The Assessment of
Clinical Skills Portfolio
New ways of viewing clinical assessment
Anticipated changes to the Canterbury Christchurch
University Doctoral Training Programme in Clinical
Psychology have necessitated re-appraisal of a number of
critical areas - especially in the assessment of clinical skills.
A Clinical Skills Portfolio in two parts is to be introduced in
the first year of training, with the first year cohort
beginning in October being the first to be examined in this
way.
Angela Gilchrist & Jan Burns
June 2011
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Introduction
Anticipated changes to the Canterbury Christchurch University Doctoral Training
Programme in Clinical Psychology have necessitated re-appraisal of a number of critical
areas, including the assessment of clinical skills. A Clinical Portfolio in two parts will be
introduced for the first time in October 2011, while the first year Adult Professional Practice
Report and Critical Review will be dropped. A significant change/addition to the assessment
of clinical skill is the anticipated use of audio and/or videotape.
Rationale
The use of audio and video in the teaching and training of therapeutic skills is in use in a
number of Clinical Psychology training programmes, both in Britain and abroad. Audiorecording is also a popular method for therapeutic appraisal on cognitive behavioural therapy
high intensity training programmes in Britain, including that at Canterbury Christchurch
University. Some training courses in Britain, e.g. Lancaster University, have introduced
video as a method to assess clinical skills. Indeed, large numbers of trainees are already
routinely using audio-recordings to facilitate their supervision, a phenomenon that has gained
momentum in recent years as a result of rapidly developing technology.
The use of audio and/or video recordings allows for a more direct observation of clinical skill
than has traditionally been allowed by the production of Professional Practice Reports, which
tend to have as a focus theory/practice links rather than therapeutic skill. Further advantages
are that a recording can be played and replayed allowing for focus on differing segments of
the therapeutic process, and how these might sit within the intervention as a whole. Trainees
will also be able to use recordings as a way of monitoring their own therapeutic skills and
development through time, so that they become a form of self-audit and supervision.
It is hoped that the use of video/audio will strengthen our assessment of clinical skills, whilst
not increasing the workload, fit in with the proposed timetable and be feasible for markers. In
the same vein as the Team Report, a multi-component assessment is suggested, which
assesses a range of competencies and is linked.
Overview
The clinical portfolio will have two parts. While these will be prepared individually, in order
to be coherent it is essential that they are regarded as a whole, with each part having a bearing
on the other.
Part 1 will consist of a Formulation and Evidence for Intervention Review (which will be
submitted in March/April of year 1, and
Part 2 (submitted in June of year 1) will consist of a Clinical and Professional Skills
Assessment having three components:
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a) A digital recording (30 minutes); b) An annotated transcript in which five generic
therapeutic competencies are discussed as well as three model specific ones within the
clinical context. The trainee will be expected to reflect appropriately on the clinical work and
understand the strengths and limitations of current competencies. A good understanding of
the lifespan and context of the client should be demonstrated by reflecting upon their specific
life circumstances and social/cultural context in relation to the therapeutic work. It is also
expected that they will also demonstrate an awareness of their further training needs. Part c) a
Clinical Viva.
Part 1: Formulation and Evidence for Intervention Review (Assessment Handbook
(2011), Appendix 8)
The purpose of this assessment is to demonstrate that the trainee has the competencies to
formulate case work and make a clinical judgment about the most appropriate intervention
given the presenting clinical issues and the service context. The review should demonstrate
theory practice linking within the formulation and that the intervention is evidence based and
adapted as needed to the individual and service context.
The assessment contributes to the following educational objectives of the programme:

An advanced and critical understanding of the scientific methods involved in research
and evaluation, including the evidence base for psychological therapies, and to have
developed the complex skills required to use this understanding in practice through
carrying out original research and advanced scholarship.

A high level of competence in assessment, formulation, intervention and evaluation
across a range of theoretical models, client groups and organisational contexts and to
have the transferable skills to apply these in complex and unique circumstances.

An advanced level of creative and critical thinking in relation to the development of
clinical practice and services as well as the personal and organisational skills to
implement, or facilitate the implementation of, these ideas in unique and complex
situations.

A detailed, reflective and critical understanding of developmental, social, cultural,
political, legal and organisational contexts and their impact on individuals and the
delivery of psychological services.

A commitment to services and the development of inclusive services which seek to
empower service users.

