Consultation Observation Tool

The COT usually involves your trainer reviewing videos of your consultations and assessing them but can also be done by your trainer sitting in with you during a surgery.  After videoing your consultations you should meet with your trainer to discuss and assess them against the COT consultation criteria. The COT marking sheet looks at 13 areas of the consultation. For each area you will be marked are marked as either competent, excellent, needs further development or insufficient evidence. You are also given a mark for your overall performance. The overall performance mark compares your performance to that expected of a fully qualified GP.


COT Marking Criteria

1. Encourages the patients contribution

2. Responds to cues

3. Places complaints in a an appropriate psychosocial context

4. Explores the patients health understanding

5. Includes or excludes likely relevant significant conditions

6. Appropriately examines (physical or mental state examination)

7. Explains the problem in appropriate language

8. Makes an appropariate working diagnosis

9. Seeks to confirm the pateints understanding

10. Makes an appropriate management plan

11. Gives the patient opportunity to be involved in significant management decisions

12. Makes effective use of resources

13. Specifies the conditions and interval for follow up


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


To help you check that you cover the competencies required in a variety of cases you can download the COT grid developed by the Bradford VTS. Cot Grid Tool


Make sure you get your patients signed consent to video. Often receptionists are asked to get signed consent for you when patients book in to your video surgery. Your practice should be able to provide you with a copy of the consent form.