• Don't leave CbDs to the last minute. You need a minimum of 2 per ESR period. Waiting until the final weeks of a post puts enormous pressure on supervisors and risks being caught out if a supervisor is unexpectedly unavailable.
• Choose genuinely challenging cases. A case where you felt uncertain or at the edge of your competence will generate far better feedback — and better grades — than a routine case you handled perfectly. Supervisors are impressed by insight and reflective depth, not just clinical knowledge.
• Prepare your Capability mapping beforehand. Know which 2–3 Capabilities you are mapping to. Think through why you chose those areas. Have specific things to say about each. Share the clinical entry with your supervisor before the day if possible.
• Use the CbD as a learning tool, not just a box to tick. Bring cases that genuinely puzzled you, cases with ethical tensions, cases involving multimorbidity, or cases where you would have done something differently with hindsight.
• Spread your Capabilities over time. By the end of training you should have evidence across all 13 Capabilities. Keep a running note of which you have covered and which need attention.
• The discussion is about what you actually did — not what you should ideally have done. Be honest about your real-time reasoning. Supervisors know you are a trainee; authenticity is rewarded.

A widely recommended approach from experienced trainees and GP trainers is to reverse-engineer your case selection from the capability descriptors rather than starting from recent patients:

1. Open the RCGP curriculum capability framework before selecting your case
2. Check your FourteenFish dashboard — look at the visual coverage indicators (sometimes called "orbs") to see which capabilities have the least evidence
3. Ask: "Which of my recent cases demonstrates this under-covered capability?" — rather than starting from cases and working forward
4. Select and map accordingly. A single well-chosen case covering three capability gaps is far more strategically valuable than three cases all covering the same area

"Keep an eye on the orbs on the main FourteenFish page to check your curriculum coverage" — confirmed GP trainer, r/doctorsUK

• Complex cases consistently perform better than simple ones — even if you feel you handled them poorly. Here's why: a sore throat or a straightforward UTI leaves almost nowhere to go in the discussion. A genuinely complex case — multimorbidity, an ethical dilemma, clinical uncertainty, a difficult consultation — naturally opens up rich discussion across multiple Capabilities. The very complexity that makes you nervous about choosing it is precisely what generates evidence.
• You can — and should — present patients you've seen more than once. CbD stands for Case-Based Discussion, not Consultation-Based Discussion. A patient you've followed over several weeks, managing an evolving picture, demonstrates depth, continuity of care, and long-term reasoning that a one-off consultation simply cannot show.
• Cases involving uncertainty are gold. Trainers and assessors are specifically looking for how you handle not knowing. A case where you were confident and right demonstrates less than one where you were uncertain, reasoned carefully through it, and arrived at a sensible plan anyway. Uncertainty handled well is a sign of a mature clinician.
• Cases that went slightly wrong are sometimes the most valuable. Choosing a case where something could have been done better — and being able to reflect on it insightfully — demonstrates exactly the kind of professional self-awareness that the CbD is designed to assess. Trying to curate only cases you're proud of misses the whole point of the exercise.

A very common mistake is writing a lengthy narrative under the 'brief description' section of a CbD or clinical case review, then writing minimal content under each capability. This buries the evidence where the ARCP panel cannot easily find it — and may not be credited.

The rule: Any information you put in the description that isn't linked to a capability will never be used in your ESR — it is effectively wasted. Everything evidence-worthy belongs under a capability heading. Decide your three capabilities before you start writing, then write the case content under those capabilities.

• The CbD preparation template should take at least 30 minutes to complete. Not 5, not 10. Trainees who dash through it in a spare moment consistently arrive less prepared. The act of writing it up carefully clarifies your own thinking — which is actually most of the preparation.
• On the second page of the template, write WHY each Capability applies — not just which ones. "This demonstrates Holistic Practice because..." is far more useful than a tick in a box. It helps you articulate your reasoning during the discussion, which is what actually gets graded.
• Share the entry with your supervisor at least a few days before. A supervisor who arrives fresh to your case with no preparation will spend the first part of the discussion getting up to speed rather than asking you meaningful questions. You both lose out.
• Track your Capability coverage running total. Keep a simple note — even a piece of paper — of which Capabilities you've already covered in previous CbDs. By mid-training, trainees who do this arrive at each CbD deliberately targeting gaps. Those who don't tend to cover the same two or three Capabilities repeatedly and are then surprised at their ESR that several areas lack evidence.

