Case-Based Discussion (CbD) — Bradford VTS
MRCGP · WPBA · CAT Assessment

Case-Based Discussion
(CbD)

Your clinical thinking on show — not just what you did, but why you did it.
(Yes, your trainer actually wants to know what was going on inside your head. Scary, but exciting.)

Updated 2025 RCGP Guidance
For Trainees, Trainers & TPDs
Bradford VTS Resource
⚠️
Important 2024–25 Update: The RCGP updated CBD requirements. CbDs are now part of the CAT (Care Assessment Tool) framework. Requirements have changed — ST1/ST2 now require 4 CbDs each (not 3), and ST3 requires 5 CATs. Competencies are now called Professional Capabilities (13 total). This page reflects current guidance.

Jump to section

What is a CbD? How it works Requirements Capabilities Grading Trainee & Trainer Guide Case Selection Writing Up Quick Checklist
Understanding CbD

What is a Case-Based Discussion?

In plain English

A CbD is a structured, one-to-one interview with your GP trainer or supervisor about a real patient case you have already managed. It is not a knowledge test — it explores your professional judgement: the reasoning, values, and decision-making behind what you actually did.

Think of it like a cooking show. The clinical notes are the finished dish on the plate. The CbD is the chef explaining why they added that extra spice, how they rescued it when it nearly went wrong, and what they would do differently next time. The dish doesn't have to be perfect — the thinking does.

🎯

Core Purpose

Assess your professional judgement in real clinical situations involving complexity and uncertainty.

📋

What it's NOT

Not a knowledge quiz. Not a viva voce. Not about whether you got the diagnosis "right." (Breathe. You already managed the patient. The hard part is over.)

🌱

Educational Value

Drives reflective learning. Forces you to articulate your thinking — which makes you a better doctor.

🔗

Part of WPBA

A CbD is a type of CAT (Care Assessment Tool), which sits within the WPBA arm of the MRCGP.

🔑 The Key Concept: Professional Judgement

Professional judgement is the ability to make holistic, balanced and justifiable decisions in situations of clinical complexity and uncertainty. It combines medical knowledge, ethics, patient context, and practical wisdom. A CbD reveals whether you have it.

Think of it like a taxi driver vs a GPS app. The GPS app (textbook knowledge) tells you the fastest route. The experienced taxi driver (professional judgement) says: "Yes — but there's a market on Tuesday mornings, your passenger has a bad back so avoid the bumpy road, and actually there's a quicker route most people don't know about." That's what we're looking for.
The Process

How Does a CbD Work?

The CbD Pathway

1
👩‍⚕️ TRAINEE selects a suitable case

Choose a case you managed independently with clinical complexity

▼
2
👩‍⚕️ TRAINEE maps to 3–4 Professional Capabilities

Identify which capabilities the case best demonstrates — share with trainer ≥3 days before

▼
3
👨‍🏫 TRAINER reviews case & plans questions

Reviews clinical summary, checks mapped capabilities, prepares structured questions

▼
4
🤝 CbD INTERVIEW — ~20 minutes

Trainee briefly presents case (2–3 min). Trainer asks structured questions. No teaching during assessment phase.

▼
5
💬 FEEDBACK — ~10 minutes

Trainee reflects on own performance first. Trainer grades each capability, gives structured feedback + development plan

▼
6
📱 TRAINER records on Portfolio (Kainos)

Grades, capability evidence and agreed actions entered on ePortfolio within agreed timeframe

▼
7
🔒 TRAINEE shreds patient paperwork

Confidentiality — all patient notes must be shredded immediately after the session

⏱ Timing Guide

  • Case presentation by trainee: 2–3 min
  • Structured questioning: ~20 min
  • Feedback & development planning: ~10 min
  • Total time: ~30–35 min

📌 Key Rules

  • Case must have been managed independently by trainee
  • Share case notes ≥ 3 days before
  • No hypothetical "what if" questions
  • Don't teach during the assessment phase
  • Trainee self-reflects on performance before trainer grades
RCGP Requirements (Updated 2024–25)

How Many CbDs Do I Need?

ST1 (Year 1)
4
CbDs minimum
≥2 per 6-monthly ESR
ST2 (Year 2)
4
CbDs minimum
≥2 per 6-monthly ESR
ST3 (Year 3)
5
CATs minimum
CbDs + other CAT types
These are minimums. The RCGP strongly encourages doing more. Quality > quantity — but you need both. Numbers are pro-rata for LTFT trainees.

🆕 What Changed? CbDs in the CAT Framework (ST3)

In ST3, CbDs sit within the broader CAT (Care Assessment Tool) framework. Other CAT formats available in ST3 include: Random Case Review, Routine Session Review, Referrals Review, Prescribing Assessment, Duty Session Review, and more. You can use any combination to reach 5 CATs, but CbDs remain the only CAT type available in ST1 and ST2.
StageMinimum CbDs/CATsWho can assess?Key notes
ST14 CbDs (≥2 per ESR)GP Educational Supervisor or approved Clinical SupervisorHospital consultants can do CbDs in hospital posts
ST24 CbDs (≥2 per ESR)GP Educational Supervisor or approved Clinical SupervisorEncourage diversity of assessors across training
ST35 CATs (can include CbDs)GP Educational Supervisor or approved Clinical SupervisorOnly GP posts in ST3; other CAT types now available

⚠️ Don't Leave It Late!

CbDs should be spread throughout training, not bunched at the end. Your trainer will not remind you — this is your responsibility. Set a calendar reminder at the start of each rotation: aim for one CbD every 4–6 weeks.

Doing all your CbDs in the final two weeks of a post is like revising for an exam the night before — technically possible, deeply unpleasant, and your trainer will absolutely notice. Don't be that person. 😅
RCGP Framework

The 13 Professional Capabilities

The CbD tests your performance against the RCGP's 13 Professional Capabilities, grouped into 4 areas. For each CbD, you should map 3–4 capabilities in advance. Your trainer may add one more during or after.

🗺️ The 4 Capability Areas (RDMp Framework)

The 13 capabilities are grouped under four themes: Relationships (how you engage with patients and colleagues), Diagnostics & Decisions (clinical reasoning), Management & Complexity (breadth of care), and Professionalism & Organisation (being a safe, organised doctor).
FtP

Fitness to Practise

Awareness of own and others' performance that could put patients at risk. Insight, health, conduct.

Tricky
EA

An Ethical Approach

Applies ethical frameworks to clinical decisions. Deals with moral complexity with integrity.

CC

Communicating and Consulting

Effective communication across consultations, letters, records, referrals. Adapts to patient needs.

DG

Data Gathering and Interpretation

Gathers and interprets information appropriately from history, records, exam and investigations.

CEPS

Clinical Examination and Procedural Skills

Performs and interprets clinical examinations and procedures safely and appropriately.

DD

Decision-Making and Diagnosis

Sound clinical reasoning. Manages diagnostic uncertainty. Uses pattern recognition and deliberate analysis.

Tricky
CM

Clinical Management

Formulates appropriate management plans. Safety-netting. Evidence-based. Patient-centred.

MC

Medical Complexity

Manages multimorbidity, risk, uncertainty. Coordinates across specialties. Safeguarding awareness.

Tricky
TW

Team Working

Shares information effectively. Collaborates with MDT. Delegates safely. Good team behaviours.

HPHS

Holistic Practice, Health Promotion and Safeguarding

Whole-person care — biological, psychological, social. Health promotion, self-management support, and safeguarding.

CHES

Community Health and Environmental Sustainability

Understands the health of the population, local services, social determinants of health, and environmental impact.

Hard in hospitals
PLT

Performance, Learning and Teaching

Reflects on practice. Engages in CPD. Contributes to others' learning. Appraisal awareness.

OML

Organisation, Management and Leadership

Time management, administration, leadership of teams and projects. Quality improvement.

