Consultation Observation Tool (COT)

This tool has been designed to be used by trainers as an evidence-collecting instrument to support the more holistic judgements made about GP trainees at the interim and final reviews during GP settings. The mini-CEX tool will be used for this purpose in a hospital setting.

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 GP trainee.

What to Do

  • The GP trainee records a number of consultations on video and selects one for assessment and discussion, or the trainee and the trainer agree one prospective patient encounter which will be the subject of direct observation. In either case the trainee must ensure that the patient has given consent as per the Guidelines for consenting patients.
  • Time is set aside for both GP trainee and trainer to view the consultation together during which time the trainer grades on the form each of the items as I (insufficient evidence) N (needs further development) C (competent) or E (excellent). A detailed guide to these performance criteria can be found in COT: Detailed Guide to Performance Criteria.
  • The trainer then formulates a global judgement for the overall consultation and offers formal feedback on the assessment conducted with recommendations for further work and development by the trainee.

How many Consultations should be viewed?

One consultation should be viewed for in-training assessment purposes at each “sitting.” Prior to an interim review at 6 months, six such assessments should be made, thus allowing the exploration of a minimum total of 12 cases over a training year spent in general practice.


While the trainer may well conduct the majority of these assessments, it is recommended that in order to improve reliability of this tool at least one other assessor (another trainer or course organiser or programme director) is involved in rating a few of the cases.

Consultation selection

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

It is likely that more evidence will be generated from consultations with greater complexity.

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