What it is
Your assessor watches a consultation (live, or on video with the patient's written consent) or listens to a telephone consultation (Audio-COT) and grades it against the COT criteria. In August 2026 the RCGP revised the criteria to match the updated curriculum; the number of COTs did not change.
- ST1 and ST2: 4 a year in total, COT in GP posts and mini-CEX in hospital posts; aim for about 2 per 6-month review (a suggested spread).
- ST3: 7 COTs, for example 6 face-to-face and 1 Audio-COT.
- Over training: at least one Audio-COT and at least one face-to-face COT.
- Assessors: an approved GP educational supervisor or an approved, trained GP clinical supervisor. Use more than one. Never another trainee.
The numbers by year
| Requirement | ST1 | ST2 | ST3 |
|---|---|---|---|
| Consultation Observation Tool (COT), including Audio-COT check current RCGP guidance | 4 per year 2 per review COT in GP posts, mini-CEX in hospital posts; combined total 4 | 4 per year 2 per review combined COT/mini-CEX total 4 | 7 per year all COT; e.g. 6 face-to-face + 1 Audio-COT |
| Mini Clinical Evaluation Exercise (mini-CEX) | counts towards the combined total of 4 with COT | counts towards the combined total of 4 with COT | Not required ST3 is normally all GP; COT used |
Full time, per training year unless stated. Less than full time: per-year totals stay the same and each 6-month review needs a pro rata share; 6-monthly ESRs and 12-monthly certificates are not pro rata. Check with your deanery and educational supervisor.
Notes on these numbers
- Consultation Observation Tool (COT), including Audio-COT, LTFT: Pro rata per review period; the per-training-year total is the same.
- Consultation Observation Tool (COT), including Audio-COT, confidence: high (totals and audio rule); medium (per-review split of 2, which is a suggested spread). Our sources were partly secondary for this item: check current RCGP guidance.
- Mini Clinical Evaluation Exercise (mini-CEX), LTFT: Pro rata.
How to do it well
- Choose real, varied cases: a child, an older person with several problems, mental health, a long-term condition review, uncertainty, an interpreter. Single-problem cases cannot show much.
- Record several consultations and pick with your trainer. Get written consent on the practice form.
- Watch it together and pause at the moments that matter: the opening, the first cue, the explanation, the shared plan, the safety-net.
- Reflect on the feedback the same week and put one action in your PDP.
- Close the loop: aim the next COT at what you were told to work on, and say so.
Audio-COT tips
- Pick a call where you had to decide whether the patient needed to be seen.
- Show how you confirm identity and location, explore without seeing the patient, check understanding, and safety-net with specific symptoms and timescales.
- The same call can also be written up as a CCR.
Common ARCP pitfalls
- Four COTs left for the last month of the review period.
- Every COT done by your own trainer.
- Reaching the end of ST3 with no Audio-COT.
- No recorded consent.
Do this now
Book your next two COTs with dates, and write down which consultation type each will cover. The case picker below suggests types you have not used yet.
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