Cultivating General Practice in the Garden of England
Case-based discussion (CbD) is a structured interview designed to explore professional judgement exercised in clinical cases which have been selected by the GPStR and presented for evaluation. Evidence collected through CbD will support the judgements made about the GPStRs at the six monthly and final reviews throughout the entire programme of GP specialty training. The CbD tool has been designed to be used in both hospital and GP settings.
CbDs may be carried out by GP trainers or educational supervisors or clinical supervisors, according to the arrangements made in each deanery.
The GPStR is responsible for selecting cases, requesting a CbD and ensuring the paperwork is properly completed. The GPStR and the trainer should ensure that a balance of cases are represented including those involving children, mental health, cancer/palliative care and older adults, across varying contexts i.e. surgery, home visits and out-of-hours contacts.
In ST1 and 2, the GPStR will select two cases and present copies of the clinical entries and relevant records to the clinical supervisor or educational supervisor one week before the discussion. The clinical or educational supervisor selects one of the cases for discussion. The discussion should be framed around the actual case and should not explore hypothetical events. Questions should be designed to elicit evidence of competence and should not shift into a test of knowledge.
In ST3, the GPStR will select four cases and present copies of the clinical entries and relevant records to the trainer or educational supervisor one week before the discussion.
The trainer or educational supervisor selects one or two of the cases for discussion, depending on time available.
The trainer or educational supervisor records the evidence harvested for the CbD in the ePortfolio against the appropriate competence areas.
Trainers or educational supervisors should aim to cover as many competences as are relevant to each case and can be covered in the time frame. It is unreasonable to expect that all the competences will be covered in a single CbD but if too few are considered useful evidence will be overlooked and there would be inadequate sampling of all the competences. It is helpful to tell the GPStR at the beginning of the discussion which competence areas you expect to look at.
It is recommended that each discussion should take about thirty minutes, including the discussion itself, completing the rating form and giving feedback to the GPStR.
A minimum of six CbDs should be carried out in each of ST1 and ST2 (three before each six month review) and twelve CbDs should be carried out in ST3 (six before the six month review and six before the final review).
These minimum requirements apply whether the GPStR is in a placement in primary or secondary care and whether they are in full time training or less than full time training. More CbDs can be done if this is agreed between the trainer and the GPStR. There may be occasions, for example, when the GPStR is short of evidence in a particular competence area and another one or two CbDs might help to fill this gap.
Nav Chana, Patti Gardiner, Amar Rughani and Nicki Williams. Talking the Talk: using case-based discussion in medical assessments. London: Royal College of General Practitioners, 2007. This DVD and accompanying workbook on case-based discussion is on sale from the RCGP Bookshop.