CBD, COT AND MINI-CEX
Case Based Discussion - What is it?
Case-based discussion (CbD) is a structured interview designed to explore professional judgement exercised in clinical cases which have been selected by the GPST and presented for evaluation. Evidence collected through CBD will support the judgements made about the GPST at the six monthly and final reviews throughout the entire programme of GP specialty training.
As a GP trainee, you’re responsible for selecting cases, requesting a CbD and ensuring the paperwork is completed properly. You and your trainer should ensure that your ePortfolio reflects a balance of cases, including:
- mental health
- cancer and palliative care
- older adults
Cases should also reflect different contexts: surgery, home visits and out-of-hours contacts. You can’t include cases that have already been used as a debrief.
Specialty training years one and two (ST1 and ST2)
In ST1 and ST2, you’ll select two cases. You present the clinical entries and relevant records to your clinical supervisor or educational supervisor one week before the discussion. Your clinical or educational supervisor selects one of these cases for discussion.
Specialty training year three (ST3)
In ST3, you’ll present four cases to your trainer or educational supervisor one week before the discussion. They will select one or two for discussion.
CBD - clarification of competency a tool for Trainees & Trainers
How to establish if the different competencies have been achieved by the Trainee or if there is evidence of potential under-performance
This has to be completed and submitted with you prospective CBD cases to your Trainer. It details the competencies you feel you have demonstrated and why. This helps focus the CBD and increases the likelihood of you achieving those competencies.
Who can assess you?
The CBD should be carried out by a consultant, an associate specialist or experienced registrar in the speciality concerned (ST4 or above ). In GP The CBDs should be carried out by trainers approved by the GP school as Clinical and Educational supervisors.
In ST3 one out of the minimum requirement of 12 CBDs can be carried out by a prospective trainer who has been trained for this as part of the pathway to becoming a trainer.
CBDs should not be carried out by other GPs employed in the practice even those who have been on the GP School Autumn and Spring courses for partners of trainers. CBDs should not be carried out by OOH supervisors unless they are an accredited GP Trainer.
The Consultation Observation Tool
The Consultation Observation Tool (COT) has been designed to be used by Trainers as an evidence-collecting instrument to support the more holistic judgements made about GPStRs. It usually involves a structured review of a videoed consultation rather than observation while your Trainer sits in your surgeries.
Who can assess you?
The COTs should be carried out by trainers approved by the GP school as Clinical and Educational supervisors.
Phrases you can use in consultation to help achieve COT competencies
COT e-portfolio view with tips for Trainers
This helps you map the competencies which you have achieved in your COTs since your last Educational Supervision, enabling you to identify the types of cases you need to select for future cases to ensure that you are on track for the MRCGP.
COT submission form
This has to be completed and submitted with you prospective COT cases to your Trainer. It details the competencies you feel you have demonstrated and why. This helps focus the COT and increases the likelihood of you achieving those competencies.
RCGP guidelines on recording consultations
Consent form for recording consultations