🧠 The 13 Capabilities at a Glance

In order — learn these in sequence and the codes will become second nature:

F
Fitness to Practise FtPAm I safe, well and fit to practise?
E
An Ethical Approach EADoing the right thing, the right way
C
Communicating and Consulting CCHow I communicate — verbal, written, digital
D
Data Gathering and Interpretation DGHistory, exam, investigations — what I gathered
C
Clinical Examination and Procedural Skills CEPSPerforming and interpreting examinations safely
D
Decision-Making and Diagnosis DDMy reasoning and clinical thinking
C
Clinical Management CMMy plan and how I executed it
M
Medical Complexity MCMultimorbidity, uncertainty, risk, coordination
T
Team Working TWMDT, delegation, sharing information
P
Performance, Learning and Teaching PLTReflection, CPD, teaching others
O
Organisation, Management and Leadership OMLAdmin, time, leadership, QI
H
Holistic Practice, Health Promotion and Safeguarding HPHSBiopsychosocial + prevention + safeguarding
C
Community Health and Environmental Sustainability CHESPopulation health, local services, inequalities, planet

🚨 The "Tricky Three" — Where Trainees Often Struggle

Three capabilities regularly trip trainees up. Here's what they actually mean:

🔴 Medical Complexity (MC) — "It's more than multimorbidity" ▼

Trainees often think this is just about patients with many conditions. It's much broader:

🍲 Analogy: Imagine you're cooking a big family meal. Medical Complexity (MC) is not just "there are many dishes." It's managing the fact that one family member is allergic to nuts, another is diabetic, the oven is broken, dinner needs to be ready in 30 minutes, and you're not 100% sure if the chicken is fully cooked. That's your complex GP patient.

  • Uncertainty — how did you manage not knowing the answer? (e.g., using safety-netting as a tool)
  • Risk — how did you explain or quantify risk to the patient? (e.g., QRISK, fracture risk)
  • Collusion of anonymity — multiple specialists involved and nobody coordinating? Did you step in?
  • Safeguarding — awareness of safeguarding concerns even if not the primary reason for the consultation
  • Health promotion within complexity — opportunistic but realistic health promotion despite complex presentations

What to write in your CbD write-up

Describe a moment of uncertainty and how you managed it. Mention any risk that needed explaining. Note if you coordinated care across specialties. Highlight any safeguarding consideration.
🔴 Decision-Making and Diagnosis (DD) — "Don't just describe the diagnosis, explain the THINKING" ▼

The most common mistake: trainees write what their diagnosis was, without showing how they reasoned their way to it. Examiners want to see clinical intelligence.

🕵️ Analogy: Think of yourself as a detective. A bad detective just says "the butler did it." A good detective explains the footprints, the motive, the alibi that didn't quite add up, and why they ruled out the gardener. Your trainer is not asking who did it — they're asking how did you figure it out?

❌ Weak write-up

"I diagnosed the patient with asthma and started inhaler therapy."

✅ Strong write-up

"I initially considered COPD vs asthma. I used System 2 thinking to avoid anchoring bias after my initial System 1 impression. The reversibility of symptoms and age supported asthma. I used spirometry to reduce uncertainty. I considered that occupational asthma was a possibility given the patient's job."

Clinical reasoning frameworks to mention:

  • Dual Process Theory — System 1 (fast/intuitive) vs System 2 (slow/deliberate) thinking
  • Cognitive biases — anchoring, availability, premature closure
  • Using time as a diagnostic tool — "watchful waiting" as a reasoned strategy
  • Pattern recognition — what triggered your initial hypothesis?
  • Probabilistic reasoning — most likely diagnosis AND important differentials
🔴 Community Health and Environmental Sustainability (CHES) — "Hard to do in hospital posts, but not impossible" ▼

Community Health and Environmental Sustainability is about understanding the health of the population — and now also the environmental impact of healthcare. It is understandably harder to evidence in hospital posts.

  • Local epidemiology — what conditions are common in your area? (e.g., high TB rates in Bradford)
  • Health inequalities — did socioeconomic deprivation affect your patient's presentation or access to care?
  • Local services — did you know which community services exist for this patient? Did you signpost appropriately?
  • Public health — screening programmes, vaccination, disease surveillance
  • Population-level thinking — does this case represent a wider trend in your practice population?
  • Environmental sustainability — did you consider the carbon footprint of investigations, medications or referrals? Could a more sustainable option achieve the same outcome? (e.g., inhaler choice, reducing unnecessary blood tests, virtual vs in-person follow-up)

Hospital post tip

Even in hospital, you can ask: "Does this patient live in an area of deprivation? Did their postcode affect their access to early diagnosis? What community follow-up will they need after discharge? What are the social determinants of their health?"
Assessment

How is a CbD Graded?

Each capability discussed in the CbD is graded on a 4-point scale. Most trainees progress from "Needs Further Development" to "Competent" over time. "Excellent" reflects a mature, independent practitioner — rare in early training and that is completely normal. (If your ST1 CbDs are all "Excellent," either you are a once-in-a-generation clinician, or your trainer has been very generous. Both are possible. Neither requires panic.)

GradeWhat it meansSigns in the CbD discussion
Insufficient EvidenceNot enough information to place on scale. Case may have been too straightforward or trainee too vague.Very brief answers; case lacks clinical complexity; trainee unable to elaborate
Needs Further DevelopmentRigid rule-following. Superficial knowledge. Unable to apply or adapt. Little situational awareness."I followed the guideline" without justification; can't identify uncertainty; no holistic awareness
CompetentApplies coherent knowledge. Sees actions in longer-term context. Deliberate, efficient planning. Copes with complexity.Articulates reasoning; acknowledges tradeoffs; shows patient-centred thinking; handles uncertainty appropriately
ExcellentIntuitive, holistic grasp. Identifies underlying patterns and principles. Integrates knowledge effortlessly to patient context.Effortless integration; sees the big picture; applies frameworks naturally; generates insight spontaneously

❓ FAQ: Do I need to satisfy every descriptor to be "Competent"?

No. The descriptors give a general picture — they are not a checklist. Trainers make a holistic professional judgement about where the trainee's performance sits on the developmental scale. One weak descriptor does not automatically mean "Needs Further Development" if the overall picture is competent.

🌟 GP Clinical Pearl — "The Trajectory Matters"

  • Early in training (ST1): "Needs Further Development" on several capabilities is completely expected and normal.
  • Mid-training (ST2): A mix of NFD and Competent shows progression.
  • Final year (ST3): Consistent "Competent" with some "Excellent" demonstrates readiness for independent practice.
  • Your Educational Supervisor reviews patterns across all CbDs — a single CbD grade does not define your progress.
  • Think of it like learning to drive. On your first lesson, stalling the car is expected. On your driving test, it's a problem. Your trainer knows which lesson you're on. 🚗
Practical Guidance

Guidance for Trainees, Trainers & TPDs

📂

Case Selection is Everything

  • Choose cases with complexity, uncertainty, or multiple contacts
  • Straightforward cases = limited scope = "Insufficient Evidence" risk
  • Pick patients who were challenging, difficult, or interesting
  • You managed the case independently (no advice from another doctor mid-consultation)
🗺️

Map Your Capabilities Well

  • Select 3–4 capabilities that your case genuinely demonstrates
  • Don't map every capability — be selective and credible
  • Think: "What does this case tell the trainer about my professional development?"
  • Your trainer may add 1 more — that's normal
🕐

Timing & Preparation

  • Share case details at least 3 days before
  • A good CbD write-up takes at least 30 minutes — not 10!
  • Print patient summary and attach to template
  • Book your CbDs proactively — don't wait to be asked
🎤

During the Discussion

  • Be honest. If you didn't do something — say so. Trainers can tell when you're bluffing. (They have seen hundreds of trainees. They know the face. 😬)
  • Being honest about a gap is far better than being dishonest
  • Elaborate when asked — don't give one-word answers
  • Use clinical reasoning language (System 1/2, uncertainty, shared decision-making)
📊

Track Your Capability Coverage

  • Use the CbD Competency Mapping Sheet after each CbD
  • Identify any capabilities repeatedly graded NFD — pick future cases to address these
  • Bring your mapping sheet to ES (Educational Supervisor) meetings
  • Aim to cover all 13 capabilities across the 3-year training period
🔒

Confidentiality

  • Patient details must be anonymised or protected
  • After the session, shred all patient paperwork immediately
  • This is YOUR responsibility — not your trainer's
  • Do not leave patient notes in tutorial rooms or libraries

