Case-Based Discussion (CBD)

Case-Based Discussion (CBD) is a structured Workplace-Based Assessment (WBA) method where a candidate discusses a clinical case they have personally managed. It focuses on exploring clinical reasoning, documentation, decision-making and the application of medical knowledge in authentic clinical situations, rather than testing factual recall. The discussion also enables assessors to evaluate record keeping and reflective practice.

CBD is a recognised and reliable tool for assessing performance and identifying areas for development.

CBD enables assessors to evaluate how candidates integrate medical knowledge, make decisions, document patient care and demonstrate professional and culturally safe practice. Through structured discussion and feedback, it helps develop reflective practice, cultural responsiveness and clinical judgement.

Benefits include:

• Assessment of real clinical decision-making
• Opportunity for formative feedback and learning
• Support in identifying strengths and development needs
• Contribution to overall WBA progress and competency evidence

Case Selection and Requirements: Candidates complete six CBDs across at least three different clinical areas, with a passing standard of five out of six.

Programs must include cases from a minimum of three clinical areas. Where rotation opportunities are limited, assessments may include patients with relevant comorbidities to meet discipline coverage.

Candidates usually select two to four cases that they have personally managed, and the assessor chooses which will be used for the CBD. In some programs, the candidate is not informed of the chosen case until the assessment begins.

To ensure coverage of different clinical areas or comorbidities, the WBA program team may ask candidates to submit several cases for review by the Program Director or team, who selects a suitable case for assessment.

Regarding recency, candidates should select cases they have been directly involved in within approximately the past two months. Across providers, this ranges from patients recently cared for (including longitudinal care) to defined timeframes such as two weeks, four weeks or two months, depending on the program or discipline. Most providers do not specify a strict timeframe but refer broadly to recency of care.

Approaches differ between programs. Some specify particular clinical areas—commonly Medicine, Surgery and Emergency Medicine—while others allow flexibility based on current rotations. If changes are made to support flexibility, providers should update their documentation before discussing these with the AMC.

Preparation: The CBD should be conducted away from the patient to maintain confidentiality.

Duration: Each CBD takes approximately 20–30 minutes, followed by 10–15 minutes of structured feedback.

Setting: Conducted face-to-face or virtually.

Assessor Role: The assessor probes clinical reasoning and provides feedback across key domains such as record keeping, assessment, management and reasoning.

The AMC National CBD Assessment Form is a two-page document used to evaluate candidate performance across clinical domains.

Form structure:

1. Candidate, assessor and patient details
2. Clinical domains for assessment
3. Global rating and assessor feedback
4. Summative outcome — “At expectation”, “Above expectation” or “Below expectation”

All sections must be completed by the assessor, including written feedback. Both assessor and candidate sign the form at the end of the assessment.

After discussion, the assessor and candidate agree on an action plan for ongoing learning and improvement.

Before conducting a summative CBD, assessors should refer to the online resources and any required WBA program training or calibration exercises.

These resources support consistency and calibration in scoring and feedback, helping assessors recognise examples of effective clinical reasoning and reflective discussion.

They also assist IMG candidates by showing how experienced assessors analyse cases, explore reasoning, and provide constructive feedback—helping candidates understand what is expected in a summative CBD.

Case-Based Discussion (CBD): Emergency Medicine – Right Iliac Fossa Pain

Case Summary

A 34-year-old woman presents to the Emergency Department with three days of worsening right iliac fossa pain, nausea, vomiting and mild diarrhoea. Differential diagnoses include appendicitis and ectopic pregnancy. The candidate discusses their clinical reasoning, investigations and management decisions with the assessor, covering diagnostic uncertainty, escalation and documentation. The discussion focuses on reflective practice, record keeping and safe decision-making under pressure.

Duration: 12 minutes 14 seconds

Case-Based Discussion (CBD): Mental Health

Case Summary
A 47-year-old man is brought to the Emergency Department by police under a mental health schedule due to agitation and suicidal thoughts. The candidate discusses their assessment, risk stratification, communication and de-escalation strategies, and management plan. The conversation highlights cultural safety, non-judgemental assessment, and reflective practice. The candidate describes how they balanced patient safety with rapport-building and voluntary admission planning.

Duration: 8 minutes 02 seconds

Additional resources

• Conducted confidentially, away from the patient.
• Must be based on cases personally managed by the candidate.
• Must include longitudinal care where applicable.
• All form sections and signatures must be completed.
• Feedback and action planning are integral to the process.