One of my father’s colleagues, Dr Joan Rutherford, very kindly offered me the chance to help her redesign an old, out of date Case-based Discussion form to make it look “more professional and appealing”. Case-based Discussion is a structured type of interview used to assess a tribunal doctor’s clinical judgement. The interviewees are assessed on three areas using the form: clinical details, legal details, and their pre-hearing interview. I have included a summary of this work experience project that Dr Rutherford emailed me:
DRAFT: First Tier Tribunal – mental health
Case Based Discussion Form Update project
Dr Joan Rutherford FRCPsych
Chief Medical Member
Work Experience Student
Project aim: to improve the Case Based Discussion form for Tribunal Doctors.
1.1 The project aims in detail are as follows:
1.2 Update the CBD form content in line with advice from Royal College of Psychiatrists’ Revalidation Lead to allow quality improvement activity
1.3 Update the CBD form content with regard to the changes in rule 34 from April 7th 2014
1.4 Improve the form’s presentation
1.5 Make the form available on-line on the tribunal website
2.1 Information about CBD
All tribunal doctors who work in the First Tier Tribunal – mental health are Consultant Psychiatrists. Case based discussion is an essential part of the supporting information supplied by a Psychiatrist when applying for revalidation. Successful revalidation – required every 5 years – allows a doctor to retain their Licence to Practise. Psychiatrists who wish to revalidate are required to complete an annual appraisal. The supporting information for annual appraisal is 2 Case Based Discussions per year and doctors must complete 10 cases (10 CBD points) over the 5 year revalidation cycle.
Case based discussions provide an opportunity for medical members to discuss tribunal cases with peers and reflect on their practice. The discussions are done in pairs, and typically last 40 minutes. One doctor presents a case and the second promotes discussion with questions and completes the CBD form, which both then sign. The aim is to encourage discussion and reflection, identify points of good practice and any suggestions for further development relevant to the case such as reading, or e-learning as part of CPD. The patient’s details are anonymised on the CBD form.
2.2 Development of original CBD form for tribunal cases
The Royal College of Psychiatrists have a CBD form for clinicians as an Appendix in their Revalidation Guide; this form rates individual standards on a numerical 0 – 4 scale, and is suited to clinical work. However, it was thought that a form which encouraged discussion and reflection was more suited to tribunal doctors.
A CBD form for tribunal cases for medical members to use was piloted in January and February 2012: medical members who participated in the pilot preferred this to the College form. The form has been used in training days and at tribunal doctor meetings. The opportunity to discuss tribunal cases is thought to be a valuable experience and is also used by tribunal doctors who are not intending to revalidate.
With the improvements in technology, the form now appears rather basic, and is available only on paper.
3.0 Project details:
3.1 Proposed suggestions for development of the CBD form
Dr Ellen Wilkinson, the Royal College of Psychiatrists’ Revalidation Lead commented that the CBD could count towards one of the two required quality improvement activities that a doctor wanting to keep their LtP needs to collect over the five year revalidation period, if it was linked with the doctors personal development plan (PDP) plan and discussed at annual medical appraisal.
3.2 Changes in Health, Education and Social Care (HESC) rules
A change to rule 34 has taken effect from 6th April 2014. The preliminary examination will not take place in all hearings, and is now known as the pre-hearing examination. So tribunal doctors who discuss cases in CBD meetings may not have had an individual interview with the patient.
3.3 Changes to collection of supporting information for revalidation
This is now collected and stored electronically. Many tribunal doctors use the Medical Appraisal Guide (MAG) form to collect and store information for their annual appraisal. Documents are uploaded electronically.
4.0 Method of preference testing the new CBD form:
4.1 The form was redesigned (by R.C.) taking into account the new requirements and need for it to be fit for uploading onto a website. Section 7 now includes an area for action by the doctor to complete the audit cycle.
4.2 The new CBD form and the original were displayed to 72 tribunal doctors attending two national professional medical meetings in London and Manchester on 4th April and 11th April 2014 respectively. Doctors were given both forms and asked to compare the forms.
|Original form||New form|
|Which design do you prefer?||1/72 (less than 1%)||71/72 (99%)|
|Which ‘suggestions for development’ section do you prefer?||0||72 (100%)|
|Which form would you prefer on the tribunal website?||0||72 (100%)|
5.1 Summary of outcome
Of the 72 doctors, 71 preferred the new form.
The project aims were met.
6.1 The CBD form content was updated in line with advice from Royal College of Psychiatrists’ Revalidation Lead.
6.2 The CBD form content has been amended in view of changes to rule 34
6.3 The presentation of the form has been improved
6.4 The form is now in a format that can be made available on the tribunal website as agreed by the website Librarian. It will be filed under the Section ‘Chief Medical Member’.
Joan Rutherford Robert Chamberlain
Copyright in all training materials in whatsoever form published or distributed in connection with the training of tribunal members belongs to the First Tier tribunal (mental health) or to the author of the materials where the author is specified. Training materials may be reproduced by other persons for the purpose of training on a not-for-profit basis only provided authorship is acknowledged and permission obtained. Training materials must not be otherwise reproduced except with permission”