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Definition and purpose

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: 


  • improve clinical decision making, clinical knowledge and patient management 
  • improve clinical record keeping 
  • provide candidates with an opportunity to reflect on and discuss their approach to the patient and identify strategies to improve their practice 
  • enable assessors to share their professional knowledge and experience in a collegial way 
  • enable candidates to access experts in clinical decision making and understand the rationale for preferred management choices 
  • guide learning through structured feedback 
  • identify areas for development as part of the continuum of learning 
  • assist candidates in identifying strategies to improve their practice. 

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). 

What is a CBD?

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. 

Who this resource is for

This resource is designed to support: 

  • the training of assessors delivering in both the formative and summative CBD assessments in accredited WBA programs  
  • work-place based assessment program directors when quality assuring the completion of CBD assessments 
  • WBA candidates  
  • organisations wishing to become accredited WBA providers. 

The CBD process

The same patient should not be used for two different assessments (e.g. mini-CEX and CBD). 

  • A CBD should be conducted away from the patient and respect patient confidentiality. 
  • A CBD generally takes place face-to-face 
  • A CBD should take about 20 minutes, plus 10 minutes of specific and constructive feedback. 
  • If the candidate has not had recent contact with patients in the discipline to be assessed, the assessor may select the patient and allow the candidate sufficient time to see the patient and write up case notes/records. 
  • An appropriate assessor should be selected. 


The ideal assessor is: 

  • willing to devote necessary time 
  • a content expert 
  • able to articulate their own clinical reasoning (based on experience, evidence and best practice) 
  • skilled in adult learning principles and assessment 
  • a good communicator who is able to give effective constructive feedback 
  • aware of, and attuned to, the level of performance expected 


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.


Sequence of activities

1. The candidate or the WBA program team will identify 2-4 cases: 

  • The records should be those of patients they have seen and documented. 
  • Patients should be those recently cared for by the candidate and may include longitudinal care patients. 
  • Each case record should have sufficient breadth, depth and complexity to enable focus on clinical decision making. 
  • The assessor prepares by exploring the general features of the case record relevant areas: 

2. The assessor considers the areas that will provide the most valuable discussion. 

  • The assessor chooses a number of areas for further discussion based on the marking domains for evaluation. 
  • The candidate gives a short summary of less than two minutes (not a case presentation). 

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: 

  • The candidate is invited to reflect on their performance 
  • The assessor gives their feedback, focusing on three or four key issues 
  • The assessor encourages the candidate in self-assessment and reflection during feedback 
  • The assessor invites the candidate to discuss how issues can be addressed 
  • The assessor summarises and checks the candidate’s understanding 

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. 

What you will learn about CBD

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: 

  • what a case-based discussion is 
  • a clear structure for engaging in a CBD 
  • how to frame useful questions 
  • how to use the CBD assessment form 
  • how to give feedback on a CBD encounter. 

How long will it take? 

The entire CBD resource will take 60–75 minutes to complete. 

The form

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: 

  • Section 1: Details of the candidate, assessor, and demographic and concise clinical details of the patient. 
  • Section 2: Clinical domain/s for assessment. 
  • Section 3: Assessor’s global rating of the candidate’s performance and the assessor’s feedback. 
  • Section 4: The summative outcome of the assessment: Candidate will be marked at expectation, above expectation or below expectation in each domain. 

At the end of the assessment the form should be signed by both the assessor and the candidate. 


Areas of assessment

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. 


Pass mark

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. 


Assessor comments

The assessor must provide constructive feedback in the written comments section of the form for all criteria that validates the rating given. 

Interactive example scenarios

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

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