{'fraction_non_alphanumeric': 0.030374753451676527, 'fraction_numerical': 0.009467455621301775, 'mean_word_length': 5.3879093198992445, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The audio-COT (consultation observation tool): developing a new assessment tool for GP training

The use of the telephone in primary care is an increasingly popular way of managing the clinical workload, as well as being an integral mode of communication between primary care clinicians and colleagues in secondary care and the wider community. Over recent years, the number of telephone consultations has quadrupled from 3% of total consultations in 1995/1996 to 12% by 2008/9. This equates to almost 36.5 million telephone consultations annually in primary care,[1] used both in-hours and ‘out of hours’ (OOH) for consultations. The importance of the telephone as a mode of consultation is recognised: the Medical Protection Society has stated ‘it is absolutely imperative to make telephone consultations ... clinically safe and effective’.[2] Evidence from current clinical practice suggests that in addition to developing face-to-face communication skills, GP trainees also need to develop telephone consultation skills. However, using the telephone in the clinical setting may not be something with which trainees are accustomed and comfortable. At present, general practice (GP) trainees may be presented with one telephone consultation case in their summative GP Clinical Skills Assessment examination,[3] yet there is currently no mandatory formative assessment of telephone consultation skills during training. The Committee of GP Education Directors (CoGPED) suggests that OOH competence should be triangulated through the assessment of evidence from several sources, something that might include a consultation observed tool (COT) assessment of a telephone consultation – an ‘audio-COT’ assessment.[4] In spite this recommendation, there is no formal audio-COT assessment tool available to support learning. Further, there is currently no formal recommendation by the Royal College of General Practitioners (RCGP) for a formative assessment of telephone skills during day-to-day clinical work. Some practices can be shown to rely heavily on the use of the telephone, for example using the ‘STOUR’ method for undertaking consultations in GP,[5] others less so. Given that trainees may move between practices over the course of their training, and practices may use the telephone to differing degrees to manage the clinical workload, trainees may be unprepared to use the telephone. A formal approach to the assessment of trainees’ telephone consultation skills should increase their confidence and may benefit patient safety.