Some ideas about Case Based Discussions

CBD and RCGP Curriculum

The Domains: / Related competency areas: / Assessments:
AKT / CSA / WPBA
knows / shows / does
Primary care management / Clinical management
Working with colleagues and in teams
Primary care administration and IM&T
Person-centred care / Communication and consulting skills
Specific problem-solving skills / Data gathering and interpretation
Making a diagnosis/making decisions
A comprehensive approach / Managing medical complexity
Community orientation / Community orientation
A holistic approach / Practising holistically
Essential Features:
Contextual features / Community orientation
Attitudinal features / Maintaining ethical approach to practice
Fitness to practise
Scientific features / Maintain performance, learning, teaching

Competencies: developing skills

Managing medical complexity
This competency is about aspects of care beyond managing straightforward problems, including management of co-morbidity, uncertainty, risk, and an approach to health rather than illness.
Theme / Needs Further Development / Competent / Excellent
Managing several problems together / Manages health problems separately, without necessarily considering the implications of
co-morbidity. / Simultaneously manages the patient’s health problems, both acute and chronic. / Accepts responsibility for coordinating the management of the patient’s acute and chronic problems over time.
Assessing and managing clinical risk / Appropriately prioritises management approaches, based on an assessment of patient risk. / Is able to tolerate uncertainty, including that experienced by the patient, where this is unavoidable. / Anticipates and uses strategies for managing uncertainty.
Health promotion / Maintains a positive attitude to the patient’s health. / Consistently encourages improvement and rehabilitation and, where appropriate, recovery. / Coordinates a team based approach to health promotion, prevention, cure, care and palliation and rehabilitation.
Data gathering and interpretation
This competency is about the gathering and use of data for clinical judgement, the choice of examination and investigations and their interpretation.
Theme
/ Needs Further Development / Competent / Excellent
Gathering information verbally / Obtains information from the patient that is relevant to their problem. / Systematically gathers information, using questions appropriately targeted to the problem. / Proficiently identifies the nature and scope of enquiry needed to investigate the problem.
Gathering information from examination / Employs examinations and investigations that are broadly in line with the patient’s problem. / Chooses examinations and targets investigations appropriately. / Uses an incremental approach, basing further enquiries, examinations and tests on what is already known …

Some ideas about doing a Case Based Discussion (CBD)

By specifying the requiredbehaviours in the curriculum, competencies and word pictures, Registrars know what they are expected to do to demonstrate that they are competent in each area.

Case Based Discussion is about exploring how the Registrar thinks and behaves, with reference to the various aspects of the GP curriculum.

How to do a CBD

  1. preparation, present 4 cases, choose 1 or 2 (in ST1 and ST2 they present 2 cases and choose 1)
  2. choose a case which will demonstrate some competencies, initially choosing randomly, later targeting choice to cover missing competencies, or areas of weakness
  3. use competency descriptor, word pictures and question planner to design questions
  4. use the planning document to write down some suitable questions
  5. do the CBD
  6. start with brief description of the case, 15 seconds, review the notes
  7. this is a discussion of what actually happened, not a hypothetical discussion
  8. push the registrar to her limit, to demonstrate the highest level of the competence
  9. note areas of weakness but do not discuss or teach these during the CBD
  10. jointly assess the level of competence, using the word pictures, agree some areas for development, record in e-portfolio
  11. now have teaching discussion, using areas of weakness noted during the CBD
  12. essential to separate the assessment part of the CBD, with the discussion afterwards which involves teaching and planning for further learning
  13. use the CBD grid to note progress, and help select competencies for future CBD

Some tips for making CBD effective

  • ES uses questions containing the word “you”
  • ES uses verbs rather than nouns when probing what the Registrar thought and did
  • Registrar selects cases which show how she demonstrated particular competencies
  • Remember that a CBD is talking about the Registrar - compare and contrast with a case discussion which talks about the patient

Some good web resources about CBD and other aspects of Training GPs:

Workplace based Learning for General Practice:

Bradford VTS website:

The Essential Handbook of GP Training and Education:

Notes about Case Based Discussions collated by Damian Kenny