What is case-based discussion?

1. What is case-based discussion? A structured interview designed to explore professional judgement exercised in clinical cases Professional judgement may be considered as the ability to make holistic, balanced and justifiable decisions in situations of complexity and uncertainty. Deciding how to make this judgement requires many skills including: • To make rational decisions in the absence of complete information or evidence • To take action or even do nothing in such situations. • To recognise uncertainty/complexity • To apply or use medical knowledge, • To apply or use an ethical and legal framework • To prioritise options, consider implications and justify decisions.

2. How many? How often? • Minimum 6 CbDs in each of ST1 and ST2 (3 before each six month review) • 12 CbDs in ST3 (6 before the six month review and 6 before the final review). •  These minimum requirements apply whether the trainee is in a placement in primary or secondary care • More CbDs can be done • CbD can be used to fill gaps in a particular competence area

3. How is a case-based discussion carried out? • Ensure that a balance of cases are represented including children, mental health, cancer/palliative care and older adults, surgery, home visits and out-of-hours contacts • ST1/2-select 2 cases ST3 select 4 cases • Trainee selects cases one week before the discussion and makes notes available to trainer ( computer record. No additional paperwork required) • Trainer selects 1 or 2 of the cases for discussion. • Discussion should take about 30min -20 min discussion – 10min feedback • It is helpful to tell the trainee at the beginning which competence areas you expect to look at. • Aim to cover as many competences as are relevant to each case- it is unreasonable to expect that all the competences will be covered in a single CbD • The discussion should be framed around the actual case and should not explore hypothetical events. • Questions should be designed to get evidence of competence and should not be a test of knowledge.  • Trainer records evidence from the CbD in the Trainee ePortfolio against the appropriate competence areas. • Completed rating form, notes on feedback and any action points arising should be kept by trainer as evidence • It is not acceptable to use a case which has been discussed before.

4. The structured question guidance should be used to develop appropriate questions • It is helpful to use pre-prepared questions – start with open questions and start with easy questions • Pick few big issues to discuss • Trainees agenda- Why this case? What were the challenges of this case? • give the trainee enough time to review the records and refresh their memory before the discussion • quality of the records presented should be assessed and documented • Use a mix of long and short cases • offer structured feedback ( set-go) at the end and recommendation for further development- always include positive feedback • descriptors of what constitutes insufficient evidence, needs further development, competent and excellent for each competency area in the e-portfolio • Trainees are judge against a fully trained and independently practicing GP

5. CBD Structured Question Guidance-> RCGP http://www.rcgp-curriculum.org.uk/nmrcgp/wpba/case-based_discussion.aspx Competency areas-questions >http://www.nottm-vts.org.uk/WPBA/Tools/CBD.htm

6. Case-based discussion notes sheet

7. resources http://www.rcgp-curriculum.org.uk/nmrcgp/wpba/case-based_discussion.aspx  Downloadable resources: • How to plan and conduct the CbD interview • CbD Structured Question Guidance • CbD Discussion Notes Sheet • Sample Form  Nav Chana, Patti Gardiner, Amar Rughani and Nicki Williams. Talking the Talk: using case-based discussion in medical assessments. London: Royal College of General Practitioners, 2007. This DVD and accompanying workbook on case-based discussion is on sale from the RCGP Bookshop. http://www.nottm-vts.org.uk/WPBA/Tools/CBD.htm