Appendix 1 . Exemplar of feedback sent to trainees following the assessment in 3 sample scenarios.

Critical Appraisal Scenario You need to spend some time developing your critical appraisal skills. Although you showed an understanding of the basics of reading a scientific paper, you did not demonstrate a structured approach to critical appraisal. I suggest you could do a critical appraisal course or get involved in your local journal club. These resources may help: https://www.cebma.org/resources-and-tools/what-is-critical-appraisal/ https://www.cebm.net/2014/06/critical-appraisal/

Safe Prescribing You completed the prescription chart accurately and legibly. The doses were correct and you reduced them in line with the known renal impairment in this patient as per the BNFC. You had good knowledge of the side effects of the medication and would counsel the parents on what to look out for. Your plan for monitoring drug levels ensured your safe approach to prescribing. Well done.

Acute Scenario Based Discussion This was a tricky scenario of a teenager with anorexia presenting with cold extremities, low blood pressure and dehydration to the Emergency Department on a Friday afternoon. You realised the need for careful fluid resuscitation. It would be fine to involve your local PICU team for advice. You were aware of the NICE guidelines for anorexia nervosa, but not of the RCPsych Guidelines for Management of Really Sick Patients under 18 with Anorexia Nervosa. https://www.rcpsych.ac.uk/usefulresources/publications/collegereports/cr/cr168.aspx

Handover You were able to prioritise the patients with the most urgent need in the handover sheet. You deployed your staff effectively taking account of the nursing shortages on the shift. This is clearly a situation you are familiar with. You paid attention to the child with a safeguarding need but were not distracted from the children with more acute medical issues. You needed a prompt to consider sending the FY1 doctor to arrange the skeletal survey for the infant with unexplained fracture so that could be done early in the shift, but you had a good plan to split the workload in this scenario where there were two potentially unwell and unstable children in asking the ST4 doctor to assess one potentially sick child while you dealt with the other one.