CASE BASED DISCUSSION
UPPING YOUR GAME
AUGUST 2015
“The aim of CbD is to enable an
assessor to provide systematic
assessment of the trainee’s
performance and to give
structured feedback”
Miller’s pyramid of clinical competence
Does
Shows
Knows how
Knows
CBD/ COT
CSA
AKT
What is a CBD?
A structured interview designed to
explore professional judgement in
clinical cases
Professional judgement:
The ability to make holistic,
balanced, and justifiable decisions
in situations of complexity and
uncertainty
Attributes being examined
• Application of medical knowledge
• Application of ethical frameworks
• Ability to prioritise, consider implications
and justify decisions
• Recognising complexity and uncertainty
Competency Areas Covered
Practising holistically
Data gathering and interpretation
Making decisions/diagnoses
Clinical management
Managing medical complexity
Primary Care Administration (IMT)
Working with colleagues
Community orientation
Maintaining an ethical approach
Fitness to practice
How is it done?
The trainee selects three cases for the
discussion and present to the trainer one
week before the meeting
Selection of cases needs careful
consideration – a balance of cases and
contexts is required
The trainer will select two of the cases for
the discussion
https://www.youtube.com/watch?v=4eVK4M50j3E
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How To Choose A Case
•it is a case based discussion, so preferably choose
cases with a number of contacts, not just a one-off
consultation
•If the case is straightforward it can be difficult to
demonstrate excellence, because the level of
challenge might be low
•be courageous and pick patients that were challenging,
difficult, hard work, complex or interesting
•complex cases often help furnish strong evidence for a
number of competency areas
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Keep a separate record of your CBDs
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How To Do Well
•Provide a commentary, or summary, of why you
chose that case and indicate which competences you
think the case allows you to demonstrate.
•Submit the relevant clinical records
•Use the Bradford VTS CBD summary template
•Only pick 3-4 competencies
•Pick the 4 that you think demonstrate your strongest
points OR alternatively are areas that are currently
weak in your ePortfolio and that you need more
evidence of
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Prepare Your Paperwork To Make It Easy
For Your ES To Assess You Highly…
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Prepare Your Paperwork To Make It Easy
For Your ES To Assess You Highly…
Prepare Your Paperwork To Make It Easy
For Your ES To Assess You Highly…
Prepare Your Paperwork To Make It Easy
For Your ES To Assess You Highly…
Getting Started
“The discussion will start from and be centred
on the trainee’s record in the notes and is
designed to assess clinical decision-making
and the application of medical knowledge
in the care of the trainee’s own patients.”
Quality of record keeping is important and
should be assessed
Know The Marking Scheme
The Practicalities
•1 hour in total
•20 minutes per case
•10 minutes for feedback on each case with
recommendations for change
•ES: Record evidence elicited
•ES: Judge the level of performance
http://www.wpba4gps.co.uk/training/case-based-discu
https://www.youtube.com/user/rcgpwork/videos
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