Case-Based Discussion
What is case-based discussion?
How is a case-based
discussion carried out?
How many? How often?
FAQs
Resources
What is case-based discussion?
Case-based discussion (CbD) is a structured interview designed
to explore professional judgement exercised in clinical cases which
have been selected by the GPStR and presented for evaluation.
Evidence collected through CbD will support the judgements made
about the GPStRs at the six monthly and final reviews throughout
the entire programme of GP specialty training. The CbD tool has
been designed to be used in both hospital and GP
settings.
CbDs may be carried out by GP trainers or
educational supervisors or clinical supervisors, according to the
arrangements made in each deanery.
Top
How is a case-based discussion carried out?
The GPStR is responsible for selecting cases,
requesting a CbD and ensuring the paperwork is properly completed.
The GPStR and the trainer should ensure that a balance of cases are
represented including those involving children, mental health,
cancer/palliative care and older adults, across varying contexts
i.e. surgery, home visits and out-of-hours contacts.
In ST1 and 2, the GPStR will select two cases
and present copies of the clinical entries and relevant records to
the clinical supervisor or educational supervisor one week before
the discussion. The clinical or educational supervisor selects one
of the cases for discussion. The discussion should be framed around
the actual case and should not explore hypothetical events.
Questions should be designed to elicit evidence of competence and
should not shift into a test of knowledge.
In ST3, the GPStR will select four cases and
present copies of the clinical entries and relevant records to the
trainer or educational supervisor one week before the
discussion.
The trainer or educational supervisor selects one or two of the
cases for discussion, depending on time available.
The trainer or educational supervisor records
the evidence harvested for the CbD in the Trainee ePortfolio
against the appropriate competence areas.
Trainers or educational supervisors should aim
to cover as many competences as are relevant to each case and can
be covered in the time frame. It is unreasonable to expect that all
the competences will be covered in a single CbD but if too few are
considered useful evidence will be overlooked and there would be
inadequate sampling of all the competences. It is helpful to tell
the GPStR at the beginning of the discussion which competence areas
you expect to look at.
It is recommended that each discussion should
take about thirty minutes, including the discussion itself,
completing the rating form and giving feedback to the GPStR.
Top
How many? How often?
A minimum of six CbDs should be carried out in
each of ST1 and ST2 (three before each six month review) and twelve
CbDs should be carried out in ST3 (six before the six month review
and six before the final review).
These minimum requirements apply whether the
GPStR is in a placement in primary or secondary care and whether
they are in full time training or less than full time training.
More CbDs can be done if this is agreed between the trainer and the
GPStR. There may be occasions, for example, when the GPStR is short
of evidence in a particular competence area and another one or two
CbDs might help to fill this gap.
FAQs
Q. What sort of paperwork
should the GPStR produce?
A. Just the actual written
notes relating to the case under discussion. This might be
paper-based or viewed on a computer screen.
Q. One or two CbDs at one
sitting: does it matter?
A. No, it depends on how much
time is available and what is agreed between the GPStR and whoever
is doing the CbD.
Q. How much evidence relating
to the CbD should be retained for quality assurance purposes?
A. Just the completed rating
form, a note of areas for feedback and action points arising.
Q. How much should the
trainer lead the GPStR in the questioning?
A. The trainer is eliciting
evidence and may use any questioning style which they consider
appropriate.
Q. Is it acceptable to use a
case which has also been used for a debrief?
A. No, this would not be a
CbD. The CbD and debrief should not be mixed but a debrief might
occur after the CbD, for educational purposes.
Top
Resources
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.
Downloadable resources:
How to plan and conduct the CbD interview
CbD Structured Question Guidance
CbD Discussion Notes Sheet
Sample
Form (doc, 252kb) also in pdf format (pdf,
60kb)