• Be honest when you didn't do something. If your supervisor asks "did you explore the patient's ideas about what was causing this?" and you didn't — say so clearly. "No, I didn't do that in that consultation, and on reflection I think I should have" is an excellent answer. It shows insight, honesty, and reflective ability. Saying "yes" when you didn't is immediately transparent to an experienced trainer — and looks far worse than the original omission.
• The CbD is not a viva — and it's not a casual chat either. It sits between the two. It is structured, it is an assessment, and it has a grading function. But it is conducted as a discussion, not as an interrogation. Approach it as a conversation about a real case with a colleague who is genuinely interested in how you think.
• Use phrases that demonstrate reflective depth, not just knowledge. "At the time I thought X, but on reflection I wonder whether Y would have been better" is far more impressive than simply restating what you did. Trainers are assessing your reasoning and your self-awareness, not just your clinical knowledge.
• Don't be thrown by "What did you actually say?" Trainers will often drill into specific moments: "How did you phrase the safety-netting advice?" or "What did you actually say when you explained the diagnosis?" This is intentional — they're checking whether your account is real or reconstructed in retrospect. Be as specific as you can. If you don't remember the exact words, say so: "I can't recall the exact phrasing, but the essence was..."
• Don't answer questions you haven't been asked. Some trainees, when asked about one capability, pre-emptively answer three others. This can actually reduce your grade — it suggests you're reciting a rehearsed script rather than responding thoughtfully to the actual question. Listen carefully. Answer what's asked. Then stop.

• Over-describing the medicine, under-demonstrating the thinking. Many IMGs are trained in systems where comprehensive case histories are valued. In a GP CbD, the case summary should be brief. The supervisor already has the clinical entry. What they want is your thinking — not a retelling of the history.
• Not explicitly linking to capabilities. In many training systems outside the UK, assessors infer competence from case descriptions. In the GP CbD, you need to make the link explicit: "This case demonstrates Communicating and Consulting because I adapted my explanation when I realised the patient hadn't understood my first attempt." Say it. Don't assume it's obvious.
• Avoiding uncertainty because it feels like admitting weakness. In many educational cultures, saying "I wasn't sure" suggests incompetence. In the UK GP CbD, it suggests maturity and self-awareness. Supervisors actively look for it. Practise saying phrases like: "I was uncertain at that point because..." and "I considered X but wasn't fully confident, so I..."
• Writing narrative stories instead of analytical reflection. The CbD is not a case report. It is an analysis. The question is not "what happened?" but "why did you make the decisions you made?" Before any CbD, reread your preparation and ask: is this a story or an analysis? If it reads like a story, go back and add the reasoning layer.
• Being defensive rather than reflective when challenged. When a supervisor challenges your reasoning, it is not an accusation — it is an invitation to show your thinking. "That's a fair challenge. My reasoning at the time was..." is an excellent response. Defensiveness closes the conversation; reflective honesty opens it.

• Stick to the 'here and now'. The CbD assesses what the registrar actually did, not what they should have done in an ideal world. Hypothetical challenge is acceptable only for particularly complex capabilities (e.g. ethics or fitness to practise).
• Read the clinical entry beforehand. Protected preparation time makes the discussion richer and more focused. You cannot conduct a meaningful CbD without having read the record.
• Protect the time. The discussion — including your feedback — should take 20–30 minutes. Don't allow it to be squeezed or interrupted.
• Feedback must be written and justified. Documenting your rationale for grades on FourteenFish is mandatory. Vague comments like "good case" or "needs improvement" without specifics are unhelpful and may be questioned at ARCP.
• You can add Capabilities during the discussion. If discussion reveals a Capability not originally mapped by the registrar, you can add it to the assessment form.
• Vary who conducts CbDs. Assessments should be conducted by more than one supervisor over the training period to allow for triangulation of evidence — this is a GMC recommendation.

• "Assess now, teach later" is a core principle for supervisors — but it also benefits trainees. If your supervisor starts teaching mid-assessment, the assessment phase gets shortened, you lose time on the capabilities you prepared, and your grades reflect less evidence than you could have provided. If this happens, it is entirely reasonable to gently say: "I'm keen to get back to the assessment if that's okay — we can explore that further in the tutorial afterwards."
• Trainers calibrate constantly. Within the first few minutes of a CbD, an experienced trainer has formed an initial impression of your level. They will then probe specifically to confirm or challenge that impression. The opening moments — how clearly you introduce the case, how confidently you explain your reasoning — set the tone for everything that follows.
• Non-verbal cues matter. Experienced trainers explicitly monitor whether the trainee looks anxious, threatened, or defensive. A good supervisor will pause and check in if you appear distressed. But if you can manage your anxiety, you perform better — and the trainer can focus on assessing you rather than managing your emotional state.
• Trainers genuinely want you to do well. A CbD is not designed to catch you out. It is designed to give you the best possible opportunity to demonstrate your competence. Trainers who conduct these regularly are skilled at asking follow-up questions that open doors rather than close them. Meet them halfway.
• Focusing only on 2–3 Capabilities is better than trying to cover all 13. Trainers consistently say that depth on two or three areas produces more useful evidence — and better grades — than a shallow pass over ten. Resist the temptation to try to prove everything in one session.