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CBD, COT AND MINI-CEX

CBD COTCBDs

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:

  • children
  • 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


CBD submission form (click) 

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. 

 

COTs

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.

In ST3 one out of the minimum requirement of  12 COTs can be carried out by a partner of a trainer who has been trained for this role by attending the Partners of GP trainers workshop at the spring and autumn school, or by an intending trainer who has been trained for this as part of the intending trainer pathway. COTs can't be carried out in hospital and should not be assessed by OOH GPs unless they are an accredited GP Trainer.

Where a trainee offers more than the minimum requirements of COT or CbD  for their stage of training it is appropriate for some or all of the "extra" assessments to be done by intending GP trainers or (for COTS only) partners who have been on the Spring and Autumn school course training them to do this.

In ST3 at least one of the COTs must be an audio COT (maximum number of audio COTs which count towards WBPA is 3 in ST3)

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 

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