Hospital Consultants &
GP Training — In a Nutshell
Because you didn't sign up to take a GP trainee and then wonder what on earth a "CBD" is. Let's fix that.
📥 Downloads
Handouts, summaries, and teaching extras — ready when you are.
Bradford VTS Downloads — Hospital Consultants & GP Training
Useful downloads for learning, teaching, or last-minute rescue revision. Use the shortcode or links below to access available resources for this topic.
Downloads for this page are available from the Bradford VTS resource library. Contact Dr Ramesh Mehay at rameshmehay@googlemail.com to request specific handouts or teaching materials for this topic.
🔗 Key Links for Hospital Consultants
Everything you need to do your role well — one click away. The Bradford VTS pages on each assessment are your best friend; read them before you attempt the assessment.
⚡ Quick Summary — If You Only Read This Section
Pinched for time? Read this box. It will put you ahead of most hospital consultants supervising GP trainees right now.
🏆 The 10 Things Every Consultant Should Know
🗺 How GP Training Works — The Big Picture
GP training is a 3-year structured programme. Here's the map so you know where your trainee fits in.
The 3-Year GP Training Journey
The Structure in Plain English
GP training lasts 3 years (ST1, ST2, ST3). Trainees are called GP Specialty Trainees (GPSTs). They spend 18 months in hospital or community posts and 18 months in GP practices. The final year — ST3 — is always spent in a GP practice.
So when you have a GP trainee attached to your department, they are most likely in ST1 or ST2. They bring clinical skills from their previous hospital training, and they're learning how to think like a GP: holistically, with uncertainty, in primary care.
At the end of training, if all three parts of the MRCGP are passed and all evidence is satisfactory, the trainee receives a CCT (Certificate of Completion of Training) — their licence to practise independently as a GP.
📋 The MRCGP — What It Is and Why It Matters
The MRCGP is the national licensing qualification for GP. Like MRCPsych for psychiatry, or MRCP for medicine — it's the gatekeeper to independent practice.
AKT
Applied Knowledge Test
3-hour computer-based MCQ exam. Tests clinical knowledge, evidence-based practice, and NHS administration. Sat in ST2 or ST3. Max 4 attempts.
SCA
Simulated Consultation Assessment
12 simulated GP consultations, each 12 minutes. Conducted remotely. Replaces the old CSA. Sat in ST3 only. Expensive — around £1,500 per sitting. Max 4 attempts.
WPBA
Workplace-Based Assessment
Continuous assessments throughout training. CbDs, Mini-CEX, CEPS, MSF, COTs, PSQ, and more. Recorded in the FourteenFish ePortfolio. This is where you come in.
What Happens If the Trainee Fails?
Each exam allows a maximum of 4 attempts. If a trainee exceeds this, they are required to leave GP training and move to another specialty. This is a significant consequence — which is why your assessments, reports, and support matter enormously. Poor WPBA evidence can contribute to early identification of a trainee in difficulty, allowing extra support before exam failures accumulate.
👥 Clinical Supervisor vs Educational Supervisor — Know the Difference
One common point of confusion. Here's the clear distinction.
🏥 Clinical Supervisor (You)
- Responsible for the trainee during this post only
- Day-to-day supervision, teaching and assessment
- Changes with every new post the trainee moves to
- In a hospital post, this is the named hospital consultant
- Must complete CbDs, Mini-CEX, CEPS during the post
- Completes the Clinical Supervisor's Report (CSR) at month 5
- Should meet the trainee at start, middle and end of placement
- Responsible for patient safety during the trainee's work
🧭 Educational Supervisor
- Responsible for the trainee across the entire 3-year programme
- Usually a GP trainer at the trainee's main practice
- Does not change post to post (usually stays the same person)
- Oversees the ePortfolio and overall capability progression
- Runs the Educational Supervision Reviews (ESRs) every 6 months
- Attends or contributes to ARCP panels
- The "big picture" supervisor — the trainee's guide for the whole journey
Your Responsibilities as Clinical Supervisor
- Hold three meetings: start, mid, and end of the placement
- Supervise day-to-day clinical work — observe and give feedback regularly
- Ensure the trainee is not doing tasks beyond their current competence unsupervised
- Complete workplace assessments (CbDs, Mini-CEX, CEPS) throughout the post
- Complete the CSR at month 5 of a 6-month post
- Facilitate the trainee's attendance at the Half Day Release programme (≥70%)
- Alert the Educational Supervisor or TPD promptly if you have concerns
- Ensure all patient notes used in assessments are handled confidentially and shredded after use
- Be trained in equality, diversity and human rights best practice
🎯 The 13 Professional Capabilities
Everything a trainee is assessed on maps to one (or more) of these 13 capabilities. When you do a CbD, you're grading specific capabilities — not "the consultation overall."
