Case Based Discussion Scoring Form
Case Number:
Assessor:
Candidate Name:
Age & Gender of Patient:
Clinical Context
Brief Description of Case:
Setting
Medical centre / Office
based practice
Hospital
Residential aged care
Aboriginal Medical
Service
Other (please specify) ________________________________________________________________
Location
RA 5 – Very Remote
Australia
RA 4 – Remote
Australia
RA 3 – Outer Regional
RA 1 & 2 – Inner
regional or major city
Other (please specify) ________________________________________________________________
Presentation
New patient to this practice
New patient for this doctor but
been at this practice before
Returning patient with new
problem
Returning patient with chronic
disease and a new problem
Review of an acute problem
Review of chronic disease
Other (please specify) ________________________________________________________________
Case Focus
Communication
Skills
History Taking
Physical
Examination
Clinical Management in
Rural/Remote Context
Professionalism
Other (please specify) ________________________________________________________________
Case Based Discussion Assessor Scoring Form
November 2015
Curriculum Statements* (tick all that apply)
Aboriginal & Torres Strait Islander Health
Obstetrics & Women’s Health
Adult Internal Medicine
Ophthalmology
Aged Care
Oral Health
Anaesthetics
Palliative Medicine
Child & Adolescent Health
Radiology
Dermatology
Rehabilitation Medicine
Mental Health
Surgery
Musculoskeletal Medicine
Other, please specify: _____________________
*Candidates must complete a minimum of six different curriculum statements over three CBD sessions, one
case must be in mental health.
Domains of Practice
Domain
Observed
Not Observed
Unsatisfactory
Not Observed
Provide medical care in the ambulatory and community
setting
Provide care in the hospital setting
Respond to medical emergencies
Apply a population health approach
Address the health care needs of culturally diverse and
disadvantaged groups
Practise medicine within an ethical, intellectual and
professional framework
Practise medicine in the rural and remote context:
Scoring
Area of Assessment
Satisfactory
Communication Skills
History Taking
Physical Examination
Clinical Management in
Rural/Remote Context
Professionalism
Case Based Discussion Assessor Scoring Form
November 2015
Global CBD Rating
At expected standard for FACRRM
Below expected standard for FACRRM
At expected standard for FACRRM:
 Overall approach systematic and consistently competent across marking categories. Has made clear
efforts to ensure patient comfort and safety and to reduce risks where appropriate.
 Communication skills effective.
 Diagnosis sound and based on information gathered.
 Appropriate history and examination undertaken.
 Relevant further tests arranged to confirm diagnosis as required.
 Management appropriate and includes short and some long-term recommendations based on
information gathered. Patient involved in decision making.
Assessors Global Comments
Assessors signature: __________________________________ Date: __/__/____
Were there any technical, or any other issues with the discussion:
Yes
No
If yes, please describe below the problems experienced: ________________________________________
_____________________________________________________________________________________
Case Based Discussion Assessor Scoring Form
November 2015