WPBA: Care Assessment Tools (CATs)

Trainees must complete a minimum of 4 CbDs in ST1 (a minimum of two for each 6 monthly Educational Supervisor Report (ESR) and a minimum of 4 more CbDs in ST2 (a minimum of two for each 6 monthly Educational Supervisor Report (ESR). In ST3 they must complete a minimum of 5 CATs (which can include CbDs). There are no set numbers for each different type of CAT and CATs are only available in ST3. The numbers required are pro rata for less than full time trainees.

CATs can be assessed by either an approved GP Educational Supervisor (ES) or an approved, appropriately trained, and updated GP Clinical Supervisor. Each assessment should last a minimum of 30 minutes with subsequent debrief time. The assessments are recommended to be completed within a protected tutorial.  

Ideally the CATs will cover the full range of the capabilities. This will provide a triangulation of grades for each capability across a range of different assessment methods. It is expected that trainees will have been assessed in all the capabilities using a formal assessment tool at least once in their training. The Educational Supervisor makes a recommendation to the ARCP panel based on all workplace-based assessments and the overall content of your Portfolio.

It is expected that a maximum of four capabilities and 2 Clinical Experience Groups be linked to each CAT so that in-depth reflection and meaningful feedback is given for each. Separate assessments can be used if the assessment covers a larger number of either. 

While it is not mandatory to have a CAT for each Clinical Experience Group, a range of types of assessment and information will need to be provided in the Portfolio to show exposure to, learning from, and competence in caring, for the range of Clinical Experience Groups across each training year. 

By the end of ST3 it is expected that the trainees are assessed as being competent or excellent for the capabilities assessed (as illustrated by the competent /excellent descriptors) and graded at or above the level expected of a GP trainee working in the current clinical post. They need to show progression in ST3 and will often have a range of evidence across logs and other assessments on which a judgement is made. 

If, following completion of the mandatory prescribing assessment in ST3, an additional prescribing CAT is used to address outstanding learning needs, this can count as one of the five mandatory CATs during ST3. However, the total number of completed CATs should demonstrate the breadth of the capabilities and clinical experience groups.

Different approaches to choosing the content for the assessment can be taken. The approach should be agreed before the assessment:

• Reviewing consecutive patients/interaction/results including a whole surgery to give a picture of overall performance.
• Reviewing a random selection of contacts looking through one particular ‘lens’, or possibly two e.g. appropriateness of the diagnosis or decision-making or documentation, use of coding and consultation length. 

Trainee self-selection is likely to yield cases that they perceive have been ‘successful’ and that the ‘right’ outcome was reached. Trainees may also naturally choose specific patient populations or capability areas. It can be helpful to vary the approach to case selection (and the lead i.e. trainee or trainer) for assessment throughout the training year to ensure there is an accurate representation. 

Generally, a retrospective approach looking at contacts is taken, but occasionally a mix with prospective approach might be appropriate e.g., a proportion of blood results/documents filed and some awaiting review and actioning. 

When undertaking a CAT, it is recommended that the supervisor ensures the trainee sees a range of patient types, conditions and mix of urgent and unscheduled care and routine appointments. It is an opportunity to address any actions that need to be planned in response to the balance of their work across Clinical Experience Groups and curriculum.

It can be helpful if the trainee and supervisor jointly choose three to four Capabilities ahead of the assessment to focus on gaps in the Portfolio. It is also recommended that the supervisor ensures the assessment maximises educational opportunities and guides the trainee to the most suitable Capabilities. 

Ahead of the assessment, the Capability descriptors should be reviewed, and questions suggested (if appropriate) in order to become familiar with what the trainee needs to demonstrate for the various grades. Specific feedback for each Capability is required with agreed plans for each following the discussion. 

Outline of how the assessment is completed

• The trainee briefly describes the case(s)/results/documents.
• The supervisor questions the trainee in a way that allows them to demonstrate the highest level they can, based on the Capability descriptors.
• Questioning continues with the supervisor postponing answering any questions from the trainee until the feedback section.
• The three to four Capabilities previously agreed are discussed in turn with time for the trainee to add anything else they wish.
• It is essential for both the supervisor and trainee to consider the Capability descriptors during the discussion.
• Once the case(s)/results/documents and Capabilities have been fully critiqued and discussed the supervisor collates developmental feedback into themes to offer to the trainee and moves to the feedback section.
• It can be helpful to ask the trainee to say which grade they feel they have demonstrated and to give their own feedback first.
• The supervisor gives feedback on what was done well and demonstrated with grade decision followed by feedback on what they should work on to improve or demonstrate in future learning events.
• The grading and discussion should be captured on the Portfolio. 
• Consideration should be given as to whether the trainee is being exposed to the full range of Clinical Experience Groups in General Practice and a broad range of curriculum types to allow future planning of workload and guide future assessments.

Documents

• CAT question generator (PDF file, 667 KB)
• Care Assessment Tool (CAT) briefing document (DOCX file, 46 KB)

Visit our full guidance on the CbD for more information.

The following is a brief summary of this type of CAT:

Preparation in advance

Trainee

• Select a case for discussion.
• State which Capabilities you feel you can demonstrate with the case.
• Prepare a short summary of the case.
• Prepare to discuss how you handled the case and how you met the Capability descriptors.

Supervisor /Trainer

• Review the case the trainee has suggested along with the medical notes. 
• Check it is suitable for the Capabilities suggested and of a sufficient complexity.
• Prepare questions to test the Capability areas and explore what the trainee actually did in that case. See CAT question generator (PDF file, 668 KB) for suggested questions.
• Review the Capability descriptors and suggested questions to become familiar with what the trainee needs to demonstrate for the various grades.

Supervisor guidance

• The trainee briefly describes the case. 
• The supervisor asks which Capabilities the trainee wishes to discuss first. 
• The supervisor questions the trainee in a way that allows them to demonstrate the highest level they can, based on the Capability descriptors. 
• Questioning continues with the supervisor postponing any questions from the trainee until the feedback section. 
• Each Capability of the 3-4 to be addressed is discussed with time for the trainee to add anything else they wish. 
• Both refer to the Capability descriptors. It is good practice for both the supervisor and trainee to consider these during the discussion. 
• Once the case and Capabilities have been fully discussed the supervisor moves to the feedback section. 
• It can be helpful to get the trainee to say which grade they feel they have demonstrated and to give their own feedback first. 
• The supervisor gives feedback on what was done well and demonstrated with grade decision followed by feedback for improvement, future different cases, and Capabilities that still need to be covered.

Capability areas suggested: 

All