A note on educators’ notes: why GP training programmes in the UK needs clearer, fairer assessment governance

Ibraheem Alghamdi is a GPST in Wales

Postgraduate GP training programmes must balance two imperatives: protecting patients and supporting the development of hardworking, reflective clinicians. To achieve this, the establishment relies heavily on narrative assessment tools, to name a few: the multi-source feedback (MSF), educators’ notes, clinical supervisor reports (CSRs) and incident reporting systems. These tools are intended to capture professionalism, behaviour and real-world performance. However, when used as high-stakes evidence without careful structure, triangulation or context, they risk undermining both fairness to trainees and the defensibility of progression decisions.

Why narrative assessment matters

There is a strong and valid counterargument to any critique of subjective assessment. Doctors who come to serious regulatory harm are often not identified through objective tests alone; ethical lapses, attitudinal problems and professionalism concerns typically emerge through patterns of behaviour observed by colleagues.¹ High-profile failures have reinforced the importance of social and organisational signals in detecting unsafe practice. Narrative tools, therefore, are not optional — they are integral. However, the problem is not the existence of such methodology, but how it is used.

Out-of-context narrative tools limitations

Educational literature consistently shows that subjective workplace data is socially constructed and highly sensitive to context. Watling and Ginsburg (2019) describe how assessment comments reflect local norms, relationships and expectations, and require expert interpretation rather than literal reading in isolation.² Without this interpretive step, short feedback fragments risk being treated as objective facts rather than situational observations, reflecting performative rather than improvement culture. Moreover, Swanwick’s synthesis of assessment theory emphasises that high-stakes decisions should arise from a programme of assessment, in which multiple sources are deliberately combined, weighted and reviewed longitudinally.³ When narrative tools are used outside such a framework, their validity for trainees’ progression decisions becomes questionable.

MSF: formative by design, summative in practice

MSF is widely intended to be formative — a structured way to prompt reflection on professional or clinical behaviour. Evidence suggests it can support learning when feedback is examined by a supervisor, or a co-supervisor who the current system lacks, with firsthand experience of the trainee’s context and trajectory.⁴ Problems arise when MSF is reduced to a quota-driven exercise and then reinterpreted summatively by decision-makers who are independent and have no direct knowledge of the trainee or the clinical environment in which comments were generated. Used appropriately, MSF can identify emerging professionalism or clinical concerns; otherwise, it risks amplifying isolated perceptions while obscuring overall competence.

Educators’ notes, CSRs and distance from observation

Another structural weakness in GP training programmes is the misalignment between those writing decisive reports and those who have directly observed the resident doctor. CSRs and educators’ notes may be based on limited contact, second- or third-hand information. When such documents are later feed into Annual Review of Competency Progression (ARCP) panels, whose members are independent and never worked with the trainee, narrative comments can acquire disproportionate weight relative to the observed performance. Assessment theory does not argue against narrative judgement; it argues for informed narrative judgement by those familiar with the learner’s work.

Incident reporting: learning systems, not silent sanctions

NHS incident reporting systems, including DATIX, are explicitly designed for organisational learning rather than individual blame. The Patient Safety Incident Response Framework reinforces a systems-focused approach to improvement.⁵ When incident reports are repurposed — implicitly or explicitly — as summative performance signals without corroboration, transparency or opportunity for response, their original function is distorted. This is not an argument to exclude incident data from training oversight, but to ensure it is handled within a clear, structured and fair process that has to be dealt with separately at first.

What better governance could look like

Improving assessment does not require importing foreign systems wholesale, nor abandoning narrative tools. Practical steps could include:

1. Explicit triangulation: progression decisions should rely on patterns across multiple sources rather than isolated comments.
2. Local interpretive review: narrative data should be contextualised by supervisors or committees with direct clinical knowledge of the trainee.
3. Clear separation of functions: educators’ notes should support formative learning; serious concerns should enter separate, transparent and structured pathways.
4. Reframing MSF: positioning it clearly as a conversation starter, with emphasis on facilitated discussion rather than numerical or narrative aggregation alone.
5. Proportionate use of incident data: DATIX reports should inform supervision and system learning, not act as unexamined summative evidence.

Narrative assessment is indispensable for identifying professionalism and ethical anomalies — domains that objective tests sometimes cannot capture. However, without clear governance and understanding of their use, narrative tools risk becoming blunt instruments that confuse perception with evidence. A fair, defensible assessment system is not one that excludes subjectivity, but one that structures it carefully. After all, aligning GP training assessment with established educational principles would better serve trainees, supervisors and — most importantly — the patients we care for.

References

1. General Medical Council. Fitness to Practise statistics 2022. London: GMC; 2023.
2. Watling C, Ginsburg S. Assessment, feedback and the alchemy of learning. Med Educ. 2019;53(1):76–85.
3. Swanwick T, Forrest K, O’Brien BC, editors. Understanding Medical Education: Evidence, Theory and Practice. 2nd ed. Oxford: Wiley-Blackwell; 2019.
4. Lockyer J, Armson H, Chesluk B, et al. Feedback data sources that inform physician self-assessment. Med Teach. 2011;33(2):e113–20.
5. NHS England. Patient Safety Incident Response Framework (PSIRF). 2022.

Featured image by Scott Graham on Unsplash