Introducing standardised case based discussions


Clinical reasoning is one of the fundamental skills that medical students must master to practice as a clinician. They must be able to take a history and perform an appropriate physical examination that will allow them to formulate a hypothesis as to why a patient might be presenting with a particular symptom. There are a number of forms of assessment, both written and clinical, that endeavour to assess a student’s clinical reasoning, but for the most part, they do not access student thinking in an interactive fashion. In addition, there are issues with standardisation of the assessment and examiner variability.

During 2015, The Department of Medical Education developed the Standardised Case Based Discussion (SCBD) as a way to explore student clinical reasoning in depth with a standardised format. Students watch a 5 minute video trigger in which a patient with a common presenting symptom is interviewed by a doctor. Students then have 10 minutes to contemplate the diagnostic possibilities of the case before they then spend 15 minutes discussing the case with an examiner. All students view the same case, and all examiners ask the same set of questions which probe the student’s thinking. To enhance the standardisation of the assessment, all examiners have to undertake a rigorous calibration process.

In November 2015 the Principles of Clinical Practice (PCP) 3 cohort of students were the first to undertake this form of assessment. (PCP 3 is one of the MD subjects in the third year of the course.) The process ran very well with 360 students being assessed in just one morning. The feedback from both students and examiners has been very positive. Students appreciated the opportunity to discuss a case in great detail to demonstrate their clinical reasoning skills. The examiners felt this was a valid and enjoyable way to assess clinical reasoning and all of them would be happy to examine again next year.