Case-based Discussion (CbD)
Competence in patient investigation, patient management, health promotion and disease prevention, and some aspects of both attitudes/ethics and continuing professional development is assessed using a CbD form (slightly modified from that used in foundation training). These forms may be completed by trainers in the following circumstances:
- During an out-patient clinic. Trainers and trainees may wish to allocate 5-10 minutes to discuss the management of a patient seen during an out-patient clinic. Case selection would be determined by either the trainee or trainer. The trainee should have had some direct clinical role with the patient e.g. history taking, clinical examination, investigations ordered or interpreted, management decisions, management of complications, critical incidents etc.
- At the end of an out-patient clinic. Trainers and trainees may wish to allocate some time at the end of clinic to review a small number of case notes where the trainee has had a significant role in the management of the patient.
- Case presentations during postgraduate teaching. Trainees are often asked to present cases at local or regional postgraduate teaching sessions. A nominated trainer should complete a CbD form after the presentation.
- During a designated teaching session. Trainers and trainees may wish to allocate a period of one-to-one teaching or small group teaching where cases are discussed and a CbD form completed.
It is recommended that about half the cases for CbD are chosen by the trainee and half by the trainer.
Trainees need to complete 10 CbDs during each year of training and these should be suitably spread throughout the year. By the end of training a trainee’s portfolio should contain at least 70 CbD forms (pro rata for a trainee entering at a level higher than ST1). Case-based discussion is an important way to show that a trainee is developing her/his patient management skills and that she/he is able to relate her/his knowledge and skills to everyday ophthalmic practice. It is therefore appropriate that the level of competence documented on the CbD forms during Y1 and Y2 is at a lower level that during Y5, Y6 and Y7.
Clinical Scenarios
As an ophthalmologist you will be expected to manage a range of clinical scenarios. This may involve referrals from other health professionals, patient self-referrals or screening for ophthalmic disease.
Below is a list of typical problems that may present to an ophthalmologist. Trainees should aim to cover all these scenarios in their case-based discussions if possible so that their portfolio reflects a wide range of clinical management situations.
| Symptoms | Signs |
Decreased Vision
Diplopia Distortion Dry Eyes Floaters Headache Night Blindness Pain
Red Eye Trauma Visual Disturbance Watery |
Ametropia
Corneal Opacities Conjunctival Pigmentation Dysgenesis/Colobomata Lens Opacities Lid Lumps Lid Malposition Macular Exudation Nystagmus Ocular Tumours Optic Disc Atrophy/Swelling Proptosis Pupil Abnormalities Raised Intraocular Pressure Retinal Haemorrhages Retinal Pigmentation Strabismus Visual Field Defects Visual Handicap in a Child Vasculature abnormalities |
During your training you will be expected to discuss the management of patients with seniors in the form of a Case-based Discussion. You should ensure that during your training all these common clinical presentations have been covered in at least one case-based discussion.
In addition, these clinical scenarios may form a focus for learning. Using these commonly encountered scenarios enhances the value of on-the-job learning, increasing learning efficiency and relevancy.
Whilst learning about a patient with one of the above clinical problems you should consider which learning outcomes may be addressed. By thinking of the patient’s problem in terms of the 13 learning outcome domains, you can integrate your knowledge (basic science and clinical), skills and attitudes.
The scenarios may be used in a variety of learning situations e.g. clinics, theatre, small / large group teaching, independent study. College Tutors may wish to use the scenarios as a framework for postgraduate teaching sessions. The College hopes to set up a “virtual classroom” to allow for online discussions based around these scenarios.