The various workplace based assessment methods are described below. These methods will be used in different ways by different specialties and not all specialties will use all methods. Please refer to the relevant curriculum for details. These assessment tools are available online in the ePortfolio. Printable versions of some of the forms can be found in this website's document library by using the search function.
Acute care assessment tool (ACAT)
The ACAT is designed to be used for supervised learning events (SLEs) on the acute medical take but may be on a ward round or covering a day's management of admissions and ward work. The ACAT looks at clinical assessment and management, decision making, team working, time management, record keeping and handover for the whole time period and multiple patients. There should be a minimum of five cases for an ACAT assessment. ACATs may be linked to a maximum of eight curriculum competencies in the ePortfolio.
Acute Care Assessment Tool (ACAT) 2020 - IMT
The internal medicine stage 1 curriculum has a critical decision point at the end of year 2 (IMY2) that determines whether the trainee has the necessary capability to lead the acute take with indirect supervision. The ACAT 2020 includes feedback on elements that are critical to running the acute take which will help the educational supervisor in making a judgement on the level of supervision required for CiP 1. Descriptors relating to CiP 1 are included in the ACAT 2020 to prompt the assessor about the elements that they should review and comment on. If any aspect of the assessment cannot be covered then it is important that the assessor states that they are unable to comment. The trainee should have seen at least five patients to make the assessment valid. The trainee should discuss with their educational supervisor the number of ACAT 2020 supervised learning events required to demonstrate capability. It is unlikely that a single ACAT could provide sufficient evidence but the assessment of overall progress by the educational supervisor will also take into account the multiple consultant reports as part an holistic assessment of the trainees capabilities.
Audit assessment (AA)
The Audit Assessment tool is designed to assess a trainee's competence in completing an audit. The Audit Assessment can be based on review of audit documentation or on a presentation of the audit at a meeting. If possible the trainee should be assessed on the same audit by more than one assessor.
Case-based discussion (CbD)
The CbD is a tool for supervised learning events (SLEs) based on a trainee's management of a patient and provides feedback on clinical reasoning, decision-making and application of medical knowledge in relation to patient care. It also serves as a method to document conversations about, and presentations of, cases by trainees. The CbD should focus on a written record (such as written case notes, out-patient letter, discharge summary). A typical encounter might be when presenting newly referred patients in the out-patient department. CbDs may be linked to a maximum of two curriculum competencies in the ePortfolio.
Direct observation of procedural skills (DOPS)
A DOPS is an assessment tool designed to evaluate the performance of a trainee in undertaking a practical procedure, against a structured checklist. The trainee receives immediate feedback to identify strengths and areas for development. Formative DOPS should be undertaken before doing a summative DOPS and can be undertake as many times as the trainee and their supervisor feel is necessary.
mini-clinical evaluation exercise (mini-CEX)
This supervised learning event (SLE) tool evaluates a clinical encounter with a patient to provide feedback on skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. It can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available. mini-CEX may be linked to a maximum of two curriculum competencies in the ePortfolio.
Multiple consultant report (MCR)
The Multiple consultant report (MCR) is designed to capture the views of consultant supervisors on a trainee's clinical performance. It must be completed by consultants or associate specialists/specialty doctors (not trainees) who are able to provide feedback on a trainee's clinical performance. Educational supervisors should not be asked to complete an MCR for their own trainees as they will complete the ES report. Each MCR form is completed by a single consultant. Therefore if four MCRs are required, four consultants should complete a form each resulting in four MCR forms. The MCRs will be automatically collated and summarised in the MCR Year Summary Sheet which will inform the educational supervisor report at the end of the training year. The MCR requests feedback on clinical performance and must be completed in addition to the Multi-source feedback (MSF) tool. The same consultant may be approached to complete both forms.
The minimum number of MCRs required by each specialty is set out in the ARCP decision aids. Trainees who are less than full time should complete the number of MCRs pro rata following discussion with their education supervisor. The MCR can be found in this website's document library by using the search function.
Multi-source feedback (MSF)
This tool is a method of assessing generic skills such as communication, leadership, team working, reliability etc, across the domains of Good Medical Practice. This provides objective systematic collection and feedback of performance data on a trainee, derived from a number of colleagues. ‘Raters' are individuals with whom the trainee works, and includes doctors, administration staff, and other allied professionals. The trainee will not see the individual responses by raters, feedback is given to the trainee by the Educational Supervisor.
Outpatient Care Assessment Tool (OPCAT)
The Outpatient Care Assessment Tool (OPCAT) has been introduced to help with the assessment of outpatient capability in Internal Medicine (clinical CiP 4) and it can also be used in higher training. The OPCAT is designed to be used in a single clinic whether that is face to face or virtual and may be used during a direct observation if the trainer is present or as an assessment at the end of a clinic. There is no minimum number of patients that should be seen although for a post clinic assessment it would be unusual if the trainee has seen fewer than three patients. It is unlikely that a single assessment could provide all the evidence required for an educational supervisor to make an entrustment decision on outpatient capability. The assessment of overall progress can also take into account the multiple consultant reports as part of the holistic assessment of the trainees’ capabilities.
It is not mandatory for trainees to use the OPCAT, but it is strongly recommended for IMTs to get structured feedback on outpatient capability, particularly during the pandemic. Educational supervisors will need to make an entrustment decision on outpatient capability and completed OPCATs will be useful evidence.
Patient survey (PS)
The Patient Survey addresses issues, including behaviour of the doctor and effectiveness of the consultation, which are important to patients. It is intended to assess the trainee's performance in areas such as interpersonal skills, communication skills and professionalism by concentrating solely on their performance during one consultation. The patient survey form, covering letter and guidance for trainees are available to download below. The patient survey form can also be sent to patients electronically via the ePortfolio. The educational supervisor should collate the patient feedback and complete the summary form on the ePortfolio.
A Welsh language version of the form and cover letter are available on request from firstname.lastname@example.org
Quality improvement project assessment tool (QIPAT)
The QIPAT is designed to assess a trainee's competence in completing a quality improvement project. The trainee should be given immediate feedback to identify strengths and areas for development. All workplace-based assessments are intended primarily to support learning so this feedback is very important. It can be based on review of QI documentation (such as a project plan and report) or on a presentation of the project at a meeting. If possible the trainee should be assessed on the same QIP by more than one assessor. Assessors can be any doctor with suitable experience - for trainees in higher specialty training this is likely to be consultants. Some curricula may have specific requirements for numbers of consultant assessments.
QIPATs are mandatory in Internal Medicine Training (IMT). Higher medical trainees should refer to the relevant ARCP decision aid for specialty requirements.
Teaching observation (TO)
The Teaching Observation is designed to provide structured, formative feedback to trainees on their competence at teaching. The Teaching Observation can be based on any instance of formalised teaching by the trainee which has been observed by the assessor. The process should be trainee-led (identifying appropriate teaching sessions and assessors).
Recommendations for specialty trainee assessment and review
In 2014 we introduced recommendations for specialty trainee assessment and review. We also produced trainee and trainer guidance which can be found in this website's document library by using the search function above.