1. MRCGP Case Based Discussion
A Beginner’s guide

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

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

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

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

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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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?

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