nMRCGP Case Based Discussion

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nMRCGPCase Based Discussion

• A Beginners guide

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Aims

• The aim of CbD is to enable an assessor to
  provide systematic assessment of the registrars
  performance and to give structured feedback

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Millers pyramid of clinical competence

Does
Shows
Knows how
Knows
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What?

• A structured interview designed to explore
  professional judgement in clinical cases

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What?

• Professional Judgement
• The ability to make holistic,balanced,and
  justifiable decisions in situations of complexity
  and uncertainty

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Attributes

• Application of medical knowledge
• Application of ethical frameworks
• Ability to prioritise, consider implications and
  justify decisions
• Recognising complexity and uncertainty

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Competency areas

• 10 out of 12
• Practising holistically
• Data gathering and interpretation
• Making decisions/diagnoses
• Clinical management
• Managing medical complexity
• Primary Care Administration (IMT)
• Working with colleagues
• Community orientation
• Maintaining an ethical approach
• Fitness to practice

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How?

• The Registrar will select three cases for the
  discussion and present to the trainer one week
  before the meeting
• Selection of cases needs careful consideration
  a balance of cases and contexts is required
• The trainer will select two of the cases for the
  discussion

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Getting Started

• The discussion will start from and be centred on
  the registrars record in the notes and is
  designed to assess clinical decision-making and
  the application of medical knowledge in the care
  of the registrars own patients.
• Quality of record keeping is important and should
  be assessed

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Getting started

• The trainer will use structured question guidance
  to develop appropriate questions to seek evidence
  indicating a level of performance
• Planning the questions in advance is important

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Proceeding

• 1 hour in total
• 20 minutes per case
• 10 minutes for feedback on each case with
  recommendations for change
• Record evidence elicited
• Judge the level of performance

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Concluding

• Make a judgement
• Needs further development
• Competent
• Excellent
• Repeat x2 in each four months

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From the pilots

• Registrars initially anxious but found it less
  stressful than current SA
• Valued feedback
• Realistic valid test of what we do everyday
• Would like more of it
• Concern re relationship with trainer

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From the pilots

• Trainers found it time consuming
• Need to protect more time for assessment
• Helpful structure
• May be more helpful in dealing with difficult
  registrars
• Concern re changed relationship with the
  registrar
• QA?

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What is important?

• Selecting the cases
• Quality of record keeping
• Planning the questions
• Documenting the outcomes
• Structured feedback

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And now

• Here is one we prepared earlier!

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