3.2 Completing case-based discussions
- A CBD focuses on a case featuring an element of a trainee’s practice, identified and presented by the trainee, as the basis for a structured, synchronous conversation between the trainee and an assessor.
- The case presented by the trainee should relate to the content of the module the CBD is submitted for. The aim of the CBD is to allow the trainee to demonstrate the skills and apply the knowledge they have acquired completing the module. The trainee should therefore be sufficiently comfortable with the module content to allow them to draw on the full range of skills and applied knowledge when they attempt a CBD.
- Trainees should be supported to complete CBDs to meet the progression requirements of the programme. The time taken to arrange and undertaken a CBD should be considered and planned for to enable trainees to meet their progression requirements
- It is good practice for trainees and training officers to discuss the trainee’s readiness to undertake a CBD before arranging an assessment.
3.2.1 Identifying a case
- A case is a piece of work related to the content of the module for which the CBD is being submitted. When CBDs are applied to medical training a ‘case’ refers to a patient case. However, for trainees on School programmes it would be more appropriate to think of a ‘case study’ or ‘showcase’ of an element of the trainee’s practice. The case does not need to feature a patient but does ultimately, need to contribute to patient care.
- It is good practice for trainees to discuss the suitability of a case with their training officer and/or assessor before submitting the case for a CBD.
- Cases may have been included in evidence for training activities.
- A case may be submitted for one CBD only. A single case may not be submitted for multiple CBDs.
- A case may be a part of a larger piece of work or project. Multiple discrete elements of the work or project can be selected to be presented for individual CBDs. Each case should showcase a different element of the work or project.
- Any reasonable adjustment made to facilitate trainee’s practice in the workplace should also be applied to the practice presented in a case. The reasonable adjustment is not subject to critique or assessment.
3.2.1.1 Identifying a case for module types
Rotations
- For rotation CBDs trainees should explore a case that they have observed in part or wholly as part of their training activities supported by local records where needed, or a case drawn solely from local records or from the literature.
- The case should provide enough information for the trainee to be able to identify the rationale for the clinical decisions made by applying their own knowledge and understanding to the case.
- Rotation modules include knowledge provided by the academic component of the programme and reflection on observations made in the workplace. At this stage in the programme trainees have no or limited hands-on practice which can be assessed and are therefore not in a position to demonstrate their own problem-solving and decision-making processes.
Specialty and Core modules
- For specialty modules, trainees should identify a case from their own practice related to the content of the module the CBD is submitted for.
- For core modules, the primary focus of the case should be on the application of professional judgement and applied professional knowledge.
- Trainees should have had significant responsibility for the case they are presenting. Trainees may have worked alongside, referred to or been supported by other healthcare professionals while working on the case, recognising trainees are not yet practising independently. In preparing the case, trainees should be able to identify where they have taken personal responsibility for the work carried out.
- As the purpose of a CBD is to assess professional and clinical judgement and application of knowledge, trainees should choose a case which will allow them to showcase these skills. Cases which challenged the trainee – for example, where something didn’t go to plan and required the trainee to apply their knowledge to solve problems and navigate decisions – may make good cases to allow trainees to showcase their skills. A case does not need to showcase ‘perfect’ practice. The aim a CBD is to assess trainees’ skills, behaviours and attitudes as applied authentically in practice with all the associated challenges, complications and nuances that involves.
3.2.2 Presenting a case
- Trainees should prepare a concise overview of the case to be discussed. The overview should provide enough information for the assessors to understand the basis of the case.
- It is good practice for the overview to be no more than three pages or slides.
- The overview should not require significant additional preparation. The aim is not to provide every detail of the case, or to document in detail all of the decisions made in the practice. These will be explored in greater detail in the discussion. Trainees should provide an outline of a scenario and a brief indication of their role and decision-making within it.
- Working documents generated in practice are ideal to share with assessors to outline the case. Additional notes may be required in order to give context. Patient-identifiable details should be removed and patient confidentiality preserved in any working documents submitted.
- The overview should be shared with assessor(s) at least five working days before the CBD takes place.
- Generative artificial intelligence should not be used to present cases. The case presented may include the used of generative artificial intelligence where it is appropriate to practice and acceptable to the workplace; i.e., where it used as a tool used to do the job. Any use of generative artificial intelligence should be clearly acknowledged.
3.2.3 The discussion
- The discussion should take the form of a structured conversation exploring the case, led by the assessor. The discussion should take a minimum of 30 minutes and a maximum of an hour.
- A maximum of two assessors can assess a CBD.
- It is good practice to involve different assessors across the required number of CBDs to get a range of opinions and feedback on the trainee’s practice, particularly for areas of practice where assessors with specialist knowledge may be required. It may also be useful to involve external assessors, e.g. an assessor from a training centre or department not routinely involved in providing training to the trainee. This broader perspective on the trainee’s practice may be beneficial for development and helpful preparation for their final assessment.
- Trainees may have a copy of the case overview presented for discussion with them during the assessment but may not refer to other sources of information. The assessment is a test of problem-solving, decision making and the application of knowledge, not solely a test of knowledge recall. Where it forms part of the discussion, it is acceptable for a trainee to explain where they would find information and how they would apply it. They do not need to supply the actual information itself.
- The time allowed for a CBD can be extended where more time is required to facilitate a trainee’s engagement with the assessment.
- A trainee may request that their training officer, or another person involved in their training, is with them during the assessment for support. This person’s presence at the assessment is only to facilitate the trainee’s engagement with the assessment, they may not contribute to the trainee’s responses and may not contest the outcome of the assessment determined by the assessor.
- Case-based discussions are synchronous conversations between an assessor and a trainee. It is expected most CBDs will be carried out by the trainee and assessor speaking to each other either in person or in a virtual environment. Where necessary to facilitate a trainee’s engagement with this assessment type, reasonable adjustments applied in the workplace to allow trainees to communicate using other methods of real time communication may also be applied to CBDs. In all CBDs, assessors must be assured that the trainee’s responses to questions are their own.
- To facilitate the training of new assessors, assessments can be observed with the agreement of the trainee and the assessor conducting the assessment. Observers must not interfere with or disrupt the assessment and cannot contest the outcome of the assessment determined by the assessor. The presence of an observer should not have a detrimental impact on the trainee performance in the assessment.
the dialogue should exercise the trainee, determine the depth and breadth of their knowledge and their ability to apply that knowledge sensibly
Guidance for using the Case-Based Discussion (CBD) (2015), Intercollegiate Surgical Curriculum Programme (ISCP).
3.2.4 Case-based discussion outcomes
- Trainees need to meet the criteria outlined in the CBD marking form to achieve a pass outcome. The marking criteria reflect the expectations for the trainee’s stage of practice; there is a mark form for rotation modules, and a mark form for specialty and core modules.
- For all CBDs undertaken, a mark form should be completed, and the outcome logged in the e-portfolio regardless of whether the outcome is a pass or a fail.
- Where the outcome of a CBD is fail, feedback provided by assessors can be used to improve practice and guide a plan for re-attempting the assessment.