1. CASE BASED DISCUSSION UPPING YOUR GAME AUGUST 2015

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

3. Miller’s pyramid of clinical competence Does Knows how Shows Knows CBD/ COT CSA AKT

4. What is a CBD? A structured interview designed to explore professional judgement in clinical cases

5. Professional judgement: The ability to make holistic, balanced, and justifiable decisions in situations of complexity and uncertainty

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

7. Competency Areas Covered 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

8. How is it done? The trainee selects 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

9. 9 https://www.youtube.com/watch?v=4eVK4M50j3E

10. How To Choose A Case 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 can be difficult to demonstrate excellence, because the level of challenge might be low be courageous and pick patients that were challenging, difficult, hard work, complex or interesting complex cases often help furnish strong evidence for a number of competency areas 10

11. Keep a separate record of your CBDs 11

13. How To Do Well Provide a commentary, or summary, of why you chose that case and indicate which competences you think the case allows you to demonstrate. Submit the relevant clinical records Use the Bradford VTS CBD summary template Only pick 3-4 competencies Pick the 4 that you think demonstrate your strongest points OR alternatively are areas that are currently weak in your ePortfolio and that you need more evidence of 13

14. 14 Prepare Your Paperwork To Make It Easy For Your ES To Assess You Highly…

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

19. Know The Marking Scheme

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

21. 21 http://www.wpba4gps.co.uk/training/case-based-discussion/cbd-in-action/ https://www.youtube.com/user/rcgpwork/videos