Case Based Discussion (CbD) - RCPsych



Guide to Case Based Discussion (CbD)

An introduction for Trainees, Assessors and Educational Supervisors

Dr Gareth Holsgrove – July 2006

Purpose

CbD is one of two workplace based assessment methods that utilise the fact that trainees regularly present and discuss their cases with more experienced colleagues throughout their training, but only very rarely is evidence captured for assessment purposes. CbD is based on a semi-structured discussion based on patients’ case notes. The companion methods, Case Presentation (CP), assesses trainees in more formal presentations such as Grand Rounds.

The aim of both CbD and CP is to enable an assessor to provide systematic assessment and structured feedback to the trainee.

Almost all of the rating scales, including CbD, (TAB and the Patient Satisfaction Questionnaires are the exceptions) have an item asking “How would you rate the trainee’s performance at this stage of their training?” This is because point 4 of the scale represents satisfactory performance for completion of that phase of training (ST1, 3, or 5), so a doctor having only recently entered that phase might be making perfectly satisfactory progress, yet only obtain ratings of 2 or 3. Therefore this item was introduced to prevent trainees becoming despondent at receiving only low ratings, and to give a measure of their ongoing progress.

How long does it take?

Case based discussions usually take about 15 to 20 minutes and are followed by immediate feedback that takes about a further 5 minutes.

How many are needed?

CbD is a useful and effective assessment method in psychiatry, and it is recommended that around 6 to 8 are carried out each year with each trainee.

How is CbD carried out?

The trainee selects two case records of patients they have recently seen and in whose notes they have made an entry. The assessor will select one of these for the case-based discussion session.

Assessors must be experienced clinicians, so would normally be consultants, staff grade doctors, or senior SpRs.

The discussion will be initiated and centre on the trainee’s contribution to the notes. It allows the assessor to examine clinical decision-making and the application or use of medical knowledge in the care of the trainee’s own patients. It also allows for discussion of the ethical and legal framework of practice, and it allows trainees to discuss why they thought and acted as they did.

It is important to note that CbD is not like a traditional viva. It is focussed on the case notes, the trainee’s contribution to the care f the patient, and what they recorded in the notes.

Filling the form

Assessors are asked only to fill in the sections on the form where they have had a chance to assess the trainee enough to make a judgement. Some cases might not be appropriate for a few aspects on the rating form to be assessed.

What happens next?

CbD is followed by immediate feedback to the trainee. Feedback might be structured by going through the rating form item by item, for example, or by reviewing first the good points and then any points needing improvement.

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