Tips for writing a useful, meaningful Case Based Discussion (CBD) for medical trainees.

(My advice is drawn from: over last 3 years I have completed 377 assessments for trainees and supervised >40 juniors)

#MedEd
1/n

DISCLAIMER: this is my advice based on my own meandering experience, as the saying goes. This is not telling you what you ought to do. If these tips don’t work for you, feel free to disregard

2/n

(At this point I am expecting people (trainees and trainers) to say ‘the portfolio & assessments are rubbish’ which is a common theme on UK #MedTwitter. I argue that the problem is that it is used in a rubbish way 99% of the time)

3/n

Trainee’s deserve specific, thoughtful feedback. ‘Carry on good work’ & ‘continue at current level’ arent examples of this (but easy to write). Most CBDs are filled on ‘in absentia’, so no conversation. This robs the assessment of its authenticity. Can we recapture it?

4/n

The first 4 questions ask for your feedback on the trainee’s assessment, management plan, judgement and professionalism. These are pretty easy to complete. The juicy stuff comes later

5/n

‘What was done well’ this is most vital part. People mistakenly believe that the ‘areas for develpmnt’ is most useful. But the desire for pos feedback for self-validation is a powerful tool for reflection& development. Go nuts in this section. Write lots. https://onlinelibrary.wiley.com/doi/10.1111/medu.12054#.X5RzkqLEgrc.twitter

Next section is ‘areas for development’. Note it is *not* asking ‘what didn’t go well’. You don’t have to think of ‘something wrong’ here. This should contain ONE thing.
I like to write a question here. A question based on the ‘what went well’ section above.

7/n

For example:
‘You held off scanning overnight due to concerns about renal function. What is the evidence around contrast-AKI?’

‘I note you admitted the pt for therapy assessment. What alternatives to admission did you have?’

8/n

Then it’s ‘agreed action’. Trainers get frustrated with this one because it seems similar to ‘areas for development’ and don’t know what to write.
I see ‘as above’ a lot.
BUT if you have asked a question in the ‘areas for development’ then this bit becomes easy...

9/n

...Point them towards the answer to your question! I write something like ‘have a look at this paper/guideline/article/ blog/ poster’ & give a link.
This helps close the loop and ensure your feedback is actionable & achievable.

10/n

This is a great place for *you* to learn something too! In this bit you could write ‘to be honest I didn’t know the answer to this but I found the below link really useful’.

Completing CBDs have been a great way for me to quickly update myself on a condition or guideline

11/n

Here endeth the lesson. I haven’t touched on the differences between in-person CBD discussions between trainee and trainee and e-ticket assessments, nor bidirectional feedback. Maybe another day.

If you have any tips about completing excellent CBDs, drop them below!

12/n