💡 What is Capability Progression?
Trainees don't develop all 13 capabilities at the same time or rate. Some may demonstrate excellent communication from day one; others may struggle with managing medical complexity until late ST2. This gradual development — tracked through ePortfolio evidence over 3 years — is called Capability Progression.
By the end of ST3, a trainee should have solid evidence for all 13 capabilities. ARCP panels look at the trajectory of development — not just snapshots. Your assessments contribute to this trajectory. This is why ongoing assessments throughout the post matter more than one perfect CbD at the end.
💻 The FourteenFish ePortfolio — Why It Matters
The ePortfolio (hosted on FourteenFish) is not just an electronic folder. It is the central evidence base that determines whether the trainee progresses each year.
What Is the ePortfolio?
Every GP trainee is given access to the FourteenFish ePortfolio (also called the RCGP Trainee Portfolio) when they register with the RCGP at the start of training. It is accessible online and used throughout all 3 years — in both GP and hospital posts.
Think of it as the trainee's professional logbook, reflective diary, and evidence filing system — all in one place. It is where all WPBA assessments are recorded, including the ones you do with the trainee.
👩⚕️ The Trainee Uses It To...
- Record learning from patient encounters
- Write reflections on significant events
- Log educational activities and tutorials
- Upload certificates and evidence
- Tag entries to the 13 Professional Capabilities
- Track progress towards exam eligibility
👨🏫 You (as Supervisor) Use It To...
- Record all WPBA assessments you complete
- Enter grades and written feedback
- Complete the Clinical Supervisor's Report (CSR)
- View the trainee's progress across capabilities
- Leave guidance and action points for development
📋 ARCP Panels Use It To...
- Review all evidence of Capability Progression
- Check minimum WPBA numbers are met
- Assess quality (not just quantity) of evidence
- Decide whether the trainee can progress to the next year
- Identify trainees who may need extra support
📝 The WPBA Assessments You Need to Know
There are 12+ types of WPBA assessment in total — but you only need to master these five. Click the Bradford VTS link for each one for detailed guidance and example forms.
Case-Based Discussion (CbD)
A structured 30-minute discussion about a real case the trainee managed. You explore their reasoning — not just what they did, but why. This is the most common assessment you'll do. It requires preparation from both sides.
→ Full Bradford VTS guide to CbD
Mini-CEX
(Mini Clinical Evaluation Exercise)
You observe the trainee with a real patient — taking history, examining, explaining — and give structured feedback on the spot. Brief (15–20 min observation) but requires focused attention.
→ Full Bradford VTS guide to Mini-CEX
CEPS
(Clinical Examination & Procedural Skills)
Assesses whether the trainee can perform specific clinical examinations or procedures correctly. Think: cannulation, venepuncture, knee examination, fundoscopy. Can be delegated to a trained registrar.
→ Full Bradford VTS guide to CEPS
Multi-Source Feedback (MSF)
Multiple colleagues rate the trainee on professionalism, teamwork, and communication. You won't run this — the trainee does. But you and your team members may be asked to contribute ratings. Respond promptly and honestly.
→ Full Bradford VTS guide to MSF
Clinical Supervisor's Report (CSR)
Your formal written assessment of the trainee's overall performance during the post. This is crucial — it feeds directly into the ARCP panel. Complete it at month 5 of a 6-month post. Do NOT leave it to the last week.
→ Full Bradford VTS guide to CSR
⚖️ The Grading System — Used Correctly
This is where many hospital consultants go wrong. The grading scale is developmental — not a pass/fail system. Understanding it correctly is essential.
| Grade | What it Means | When to Use It |
|---|---|---|
| IE Insufficient Evidence |
You chose not to focus on this capability, or the case didn't lend itself to assessing it. | Acceptable occasionally. If IE repeatedly appears for the same capability, the trainee needs to seek better cases. |
| NFD / BE Needs Further Development / Below Expectations |
The trainee performed below what you'd expect from someone at this stage of training. This is a developmental signal — NOT a fail grade. | Use this honestly, especially in ST1 and ST2. It identifies where training energy should go next. |
| ME Meets Expectations |
The trainee performed at the expected level for their stage. Steady, appropriate progress. This is a good, healthy, normal grade. | This should be the most common grade in ST1 and ST2. It means the trainee is on track. |
| AE / Excellent Above Expectations / Excellent |
The trainee genuinely impressed you — performed notably above what you would expect at this stage. | Rare. Should only appear when you were truly wowed. If every box is AE, the assessment becomes meaningless. |
This shows what grade distribution is expected for a trainee making good progress. It is not a rule — it is a guide for calibration.
Trainees sometimes push back on NFD or BE grades — especially if they're used to being marked Excellent in foundation training. Here's how to handle it calmly and constructively.
💬 The Trainee's Voice — What GP Trainees Actually Experience
This is what GP trainees consistently report about their hospital posts. It comes from trainee surveys, published research, GP training forums, and trainee accounts from across the UK. Reading this section will make you a better supervisor — and more importantly, a better advocate for your trainee.
What GP Trainees Report About Hospital Posts
These are the things trainees consistently say made a hospital post genuinely excellent. They are not difficult or time-consuming. They just require thought.
✅ What Makes a Hospital Post Genuinely Good for a GP Trainee
- A proper meeting on day one — covering learning objectives, assessment plan, and timetable for the post
- Consultants who ask "what would you do as their GP?" after seeing patients in clinic — this one question transforms the learning
- CbD sessions booked into the diary from week two — not improvised at the end
- Access to outpatient clinics, not just ward work — this is where GPs learn most from hospital posts
- Feedback that is specific and developmental — even one clear "here's what to work on" per session has real impact
- Consultants who actively protect the trainee's VTS half-day attendance
- Being introduced to the team properly as a GP trainee — not as a generic junior doctor
- A mid-post review that identifies gaps and redirects the remaining weeks
- Consultants who show genuine curiosity about what GP trainees need to learn
- Being treated as a colleague — not a service resource
🏥 Hospital Specialty Thinking
- Filtered patient population — referred cases only
- Diagnosis often already narrowed before seeing patient
- Investigation-heavy approach is expected
- Single-organ / single-system focus
- Team-based, protocol-driven management
- Speciality knowledge depth is the goal
🩺 GP Primary Care Thinking
- Unfiltered population — any problem, any age
- Undifferentiated presentations — diagnosis often uncertain
- Watchful waiting is often the right answer
- Holistic, multi-morbidity, social context
- Patient-led, shared decision-making
- Breadth of knowledge and uncertainty tolerance is the goal
💡 Insider Tips — What the Best Supervisors Actually Do
These are the practical insights from experienced GP educators, senior GP trainers, TPDs, and the medical education community — distilled into clear, actionable advice. They are not in any official handbook. They are learnt by doing.
The Ideal Clinical Supervisor — A Post in Five Moments
The single biggest differentiator between good and poor hospital posts is whether there is a proper meeting in the first week. Not a corridor chat. A sit-down meeting. Thirty minutes is enough.
Ask these five things:
- "What have you already covered in your ePortfolio?" — This tells you where the gaps are, so your assessments are targeted rather than random.
- "What are your learning goals for this post?" — A GP trainee has specific curricular learning objectives for every post. Ask what they are.
- "Which clinics and activities would be most useful for your GP training?" — Outpatient clinics are usually more relevant than ward work. Plan this together.
- "When is your VTS day each week, and have you put it in the rota?" — Sort this on day one. Do not leave it to the trainee to fight for it later.
- "Let's book the assessment dates now." — Put CbDs and Mini-CEX into both your diaries immediately. Don't rely on goodwill later.
The most common mistake consultants make in CbDs is turning them into a knowledge quiz: "What are the causes of X?" or "What is the NICE guideline for Y?" That is NOT what a CbD is for.
