Case Based Discussion

Case-based discussion (CbD) is a structured interview designed to explore professional judgement exercised in clinical cases which have been selected by the GP trainee and presented for evaluation. Evidence collected through CbD interviews (called ‘Discussions’ below) will support the judgements made about trainees at the interim and final reviews throughout the entire programme of GP training. The CbD tool has been designed to be used in both hospital and GP settings.

Professional judgement may be considered as the ability to make holistic, balanced and justifiable decisions in situations of complexity and uncertainty. It may include the ability to make rational decisions in the absence of complete information or evidence, and to take action or even do nothing in such situations. It requires a selection of attributes: recognising uncertainty/complexity, application or use of medical knowledge, application or use of ethical and legal frameworks, ability to prioritise options, consider implications and justify decisions.

How to start

The GP trainee is responsible for selecting cases, organising the Discussion and ensuring the paperwork is properly completed.
The trainee 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.

How many cases should be discussed?

Years ST1 and ST2

For each Discussion the trainee will select two cases and present copies of the clinical entries and relevant records to the assessor one week before the discussion.
The assessor selects one of the cases for discussion.

Prior to each interim review, discussions of a minimum of 3 cases should have taken place, discussing 3 out of 6 cases. There will 2 reviews each year, and therefore a minimum of 6 cases each year.

Year ST3

For each Discussion the trainee will select four cases and present copies of the clinical entries and relevant records to the assessor one week before the discussion.
The assessor selects one or two of the cases for each session, depending on time available.

Prior to the 30 month review, discussions of a minimum of 6 cases should have taken place. If one case is discussed at each session, then there would have been 6 cases from a possible 24 during the six months If two cases are discussed at each session, then there would have been 6 cases from a possible 12.

Prior to the final review, discussions of a minimum of 6 more cases should have taken place, discussing 6 more cases from a possible 24.