The requirements
Audio COTS count towards the number of COTS that are required in each training year. These are as follows:
- In ST1, a minimum of four COTS and/or Mini CEXs are required - this is four in total. A minimum of two MiniCEXs should be completed per non-primary care placement.
- In ST2, a minimum of four COTS and/or Mini CEXs are required - this is four in total – e.g. two COTs and two MiniCEXs.
COTS are completed in primary care placements, and in ST1 and in ST2, two COTs should be completed per primary care placement. MiniCEXs are completed in non-primary care placements and in ST2 two MiniCEXs should be completed per non-primary care placement.
- In ST3, a minimum of seven COTS are required.
In ST3 it would be expected that competence in consulting is demonstrated both in face-to-face consultations and on the telephone. There is no set number for how many of each are needed.
COTs of all types should be completed over the course of training including audio, face to face/in person (i.e. patient is in the same room as the GP in training/registrar) and virtual/remote.
For example, if six "face to face" COTS and one Audio COT were completed in ST3, this would meet the minimum requirements for ST3. At least one Audio COT and one face to face/in person COT should be completed over the course of training.
How the Audio-COT works
The supervisor will review a number of telephone consultations completed during rotations in primary care, either via direct observation of a telephone consultation (e.g. using a dual headset) or via an audio recording (where the doctor and patient are both audible). The supervisor will discuss the case with the registrar and give feedback. An Audio-COT assessment is then completed as evidence on the Portfolio.
Selecting consultations for an Audio-COT
The Audio-COT is not a pass/fail exercise. While it is natural to select telephone consultations in which performance was felt to be good, the assessment is part of a wider picture of overall practice and presenting recordings that perhaps did not go as well as was hoped may result in greater learning.
Complex consultations are likely to generate more evidence. The telephone consultations used for an Audio-COT should typically last between 10-15 minutes.
Telephone consultations are undertaken in both the Urgent and Unscheduled Care/Out of Hours setting as well as 'in-hour' in the GP setting and undertaking assessments in both clinical environments is encouraged. However, the assessor must be an approved GP Educational Supervisor, or approved and appropriately trained and updated GP Clinical Supervisor.
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.
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
The supervisor will review the consultation with the registrar, relating their observations to the WPBA Capability framework and Audio-COT performance criteria - see below. The supervisor will then make an overall judgement and provide structured feedback, with recommendations for further development.
Capabilities
The Audio-COT has been mapped to the RCGP Capability statements, which in turn will link to Workplace Based Assessment evidence in the Educational Supervisor Review.
You can reflect on a consultation that was assessed with an Audio-COT in a Clinical Case Review (CCR) to demonstrate additional capabilities.
Assessing the Audio COT
Either an approved GP Educational Supervisor, or approved, appropriately trained and updated GP Clinical Supervisors can assess Audio-COTs.
Educational Supervisors and some Clinical Supervisors have access to the Portfolio. If this is the case, the supervisor can log on and complete the assessment. For those who do not have access to the Portfolio, a ‘ticket’ should be sent in advance to the assessor.
On the ‘Generate a New Ticket’ page, select the ‘Audio-COT assessment form’ and provide 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 that should be completed by the assessor in person with the registrar.
The Audio-COT overall is assessed as:
- Below the level expected prior to starting on a GP Training programme
- Below the level expected of a GP trainee working in the current clinical post
- At the level expected of a GP trainee working in the current clinical post
- Above the level expected of a GP trainee working in the current clinical post
It is possible that not all assessed areas within a COT will be graded as competent in all consultations. However, by the end of ST3, it is expected that a GP registrar will have been graded as competent in all areas in a COT at some point during ST3, and that the most recent COTs are graded at - or above - the level expected for that stage of training.
The assessor should provide specific, constructive feedback both verbally and documented on the Audio-COT form, which aims to enhance performance. The observation and feedback on performance and agreed actions for development from the assessments are important to capture within the assessment. The feedback will be used as evidence of progress within the ESR. Areas of strength and suggestions for development are both encouraged.