3.3 Case-based discussion roles and responsibilities

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3.3.1 Training officer responsibilities

Training officers are responsible for facilitating completion of CBDs.

Training officers should support trainees to be ready to undertake CBDs. This may include discussing the suitability of cases for presentation and trainees’ expectations and understanding of the requirements of assessment.
Where assessment of CBDs is delegated, training officers must ensure that assessors have the appropriate skills and knowledge to assess the activity. Training officers are responsible for approving nominated assessors in OneFile.
Feedback from CBDs, particularly failed attempts, may be helpful to identify training needs. Training officers should adapt support and plans for training to allow trainees to develop their practice appropriately in response to feedback.
- If a training officer receives feedback that identifies a safety issue for patients, employees or the trainee themselves they should follow all appropriate routes to manage the issue. Where the issue impacts the trainee’s safety or ability to train, they should also raise this with the School.

3.3.2 Assessor responsibilities

Assessors are responsible for conducting CBDs, completing the mark form, including providing constructive feedback and determining an outcome for the assessment. Assessors must record the outcome of the assessment in the e-portfolio.
Assessors should hold appropriate registration or accreditation for the programme such as Clinical Scientist or be of equivalent standing within the profession with experience of the level of specialty practice expected post-programme.
Assessors should have experience of applying their own profession and clinical judgement, problem solving and decision-making skills to the area of practice presented in the case.
Current trainees cannot act as assessors for other trainees.
Where assessors have concerns about the trainee’s practice, they should raise these concerns with the training officer and where relevant, other people responsible for training in the department, to allow support to be put in place and/or the issue to be addressed locally.
Assessors must be aware that they are exercising a professional responsibility when engaging with assessment and passing judgement on trainees’ performance. Assessors must adhere to their own professional standards and responsibilities as an employee and registrant where applicable, including raising critical issues in practice or performance through the appropriate routes.

3.3.2.1 Assessor preparation for case-based discussions

In preparation for the CBD, assessors should review and familiarise themselves with the case overview provided by the trainee and prepare some open questions to facilitate the discussion. The example questions in section 3.3.4 may be useful. The questions asked should encourage trainees to critically reflect on the case and demonstrate and justify their problem-solving and decision-making skills. The aim of the discussion is to allow trainees to showcase their application of professional and clinical judgement.
The questions asked should not focus solely on the trainee’s recall of knowledge, more on the trainee’s processes for identifying, synthesising, and applying scientific knowledge to inform their judgements and decision-making. For example: how did they recognise they needed more information? Where would they find more information? How did they identify the information was relevant? How did they apply the information they found?
Through the questions asked in the discussion, assessors should be able to make an informed decision on all the elements of practice specified by the CBD mark form. The assessor must not decide if an element of practice specified by the marking criteria is relevant to the case or not. Within the discussion, the trainee must be allowed, or can be prompted, to identify if and how they have drawn on that element of practice for this case. If the trainee correctly identifies that they have not drawn on that element because it is not relevant to this case, this should be marked as a pass for that element of practice on the mark form.
Assessors should ensure that they will be available and unlikely to be disturbed or interrupted during the assessment, in order to give their full attention to the trainee for the time required to complete the assessment.

The discussion can be quite challenging and a trainer may find an early difficulty in suppressing the urge to say ‘What if … ?’ (the discussion is an assessment of what the doctor did with a particular case, not what they might have done). So, doctors can be asked what they did and why, what evidence they have for that action and even ‘What is your next step?’ However, assessors should not go down the line of hypothetical exploration.

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

3.3.2.2 Assessor’s role in the discussion

The discussion should be a minimum of 30 minutes and a maximum of an hour.
The discussion should be led by the assessor and take the form of a structured conversation exploring the case.
During the discussion, the assessor should try not to make assumptions about aspects of the case that the trainee has not provided information about. Questions should be asked to determine the trainee’s approach or rationale.
Judgements made by the assessor should be informed primarily by the trainee’s input to the discussion rather than the case overview provided. The aim of the assessment is to explore trainees’ skills, behaviours, and attitudes in applying judgement and in problem-solving and decision-making, rather than their ability to research and write up a case.
In all CBDs, assessors must be assured that trainees’ input to the conversation and responses to questions are their own.

3.3.2.3 Providing an outcome and feedback

Assessors must ensure that their judgement is based on the trainee’s performance in the case-based discussion being undertaken only. If assessors have experience of the trainee’s practice outside the bounds of the assessment being undertaken, this should not be considered in making judgement on the trainee’s performance in the CBD being considered.
Assessors must complete and sign a CBD mark form and record the outcome of the assessment in the e-portfolio for each CBD completed.
The completed CBD mark forms and the outcome of the assessment should be provided to the trainee via the e-portfolio within five working days of the assessment taking place. It is good practice to provide the form and record the outcome directly after the assessment has been completed.
All CBDs should be logged in the e-portfolio, regardless of whether the outcome is a pass or a fail.
It is good practice for assessors to provide feedback on the CBD mark form to support trainees to continue to develop their practice. Feedback is particularly important for rotation CBDs and in the case of a fail outcome, where feedback can be used to identify training needs and plan training. If verbal feedback is provided as part of the discussion, this should also be recorded on the marking form.

3.3.3 Trainee responsibilities

Trainees are responsible for identifying and presenting a case and engaging in a discussion of the case with an assessor to complete the required number case-based discussions.
It is good practice for trainees to discuss the suitability of a case for presentation and their readiness to undertake the assessment with their training officer and/or assessor before arranging a CBD.
Trainees should provide an overview of the case for discussion to assessors at least five working days before the CBD takes place. It is good practice for the overview to be no more than three pages or slides.
Trainees should make sure they plan to meet their progression requirements and carefully consider the time taken to arrange and complete a CBD.
When undertaking CBDs, trainees must behave appropriately and reasonably in the line with the expectations of trainee on a School programme, an employee of their healthcare organisation and a registrant or pre-registrant, where appropriate. This includes following all relevant local and School policies and behaving in accordance with professional standards of conduct, performance and ethics and the NHS constitution values and behaviours.

resources

Case-based discussion marking forms

publications

NSHCS CBD Mark Form – Rotations

NSHCS CBD Mark Form – Specialty and Core