Utility of Case-Based Discussions as Workplace Based Assessments in Medical Training: A Scoping Review

Background Case-based discussions (CbDs) are a commonly used workplace-based assessment (WBA) method in postgraduate medical education. It is unclear whether they are appropriate for use with medical students, particularly early in their clinical placement experience. The objective of this scoping review is to understand the extent and type of evidence in relation to the utility of CbDs as structured WBA throughout medical training. Methods Joanna Briggs Scoping Review Methodology was used to examine original research articles pertaining to: (population) medical students, doctors, and supervisors; (concept) formal discussion between a single learner and a supervisor about a real patient and (outcome) educational impact, feasibility, acceptability, cost-effectiveness, reliability, and validity. Outcome measures were informed by van der Vleuten and Schuwirth’s Assessment Utility Model. Results There were 4375 papers found of which 131 assessed by full-text analysis. Of the 41 original research studies and 3 systematic reviews included in the analysis. Only one included medical students. Validity of CbD was variable and highest in some studies using assessment tools with behavioural anchors. Protected time and engaged assessors improved validity. There was moderate evidence of change in attitudes and perceptions of learners. Some evidence demonstrated improved clinical reasoning and suggested improvements in patient safety. Learner acceptability was improved by engaged assessor/trainers who provided meaningful, actionable feedback and follow-up. Assessor engagement was reportedly improved with training and in studies involving longitudinal relationships with learners as found in general practice. There were insufficient studies in feasibility and cost-effectiveness, although the time required to undertake CbD was recognised as an important factor affecting both. Conclusion Whilst there was evidence of positive educational impact for CbD, there was a striking scarcity of literature investigating CbDs in medical student learners, which is discordant with the increasing emphasis on workplace-based learning in the contemporary medical education context.