What will your performance assessment consist of?

The assessment instruments

Assessed interviews

If your assessment is taking place in just one phase, there will be an assessed interview at the end. If your assessment is split in to two phases, you are likely to have two assessed interviews, 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. If the observer is a lay assessor, you should make sure the patient is aware they are 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 medical 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.

Colleague interviews and questionnaires

The assessment team may ask some of your current or recent colleagues to assist with the assessment. Colleagues will be asked to complete a questionnaire, or attend an interview, about their experience of working with you and your day-to-day practice. When deciding who to ask, the team will use the list of colleagues you provided in your portfolio, but they may also choose other people. We will explain to anyone we contact about your assessment that it is confidential.

Interviews are broader in scope than questionnaires. The team will usually choose to interview those colleagues who are likely to have experience of your performance in a range of different areas.

You may put forward a colleague to take part in the assessment if you wish. They will be sent a questionnaire to complete unless the team decide to interview them.

We have guidance for interviewees and those completing questionnaires which explains what is involved.

Nominating a colleague to take part

You can nominate someone who is not a member of your current or most recent clinical team. However, the person you choose must have worked closely with you on a regular basis, not more than two years ago. This could be in a managerial or educational capacity. If you would like to nominate someone please:

• check they are willing to take part
• ask them to read our guidance for interviewees and those completing questionnaires. We will be happy to discuss the process with them if they have any questions
• obtain their consent to share their details with us then send us their name, job title and the phone number and email address they would like us to contact them on

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 usually be set up in a separate 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
• performing an examination or other procedure on a high-fidelity simulator which can be programmed to show normal and abnormal clinical signs. A role player may speak from outside the room using a microphone connected to the simulator. You can find more information and a video on the manufacturer’s website. 
• a written task, which might include writing a prescription using this hospital drug chart
• interpreting investigation results or other information.

The stations are designed to assess different areas which are based on the domains of Good medical practice. 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.

Simulated surgery

The simulated surgery is a test for general practitioners. 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. Your 'patients' will be roleplayers working to a brief.  You will be provided with a short summary clinical record for each patient. 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. 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.

OSCE Station & Consultation timings 

You will have a maximum of 10 minutes to complete each scenario. After 7 minutes, the Performance Assessment Officer will knock on the door of your consultation to indicate that you have 3 minutes left. After 10 minutes, the Performance Assessment Officer will open the door and advise that must finish and move on to the next scenario.

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. Normal value ranges are given in the question paper.  

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

Simulated patient survey

The simulated patient survey can be used alongside an OSCE or simulated surgery.  It provides a view of your communication from a patient’s perspective.  The roleplayers acting as your patients, or their carers, will be asked to complete a survey after their consultation with you.  They will be asked how good, on a three-point scale, you were at:

1. Being polite and considerate
2. Listening
3. Explaining things in a way the patient would understand
4. Involving the patient in decisions

They will also be asked how they would rate your communication with the patient overall, and to give an explanation for their answer. 

The survey responses will be included in the assessors’ report.

Surgical skills assessment

If you work at a senior level in a specialty that requires proficiency in surgical procedures, the team may choose to conduct a surgical skills assessment.

You will be asked to perform a number of surgical procedures on a cadaver specimen in an anatomy lab. The team will guide you through the procedures they wish you to demonstrate and will observe and assess your performance.

We may contact you for further information about your surgical practice, such as your operation logbook or the equipment you use in your workplace.