MRCGP & GP Training
What is an Audio COT? And why is it important? We've enough assessments already!
Let’s start by answering the question “What is it”. An audio-COT is like a COT, but instead of assessing a video consultation, your trainer will assess one of your TELEPHONE consultations (hence the word audio).
General Practice has evolved, and more and more consultations are being carried out by phone. Back in the 1990s 3% of our consultations were via telephone. Now it’s like 20%. Staggering isn’t it? So we hope you can see why it needs to be tested. And many of the things we do can be done over the phone. In the current crisis of patient demand and with newer and better technologies, we need to think about different ways of doing the consultation than the traditional face-to-face way.
Different skills are needed to carry out a consultation safely and appropriately on the phone from those needed for face-to-face consultation. Therefore, introducing audio-COTs means your telephone skills get assessed, and if they get assessed, that means you will be taught how to improve and your skills will get better and better. Now -- that can’t be a bad thing can it? And we need to ensure GP training helps trainees perform in a clinically safe and effective way on the telephone.
And finally, you MAY get a telephone consultation case in your CSA -- and the audio-COT and subsequent training will help! The usefulness of the audio-COT has been established. Audio-COT is a tool for facilitating learning and assessment of GP trainee telephone consultations.
But the Audio-COT marking crib isn't like the COT marking crib
Actually, if you look closely, there are elements that are very similar. Of course, there are some that will be different because the nature of doing a telephone consultation is different to that of a face-to-face one in parts.
How will I be assessed? Who can assess me?
- Currently you only need to be assessed on one Audio-COT in ST3. However, the more you can do at any ST stage in a GP post, the better. You’ll be providing the panel with more and more evidence for your capabilties AND no doubt the GP assessing you will provide invaluable feedback making you better and better.
- You will be assessed either via direct observation of a telephone consultation or via an audio recording.
- There is an audio-COT marking crib sheet that the supervisor will assess you against. This is provided in the “DOWNLOADS” section above. It will be entered into your ePortfolio.
An Audio-COT example
How many Audio-COTs do I need to do?
Your GP supervisor (can be a trainer or qualified GP) will review a number of your telephone consultations throughout your GP training in your GP posts.
- The current MINIMUM RCGP requirement is simply ONE audio-COT assessment in ST3 (and it can replace an one of the COTs in terms of numbers).
- You can do lots more, but in ST3, you can only use a maximum of 3 Audio-COTs in place of 3 normal COTs. Put another way, if you wanted to, in ST3 you could do 9 NORMAL COTs and 3 Audio-COTs.
- It would be great if you can do some Audio-COTs in ST1/ST2 -- but remember, at this stage, the audio-COTs cannot be used to replace the minimum number of COTs that you need to do. And they should only be done in GP posts, not hospital.
- Don’t forget -- you can do them during your OOH sessions too!
- As we get used to doing Audio-COTs, I imagine the requirement will change in the future to do more.
- Remember, minimum numbers are minimum. Don’t aim for minimum. Try and do much more than the minimum for ALL of your WPBA assessments.
Any advice for me on how to select which telephone consultations?
- Often, your reception staff will write down on the appointment ledger the reason for the call. Try and look at your list of telephone consultations and pick ones that sound quite complex. Complex consultations are likely to generate more evidence. Trust us when we say this. Please do not use simple ones like “asking for a repeat prescription of her contraceptive” or “going on holiday, needs more medication”
- Use a telephone consultation that you think will last between 5-15 minutes. Don’t select anything that is going to last less than 5 minutes! An Audio-COT should typically last between 5-10 minutes.
- Think about the type of patient. Call backs to discuss and End of Life Care patient is likely to generate more evidence than say a sore throat. Mental Health is another good one to choose.
It is natural for trainees to want to choose telephone consultations in which they feel they have performed well. This isn’t a problem: the ability to discriminate between good and poor consultations indicates professional development. Trainees are reminded that the Audio-COT isn’t a pass/fail exercise: it is part of a wider picture of their overall practice.
Any advice for me on how to perform well on Audio-COTs?
It’s simple, work on your telephone consultation skills. To do that…
- Read up about telephone consultations and the skills, tips and techniques to make them work well for you and the patient. Click on the “Telephone Consultations” online resource link above if you want to read around the subject.
- Then… practise, practise and practise.
- And try and do lots of telephone work with your trainer and/or at your OOH sessions. Ask your trainer or supervisor to listen in on you and ask them to give you feedback. And then, reflect on that feedback in your ePortfolio.
Do I need to seek patient consent to do this?
- If it is an audio recording that you will be working from -- check with your practice -- they may already have a message saying “all consultations are recorded and may be used for training purposes”.
- If it is a live telephone consultation where the GP assessor is listening in, then the patient needs to be informed as per consent guidance in the “DOWNLOADS” section above.
What bits of the Audio-COT marking crib link to the Professional Competencies?
Easy -- just look at the document in the DOWNLOADS section called Audio-COT capability linkage.