General Practice has evolved, and more consultations are being carried out by phone. Different skills are needed to carry out a consultation safely and appropriately on the phone from those needed for face-to-face consultation.
Audio-COT provides an additional tool to enable the assessment of your telephone consultation skills, which complements the existing components of the WPBA. The Audio-COT uses the same methodology and process of completing the assessment as the COT, but is used in a different setting.
How the Audio-COT works
Your supervisor will review a number of your telephone consultations during your rotations in primary care, either via direct observation of a telephone consultation or via an audio recording. Your supervisor will discuss the case with you and give you feedback. An Audio-COT assessment is then completed as evidence and documented in your Portfolio.
Selecting consultations for an Audio-COT
You can either be observed directly undertaking a telephone consultation (using a dual headset, for example) or via a recording of the discussion (both patient and doctor).
Complex consultations are likely to generate more evidence. The telephone consultation used for an Audio-COT should typically last between 5-10 minutes. Telephone consultations should be drawn from your entire period of GP training, reflecting a range of patient contexts.
Telephone consultations can be complex: it is therefore recommended that Audio- COTs are completed during the ST3 year of GP training. It is mandatory for one Audio-COT to be completed in ST3.
Telephone consultations are undertaken in both the Unscheduled care / OOH setting and the GP setting; you are encouraged to undertake assessments in both clinical environments.
Telephone consultations can either take the form of 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.
It is natural for you to select telephone consultations in which you feel you have performed well; the ability to discriminate between good and poor consultations indicates professional development. However, you are reminded that the Audio-COT is not a pass/fail exercise. The assessment is part of a wider picture of your overall practice, and presenting recordings that you feel perhaps did not go as well as you had hoped may result in greater learning.
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 on the RCGP website.
Collecting evidence from the consultation
Your supervisor will review the consultation with you, relating their observations to the WPBA Capability framework and Audio-COT performance criteria. Your supervisor will then make an overall judgement and provide structured feedback, with recommendations for further development. You are encouraged to reflect on the telephone consultation through a separate learning log entry.
The Audio-COT has been mapped to the RCGP Capability statements, which in turn will link to work place based assessment evidence in the Educational Supervisor Review.
Trainee rating and overall assessment
Trainees are rated for each area within the Audio-COT as one of ‘not observed’, ‘needing further development’, ‘competent’ or ‘excellent’. Your supervisor is rating you against detailed performance criteria. ‘Competent’ refers to the standard that would be expected of a GP trainee on completion of their training. A global judgement is made at the end of the assessment tool regarding the safety of the telephone call.