An advanced capacity to reflect on, manage and respond constructively to the
personal and professional pressures and constraints encountered during the course of
training and thereby demonstrate a readiness for practice.
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More specifically, the assessment will facilitate the following skills to be developed:
a) To be able to search the available literature on a selected topic in a systematic and
rigorous way using electronic and manual methods.
b) To be able to focus the review within specific parameters e.g. time available, length of
report and level of sophistication necessary.
c) To be able to construct a clinical formulation that is theoretically grounded and
appropriately conclusive, taking into account the developmental and contextual
history of the client and which leads to clear indications for intervention.
d) To be able to describe a specific clinical intervention and provide a rationale for why
that approach is the intervention of choice given the specific circumstances of that
individual and service context.
e) To be able to succinctly link the intervention to the available evidence base and
describe the support this literature offers this clinical judgement.
f) To be able to reference national guidance in relation to general presenting issues.
g) To be able to describe and provide a rationale for any adaptations being made to the
intervention to ensure that it best fits the needs of this client within this service
context.
h) To be able to be appropriately critical of the existing limitations of the evidence base
in reference to the intervention proposed.
i) To provide a brief action plan resulting from the chosen intervention.
Part Two: Clinical and Professional Skills Assessment (Assessment Handbook, (2011)
Appendix 10).
The purpose of this assessment is to demonstrate that the trainee has the basic clinical skills
to work therapeutically in a clinical context. It consists of three components which are
assessed together to form one assessment.
a. Digital recording (30 mins)
b. Annotated transcript
c. Clinical Viva
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The assessment contributes to the following educational objectives of the programme:

A reflective approach to practice and for this to be evident in terms of a high level of
self awareness (personal reflection) and an advanced awareness of the perspectives of
other individuals, groups and organisations (context reflection).

An advanced and critical understanding of, and ability to apply, at least four
theoretical models on which clinical psychology draws (in particular, behavioural,
cognitive, systemic and psychoanalytic) and to be able to adapt the therapeutic model
to work effectively in highly complex and novel contexts occurring across the
lifespan.

An ethical approach to the work which demonstrates a high level of professional
behaviour, including reliability, responsibility for actions, respect for colleagues and
other professionals and service users, openness and an awareness of the limits to
competence.

A high level of competence in assessment, formulation, intervention and evaluation
across a range of theoretical models, client groups and organisational contexts and to
have the transferable skills to apply these in complex and unique circumstances.

An advanced level of creative and critical thinking in relation to the development of
clinical practice and services as well as the personal and organisational skills to
implement or facilitate the implementation of, these ideas in unique and complex
situations.

A detailed, reflective and critical understanding of developmental, social, cultural,
political, legal and organisational contexts and their impact on individuals and the
delivery of psychological services.

