Some ideas about Case Based Discussions
CBD and RCGP Curriculum
The Domains:
Related competency areas:
Primary care management
Clinical management
Working with colleagues and in teams
Primary care administration and IM&T
Communication and consulting skills
Data gathering and interpretation
Person-centred care
Specific problem-solving
skills
A comprehensive approach
Community orientation
A holistic approach
Essential Features:
Contextual features
Attitudinal features
Scientific features
Assessments:
AKT
CSA
WPBA
knows shows does
Making a diagnosis/making decisions
Managing medical complexity
Community orientation
Practising holistically
Community orientation
Maintaining ethical approach to practice
Fitness to practise
Maintain performance, learning,
teaching
Competencies: developing skills
Managing medical complexity
This competency is about aspects of care beyond managing straightforward problems, including
management of co-morbidity, uncertainty, risk, and an approach to health rather than illness.
Theme
Needs Further
Development
Manages health problems
separately, without
necessarily considering
the implications of
co-morbidity.
Competent
Excellent
Simultaneously
manages the patient’s
health problems, both
acute and chronic.
Accepts responsibility for
coordinating the
management of the
patient’s acute and chronic
problems over time.
Assessing and
managing
clinical risk
Appropriately prioritises
management approaches,
based on an assessment
of patient risk.
Is able to tolerate
uncertainty, including
that experienced by
the patient, where
this is unavoidable.
Anticipates and uses
strategies for managing
uncertainty.
Health
promotion
Maintains a positive
attitude to the patient’s
health.
Consistently
encourages
improvement and
rehabilitation and,
where appropriate,
recovery.
Coordinates a team based
approach to health
promotion, prevention,
cure, care and palliation
and rehabilitation.
Managing
several
problems
together
Notes about Case Based Discussions collated by Damian Kenny www.damiankenny.co.uk
Data gathering and interpretation
This competency is about the gathering and use of data for clinical judgement, the choice of
examination and investigations and their interpretation.
Theme
Needs Further
Development
Competent
Excellent
Gathering
information
verbally
Obtains information
from the patient that is
relevant to their
problem.
Systematically gathers
information, using
questions appropriately
targeted to the
problem.
Proficiently identifies
the nature and scope
of enquiry needed to
investigate the
problem.
Gathering
information
from
examination
Employs examinations
and investigations that
are broadly in line with
the patient’s problem.
Chooses examinations
and targets
investigations
appropriately.
Uses an incremental
approach, basing
further enquiries,
examinations and
tests on what is
already known …
Some ideas about doing a Case Based Discussion (CBD)
By specifying the required behaviours in the curriculum, competencies and word pictures,
Registrars know what they are expected to do to demonstrate that they are competent in each
area.
Case Based Discussion is about exploring how the Registrar thinks and behaves, with reference
to the various aspects of the GP curriculum.
How to do a CBD
1. preparation, present 4 cases, choose 1 or 2 (in ST1 and ST2 they present 2 cases and
choose 1)
2. choose a case which will demonstrate some competencies, initially choosing randomly,
later targeting choice to cover missing competencies, or areas of weakness
3. use competency descriptor, word pictures and question planner to design questions
4. use the planning document to write down some suitable questions
5. do the CBD
6. start with brief description of the case, 15 seconds, review the notes
7. this is a discussion of what actually happened, not a hypothetical discussion
8. push the registrar to her limit, to demonstrate the highest level of the competence
9. note areas of weakness but do not discuss or teach these during the CBD
Notes about Case Based Discussions collated by Damian Kenny www.damiankenny.co.uk
10. jointly assess the level of competence, using the word pictures, agree some areas for
development, record in e-portfolio
11. now have teaching discussion, using areas of weakness noted during the CBD
12. essential to separate the assessment part of the CBD, with the discussion afterwards which
involves teaching and planning for further learning
13. use the CBD grid to note progress, and help select competencies for future CBD
Some tips for making CBD effective
ES uses questions containing the word “you”
ES uses verbs rather than nouns when probing what the Registrar thought and did
Registrar selects cases which show how she demonstrated particular competencies
Remember that a CBD is talking about the Registrar - compare and contrast with a case
discussion which talks about the patient
?? ICE ! ** ?
∆ “ * + ”?? !!
The ES is exploring what is/was
going on in the Registrar’s head
when he was consulting.
Some good web resources about CBD and other aspects of Training GPs:
Workplace based Learning for General Practice: www.wpba4gps.co.uk
Bradford VTS website: www.bradfordvts.co.uk
The Essential Handbook of GP Training and Education: www.essentialgptrainingbook.com
Notes about Case Based Discussions collated by Damian Kenny www.damiankenny.co.uk