Official Partner The Royal Society of Medicine


Assessment Tools

Throughout a doctor’s postgraduate training, there will be a wide variety of assessment tools employed to gauge progress and aptitude. The below list covers the more prominent tools that will be used to measure a junior doctor’s skills throughout training.

Case-Based Discussion, or CbD

The CbD is an interview designed to assess a doctor’s professional judgement when reviewing clinical cases, and is part of the Trainee ePortfolio, and Workplace-Based Assessment component of most postgraduate training programmes.

The CbD is used in both hospital and GP settings, and can be carried out by ST4+ doctors, or General Practitioners. A trainee’s supervisor should ensure that the ePortfolio reflects a balance of cases relevant to the training programme, as well as cases in different settings for GP trainees, such as surgeries, patient homes, and out-of-hours or on-call work.

Clinical Evaluation Exercise, or Mini-CEX

The Mini-CEX assesses clinical skills, aptitudes, and behaviours in clinical practice. The Mini-CEX is structured as a snapshot of an interaction with patients in a clinical setting. Each Mini-CEX represents a different clinical issue and is observed by a senior healthcare professional.

Multi-Source Feedback, or MSF

The MSF tool is used to collect the opinions of a junior doctor’s colleagues, with regards to the doctor’s performance. This constitutes part of the WBA, which is a component of many exams such as the MRCGP. It is up to the candidate to arrange MSF times with their trainer, and to set aside time for a feedback discussion. The respondents should aim to seek feedback from the whole multidisciplinary team, including doctors, nurses, allied healthcare professionals, and administrative staff.

Direct Observation of Procedural Skills, or DOPS

The DOPS is designed to assess the ability of a doctor to perform relevant practical procedures against a structured checklist. Depending on speciality training, different DOPS will be required at different stages of training.

Acute Care Assessment Tool, or ACAT

The ACAT has been designed to provide supervised learning events (SLEs) to assess trainees over a prolonged period, typically one shift, as well as over multiple domains. It assesses how a trainee handles a ‘take’ or ED shift, including management of at least five clinical cases, interaction with the healthcare team and leadership skills, as well as organisation, time management, and prioritisation skills.

Extended Supervised Learning Event, or ESLE

The ESLE is an extended training tool, typically over a period of at least three hours, focusing on higher level and non-technical skills. In addition to managing their own workload, trainees are expected to provide decision, management and leadership support to peers and junior doctors.

Consultation Observation Tool, or COT

The COT involves a junior doctor’s supervisor reviewing their patient consultations, either by directly observing the doctor at work, or by reviewing video evidence. The resulting discussion is used as evidence for the trainee’s ePortfolio. The trainee is also in charge of arranging supervision or recording. The more complex the consultation, the more evidence it is likely to generate.

For GPs, the COT should include evidence from the entire period of GPST, including consultations in different contexts, and at least one case involving children under 10 years of age, adults over the age of 75, and those with mental health concerns.

One of the measures of a successful consultation is the effective use of time, and as such, candidates should refrain from presenting examples that exceed 15 minutes in length.

COT is not pass/fail, but rather a contributing factor to a holistic measure of performance.

Patient Satisfaction Questionnaire, or PSQ

The PSQ provides patient feedback on a trainee’s relationship-building skills and empathy. It also forms part of the Trainee ePortfolio. Dates need to be arranged with the trainer, and the questionnaires and letters of explanation should be given to consecutive patients. Patients should then complete the questionnaires and return them, and the process will repeat until 40 forms have been returned.

Clinical Examination and Procedural Skills, or CEPS

For GP trainees, the CEPS assessment tests a candidate’s ability to examine patients. More than five intimate examinations are usually required.

Clinical Supervisor’s Report, or CSR

The CSR is a short report from a trainee’s clinical supervisor from each of their hospital posts, recorded in the trainee’s ePortfolio, and bringing together the 12 competences from the WPBA framework. These 12 competences are split into the four clusters of relationship, diagnostic, management, and professionalism.

Workplace-Based Assessment, or WPBA

The WPBA is one of three components of the MRCGP exam. It is a framework designed to evaluate a doctor’s performance in areas that can only be tested in the workplace. The WPBA supports the trainee’s development and identifies any key areas of difficulty.

Teaching Observation, or TO

The TO is designed to assess the trainee’s ability to provide structured, formal teaching in the clinical setting.

Learning Log, or LL

This is used to collect evidence about the trainee’s progress and then share it with their supervisors. Entries the candidate chooses to share can be read by clinical and educational supervisors and helps them make decisions when taking a view on the trainee’s competence progression.

Audit Assessment, or AA

The AA assesses a trainee’s ability to perform an audit, including reviewing audit documentation and presentation of the audit at a meeting. This should ideally be completed by a number of different assessors.


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