An advanced ability to communicate with service users and other professionals within
services in a manner that helps to build effective partnerships and strong working
relationships.
More specifically, these assessments will facilitate the following skills to be developed:
Clinical: Generic Skills
a. To be able to demonstrate generic basic therapeutic skills within a real clinical
context. Specifically, these skills are:
i. Active Listening
ii. Empathy
iii. Accurate Reflections
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iv. Ability to be Responsive to the Client
v. Exploration of Client Concerns
b. To be able to identify what these skills are and when they occur.
Clinical: Model Specific
c. To be able to identify model specific basic interventions within a real clinical context.
Critical Reflection
d. To be able to reflect appropriately on clinical work and understand the strengths and
limitations of current competencies.
Lifespan and Context
e. To be able to reflect upon the specific life circumstances and social/cultural context of
the client in relation to therapeutic work.
Professional Skills
f. To be able to abide by ethical and professional standards when presenting and
discussing clinical work. Specifically,
i.
To be able to talk about client work in a respectful way
ii.
To be able to present and discuss such issues in a way which maintains client
confidentiality
iii.
To be able to demonstrate a professional approach to discussing their work.
iv.
To demonstrate that the submitted work is representative of their general level
of skills and approach to clinical work.
g. To be aware of further training needs.
General
Issues of Consent
Confidentiality and Legal Issues
Trainees will be expected to gain the written consent of clients before proceeding with
audio/video recording of sessions for examination purposes. Guidance about this should be
sought from the Trust or organisation where the work was carried out. Such organisations
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may have their own guidance regarding the use of clinical material for educational purposes.
An example is the Surrey and Borders Partnership NHS Trust policy, which can be found at
http://www.sabp.nhs.uk/foi/policies/.
It will be important that clients know that the recording will be viewed/heard by programme
staff involved in marking the assignment. Written evidence of consent will be kept in the
clinical records of the client. A copy of this should not be supplied with the Portfolio, as this
would identify the client, but a sheet signed by the trainee should be attached to the transcript
indicating that consent has been agreed by the client for both written and recorded
information to be presented for examination under the appropriate guidelines; that this has
followed the organisation guidance where the clinical work was carried out and that the
presented material has been fully anonymised.
Clinical supervisors will also need to verify that a video/audio recording represents work with
a client that the trainee has seen on placement. The video/audio material must be treated with
the same respect as clinical case notes and it is expected that trainees will adhere to HPC and
BPS guidelines on the handling of confidential material in this regard.
Trainees will need to follow the guidance set down by their respective Trusts with regard to
the handling and storage of the recordings. Guidance produced by the Oxleas Trust (2011) for
example, states that once a session has been recorded it should be transferred onto computer
and encrypted as soon as possible. The encrypted version should then be transferred to a
DVD (video) or in the case of an audio recording, a CD or memory stick. Trainees are all
supplied with encrypted memory sticks that can be used for this purpose. The recording
should be completely erased/deleted from the computer and from the recording equipment. If
it is necessary to work on the recording on any other computer, the trainee should not save
the recording to the new computer but work from the DVD/CD or memory stick.
The DVD/CD or memory stick and transcript should not contain any client identifying details
on them; but only the trainee’s name. Once the recording is considered ready for examination
along with the rest of the Portfolio it will be delivered in encrypted form to the Assessments
Administrator at the University. The password to the material may need to be emailed or
telephoned separately.
Similarly, examiners of the Portfolios will receive encrypted DVD’s, CD’s or memory sticks,
along with the transcripts. Passwords may again need to be emailed or telephoned separately,
so as to ensure confidentiality. Examiners will need to work discreetly with the recordings so
as to ensure that clients are not given any unnecessary exposure (for example, to family
members or other members of the household).
Clients should be given the assurance that they have the right to withdraw their consent for
the use of video/audio recording at any time without any repercussions for their treatment. In
these cases, the respective recordings will need to be erased. From the University’s point of
view, any recordings can be destroyed after the respective Board of Examiner’s meeting; but
since Copyright for any recordings may remain with the respective Trust, trainees should
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refer to their Trust guidance on this matter. Examiners should be sure to return their
DVD’s/CD’s or memory sticks to the Assessments administrator at the University.
Further legal requirements
Trainees will also need to ensure that they have met the requirements of any particular Trust
with regard to both ethics and confidentiality. Most Trusts will subscribe to the NHS Code on
Confidentiality (2003); the Data Protection Act (1998), Human Rights Act (1998) and the
common law of confidentiality. The HPC regulations with regard to confidentiality (2007)
will need to be upheld, as will the BPS Code of Conduct (2006) as it pertains to
confidentiality.
Technology
The University has a limited number of video recorders and trainees can expect to obtain an
audio recorder as a requirement of the course. This should be kept specifically for the purpose
of making clinical audio recordings. It is felt that by reserving a device for this exclusive
purpose, confidentiality procedures will be enhanced.
As already indicated, trainees should submit their work either by encoded memory stick or
CD (audios) or by DVD (videos). Great care should be taken in downloading recordings onto
a computer, and it should be avoided where possible. Where this cannot be avoided (for
example it may be necessary to do so in the first instance so as to set up encryption), the
trainee should take steps to ensure that deletion occurs immediately after viewing/listening to
the recording, bearing in mind that some digital material can be retrieved from the hard drive
even once it is deleted. The Canterbury Christchurch University programme is able to draw
on the experiences of the high intensity CBT programme with regard to both the production
and evaluation of audio recordings.
Guidelines: Digital Recording (Assessment Handbook (2011) Appendix 10)
a) This may be an auditory recording of a session, or a video-recording with soundtrack
just showing the trainee, or a video and soundtrack showing client and trainee.
b) It must be of 30 minutes duration and a continuous section of one therapeutic session.
c) The auditory track must be audible for both parties. Additional information about the
technical production of this material is available on blackboard.
d) The selection of the therapeutic work to sample must be made so that the five basic
core competencies as set out in the marking criteria are able to be demonstrated, in
addition to three ‘model specific’ competencies being identified, as set out in the
marking criteria.
e) Trainees are strongly advised to discuss this selection of case material with their
supervisors and to be able to choose from a number of recordings.
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Guidelines: Annotated Transcript (Assessment Handbook (2011) Appendix 10)
1. This must be a transcript of the whole of the session from which the digital recording
has been taken.
2. The annotation should only be of the selected 30 minutes presented in the recording.
This allows the examiner to see more of the context of the selected 30 mins, if needed.
3. The annotation should address four issues:
3.1 It should identify where each of the 5 core clinical competencies are
demonstrated.
3.2 It should identify 3 model specific interventions and describe what these are or if
3 cannot be identified, opportunities should be identified where model specific
interventions could have occurred and describe what these might have been.
3.3 It should make one reflective comment where consideration was given to the
individual life circumstances of the person, this may or may not have been
articulated in the session, but was at least considered.
3.4 It should make some critique of the therapeutic work, pointing out where
interventions could have been made but were not or where improvements could
be made (max 500 words).
4. The competencies demonstrated must be congruent to the process of the therapy.
Guidelines: Clinical Viva (Assessment Handbook (2011) Appendix 10)
1. The clinical viva has a number of aims:
a. To explore with the trainee areas of competences that might not have been
adequately demonstrated within the recording and annotated transcript.
b. To explore with the trainee their depth of understanding of clinical competencies
and therapeutic alliance.
c. To explore with the trainee their current understanding of the therapeutic model in
which they were working.
d. To assess their ability to meet the professional competencies identified in 1 i-iv
above.
2. The viva will last 30 to 45 minutes and will be carried out normally by the two
examiners who have marked Part 1 of the Clinical Portfolio.
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Viva - General
The viva may concentrate on the formulation or the recording and transcript or both, asking
the trainee to further elaborate and demonstrate their understanding. Examiners should be
interested in why the trainee has made the choice of a particular vignette/s of work and how it
might be situated within therapeutic interventions as a whole. The trainee should be able to
draw on available evidence for having decided to work in the chosen way or to put forward a
good clinical defence if the evidence was circumvented for any reason. The trainee should
also be able to reflect on ethical issues as well as more practical service issues that may have
impinged upon the work.
As with the Professional Practice Report, the formulation will lie at the heart of the piece of
work under consideration. The trainee will be expected to demonstrate a sound knowledge of
how the client’s particular set of difficulties might be imported into theory and translated
within a meaningful context. It has to be said that no matter how impressive the trainee’s
transcript of the audio/video recording, it is unlikely to stand up as a piece of meaningful
clinical work in the absence of an appropriate formulation.
Trainees will be expected to demonstrate at least five generic clinical competencies in their
audio/videotapes. These will be competencies that could be said to be ‘transtheoretical’ in
that they should pertain to all good therapeutic work. This is in keeping with a large body of
research evidence which suggests that the relationship between client and therapist is the best
predictor of therapeutic outcome (Hubble, Duncan and Miller, 1999). It is hoped that three
‘model specific’ competencies will also be identified from the recording, or if this is not
possible, that the trainee will be able to discuss opportunities for ‘model specific’
interventions that may not have been taken up.
The trainee will be expected to clearly ‘defend’ their video/audio recording in the viva
discussion of their work. It is considered imperative that the trainee is able to reflect
critically on the work that has been undertaken and that they are able to demonstrate a
learning curve through its execution. Particular consideration should be given to ‘the
unexpected’ in therapy, for example alliance ruptures, issues of disengagement or important
disclosures being made during the ending stage, as examples. A trainee’s ability to think
critically through these issues will give the examiners a good idea as to whether or not the
therapy was well and thoughtfully managed with the client’s main interests kept to the
forefront of the process.
Conclusion
Review of the Doctoral Training Programme in Clinical Psychology at Canterbury
Christchurch University has resulted in the necessity of a reappraisal of how clinical skills are
thought about and demonstrated. It is considered viable to introduce an examination in two
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parts of trainees’ clinical skills as a means of realistically assessing their understanding of
having a rationale for a Clinical Psychology intervention, formulating it and then proceeding
to intervene. Vignettes from audio/video recordings are considered a practical and vibrant
way of tapping and enhancing trainees’ clinical skills, despite the considerable legal, ethical
and technological challenges inherent to this process.
Further reading
Potential examiners are encouraged to read Canterbury Christchurch University’s Doctorate
in Clinical Psychology (D.Clin. Psychol) Assessment Handbook for further information on
assessment and marking criteria (Appendices 8 -11).
Angela Gilchrist & Jan Burns
June, 2011.
REFERENCES
British Psychological Society (2006). Code of Conduct, Ethical Principles and guidelines.
Leicester: British Psychological Society.
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Canterbury Christchurch University (2011). Doctorate in Clinical Psychology (D. Clin.
Psychol) Assessment Handbook.
Data Protection Act (1998). (Electronic Version) www.legislation.gov.uk.
Department of Health (2003). NHS Code on Confidentiality. Policy Document. Department
of Health.
General Medical Council (2002). Guidelines on making and using visual and audio
recordings of patients. (Electronic Version) www.gmc-uk.org/standards/aud vid.htm
Health Professions Council (2007). Confidentiality: Guidance for Registrants – Consultation
Document. Health Professions Council.
Hubble, M.A. Duncan, B. and Miller, S.D. (1999). The Heart and Soul of Change: What
Works in Therapy. American Psychological Association.
Human Rights Act (1998). (Electronic Version) www.legislation.gov.uk.
Oxleas NHS Foundation Trust (2011). The Visual and Audio Recording of Patient’s/Families
Policy. Trust Policy Document.
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