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WPBA: Case-Based Discussion (CbD)

The CbD is a structured oral interview designed to assess your professional judgment in a clinical case. The assessment assesses your performance against the Capabilities and looks at how you made holistic, balanced and justifiable decisions in relation to patient care. It assesses your understanding and application of medical knowledge, ethical frameworks, ability to prioritise and how you recognised and approached the complexity and uncertainty of the consultation.

How to complete a CbD

CbDs can be carried out in hospital by Clinical Supervisors (which is best practice), by doctors who are ST4 or above, or Specialist and Associate Specialist (SAS) doctors with equivalent experience who have met the GMC assessor requirements. You choose who undertakes your CbDs. You are encouraged to complete assessments with a range of assessors. Your named Clinical Supervisor should complete at least one CbD during each rotation. Within primary care placements in ST1/2, your assessors will be approved GP Clinical/Educational Supervisors who have met the GMC standards.

Protected time is needed for the assessment.

The case should be one that you have managed independently. It is NOT appropriate to have received advice from another doctor for the consultation and then to be assessed on actions taken by that other doctor.

You need to share the clinical entry with your supervisor before the assessment so they can familiarise themselves with the case.

Before the assessment you will need to map the case to up to three Capability areas as you will be discussing these areas during the assessment. It is these Capabilities your supervisor will grade. The Capabilities should not necessarily be those that you covered well, as more useful learning can be achieved by choosing areas that you found challenging. You also need to be aware of the Capabilities you have chosen in previous assessments to ensure you cover the range of Capabilities during your training. Your supervisor can support you in case and Capability selection if you are unsure how to do this.

The RCGP has produced questions to support assessors in assessing the Capabilities and it would be useful for you have a look at these prior to your assessment.

The CbD discussion should normally take no longer than 30 minutes for your discussion and your supervisor’s feedback. During the discussion, if your supervisor feels any other Capabilities have been covered, these can be added to the assessment form.

Your supervisor will then complete the assessment form within your Portfolio. Each of the discussed Capability areas will be graded. Your supervisor will document their feedback on your performance and their justification for their grades as well as their recommendations for further development.

Some assessors will have full access to your Portfolio but in non-primary care settings you may need to send them a ticket code to enable the assessment form to be completed. In this situation, having ideally agreed a mutually appropriate time to complete an assessment, it is preferable to send the ticket code in advance to your assessor.

To use the ticketed feedback system you need to click on ‘generate a new ticket’ within the Portfolio after which the ‘generate a new ticket’ page will appear. You select the ‘CbD assessment form’ and complete your assessor’s details. An email will then be sent providing a login code for the assessor to use to complete the ticketed CbD assessment form.

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Case-Based Discussion (CbD) FAQs

CbD stands for case-based discussion. These are structured interviews that you have with your Educational Supervisor (ES). They are designed to explore the professional judgements you have made in clinical cases. You select the case you want to discuss with your assessor and prepare the case against 3 or 4 relevant Capability areas.

Trainees are expected to complete four CbDs in each training year (2 in each 6-month period for a full-time trainee). The numbers of CbDs required are pro rata for less than full time trainees.

Ideally the CbDs will cover the full range of the Capabilities providing triangulation of grades for each Capability across a range of different assessment methods. It is expected that all Capabilities will have been assessed using a formal assessment tool at least once in the three-year training period but not all need to be done within a CbD. You will have, prior to the CbD, prepared up to 3 Capability areas you wish to discuss with your supervisor.

It is expected that the CbDs will cover the range of Clinical Experience Groups. While it is not mandatory to have a CbD for each Clinical Experience Group, a range of types of assessment and information will need to be provided in the Portfolio to show exposure to, learning from, and competence in caring for, the range of Clinical Experience Groups across each training year. All Clinical Experience Groups should be covered by the range of assessments completed.

It is expected that a maximum of 3 Capabilities and 2 Clinical Experience Groups be linked to each CbD so that in-depth reflection and meaningful feedback is given for each. Separate assessments can be used if the assessment covers a larger number of either.

No. it is expected that the assessments will be spread over time to demonstrate that you are progressing. The number of assessments stated are a minimum and if you are not demonstrating the grade expected for your level of training, additional assessments should be completed.

This will depend on the complexity of the case. A CbD usually takes between 20-30 minutes. The time for each assessment will depend on the content and the discussion you have with your supervisor.

You can only be assessed on the case if you have prepared the case and stated which of the Capabilities you feel you have demonstrated in advance of the discussion.

The assessment is about what you actually did so that your performance in the Capability being reviewed can be assessed. However, for some more difficult Capabilities it may be necessary to add hypothetical challenge to assess your knowledge, for example with regard to ethics or fitness to practice. The assessment is most robust when based on what you actually did in that case.

Yes. It is expected that you will be assessed in a range of cases that cover varying complexities. You will be asked to bring more complex cases if all those you bring are of low challenge.