence)

N (needs further development)

C (competent)

E (excellent)

The meanings for each of these individual grades are as follows:

(I) Insufficient evidence

From the available evidence, the doctor's performance cannot be placed on a higher point of this developmental scale. This should not be taken to be a ‘bad fail', but rather may be a consequence of selecting a consultation that simply did not lend itself to demonstrating that particular competency.

(N) Needs further development

Rigid adherence to taught rules or plans. Superficial grasp of unconnected facts. Unable to apply knowledge. Little situational perception or discretionary judgement.

(C) Competent

Accesses and applies coherent and appropriate chunks of knowledge. Able to see actions in terms of longer-term goals. Demonstrates conscious and deliberate planning with increased level of efficiency. Copes with crowdedness and able to prioritise.

(E) Excellent

Intuitive and holistic grasp of situations. No longer relies on rules or maxims. Identifies underlying principles and patterns to define and solve problems. Relates recalled information to the goals of the present situation and is aware of the conditions for application of that knowledge.

After awarding a grade for each performance criterion, your trainer will then decide on a global judgement for the consultation as a whole. Do not be unduly dismayed if your trainer decides that you ‘need further development' in some of the areas. This is to be expected, particularly in the earlier stages of your training in general practice. He/ she will explain why each grade was awarded, giving you feedback including some recommendations for further work before your next COT session.

Putting it on your ePortfolio

At the same time, or immediately after any observed videoed or live COT consultation, the trainer will have accessed your ePortfolio site with his/her individual password. This means that your COT grades and comments can be entered directly into the ePortfolio. After adding your feedback notes and any suggestions for further development all of this information will be submitted electronically to the ePortfolio and permanently stored. You will now be able to access this information by using your own log-in, as will your educational supervisor.

Once a COT has been submitted electronically, it will not be possible to alter or remove the record of the assessment. It is therefore worth checking the details of the grades and feedback with your trainer to ensure they are correct. You may feel that you do not wish to submit a COT if you were disappointed in the way that your trainer judged it. But having chosen the consultation as one of the COT assessments, your trainer is obliged to submit it. As there is no ‘pass/fail' , this should not worry you – there is no maximum number of COTs stated, so you can always work on the feedback suggestions and give it another go at a later date!

Dr Mei Ling Denney is a VTS course organiser in Cambridgeshire, and RCGP examiner

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