3.1 The purpose of case-based discussions


3.1 The purpose of case-based discussions

  • Case-based discussions (CBDs) were designed to assess the clinical reasoning of doctors in training. This assessment type has been adopted and contextualised by training programmes for a range of healthcare professionals, including programmes delivered by the School. For School programmes, CBDs are used to assess the professional and clinical judgement and the synthesis and application of scientific knowledge required for post-programme practice.
  • The assessment focuses on a trainee’s application of professional judgement during their practice and therefore represents an authentic exploration of the trainees’ skills, behaviours, and attitudes. Trainees are invited to critically reflect on a case, demonstrating and justifying their problem-solving and decision-making processes and their application of knowledge. The purpose of CBDs is therefore to ensure trainees can exercise the professional and clinical judgement and apply the problem solving and decision-making skills expected for post-programme practice.

CBD uses the records and investigations of a case for which the trainee has been directly responsible as the basis for dialogue between the trainee and the assessor, (…) to explore the knowledge, judgement and clinical reasoning of that trainee. More complex cases are used as training progresses. All aspects of diagnosis, assessment and management of a case, including ethical and professional aspects such as the quality of the record keeping and presentation can be explored. CBD is not an assessment solely of factual knowledge.

Guidance for using the Case-Based Discussion (CBD) (2015), Intercollegiate Surgical Curriculum Programme (ISCP).

Case-based discussion is an assessment instrument that probes the doctor’s clinical reasoning; it may be described as a structured interview designed to explore professional judgement exercised in clinical cases. Professional judgement may be considered as the ability to make holistic, balanced, and justifiable decisions in situations of complexity and uncertainty. Case-based discussion can explore a full range of these issues, such as the ability to recognise dilemmas, see a range of options, weight these options, decide on a course of action, explain the course of action and assess its results.

Brown, N., Holsgrove, G., & Teeluckdharry, S. (2011). Case-based discussion. Advances in Psychiatric Treatment, 17(2), 85-90. doi:10.1192/apt.bp.107.003939

3.1.1 Application of case-based discussions to School programmes

  • Completion of CBDs throughout each phase of the programme assesses trainees’ learning and development. Completion of CBDs is documented in the trainee’s e-portfolio.
  • CBDs are required for all rotation and specialty modules and some core modules. The number of CBDs required for successful completion of each module is specified by the specialty curriculum. Trainees must pass the specified number of case-based discussions to complete each module of the programme.
  • CBDs assess trainees’ learning from the module they are submitted for. Trainees develop their skills through completing training activities specified for the module, CBDs allow trainees to showcase the skills they have acquired from the module to an assessor in person.