CBD- template

 Case-Based Discussion

Name:

Clinical setting – A&E □   Outpatients Dept □    In-Patient □        Acute Admission □

Clinical problem category – Pain □ Airway/Breathing □   CVS/circulation □

Neuro □ Gastro □ Other □

Focus of clinical encounter - Medical Record Keeping □                     Clinical assessment □ Management □                      Professionalism □

Complexity of Case – Low □ Average □ High □

Assessors Position – Consultant □ SpR □ GP □ 

  

Please tick the appropriate box	Below expectations	Borderline	Meets expectations	Above average	Unable to comment
Medical Record Keeping
Clinical assessment
Investigation and Referrals
Treatment
Follow up and future planning
Professionalism
Overall clinical judgement

Comments & actions agreed: (Anything especially good/suggestions for development)

Assessors Signature:                                           PRINT NAME

 

DATE: