3.3 Case-based discussion roles and responsibilities


3.3 Case-based discussion roles and responsibilities

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. 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 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. 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.
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3.3.4 Example questions for discussion

Some example questions assessors may wish to use in discussions.

  • How did you use pre-existing information to help formulate your decision?
  • Had you gathered any further information about this case from others?
  • What examinations and/or investigations did you do? Explain why did you did all of these
  • How did you interpret your findings from your examinations and/or investigations?
  • What differential diagnoses did you consider? What features made each one more or less likely?
  • How did you come to your final working conclusion? Remind me which bits of the information were instrumental in this?
  • Did you use any tools, guidelines, or frameworks to help you with making the decision? (Which ones?)
  • Tell me about how you used time to help you when making decisions here.
  • What were your options? Which did you choose? Why this one? Convince me that you made the right choice
  • Did you consider any evidence in your final choice? Tell me about it
  • How close to the limits of your competence were you in managing this case?
  • Did you involve or make a refer to anyone else? What was the added value of involving this other team or person? (Considerations here might include use of resources, (including time) but also patient safety, and/or recognition of limits of scope of practice)
  • Were there any areas of uncertainty? What strategies did you use to manage that uncertainty?
  • Tell me about the ethical aspects of his case? What were they? How did you manage them?
  • Did any of your own values attitudes or ethics influence your behaviour this case?
  • What particular professional codes of practice did you have to make sure you adhered to in this case? (e.g.in relation to Equality and Diversity issues or those who might perceive themselves as marginalised)
  • Was there a need to address confidentiality issues
  • What ethical principles did you use to inform your choice
  • Was there any point where you felt out of your depth? How did you define your limits? What did you then do?
  • It sounds like this was quite an emotionally charged case. It may have caused some internal feelings. How did you manage or neutralise those to ensure they did not impact on your work?
  • OK so going back to where we were looking at,
  • What would you do if?
  • Great. Thinking more now about the area of xxx, tell me?
  • Tell me more about …? or Explain a bit more around?
  • Describe what you did when …?
  • Explain why you think this happened?
  • Thinking about ………., can you evaluate what went wrong/well and what you learned from it?
  • You’ve outlined …….., now explain what you think you could have done differently?
  • When you performed this activity, explain to me how you planned for it and what you did?