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CBD is an alternative term for chart stimulated recall. It is designed to allow the assessor to probe the candidate’s clinical reasoning, decision making and application of medical knowledge in direct relation to patient care in real clinical situations. It is a validated and reliable tool for assessing the performance of candidates and identifying those in difficulty. The CBD tool has greater validity and reliability when aligned with specific constructs in discussing the patient (i.e. elements of history, examination, investigations, problem solving, management, referral and discharge planning).
Case-based discussion is designed to:
For more information, see the background paper, Norcini J, Burch V. WBA as an assessment tool: AMEE Guide No. 31. Medical Teacher. 2007; 29: 860-862 (PDF 1.9 MB).
A CBD uses data recorded by the candidate on a real patient. It involves a comprehensive review of a patient’s clinical situation based on a discussion between the candidate and their trained assessor. The candidate is given feedback from the assessor across a range of areas relating to clinical record keeping, clinical assessment, management and clinical reasoning.
A CBD takes place face-to-face (or by other connection if the assessor is not on site) over approximately 20–30 minutes in total.
This is usually split 50/50 for candidate reflection and discussion and assessor discussion and feedback, which should be an interaction between colleagues focusing on clinical reasoning, decision making and application of knowledge in direct relation to patient care.
A CBD is not a long case, a viva, a bedside presentation, a knowledge test or a mini-CEX.
This resource is designed to support:
The same patient should not be used for two different assessments (e.g. mini-CEX and CBD).
The ideal assessor is:
Before conducting a summative CBD, the assessor should have completed this online resource so that they are fully prepared. WBA providers are expected to provide training in CBD which includes additional calibration exercises. The assessor must be familiar with the level of performance expected for the level of training of the candidate.
1. The candidate or the WBA program team will identify 2-4 cases:
2. The assessor considers the areas that will provide the most valuable discussion.
3. The assessor asks questions, covering each domain and using guidelines from the assessment form.
4. The assessor and candidate engage in a feedback process, where:
5. The assessor completes a CBD form and both the assessor, and the candidate sign it.
6. The assessor and the candidate together consider an action plan.
This resource will give you practical tools for conducting a case-based discussion assessment in medical practice and in the Australian Medical Council’s standard pathway (WBA). Examples are given in the disciplines of medicine and surgery.
By completing this resource, you will learn:
The entire CBD resource will take 60–75 minutes to complete.
The AMC national CBD assessment form is a two-page document that enables evaluation of a candidate’s performance in various clinical domains. The assessor must include constructive feedback. At the end of the interaction both the assessor and the candidate must sign the form.
A copy of the CDB form can be found here.
The form is subdivided into four sections:
At the end of the assessment the form should be signed by both the assessor and the candidate.
Clinical record keeping
De-identified written or digital records are acceptable. Records should be legible and demonstrate relevance, comprehensiveness and effective communication skills.
Clinical assessment: History and examination
History should be comprehensive, focused and relevant to the presenting problem. It should encompass all active problems, including relevant details of social, family and past history, allergies, current treatments, and elements relevant to the specific discipline (e.g. women’s health, mental health, child health).
The examination should be focused on the system and areas relating to the presenting problem but needs to include all systems relevant to other active problems.
Clinical assessment: Differential diagnoses, summary, and problem list
Clinical assessment should have a provisional diagnosis, with reasonable consideration of differential diagnoses and a problem list that includes all active problems. It should include a summary that demonstrates appropriate clinical reasoning.
Management plan: Investigations, treatment, and follow-up
Investigations should be targeted, relevant and show an awareness of cost–benefit considerations.
The management plan should demonstrate accurate interpretation of investigations, institution of the appropriate therapy (drugs and/or procedures) and a relevant follow-up plan.
Clinical reasoning/clinical judgement
Clinical reasoning should be appropriate to the level of the candidate and based on all available evidence at the time of patient interaction.
At or above expected level (3-5): At the level expected, the candidate demonstrated safe practice, which included acceptable documentation, appropriate clinical reasoning and an ability to justify decisions to enable appropriate management.
Below expected level (1-2): The candidate failed to demonstrate the expected level of clinical care and clinical reasoning to ensure safe practice and enable appropriate management.
Overall performance is a global rating of the candidate’s performance at the appropriate level of competent or not competent.
The assessor must provide constructive feedback in the written comments section of the form for all criteria that validates the rating given.
You should undertake the lessons sequentially. You will get the most value if you allocate sufficient time to review and reflect on the material and commit yourself to responding to the interactive components as directed.
The examples show CBD interactions and associated feedback sessions for you to review and score as you would in practice.
Your task is to:
1. Select a set of examples (below)
2. Download and/or view case notes
3. View full video interaction
4. Rate the candidate and submit
5. View and compare your ratings and comments on the candidate’s performance with the assessor’s rating
6. Review the interaction again (optional)
Feedback steps
7. Note four areas you would focus on if you were conducting the feedback session
8. View and compare your feedback focus points with the assessor’s rating
9. View the video interaction
Example one
a) CBD interaction
b) Feedback
c) Review the assessor’s CBD form
Example two
a) CBD interaction
b) Feedback
c) Review the assessor’s CBD form
Example three
a) CBD interaction
b) Feedback
c) Review the assessor’s CBD form
Example four
a) CBD interaction
b) Feedback
c) Review the assessor’s CBD form
Example five
a) CBD interaction
b) Feedback
c) Review the assessor’s CBD form
Example six
a) CBD interaction
b) Feedback
c) Review the assessor’s CBD form