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Case-based discussion: a useful tool for revalidation

  • Laurence Mynors-Wallis (a1), Denise Cope (a1), Andrew Brittlebank (a2) and Fauzan Palekar (a3)
Abstract
Aims and method

Revalidation is the process by which doctors demonstrate that they are up to date and fit to practise. Case-based discussion has been identified by both psychiatrists and service users and carers as a potentially useful tool for revalidation. The aim of this study was to examine the feasibility of case-based discussion for assessments to use in revalidation. A pilot using case-based discussion as an assessment/developmental technique for revalidation was undertaken in six trusts involving 86 consultant psychiatrists.

Results

The average time taken for each case-based discussion including preparation and reflection was 48 min. All but one of the doctors involved in the case-based discussion pilot described the process as useful or very useful in improving clinical practice. In total 87% of the assessed doctors and all of the assessors reported that they considered case-based discussion to be a useful part of the revalidation process assessed. The majority of doctors assessed believed that cases should be chosen at random (91%).

Clinical implications

Case-based discussions have the potential to be a useful quality improvement tool for revalidation.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Laurence Mynors-Wallis (laurence.mynors-wallis@dhuft.nhs.uk)
Footnotes
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See commentary, pp. 235–236, this issue.

Declaration of interest

None.

Footnotes
References
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1 General Medical Council. Good Medical Practice. GMC, 2006.
2 Royal College of Psychiatrists. Good Psychiatric Practice (3rd edn). Royal College of Psychiatrists, 2009.
3 NHS Revalidation Support Team. Strengthening NHS Medical Appraisal to Support Revalidation in England. Department of Health, 2009.
4 Brown, N, Mallik, A. Case-based discussion. In Workplace-Based Assessments in Psychiatry (eds Bhugra, D, Malik, A, Brown, N). Royal College of Psychiatrists, 2007.
5 Babu, KS, Htike, MM, Cleak, VE. Workplace-based assessments in Wessex: the first 6 months. Psychiatr Bull 2009; 33: 474–8.
6 Menon, S, Winston, M, Sullivan, G. Workplace-based assessment: survey of psychiatric trainees in Wales. Psychiatr Bull 2009; 33: 468–4.
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BJPsych Bulletin
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  • EISSN: 1758-3217
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Case-based discussion: a useful tool for revalidation

  • Laurence Mynors-Wallis (a1), Denise Cope (a1), Andrew Brittlebank (a2) and Fauzan Palekar (a3)
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eLetters

Peer Groups for revalidation purposes in psychiatry

Keerthy Raju, ST5 in Old Age Psychiatry
11 October 2011

The authors conducted this pilot study amongst consultant psychiatrists where the assessments were carried out between two consultants acting as assessor and assesses followed by them swapping places during future assessments . However this method is open to criticisms as one gets to choose their assessor leading to favouritism andbiased feedback. A way of minimising and overcoming such issues would be the use of peer supervision groups for revalidation purposes amongst consultant psychiatrists.

Peer Supervision groups (PSGs) are leaderless groups offering opportunities for interpersonal learning from peers. They should normally consist of four to six members who would meet regularly with one person taking responsibility for completing the case-based discussion summary sheet with ratings and action plan. The group should adhere to the contract which in this case is the requirement to complete the stipulated number of case-based discussions over the year. In addition, the shared history of the group would encourage deeper exploration, helping others and reassurance of hearing others struggle. The main disadvantages may be that its time consuming and may lead on to conformity amongst members.

Peer Supervision Groups have the potential to play a key part in validation purposes for psychiatrists and overall might create a stable long term group likely to benefit its members for years.

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Conflict of interest: None declared

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CbD: Focus on Feedback not Tickboxes

Asif M Bachlani, Str 6 General Adult Psychiatry
22 June 2011

As a trainee who has gone through Modernising Medical Careers (MMC) and completed numerous Workplace Based Assessments (WPBAs) including CbDs (Case based discussions) I read with interest the paper by Mynors-Wallis et al (1) on CbD as a tool for revalidation. Their conclusions were that consultants were positive about CbD but research on trainees showed resentment and mistrust. I suspect that the trainees' views mentioned by Mynors-Wallis et al are not representative of current opinion, as the study does not acknowledge when the research was done, which was just after the MMC and six months after WPBAs were rolled out. This was the time when there had been a seismic change in delivery of training with both trainees and supervisors adjusting to the new landscape.

I carried out research focusing on the Educational Value of WPBA (2) eighteen months later using a questionnaire and interviews of trainees. The questionnaire was completed by 47.6% of trainees (41/86 StR1 – 5) and 40.9% of educational supervisors (35/86). This showed that 73% of trainees and 79% of supervisors felt that WPBA had an educational value which was heavily dependent on feedback. Similarly in the results obtained by Babu et al (3), CbD was ranked the most useful by trainees, with no difference between higher and lower trainees. Trainees valued the discussion around the case, particularly on diagnosis and management, and supervisors felt that this gave better sense of trainees independent functioning. Both supervisors and trainees identified the importance of Assessor training, and noted the tension between the formative and summative components with trainees asking for more focus on feedback rather than scores. This has been previously identified by Malhotra et al(4) with residents’ perceptions of the WPBA as an assessment versus educational tool and by PMETB itself (5) where they state that WPBA must be used formatively and constructively otherwise they become no more than hoops to be jumped through with the educational validity lost.

As a future consultant with my experience of WPBAs I value the opportunity of discussing cases in a peer group as CbDs are the cornerstone of professional development and useful for developing one’s clinical practice. Given the concern raised by PMETB about how WPBAs are used, I would urge the College to learn these lessons and use CbD as a developmental ‘formative’ tool with the focus on discussion, reflection and feedback and not let this become just another tick box exercise.

References1.Mynors-Wallis L, Cope D, Brittlebank A, Palekar F. Case-based discussion: a useful tool for revalidation. Psychiatrist 2011; 35: 230-42.Bachlani, A. Workplace based Assessment – Is the educational value being lost?” Medical Educator Trainee Conference, Wessex Deanery, 2009 unpublished.3.Babu S, HtikeMM, CleakVE. Workplace-based assessments in Wessex: the first 6 months. Psychiatr Bull 2009; 33: 474-8.4.Malhotra S, Hatala R and Courneya CA 2008. Internal medicine residents’ perceptions of the Mini-CEX. Medical Teacher; Vol 30 p414-4195.Postgraduate Medical Education and Training Board. Workplace based Assessment A guide for implementation. Postgraduate Medical Education and Training Board 2009
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