case based discussion CBD nMRCGP

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CBD - Case Based Discussion

What Is It?

what is CBD

One CbD interview is likely to allow approximately three competences to be discussed (the others will be graded “insufficient evidence”)

CBD - the process in GP Post

the cbd process

The assessment form and the feedback given must be uploaded onto your e-portfolio.

CBD - the process in Hospital Posts

NEED TO DO:
- 3 PER 6 MONTHS IN ST1
- 3 PER 6 MONTHS IN ST2
- 6 PER 6 MONTHS IN ST3
In hospitals, CBD happens in the same cyclical way displayed above EXCEPT the trainee presents 2 cases from which one is selected (not three as in the diagram above).
CBD isn’t what most people understand by case discussion – it’s a formal, structured exercise which needs preparation by both trainee and educator.
The discussion should be framed around the actual case and should not explore hypothetical events.
Questions should be designed to elicit evidence of specific competences rather than testing knowledge.
They are assessed on a selection (perhaps 3 or 4) of 10 competences:

1) practising holistically 2) data gathering and interpretation 3) making a diagnosis/decisions 4)clinical management 5) managing medical complexity 6) primary care admin and IMT 7) working with colleagues and in teams 8) community orientation 9) maintaining an ethical approach and 10) fitness to practise

The Gradings

The competences are rated on a clearly defined 4-point scale – we’d expect trainees to progress from ‘needs further development’ to ‘competent’, and rarely achieve ‘excellent’ which is a description of a mature practitioner

Insufficient evidence From available evidence, cannot be placed on a higher point of this developmental scale.
Needs further development Rigid adherence to taught rules or plans. Superficial grasp of unconnected facts. Unable to apply knowledge. Little situational perception or discretionary judgement.
Competent Accesses and applies coherent and appropriate chunks of knowledge. Able to see actions in terms of longer-term goals. Demonstrates conscious and deliberate planning with increased level of efficiency. Copes with crowdedness and is able to prioritise.
Excellent Intuitive and holistic grasp of situations. No longer relies on rules or maxims. Identifies underlying principles and patterns to define and solve problems. Relates recalled information to goals of present situation and is aware of the conditions for application of that knowledge.

The Competency Descriptors: To be classed as ‘competent’, does the trainee has to satisfy every single one of the descriptors in the list for that competency.

The answer is No – the descriptors are just there to give you a general idea of the sort of thing which is required. It is always worthwhile having the competency descriptors in one hand and your CBD question maker list in the other. Ask the questions you've developed for the CBD case and see how the trainee's response fits in with the competency descriptors list.

Here is the competency descriptors list again (which can also be found in the downloads blue box above).

Can You Give Me Any Further Guidance?

Of course we can.

* Case selection is important; 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 would be difficult for you to demonstrate excellence, because the level of challenge might be low. Make sure the cases are not too complicated; too complicated and both of you (you and the trainer) may get muddled and lose track of where you are.

* Although not essential, you can facilitate a good outcome by, in addition to submitting the relevant clinical records, also providing a commentary, or summary of why you chose that case and indicate which competences you think the case allows you to demonstrate. In the downloads section of this webpage is a CBD summary template for trainees; use it.

* Only pick 3-4 competencies that you want to be tested on; if you feel the case demonstrates say 8 or 9 of them, then it will be A) difficult for the trainer to decide what to focus on and B) impossible for to explore the whole 8 or 9 items in any true depth within a 20 minute discussion. So, even if you do think a case demonstrates 8 or 9 areas (say), pick the 4 that you think demonstrate your strongest points in that case or alternatively the areas that have not been explored thus far in previous CBDs.

* As you build up cases, try and map out which areas are yet outstanding and try and pick future cases to meet these areas