What will your assessment consist of?

How the content is decided

We may set some broad parameters, but the assessment team will choose the content based on:

  • your speciality and grade
  • the information you provide about your practice in your portfolio
  • the areas of your practice you agreed to address through your undertaking

The component parts of an assessment are chosen from a suite of our assessment instruments. Some instruments, collectively referred to as a peer review, are designed to assess your actual performance in the workplace whilst others, known as tests of competence, offer an objective assessment of your knowledge, clinical and consultation skills. Occasionally, assessment tools offered by external providers, such as a royal college or medical school, are also used. 

The assessment instruments

Instrument

Type

How you performance is assessed

First Interview

Generic

Your responses will not be judged

Second and third interviews

Generic

The assessors will independently record comments and assign them a category and judgement as explained in ‘How your performance will be described and graded’.

Observation of practice

Peer review

Medical records review

Peer review

Case based discussion

Varies – see instrument details below

Third party Interviews

Peer review

Site tour

Peer review

Objective Structured Clinical Examination (OSCE)

Test of competence

All assessors record comments and judgements (as described in the box above). The lay assessor will judge your interactions with the role players.

The medical assessors will independently score your performance on a structured marking schedule. Your total score for each station is compared with that achieved by a reference group. 

Simulated surgery (GPs only)

Test of competence

This test is assessed, and the results are presented in the same way as the OSCE. Additionally, there will be an analysis of the score you achieved in three different domains:

  • data gathering, technical and assessment skills
  • clinical management skills and
  • interpersonal skills

Knowledge test

Test of competence

Your score will be compared with:

  • the scores that would be expected to be achieved by a reference group
  • a standard set mark

Reporting module (radiology and pathology only)

Test of Competence

The assessors will independently record comments and assign them a category and judgement as explained in ‘How your performance will be described and graded’.


First interview

This introductory interview is an opportunity for you to:

  • meet the assessment team
  • ask questions about the process
  • tell the team about anything that is relevant to the assessment of your performance, for example, recent continuing professional development or any difficulties that you feel have affected your work. You may also offer the team written information at this interview, though this is accepted at the team’s discretion.

The team will:

  • introduce themselves and explain the assessment process to you, making sure that you understand what will happen at each stage and when you need to attend
  • ask questions to learn more about your experience and practice.

The team may also request additional information from you such as audits or evidence of continuing professional development, which you should bring to a subsequent interview.

The assessors will be recording, but not judging, your responses. If you’d like, you can be accompanied by a supporter.

Second and third interviews

If your assessment is taking place in just one phase, then a second interview will be held at the end of the process. If your assessment is split in to two phases, you are likely to have a second and third interview, one at the end of each phase. Your supporter can also attend.

The purpose of these concluding interviews is to give you the opportunity to:

  • present any further relevant information to the team
  • comment on the conduct of the assessment and any matters which have arisen during the assessment.

If there are any topics or issues which have not been fully explored in other parts of the assessment the team may ask about these. Your responses will be recorded and given a judgement. They will also make sure you understand what the next stage of the process is.

Observation of practice

If the circumstances of your employment allow, the team will observe you conducting a typical surgery, clinic, ward round or other duties. If recordings of your work exist, such as out of hours telephone consultations, these may be used instead.

It’s your responsibility to get the patient’s written or verbal consent to having an observer present and explain that refusal will not jeopardise their care. If consent has been obtained in advance you should ask the patient to verbally reconfirm at the time of the consultation. You do not need to say that the observer is assessing you but you do need to make it clear that the lay assessor is not a doctor.  

We will liaise with you and your employer to arrange the observation.

Medical record review

If you are working, or have recently been engaged in clinical practice, the assessment team may choose to review a sample of your records. These are usually patient records but may include any record of your practice, such as recordings of telephone consultations, videos of surgery, MDT minutes etc. The sample is selected by the assessment team to reflect the breadth of your practice. In general practice a typical sample would be 50 patient records. In other specialties the sample varies, but typically exceeds 30 patient records. We will liaise with the organisation holding the records to arrange access; you are not usually involved in providing the records.

The assessors will individually and independently assess the records and record their findings. They will record their comments and judgements on standard forms.

Case based discussion

The assessment team will select a number of cases to discuss with you. Pre-planned questions, covering a range of topics and assessment categories, will be used to explore the reasoning behind your decisions or actions. The format of the case based discussion will depend on whether or not a medical record review has taken place.

Assessments that include a medical record review

If your assessment includes a medical record review the cases will be drawn from the sample of patient records that the assessors reviewed. If an observation of practice took place some of the cases you dealt with during this exercise might also be included.

Typically, 12 cases will be discussed with three questions asked about each case. The discussion takes between two and three hours, excluding breaks. Before the discussion, we'll give you copies of the full complete patient records, or the relevant extracts, so that you can remind yourself of the details of the case.

Assessments that do not include a medical record review

If your assessment does not include a medical record review (usually because you have not recently been in clinical practice) the assessors may choose to discuss some of the scenarios you were presented with during the OSCE and, for GPs, the simulated surgery.

Typically, discussions last between one and two hours with between one and three questions per scenario chosen. It is unlikely that you will be asked about every scenario. Before the discussion you will be told which scenarios have been selected and will be given a reminder of the scenario/task.

Third party interviews

The assessment team will choose interviewees who have recent, first-hand knowledge of your practice. They will refer to the list of colleagues in your portfolio but may also select other people. You may be invited to nominate one or two colleagues to be interviewed.

The assessors will ask a standard set of scripted questions, which are structured by the assessment categories. The interviewee will be asked for their experience and opinion of how you perform on a day-to-day basis and for examples to support their comments.