🚫 Common Trainee Mistakes

  • Choosing a case that is too straightforward (insufficient evidence)
  • Rushing the write-up (10 minutes instead of 30)
  • Mapping too many capabilities superficially
  • Saying "yes I did that" when you didn't — trainers know
  • Leaving CbDs to the last few weeks before an ARCP
  • Only discussing the clinical management without exploring reasoning or uncertainty
  • Forgetting to shred patient paperwork after the session

💡 Trainee Survival Tips

  • Ask for a CbD, don't wait. Say: "Can we schedule a CbD in next Tuesday's tutorial?" Your trainer will appreciate the initiative.
  • Complex cases are your friend. A messy, uncertain case gives you far more to discuss than a straightforward earwax removal. (Nobody ever got "Excellent" for a normal blood pressure check.)
  • Think out loud. The CbD is a window into your mind — let the trainer see how you think, not just what you did.
  • Read the capability descriptors. It takes 30 minutes and will transform your write-ups. Many trainees never read them. Don't be one of them.
  • Build a portfolio mindset. After each interesting case in clinic, ask yourself: "Would this make a good CbD?" Keep a running list in your phone notes — the human brain is not designed to remember things at 6pm on a Friday. 📱

🎯 The Trainer's Golden Rule

During the assessment phase — assess, don't teach. Teaching during assessment shifts the balance of the session, inflates time, and muddies the evidence. Flag teaching points and return to them in the feedback section. There is plenty of time there.

Think of it like a football referee who stops the match every five minutes to coach the players. The game never finishes, nobody knows what the score is, and everyone goes home confused. Referee first. Coach second. 🏈
📋

Before the CbD

  • Read the case notes and mapped capabilities
  • Use the CbD Question Maker if you need question ideas
  • Be familiar with what "Competent" looks like for each capability
  • Set the agenda at the start — agree capabilities to cover
👂

Active Listening

  • Listen to what the trainee says, not just planning your next question
  • Take notes as they speak — capture phrases to explore later
  • Watch non-verbal cues: hesitation, discomfort, over-confidence
  • Ask: "Do you believe them? Do their answers stack up?"
❓

Effective Questioning

  • Open questions first: "Tell me about your thinking when..."
  • Probe inconsistencies: "You said X earlier — but then you also said Y..."
  • Don't over-explore if you're satisfied — move on efficiently
  • Advanced skill: craft questions that explore 2+ capabilities at once
💬

Giving Feedback

  • Ask the trainee to self-reflect first: "How do you feel that went?"
  • Collate feedback into themes — not a long list of points
  • Specific feedback per capability with an agreed development action
  • Balance positive and developmental — this is formative assessment
🎓

Honesty Culture

  • Tell trainees from day one: "Be honest. We all forget things."
  • Normalise not knowing: it's safer than pretending
  • If you sense a trainee is embellishing — explore, don't accuse
  • "What exactly did you say to the patient about that?"
📱

Portfolio Entry

  • Record grades and narrative feedback on ePortfolio promptly
  • Specific feedback is more educational than "good effort"
  • Include agreed development actions — trainee should action these
  • Your assessor self-rating is also part of the quality process

Sample CbD Questions by Capability

These are starting points. The best questions emerge dynamically from what the trainee says.

Decision-Making and Diagnosis (DD) — Sample Questions ▼
  • Walk me through your reasoning — what was your first impression and how did it evolve?
  • What were the key differentials you were holding in mind?
  • Was there a moment of uncertainty? How did you manage that?
  • Were there any cognitive biases that might have influenced your thinking?
  • What would have made you more confident/less confident in your diagnosis?
  • How did you use time as a diagnostic tool in this case?
Medical Complexity (MC) — Sample Questions ▼
  • How did you manage the uncertainty in this case?
  • Were there competing priorities in this consultation — how did you balance them?
  • Were there any safeguarding considerations — even background ones?
  • How did you explain risk to this patient?
  • Were multiple services involved — how did you coordinate that?
  • Was there an opportunity for health promotion — realistic or not, why?
Community Health and Environmental Sustainability (CHES) — Sample Questions ▼
  • Do you know what resources are available in the community for this patient?
  • Does where this patient lives affect their health in any way?
  • Is this presentation common in your practice area — why might that be?
  • Did social determinants of health play a role in this case?
  • Are there any population-level implications of this case?
Holistic Practice, Health Promotion and Safeguarding (HPHS) — Sample Questions ▼
  • What did you understand about the patient's concerns and ideas about their condition?
  • Were there psychological aspects to this presentation? How did you address them?
  • How did the patient's social circumstances affect your management plan?
  • Did the patient's values and preferences influence your decisions?
  • Was this a truly shared decision — what did that look like in practice?