A CbD explores professional judgement — not recall. Use these question structures instead:
| Instead of asking... | Try asking... |
|---|---|
| "What are the side effects of methotrexate?" | "Why did you choose that management approach rather than one of the alternatives?" |
| "What's the threshold for referring to secondary care?" | "What was going through your mind when you decided not to refer at that point?" |
| "Name three differentials for this presentation." | "What was the most uncertain part of this case for you, and how did you handle that uncertainty?" |
| "What should you have done differently?" | "If you saw this patient again tomorrow, what would you do differently and why?" |
| "Did you consider safeguarding?" | "Were there any aspects of this case that gave you pause from an ethical or safeguarding perspective?" |
Most feedback given in medical training is vague, positive, and quickly forgotten. The feedback that actually helps trainees grow is specific, balanced, and linked to a clear action.
The BOOST Feedback Framework — Simple and Effective
The RCGP publishes "Super Condensed Curriculum Guides" — one-page summaries of what a GP trainee needs to learn from each hospital specialty post. There is a guide for medicine, surgery, paediatrics, psychiatry, O&G, emergency medicine, and many more.
These guides are designed to help you understand what learning opportunities to provide for a GP trainee in your specific specialty. They are one of the most underused resources in GP training — and one of the most useful.
There are over 20 guides — covering almost every hospital specialty GP trainees commonly rotate through.
Review the guide for your specialty before your next GP trainee starts. It takes 10 minutes. It will change how you think about what to offer them.
The Clinical Supervisor's Report (CSR) is reviewed at the Educational Supervision Review and ARCP panel. A vague, rushed, or over-generous CSR is either ignored or — worse — gives the trainee a false sense of security when they actually need developmental support.
Here is what makes a CSR genuinely useful:
- Be specific about strengths. "Good communicator" tells us nothing. "Consistently checked patient understanding at the end of each consultation and adapted their explanations" tells us everything.
- Name the developmental areas clearly. If there is a pattern of difficulty — say it. "Consistently struggled to present a clear differential in complex cases" is more useful than a vague "needs to develop clinical reasoning."
- Reference your direct observations. The CSR carries more weight when it says "on three occasions I directly observed…" rather than general impressions.
- Seek colleague input. You don't have to write it alone. Ask your registrars, nurses, and junior team members what they've noticed. The CSR reflects the trainee's whole performance — not just what you've seen.
- Complete it at month 5. If you wait until month 6, it will be after the trainee's ES meeting. They will not get the benefit of your input at the right time.
You may occasionally have concerns about a trainee's progress, behaviour, or professionalism during their post. Here is how to handle it correctly.
All GP trainee assessments — every CbD, Mini-CEX, CEPS and the CSR — are recorded in the FourteenFish ePortfolio (also called the RCGP Trainee Portfolio). Paper forms are outdated.
To record any assessment, you need a FourteenFish account. The good news: it is completely free for supervisors and takes about three minutes to set up.
- Go to fourteenfish.com and register as an assessor
- Ask your trainee to grant you access to their portfolio
- You can then view their evidence, complete assessments, and write the CSR — all online
⭐ Making Your Post Genuinely Great — The Gold Standard
Going from "adequate" to "excellent" as a clinical supervisor does not require more time. It requires more intentionality. Here is what the best posts look like — and why they matter.
The Clinical Supervisor Quality Pyramid
🏆 The Gold Standard Hospital Post — A Checklist for Consultants
Tick these off at the end of your trainee's post. If you can say yes to most of them, you have done an excellent job.
🎓 A Note From the Medical Education Community
Research published in peer-reviewed medical education journals — and captured in GP trainee surveys — consistently shows that GP trainees who have engaged, knowledgeable hospital supervisors do better. They have richer ePortfolios, more diverse evidence, and better career outcomes.
The consultants who make the biggest difference are not necessarily the most senior or the busiest. They are the ones who take five extra minutes to ask a good question. Who say "I thought about what I'd do as your GP, and here's what I noticed." Who book the CbD in the diary on week two.
That is the kind of supervisor your trainee will remember — and thank — long after the post is over.
❓ Common Questions — Answered Honestly
The questions we hear most from hospital consultants, answered directly.
Yes — the RCGP publishes a comprehensive GP Curriculum that covers all specialties a GP trainee rotates through. It is organised around the 13 Professional Capabilities and includes topic guides for specific clinical areas.
You can find the curriculum section relevant to your specialty at rcgp.org.uk/mrcgp-exams/gp-curriculum. It's worth spending 15 minutes reading through it — it will give you a much clearer picture of what your trainee needs to get from their time with you.
Yes — and be glad they do! The RCGP places responsibility for getting assessments done on the trainee, not the assessor. Trainees who badger you are doing exactly what they're supposed to do.
When they ask, the best response is: "Good reminder — let's book it in. Looking at my diary, how about Tuesday at 8:30 before the ward round?" Assessments need to be spread throughout the post — you cannot do them all in the last two weeks.
GP trainees attend a Half Day Release (HDR) programme — typically one afternoon per week — run by their Vocational Training Scheme (VTS). This is where they attend taught sessions, group learning, and scheme-wide teaching with other GP trainees.
The requirement: Trainees must attend at least 70% of possible HDR sessions. This means 70% of the total possible sessions in the post — not 70% of those that don't clash with nights or annual leave. This requirement is recorded in the trainee's Form B (their educational contract for the post).
If your post consistently fails to release trainees for 70% of HDR sessions, the post risks being removed from GP training altogether. Your local TPD can help if rota arrangements make this genuinely difficult — talk to them early.
An ARCP (Annual Review of Competence Progression) panel meets once a year to review the trainee's ePortfolio evidence and decide on progression. The panel typically includes Educational Supervisors and TPDs.
Possible outcomes include: satisfactory progress (move to next year), unsatisfactory with an action plan, or — in serious cases — removal from the training programme. Your CSR is one of the key documents reviewed. A thorough, honest CSR is genuinely valuable to this panel.
Learning need identification comes from three sources working together:
- The trainee themselves — reviewing their ePortfolio for gaps, checking which capabilities lack evidence, and reviewing the curriculum for areas they find less confident.
- You, the Clinical Supervisor — observing them in clinical practice, noticing patterns from your colleagues' feedback, and identifying gaps through your formal assessments.
- The Educational Supervisor — at Educational Supervision Reviews (ESRs), the trainee's whole portfolio is reviewed against the capability framework to build a specific learning plan.
Your assessments are one of the most direct ways to surface learning needs. A good CbD that honestly identifies where the trainee needs to develop is more valuable than three CbDs that praise everything.
Start here — you've already taken the right first step by reading this page. Now do three things:
- Read the Bradford VTS page for each assessment you'll be doing — especially the CbD page and the CSR page. They contain practical forms, examples, and guidance.
- Speak to your local Training Programme Director (TPD) — they are usually very willing to run a short group training session for hospital consultants on your site. Ask for it.
- Consider starting a Hospital Consultants' GP Training Group at your trust — a peer group that shares experience, calibrates grades, and develops skills together. Your TPD will support this.
Yes — key parts of the FourteenFish ePortfolio are accessible to the Clinical Supervisor through a permissions system. The trainee needs to grant you access. Ask them to show you their portfolio at the start of the placement and again at the midpoint.
Looking at the portfolio together serves two purposes: it shows you what evidence already exists (so you can target your assessments to fill gaps), and it reinforces to the trainee that the portfolio is a live educational document — not just an admin exercise to be done at ARCP time.
🏁 Final Take-Home Points
- GP training is 3 years (ST1, ST2, ST3). Hospital posts happen in ST1 and ST2. ST3 is always in GP practice.
- The MRCGP has three parts: AKT (written exam), SCA (simulated consultations), and WPBA (workplace assessments). You are responsible for WPBA.
- Your five key tasks: CbD, Mini-CEX, CEPS, MSF participation, and the Clinical Supervisor's Report (CSR).
- Complete the CSR at month 5, not month 6. ARCP panels depend on it. Diarise it now.
- Grade honestly. "Meets Expectations" is excellent for an ST1. "Excellent" should be reserved for when you are genuinely wowed. Grade inflation harms the trainee by hiding developmental needs.
- NFD is not a fail grade. It is a learning signal. Use it kindly but honestly — and always pair it with a specific action plan.
- Everything you assess maps to one of 13 Professional Capabilities. Knowing them makes your assessments much more useful and specific.
- All assessment records go into the FourteenFish ePortfolio. This is the evidence base reviewed at ARCP panels to decide progression.
- You are the Clinical Supervisor for this post only. The Educational Supervisor holds the bigger picture. Communicate with them if you have concerns.
- Trainees must attend at least 70% of Half Day Release sessions. You must build your rota to allow this. If you're unsure how, speak to your TPD.
- You didn't receive the training GP Trainers receive — but now you've read this, you're already ahead of most. Thank you for investing this time in your trainee's future.