An Overview of the Foundation Programme in - London Deanery

Case-based discussion (CBD)
Guidance for foundation doctors and trainers
This guidance is designed to accompany the ‘SLE Frequently asked questions’ document.
What is case-based discussion (CBD)?
A c ase-based di scussion i s a s upervised l earning ev ent ( SLE) to ol. T his i s a s tructured
discussion of a clinical case managed by the foundation doctor. Its strength is investigation
of, and feedback on, clinical reasoning.
Who can contribute to the developing the clinical teacher?
Foundation d octors will o btain mo st b enefit if they re ceive feedback from a v ariety o f
different people. Feedback should usually be from:
� s upervising consultants
� G P principals
� doctors who are more senior than an F2 doctor
� experienced nurses (band 5 or above); or
� allied health professional colleagues.
How does it work?
The process is typically led by the foundation doctor. Cases should be chosen jointly by the
foundation doctor and trainer to address a spread of topics which reflect individual learning
needs. F eedback a nd ac tions advised for further l earning ar e r ecorded s olely for the
foundation doctor’s benefit.
Ideally, the foundation doctor should select two case records from patients they have seen
recently, an d i n w hose n otes the y have m ade a n entr y. T he tr ainer s hould select one o f
these for the CBD session. The discussion must start from and be centred on the foundation
doctor’s own record in the notes. The SLE typically takes 20 minutes including feedback and
completion of the form. It may be necessary to allocate more time.
What areas should CBD focus on?
CBD is most useful when considering the following areas:
Focus
encounter
of Positive indicators
Medical record Legible; s igned; dated; a ppropriate to the pr oblem; u nderstandable i n
keeping
relation to and i n s equence w ith o ther en tries; he lps the next c linician
give effective and appropriate care.
Clinical
Understood th e p atient’s s tory; m ade a c linical as sessment based o n
assessment appropriate questioning and examination.
Investigation Discusses th e r ationale for t he i nvestigations a nd n ecessary r eferrals;
and referral understands w hy di agnostic s tudies w ere or dered or per formed,
including the risks and benefits in relation to the differential diagnosis.
Treatment Discusses the r ationale for t he treatment, in cluding t he r isks and
benefits.
Follow-up and Discusses t he r ationale for t he formulation o f t he m anagement plan
future planning including follow-up.
Professionalism Discusses ho w t he c are of this pa tient, as r ecorded, de monstrated
respect, compassion, empathy and established trust; discusses how the
patient’s n eeds for c omfort, r espect, c onfidentiality w ere ad dressed;
discusses how t he r ecord d emonstrated an ethical ap proach, a nd
awareness o f any r elevant l egal frameworks; has i nsight i nto own
limitations.
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