🏥 For Training Programme Directors

CbDs are a high-yield assessment tool when used well. They are also a sensitive indicator of trainees in difficulty. This section summarises key quality assurance considerations.
📊

Quality Assurance of CbDs

  • Review trainee portfolios at ARCP for CbD distribution and capability coverage
  • Calibration workshops help trainers apply grades consistently
  • Watch for trainers who consistently give "Excellent" across all capabilities — over-lenient assessment is unhelpful
  • Watch for portfolios with only "Competent" grades — are trainers challenging trainees appropriately?
🚨

CbDs as an Early Warning System

  • Repeated NFD in core capabilities across multiple CbDs is an early indicator of difficulty
  • Trainees using very simple cases may be avoiding complexity — explore this
  • Thin narrative feedback with no development actions suggests poor engagement from trainer or trainee
  • Late clustering of CbDs (all at end of rotation) indicates poor engagement
🎓

Trainer Development

  • New trainers benefit from using the CbD Question Maker initially
  • Model good CbD technique in faculty development workshops
  • Advanced trainers: practise crafting questions that probe 2+ capabilities simultaneously
  • Encourage trainers to read the capability descriptors annually — drift in standards is real
🌍

Supporting IMG Trainees

  • IMGs may be unfamiliar with this assessment format — explicit orientation is important
  • UK-specific capabilities (community orientation, NHS systems) need contextual teaching
  • Language complexity in feedback should be plain and clear
  • Culture of honesty in CbDs may need explicit encouragement in some training cultures
CbD Red FlagPossible MeaningTPD Action
All CbDs done in final 2 weeks of rotationPoor engagement; box-ticking; time-management concernsDiscuss at ES meeting; set calendar targets for next post
All cases are simple/straightforwardAvoidance of complexity; may reflect anxiety or lack of insightReview with trainer; encourage supported complex cases
Persistent NFD in same capability areaTrue capability gap; may indicate learning difficultyTargeted teaching plan; consider CSR discussion; involve supervisor
Only "Excellent" grades throughoutLenient assessment; calibration driftCalibration meeting with trainer; compare with other WPBAs
Very thin or generic portfolio feedbackTick-box approach from trainer; trainee disengagedFaculty development; provide feedback examples; mentoring

🌍 Welcome, International Medical Graduates

If you trained outside the UK, the CbD may be quite different from anything in your previous training. This section explains what makes the UK approach distinctive.

You have passed medical school, postgraduate exams, PLAB, and immigration paperwork. A CbD is not going to beat you. You've got this. 💪

What's Different About UK CbDs?

  • Not a knowledge test. In many countries, "case discussion" means demonstrating knowledge. UK CbDs assess your reasoning and professional judgement. (You will not be asked to recite the treatment algorithm for hypertension. You will be asked why you chose one approach over another for this particular person at this particular moment.)
  • Honesty is valued. Saying "I didn't know" or "I wasn't sure what to do" is respected. Bluffing is not.
  • Holistic thinking is expected. The UK expects you to consider psychological, social, and cultural factors alongside the medical problem.
  • Patient-centred language matters. "I told the patient to..." is weaker than "The patient and I agreed together to..."
  • Community context matters. You are expected to understand health inequalities and local population health.

Key UK-Specific Concepts

  • NICE guidelines — the primary evidence base for clinical management in the UK
  • Safety-netting — always part of the management plan; explicit in UK GP practice
  • Shared decision-making — patient autonomy is central; not just "doctor knows best"
  • NHS systems — understanding referral pathways, primary/secondary care boundaries, out-of-hours services
  • Mental health awareness — bio-psycho-social model is not optional; always consider mental health
  • GDPR & confidentiality — patient data must be shredded after CbD

🌟 IMG Quick Guide — "CARE" Framework for CbD

C
ContextAlways describe the patient in their full social, cultural and psychological context
A
AutonomyShow that you respected the patient's right to make their own decisions
R
ReasoningExplain your thought process — not just what you decided, but how you got there
E
EvidenceReference NICE guidelines, local protocols or clinical reasoning frameworks where relevant

💬 Common Language in UK GP CbDs

  • "I safety-netted the patient by..." (explained what to do if symptoms worsen)
  • "We made a shared decision to..." (patient involvement in management)
  • "I considered the patient's ICE (Ideas, Concerns, Expectations)..."
  • "This was an example of managing uncertainty because..."
  • "I used a System 2 approach to avoid anchoring on my initial impression..."
  • "I referred to NICE guidelines for [condition] and adjusted because..."
Preparation

Choosing the Right Case

Case selection is one of the most important decisions you make as a GP trainee. The right case can demonstrate multiple capabilities beautifully. The wrong case leaves trainer and trainee staring blankly at each other for 30 awkward minutes. (We have all been in that room. It is not fun.)

✅ Ideal CbD Case Features

  • Multiple contacts with the same patient over time
  • Clinical uncertainty or diagnostic challenge
  • Multimorbidity or complex social situation
  • Ethical dilemma or conflict of values
  • Involved coordination with specialists or community teams
  • You had to explain risk to the patient
  • Safeguarding concern — even a background one
  • A case where something didn't go to plan and you reflected on it

❌ Cases to Avoid (or Use Carefully)

  • Simple, single-consultation, straightforward presentations
  • Cases where another doctor made all the decisions
  • Pure prescribing follow-ups with no clinical complexity
  • Cases where you know nothing beyond the chief complaint
  • Cases you didn't really manage yourself independently

Case Ideas by Clinical Area

AreaGood CbD Case ExamplesWhy It Works
Mental HealthDepression with safeguarding concern; Psychosis first presentation; Alcohol dependency with liver diseaseMC, ethics, holistic thinking, community services
MultimorbidityElderly patient with diabetes, heart failure and cognitive impairment; Polypharmacy reviewComplexity, prioritisation, coordination, risk
PaediatricRecurrent A&E attendances for asthma; Child with unexplained weight loss; Safeguarding alertSafeguarding, community orientation, teamwork
End of LifePatient declining treatment; Breaking bad news; Carer stress and respite planningEthics, holistic, communication, community resources
Diagnostic UncertaintyUndifferentiated chest pain; Tiredness/fatigue workup; Medically unexplained symptomsDiagnostic reasoning, managing uncertainty, patient-centred
Chronic DiseasePoorly controlled T2 diabetes despite treatment; Non-adherent hypertension patient; Asthma review with occupational causeClinical management, health promotion, holistic
The Write-Up

How to Write Up Your CbD

⏱ Time Investment

A well-written CbD should take you at least 30 minutes. Not 10. Not 5. 30. The quality of your write-up directly determines the quality of the discussion that follows. Rushing this wastes everyone's time.

If your write-up took 8 minutes, your trainer will know. The write-up will be thin, your case description will be vague, and the whole discussion will feel like trying to have a conversation about a film that neither person has actually watched. Spend the 30 minutes. Honestly.

Two-Step Write-Up Process

1️⃣

Step 1: The Clinical Summary (Page 1)

  • Paste your consultation notes from SystmOne/EMIS — or write a brief summary in your own words
  • If you've seen the patient multiple times — include a brief overview of the full journey
  • Include: presenting complaint, PMH, medications, key examination findings, investigations, management plan, safety-netting
  • Attach a printed patient summary from your clinical system
2️⃣

Step 2: Capability Mapping (Page 2)

  • Select 3–4 capabilities your case demonstrates
  • For each one: write WHY and HOW the case provides evidence
  • Be specific — use quotes from the consultation if helpful
  • Avoid vague phrases like "I communicated well" — say HOW
  • Your trainer will grade these and may add 1 of their own

✏️ Strong vs Weak Write-Up: Comparison

Capability❌ Weak✅ Strong
DD"I considered asthma and COPD""Initial System 1 impression was COPD given smoking history. I used System 2 to consider reversibility — spirometry showed 15% reversibility. I held both diagnoses open and used time as a diagnostic tool: a 4-week SABA trial helped confirm asthma."
MC"Patient had multiple conditions""Managing diabetes in the context of renal impairment required me to deviate from standard NICE guidance. I documented my reasoning for this. I was uncertain about metformin dose and used the BNF and discussed with the pharmacist — an example of using the team to manage my uncertainty."
HPHS"I asked about how the patient was feeling""The patient's ICE revealed they feared a cancer diagnosis, which was driving their anxiety more than the symptoms themselves. I addressed this directly, which transformed the consultation from purely biomedical to genuinely holistic. We agreed on a management plan that addressed both the physical and psychological aspects."

📝 Management Plan — What Trainers Look For

  • Medical soundness — is the plan appropriate and evidence-based?
  • Justification — if you deviated from standard practice, explain why
  • Conciseness — bullet points are fine; no need for an essay
  • Safety-netting — ALWAYS include this where appropriate. Not everything needs safety-netting, but most GP cases do.
  • Example: "1. Amoxicillin 500mg TDS 5/7 (NICE guidance for acute otitis media) 2. Ibuprofen PRN for pain 3. Safety net: return if no improvement in 72h or if develops fever/hearing loss."

🔗 Use the Professional Capabilities Cheat Sheet

Bradford VTS has a detailed Professional Capabilities write-up guide which tells you exactly what to write for each capability. This is probably the single most useful tool for improving your CbD write-ups quickly. Visit: bradfordvts.co.uk/mrcgp/professional-capabilities/
Quick Reference

CbD Master Checklist

✅ Trainee Pre-CbD Checklist

  • Case has genuine clinical complexity
  • I managed this case independently
  • Write-up took at least 30 minutes
  • 3–4 capabilities mapped with specific justification
  • Shared with trainer ≥3 days before
  • Patient summary printed and attached
  • Management plan includes safety-netting
  • Patient details anonymised where needed

✅ Trainer Pre-CbD Checklist

  • Read the case notes and mapping in advance
  • Reviewed capability descriptors for mapped areas
  • Prepared questions (or reviewed Question Maker)
  • Scheduled at least 35 minutes protected time
  • Reminded trainee to be honest and reflective
  • Set agenda at start of session
  • Planned NOT to teach during assessment phase

✅ After the CbD — Both Parties

  • Trainer has graded each capability on ePortfolio
  • Specific narrative feedback entered (not just "good case")
  • Agreed development actions documented
  • Trainee has shredded all patient paperwork
  • Trainee has updated CbD capability mapping sheet
  • Trainee has identified next case to address capability gaps
Resources

Downloads & External Links

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For Trainees

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For Trainers

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External Links

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"Remember, the CbD is not a test to pass or fail. It's a structured educational conversation. It's a chance to hit the pause button on a busy day and think deeply about your patients with a more experienced colleague. Embrace the complexity, be honest in your reflections, and use the time to become the thoughtful, safe GP you're training to be."

Dr. Ramesh Mehay

Programme Director, Bradford VTS · Founder, Bradford VTS Online

We hope this guide helps. Good luck! 🌟

⚡ 60-Second Summary

A CbD is a structured one-to-one discussion about a real case you managed independently. It tests your professional judgement — the reasoning, values and holistic thinking behind your decisions. It is mapped to the 13 RCGP Professional Capabilities. You need 4 in ST1, 4 in ST2, and 5 CATs in ST3. Pick complex cases, write up carefully, be honest, and discuss your thinking — not just your actions. It is one of the most educationally powerful tools in GP training when done well.

If you've read this whole page and still feel nervous — that's completely normal. It means you care. And caring is the first step to doing it well. Now go book that CbD. 🏃

Bradford VTS — The universal GP training website for everyone, not just Bradford. Created by Dr Ramesh Mehay.

RCGP CbD Page  |  Professional Capabilities  |  Disclaimer

Content updated to reflect RCGP 2024–25 guidance. Always check the RCGP website for the most current requirements.

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