1. Promoting Excellence in Family Medicine nMRCGP Case Based Discussion A Beginners guide

2. Promoting Excellence in Family Medicine Aims The aim of CbD is to enable an assessor to provide systematic assessment of the registrars performance and to give structured feedback

3. Promoting Excellence in Family Medicine Miller s pyramid of clinical competence Does Knows how Shows Knows

4. Promoting Excellence in Family Medicine What? A structured interview designed to explore professional judgement in clinical cases

5. Promoting Excellence in Family Medicine What? Professional Judgement: The ability to make holistic,balanced,and justifiable decisions in situations of complexity and uncertainty

6. 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

7. Promoting Excellence in Family Medicine Competency areas 10 out of 12 Practising holistically Data gathering and interpretation Making decisions/diagnoses Clinical management Managing medical complexity Primary Care Administration (IMT) Working with colleagues Community orientation Maintaining an ethical approach Fitness to practice

8. 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

9. Promoting Excellence in Family Medicine Getting Started The discussion will start from and be centred on the registrars record in the notes and is designed to assess clinical decision-making and the application of medical knowledge in the care of the registrars own patients. Quality of record keeping is important and should be assessed

10. 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

11. 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

12. Promoting Excellence in Family Medicine Concluding Make a judgement Needs further development Competent Excellent Repeat x2 in each four months

13. 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

14. 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?

15. Promoting Excellence in Family Medicine What is important? Selecting the cases Quality of record keeping Planning the questions Documenting the outcomes Structured feedback

16. Promoting Excellence in Family Medicine And now After the break Here is one we prepared earlier!

17. Promoting Excellence in Family Medicine