We do not disclose the questions in advance but some examples include:

  • Do you have experience of how [doctor’s name] keeps his/her skills and knowledge up to date? If yes – please give us examples.
  • Do you have experience of [doctor’s name] taking a history from patients? If yes  please give us examples.
  • Do you have experience of [doctor’s name] teaching, training or providing supervision or support to colleagues? If yes  please give us examples.

Interviews are chaired by the lay assessor, accompanied by at least one other assessor. They will make notes and record judgements during the interviews. An independent professional shorthand writer will take a full transcript of each interview which will be sent to you for comment.

Guidance for doctors invited to nominate interviewees

Your nominees should have recent, first-hand knowledge of your day-to-day practice. Before giving their details to us you should check that they:

  • are willing to take part in the assessment
  • have read our Guide for interviewees so they understand the purpose of the interview. We will be happy to discuss the process with them if they have any questions.
  • will be available on at least one of the days the assessment is taking place.

You should give us their name, job title, telephone number and email address. We will contact them to arrange an interview time.

Site tour

The purpose of the site tour is to gain a better understanding of your working environment, the resources available to you, and how these may have affected your performance. Typically, a manager or clinical lead shows the team around. We will liaise with the relevant person to arrange this.

Objective Structured Clinical Examination (OSCE)

The OSCE is a series of scenarios which will be relevant to your practice and experience. They will be chosen from a list by the assessment team. Each scenario, known as a station, will be set up in a separate area or room.

A typical OSCE contains 12 stations with a guide time of seven minutes per station. The assessors will observe you directly or via a video link. 

At each station you will be given a task to perform which may involve:

  • using medical equipment or anatomical models
  • interacting with patients or with role players acting as patients, carers or colleagues
  • a written task
  • interpreting investigation results or other information.

The stations are designed to assess different areas which are based on the domains of Good medical practice and are shown in the table below. Each station will focus on one area, but the assessment of your performance will not be limited to this area. If, for example, the task is to perform an examination you should concentrate on this but be aware that other actions, such as your communication with the patient, will also be assessed.

Domain of Good medical practice

Area assessed by station

Area assessed by station

Knowledge, skills and performance

Assessment

History

Examination

Investigation

Diagnosis

Management

Treatment and advice including health promotion

Prescribing

Referral and follow-up

Practical procedures

Record keeping

Maintaining professional performance

Applying knowledge and experience including scientific knowledge

Safety and quality

Patient safety

Quality assurance

Communication, partnership, teamworking and trust

Relationships with patients

Working with colleagues

Teamwork

Leadership

Teaching

Maintaining trust

Professionalism including probity, ethical and medico-legal

Simulated surgery

The simulated surgery is a test for general practitioners. You will consult with approximately ten ‘patients’ who are role players working to a brief. The test will take place in a room set up like a typical consulting room and you should approach the exercise as if you are covering a surgery as a locum. However, there will be no computer and you are not expected to write any notes. Any prescriptions you issue should be written on the prescription pad provided. You will be provided with a brief clinical record for each patient. The consultations are designed to last ten minutes and will test your:

  • data gathering, technical or assessment skills
  • clinical management skills
  • interpersonal skills.

The assessors will observe the consultations from another room by a video link.

Reporting session

This test may be included in your assessment if you practice radiology or pathology or work in a diagnostic, non-patient facing role. You will be presented with a series of images or slides and may be asked:

  • whether the case shows a normal or abnormal appearance
  • to give a diagnosis
  • to discuss management options. 

Knowledge test

The knowledge test is designed to assess applied, rather than purely theoretical, knowledge and you may therefore find that the questions are more vocational than other examinations you may have sat. 

Most knowledge tests have between 90 and 120 questions. The paper will contain core questions about professionalism and the duties of a doctor and clinical questions relevant to your specialty.

The test will be invigilated. A time limit will be given, usually between 90 minutes and two hours depending on the number of questions. If you are a GP it is likely that you will sit a two hour paper comprising 120 questions.

You will be given an answer sheet and the invigilator will make sure you understand how to complete this before the test starts. The test will not be negatively marked (marks will not be deducted for incorrect answers) so it is in your interest to try to answer every question. You may take a break at any point during the test.

You are not permitted to access any devices or reference material during the test but you will be provided with a list of expanded abbreviations and normal values to refer to.

The questions will be in single best answer format. This type of question consists of a clinical scenario, a question about the scenario and a list of five possible answers.

You may feel there are several possible answers to a question, but you must choose the best one from the option list. If you enter more than one answer for a question on the answer sheet you will not get any marks for that question.

You should read the scenario and question and think of the answer you would give before you look at the options. You should then look for your answer in the list of options. If you cannot find the answer you thought of, you should look for the answer which, in your opinion, is the best answer to the problem posed.

Example of single best answer questions

  1. A 17 year boy attends the Accident and Emergency Department having been taken ill whilst playing football. He gives a history of sudden onset of left-sided chest pain followed by severe and persistent breathlessness.

    What is the single investigation most likely to provide a definitive diagnosis?
    1. Blood gases
    2. Chest x-ray
    3. Echocardiogram
    4. Electrocardiogram (ECG)
    5. Pulmonary function tests
  2. An 83 year old woman with a chest infection becomes confused and has poor concentration. She is restless and frightened. She is verbally abusive and has perceptual abnormalities. There is no significant previous psychiatric history.

    Which is the single most likely diagnosis?
    1. Acute confusional state
    2. Drug induced psychosis
    3. Lewy body dementia
    4. Multi-infarct dementia
    5. Psychotic depression