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Promoting Excellence in Family Medicine
nMRCGPCase Based Discussion
A Beginner’s guide
Promoting Excellence in
Family Medicine
Aims
“The aim of CbD is to enable an assessor to provide
systematic assessment of the registrar’s performance
and to give structured feedback”
Promoting Excellence in
Family Medicine
Miller’s pyramid of clinical competence
Does
Knows how
Shows
Knows
Promoting Excellence in
Family Medicine
What?
A structured interview designed to explore professional
judgement in clinical cases
Promoting Excellence in
Family Medicine
What?
Professional Judgement:
The ability to make holistic,balanced,and justifiable decisions in situations of complexity and uncertainty
Promoting Excellence in
Family Medicine
Attributes
• Application of medical knowledge
• Application of ethical frameworks
• Ability to prioritise, consider implications and justify decisions
• Recognising complexity and uncertainty
Promoting Excellence in
Family Medicine
Competency areas
10 out of 12Practising holisticallyData gathering and interpretationMaking decisions/diagnosesClinical managementManaging medical complexityPrimary Care Administration (IMT)Working with colleaguesCommunity orientationMaintaining an ethical approachFitness to practice
Promoting Excellence in
Family Medicine
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
Promoting Excellence in
Family Medicine
Getting Started
“The discussion will start from and be centred on the registrar’s record in the notes and is designed to assess clinical decision-making and the application of medical knowledge in the care of the registrar’s own patients.”
Quality of record keeping is important and should be assessed
Promoting Excellence in
Family Medicine
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
Promoting Excellence in
Family Medicine
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
Promoting Excellence in
Family Medicine
Concluding
Make a judgement
Needs further development
Competent
Excellent
Repeat x2 in each four months
Promoting Excellence in
Family Medicine
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
Promoting Excellence in
Family Medicine
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?
Promoting Excellence in
Family Medicine
What is important?
Selecting the cases
Quality of record keeping
Planning the questions
Documenting the outcomes
Structured feedback
Promoting Excellence in
Family Medicine
And now
After the break
Here is one we prepared earlier!
Promoting Excellence in
Family Medicine
