WBA Forms

The below forms can be used for medical students or Prevocational doctors (i.e. Interns or Residents) in order to provide formative feedback on performance.

Once completed the form will send the result in pdf to the student or trainee (plus assessor if requested) for their own records.

They are similar to but not meant to replace any WBA forms that are included in the official student logbook.

Case Based Discussion

WBA CBD

Workplace Based Assessment Form suitable for medical students and prevocational doctors
  • The CBD (Case Based Discussion) is a form of evidence based Workplace Based Assessment Tool. The CBD is particularly useful for gaining feedback in relation to information gathering and clinical reasoning skills. You should plan to do a CBD with your Registrar or Consultant on patients under your care. We suggest seeing the patient first on your own and then reviewing other sources of information (including talking to family, GPs and other team members). CBDs will normally take around 30 minutes to conduct, including feedback from faculty. You should find a quiet place to conduct the CBD e.g. office, bring any notes or files you may need. Consider bringing an example of a clinical note for your assessor to review as well. Present the Case as if you are handing over. Expect that there may be some questions about the case.
  • Enter the name of the student or trainee
  • Enter the name of the person doing the assessment
  • Enter a brief description of the patient (e.g. 35 year old woman with exacerbation of psychosis seen on inpatient unit)
    Please rate the level of performance for this component of the exercise.
    Please rate the level of performance for this component of the exercise.
    Please rate the level of performance for this component of the exercise.
    Please rate the level of performance for this component of the exercise.
    Please rate the level of performance for this component of the exercise.
  • Please rate the student or trainees overall clinical competence.
  • Enter student or trainee email (so form can be sent).
  • Enter assessor email (so form can be sent).
Mini CEX

WBA Mini CEX

Workplace Based Assessment Form suitable for medical students and prevocational doctors
  • The Mini CEX (Mini Clinical Examination) is a form of evidence based Workplace Based Assessment Tool. The Mini CEX is particularly useful for gaining immediate feedback in relation to general clinical skills. You should plan to do a Mini CEX with your Registrar or Consultant on patients under your care. We suggest seeing the patient first on your own and then taking your assessor back to in order to demonstrate skills in relation to history taking, mental state examination, risk assessment and general counselling skills. Mini CEXs will normally take around 30 minutes to conduct, including feedback from faculty. You should endeavour to ensure that both you and your patient are ready to participate in the Mini CEX at the agreed time and that an appropriate room is available. At the end of your interview and prior to receiving feedback the patient will be invited to make a comment on your performance.
  • Enter the name of the student or trainee
  • Enter the name of the person doing the assessment
  • Enter a brief description of the patient (e.g. 35 year old woman with exacerbation of psychosis seen on inpatient unit)
    Please rate the level of performance for this component of the exercise.
    Please rate the level of performance for this component of the exercise.
    Please rate the level of performance for this component of the exercise.
    Please rate the level of performance for this component of the exercise.
    Please rate the level of performance for this component of the exercise.
  • If appropriate please ask the patient to comment on their level of comfort with the conduct of the student or trainee during interview.
  • Please rate the student or trainees overall clinical competence.
  • Enter student or trainee email (so form can be sent).
  • Enter assessor email (so form can be sent).

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