Case-based discussions: UK surgical trainee perceptions

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An increasing emphasis on accountability led to the development of the Intercollegiate Surgical Curriculum Project (ISCP) in the UK. A major feature of ISCP was a focus on competence with the institution of formative assessments to aid learning and provide portfolio evidence. Case-based discussions (CBDs) are one of the main formative assessments used at all stages of training. The aim of this study was to review the use of CBDs by surgical trainees to determine if and when they are useful, and whether they are perceived as being used correctly.


Semi-structured interviews were carried out with both higher and core surgical trainees. Inductive reasoning principles were used to analyse and interpret the responses to open questions. Common themes were determined and thematic analysis was carried out.


Forty-two surgical trainees (21 core and 21 higher trainees) were interviewed. Core trainees felt that CBDs were more likely to be used correctly, and both groups thought that they were a positive feature of training. Few stated that they were used to shape training needs. Positive themes identified included the provision of feedback, identifying learning portfolio evidence and encouraging reflection. Negative themes included a ‘tick-box’ mentality and that the value was diminished by a lack of engagement with the process from trainers.


Trainees regarded CBDs as a positive feature allowing the discussion of complicated cases, and encouraging higher thinking and reflection; however, concerns were raised regarding their implementation, which has led to a diminishing of their value.

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