CbD for MRCGP Workplace Based Assessment

The Case-based Discussion (CbD) is a structured interview designed to assess your professional judgement in clinical cases. CbD is one of the tools used to collect evidence for your Trainee ePortfolio, as part of the Workplace Based Assessment component of the MRCGP exam.

How Case-based Discussion (CbD) works

The CbD tool has been designed to be used in both hospital and GP settings. For information about who can complete CbD, please see the guidance on who can act as an assessor for workplace based assessments.

Selecting cases for CbD

As a GP trainee, you're responsible for selecting cases, requesting a CbD and ensuring the paperwork is completed properly. You and your trainer should ensure that your ePortfolio reflects a balance of cases, including:

children
mental health
cancer and palliative care
older adults

Cases should also reflect different contexts: surgery, home visits and out-of-hours contacts. You can't include cases that have already been used as a debrief.

Specialty training years one and two (ST1 and ST2)

In ST1 and ST2, you'll select two cases. You present the clinical entries and relevant records to your clinical supervisor or educational supervisor one week before the discussion. Your clinical or educational supervisor selects one of these cases for discussion.

Specialty training year three (ST3)

In ST3, you'll present four cases to your trainer or educational supervisor one week before the discussion. They will select one or two for discussion.

What's covered in the discussion

The discussion is framed around the actual case rather than hypothetical events. Questions should be designed to elicit evidence of competence: the discussion should not shift into a test of knowledge.

Your trainer or educational supervisors will aim to cover as many relevant competences as possible in the time available. It's unrealistic to expect all competences to be covered in a single CbD, but if there are too few you won't have sufficient evidence of progress. It's helpful to establish at the start of the discussion which competence areas your trainer or supervisor is expecting to look at.

The trainer or educational supervisor records the evidence harvested for the CbD in the Trainee ePortfolio, against the appropriate competences.

It is recommended that each discussion should take about 30 minutes, including the discussion itself, completing the rating form and providing feedback.

When the CbDs happen

In full-time training you'll need to carry out a minimum of six CbDs in each of ST1 and ST2. In ST3, you carry out 12 CbDs.

These minimum requirements apply whether you're in a placement in primary or secondary care. You can do more CbDs if your trainer agrees - for example, if you're short of evidence in a particular competence area.

CbD form and guidance

Guidance for CbD [PDF]
Sample CbD form [PDF]

CbD question generators

CbD question generator for GPs [PDF]
CbD question generator for non-GPs [PDF]

CbD - Frequently Asked Questions

What is a CbD?

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.

How many CbDs am I required to do?

As an ST1/2 it is expected that you would only do CbDs. Trainees are expected to complete four CbDs in each training year (2 in each 6-month period for a full time trainee).

Do all the capabilities have to be graded in at least one CbD?

Ideally the CbDs will cover the full range of the capabilities providing triangulation of grades for each capability across a of 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.

Do I need to do a CbD for each of the Clinical Experience Groups?

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.

Is the number of CbDs required reduced for less than full time trainees?

The numbers required are prorata for less than full time trainees.

How many capabilities and Clinical Experience Groups can be linked to each CbD?

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.

Can all the CbDs in ST1 and ST2 be done in one tutorial?

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.

How long will it take to complete a CbD?

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.

Do I have to give my assessor details of the case in advance?

Yes. 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.

Can I be asked about theoretical situations rather than just the case I managed?

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.

Do I need to provide cases of varying complexity?

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.