MRCGP Case Based Discussion A Beginner’s guide

Aims “The aim of CbD is to enable an assessor to provide systematic assessment of the registrar’s performance and to give structured feedback”

Miller’s pyramid of clinical competence Does Shows Knows how Knows

What? A structured interview designed to explore professional judgement in clinical cases

What? Professional Judgement: The ability to make holistic,balanced,and justifiable decisions in situations of complexity and uncertainty

Attributes Application of medical knowledge Application of ethical frameworks Ability to prioritise, consider implications and justify decisions Recognising complexity and uncertainty

Competency areas 10 out of 12 Practising holistically Data gathering and interpretation Making decisions/diagnoses Clinical management Managing medical complexity Primary Care Administration (IMT) Working with colleagues Community orientation Maintaining an ethical approach Fitness to practice

How? The Registrar will select three cases for the discussion and present to the trainer one week before the meeting Selection of cases needs careful consideration – a balance of cases and contexts is required The trainer will select two of the cases for the discussion

Getting Started “The discussion will start from and be centred on the registrar’s record in the notes and is designed to assess clinical decision-making and the application of medical knowledge in the care of the registrar’s own patients.” Quality of record keeping is important and should be assessed

Getting started The trainer will use structured question guidance to develop appropriate questions to seek evidence indicating a level of performance Planning the questions in advance is important

Proceeding 1 hour in total 20 minutes per case 10 minutes for feedback on each case with recommendations for change Record evidence elicited Judge the level of performance

Concluding Make a judgement Needs further development Competent Excellent Repeat x2 in each four months

From the pilots Registrars initially anxious but found it less stressful than current SA Valued feedback Realistic – valid test of “what we do everyday” Would like more of it Concern re relationship with trainer

From the pilots Trainers found it time consuming Need to protect more time for assessment Helpful structure May be more helpful in dealing with difficult registrars Concern re changed relationship with the registrar QA?

What is important? Selecting the cases Quality of record keeping Planning the questions Documenting the outcomes Structured feedback