Competency Based Fellowship Program (CBFP) Case-based Discussion (CbD)

Competency Based Fellowship Program (CBFP) (Ideally) the trainee will have managed several cases Records of four cases to be chosen by the trainee (suitable to the assessor’s area of expertise)

Competency Based Fellowship Program (CBFP) The trainee has been directly involved in the chosen cases and has contributed to the notes The assessor chooses one of the four cases for the trainee to explain in detail An assessment of the Trainee’s work, supervisor teaching deferred till feedback.

Competency Based Fellowship Program (CBFP) The trainee presents the relevant aspects of the case (15-20 minutes) The assessor prompts on further discussion points Feedback occurs immediately Followed by discussion and reflection CbD completed in one 60 minute supervision session or less

Competency Based Fellowship Program (CBFP) Prompts for assessors are supplied as suggestions only, e.g: What specific features led you to this impression/conclusion or diagnosis? What other conditions have you considered/ruled out? What specific features led you to the management/therapy that you chose?

Competency Based Fellowship Program (CBFP) The CbD assesses: clinical reasoning decision making the integration of medical knowledge within case management and the trainee’s ability to document this

Competency Based Fellowship Program (CBFP) Examples of Stage 1 CbD’s: Mental health legislation Acute management / Psychiatric emergency Safe Prescribing Multicultural skills Consumer / Carer/ NGO Risk assessment

Competency Based Fellowship Program (CBFP) Examples of Stage 2 CbD’s: Report writing Formulation Acute management (CL, CAP, ADD) Safe prescribing (CL, CAP, POA) Multicultural skills NGO

Competency Based Fellowship Program (CBFP) “Indicate” (on form) “the activity assessed” Assessment or management of : emergency (acute psychosis, suicidal feelings and acts); High or low prevalence condition Severe and enduring illness Clinical review or Assessment of response Informed consent Other (specify):

Competency Based Fellowship Program (CBFP) Dimensions of CbD Assessment (1) Clinical record keeping: Legible, structured, signed, clear and comprehensible with no important omissions. Clinical assessment: Appropriate support for diagnosis and differential diagnoses.

Competency Based Fellowship Program (CBFP) Dimensions of CbD Assessment (2) Risk assessment and management: Medical treatment: Adequate and appropriate. Investigation: Includes talking to relevant informants.

Competency Based Fellowship Program (CBFP) Dimensions of CbD Assessment (3) Referral: When required. Follow-up, care planning and transfer of care: Appropriate arrangements made, recorded & communicated.

Competency Based Fellowship Program (CBFP) Dimensions of CbD Assessment(4) Professionalism: Appropriate professional standards demonstrated in all aspects of the case. Clinical reasoning: Good, logical clinical reasoning and appropriate decision-making.

Competency Based Fellowship Program (CBFP) CbD Assessment Summary Up to 9 dimensions Clinical record keeping Clinical assessment Risk assessment and management Medical treatment Investigation Referral Follow-up, care planning & transfer of care Professionalism Clinical reasoning

Competency Based Fellowship Program (CBFP) Rating Rating relevant to each stage (1,2,3) 1-9 scale: (1 2 3) ‘Below Standard’ (4 5 6) ‘Meets Standard’ (7 8 9) ‘Above Standard’ What areas has the trainee to improve on to reach the desired standard ?

Competency Based Fellowship Program (CBFP) Feedback Anything especially good? Suggestions for improvement Agreed action/goals: