Workplace-Based Assessment
Case-Based Discussion (CBD)
These slides have been prepared to facilitate discussion on the use of the CBD.
The suggested practical group exercise at the end is designed to be used with a training video.
Overview
•
•
•
•
•
•
•
•
What is CBD?
Purposes of CBD
How does CBD work?
CBD settings
Who should use CBD?
CBD Competencies
CBD Form
CBD Blueprint
•
•
•
•
•
•
•
•
How many CBDs?
CBD validity and reliability
Preparation for the CBD
During the CBD
After the CBD
Group exercise
Other examples of CBD
Further Reading
What is CBD?
• Mandatory workplace assessment for learning
• An in-depth interview between a trainee and a senior
trainer
• Uses medical records as the basis for focussed discussion,
exploring the trainee’s knowledge, judgement and clinical
reasoning in the management of challenging cases
• Covers a range of clinical problems relevant to the stage of
training and specialty
• The focus of the discussion can be on any or all of record
keeping, clinical assessment, management and
professionalism
Purposes of CBD
• To provide feedback to help the trainee improve their
clinical judgement, decision making and professional skills
• To encourage a reflective approach to learning
• To help the trainee build evidence of their progress
• CBDs form one of the indicators that inform the AES’s end
of placement report for the ARCP
• Individual CBDs are not designed to sign off independent
practice.
CBD Competencies
•
•
•
•
•
•
•
•
•
Medical record keeping
Clinical assessment
Management and follow up planning
Professionalism
Diagnostic skills and underlying knowledge base
Clinical judgement and decision making
Communication and team working
Leadership
Reflective practice
How does CBD work?
• The trainee selects the medical notes from a few challenging,
complex or difficult cases from which the assessor can choose
• The trainee does most of the talking, taking the assessor through
the whole period of the case, explaining what happened and why.
• The assessor follows up with supplementary questions as
necessary
• The assessor and trainee make judgements about the
management of the case
• The assessor provides feedback on progress, covering strengths,
exploring development needs and agreeing action plans within a
feasible timescale.
• The CBD discussion is expected to take at least 30 minutes
CBD settings
CBD is one of a number of WBAs that should be undertaken
frequently with different assessors in different settings.
•
•
•
•
Case presentations to a departmental/hospital meeting
Patients seen in the outpatient clinic
Patients seen in A&E (especially if not admitted)
Patients managed during nights on-call when the trainee
may practice more independently
Who should use CBD?
Trainee
• CBD is applicable to trainees in all training stages
Assessor
• Consultants
• Senior trainees, more advanced than the assessee
• Senior SAS grade surgeons
Assessors must have received training in the tool and be
expert in the clinical problem/task
CBD Form
• Assessed against the end
point for the stage of training
• Relates to reflective writing
• Summary of clinical problem
• Focus of encounter
• Complexity of the case
• Competency areas
• 3-point rating scale
• Not assessed for areas not
in remit or not observed
• Area for written feedback
• 4-point global summary
• Trainee can add reflection
• Trainee can link to syllabus
CBD blueprint
Good Medical Practice
Assessment blueprints
help to ensure that
assessment methods are
mapped to the domains of
Good Medical Practice
and the surgical
curriculum.
A single method will
cover some domains and
the range of assessments
should cover all domains
** Directly assessed
*
Indirectly assessed
Knowledge
Skills and
Performance
Judgement
a) Maintain your professional
performance
*
**
*
b) Apply knowledge and experience
to practice
*
*
*
*
*
*
*
*
*
*
**
**
**
**
**
**
**
**
**
**
**
**
*
*
**
*
**
**
*
*
*
**
c) Keep clear, accurate and legible
records
Safety and
Quality
Communication
Partnership &
Teamwork
Maintaining
Trust
Curriculum
Knowledge
a) Put into effect systems to protect
patients and improve care
b) Respond to risks to safety
c) Protect patients and colleagues
from any risk posed by your
health
a) Communicate effectively
b) Work constructively with
colleagues and delegate
effectively
c) Establish and maintain
partnerships with patients
a) Show respect for patients
b) Treat patients and colleagues
fairly and without discrimination
c) Act with honesty and integrity
Technique
*
*
*
Professional
*
How many CBDs?
• To be used throughout surgical training
• The number will vary according to the trainee’s needs and
should be agreed with the trainee’s AES
• The majority should be completed with the CS in each
placement (with at least one with the AES)
• The JCST Quality Indicators state that training posts
should offer at least 40 WBAs per year, of which the CBD
should be of an equal proportion to other WBA methods.
This is checked at the ARCP
• Each surgical specialty or training region may also
recommend a specific number of CBDs
CBD validity and reliability
Validity and reliability is enhanced by:
•
•
•
•
•
•
•
Assessor training and trainee induction
Linking CBD to Learning Agreement objectives
Using trained and qualified assessors
Using CBD as an assessment for learning
Feedback addressing trainee development needs
Using CBD frequently throughout training
Increasing the complexity of the case according to the
trainee’s competence and progression
• Triangulation with other assessment methods
• Trainee reflection on feedback
Preparation for the CBD
Trainee:
• Arrange CBD with the assessor well in advance
• Arrange to have the form to hand, either printed or online
• Reflect on the case beforehand and bring a piece of
reflective writing to aid discussion
Assessor:
• Receive training in the tool
• Ensure it is a case with which you have expertise and be
familiar with the medical notes
Both:
• Make time and arrange a suitable quiet room so that there
are no distractions
• Agree the focus of the assessment
During the CBD
Trainee:
• Explain: The case and any complexities, the patient’s needs and
how they were attended to, your planning, decision making and
leadership, considerations, protocols, key people involved,
investigations and findings, methods for expanding your knowledge
and any research undertaken, any concerns etc.
• Reflect on: Links to other cases or events, rationale for your
assumptions. Your experience of handling data, information and
people etc. What went well, what you learned, further learning and
how you intend to achieve it.
Trainer:
• Use open questions to explore the reasoning behind actions and
decisions made e.g. What options did you consider?
What were the patient’s main concerns?
After the CBD
Trainee:
• Upload feedback to the portfolio accurately in good time
• Record any re-evaluation of your initial reflections in light
of the discussion (either in a private or portfolio area),
keeping confidential the details of patients and colleagues
• Follow up action plans
Trainer:
• Validate the assessment in good time
• If necessary, follow up on any actions agreed
• Discuss the trainee’s needs with the AES if necessary
Group exercise
Purpose: To practice rating CBD, discuss best practice and enhance consistency
Technique: With a group of new and experienced trainers:
1.
2.
Group discusses the meaning of the CBD competencies
Group views a CBD video (see ISCP CBD example videos)
http://www.iscp.ac.uk/surgical/assessment_discussion.aspx (pause at point of feedback in order to
discuss the trainee’s performance)
3.
4.
5.
Each trainer completes the CBD Form ratings and writes feedback comments
based on the video
Group compares ratings and discusses written feedback
Each trainer reflects on whether they would adjust their ratings/comments in
light of discussion
Repeat the exercise with another video (alternatively a case presentation or role play).
Further discussion:
• CBD uses and settings
• Different applications for early years and higher training
• Techniques for encouraging the trainee to speak openly
Further reading
1.
ISCP Guidance notes on using the CBD
https://www.iscp.ac.uk/static/public/cbd_guidance.pdf
2.
ISCP Guidance notes on using the Reflective CBD
https://www.iscp.ac.uk/static/public/reflective_cbd_guidance.pdf
3.
ISCP Tips for using CBD
https://www.iscp.ac.uk/static/public/cbd_tips.pdf
4.
Academy of Medical Royal Colleges: Improving Assessment
http://www.aomrc.org.uk/doc_view/49-improving-assessment