RANDOM CASE ANALYSIS FORM

Registrar Name:

Term: Date:

Supervisor Name:

Practice:
Review a random selection of clinical notes. Use the “Brief Guide to Random Case Analysis” to Assist your
review of the cases. Record your notes about the cases on first page and your summary on the formative
assessment and feedback pages. Discuss your assessment with your registrar.
SECTION 1 – CASE STUDY

CASE 1 Complexity: high med low

Brief Details (age, gender, reason for visit):

Points noted in this case:

CASE 2 Complexity: high med low

Brief Details (age, gender, reason for visit):

Points noted in this case:

CASE 3 Complexity: high med low

Brief Details (age, gender, reason for visit):

Points noted in this case:

CASE 4 Complexity: high med low

Brief Details (age, gender, reason for visit):

Points noted in this case:

CASE 5 Complexity: high med low

Brief Details (age, gender, reason for visit):

Points noted in this case:

CASE 6 Complexity: high med low

Brief Details (age, gender, reason for visit):

Points noted in this case:

SECTION 2 – FORMATIVE ASSESSMENT AND FEEDBACK SHEET
This assessment must be discussed with the Registrar at the conclusion of the case discussion.

Domain 1 – Communication Skills and the Patient-Dr Relationship

Evidence of meeting patient’s agenda.
Use of handouts and other resources to facilitate explanation.
Arranges follow up and ongoing care.
Comments:

Domain 2 – Applied Professional Knowledge and Skills

Considers differential diagnosis and appropriate clinical reasoning behind decisions made.
Manages common and serious conditions.
Manages undifferentiated problems.
Rational prescribing, use of evidence and appropriate investigations and referrals.
Comments:

Domain 3 – Population Health and Context of General Practice

Appropriate health screening interventions.
Considers the impact of patient’s family, workplace, cultural background.
Public health issues addressed where relevant.
Comments:

Domain 4 – Professional and Ethical Role

Demonstrates duty of care to patients and clear doctor-patient boundaries.
Consent obtained for procedures and for release of information to third parties.
Comments:

Domain 5 – Organisational and Legal

Notes are adequate to enable another doctor to take over care of the patient and justify the item number
billed.
Use and review of recall and reminder systems. Uses practice team.
Appropriate time for consultation and provision of certificates.
Comments:

Page 2 of 3
RCA FORMATIVE ASSESSMENT AND FEEDBACK SUMMARY

Keep doing:

Do more of / try doing:

Do less:

Stop doing:

SECTION 3 – OVERALL ASSESSMENT

OVERALL ASSESSMENT YES NO UNSURE

Is the Registrar at the expected standard for his/her current stage of training?

Comment required if “No” or “Unsure:

REVIEW OF LEARNING PLAN COMPLETED? YES NO

Review the Registrar’s learning plan. New learning needs identified by the visit should be added. Existing
learning needs that have been demonstrated to be completed ruing the visit should be archived.

Comment:

WERE SIGNIFICANT PATIENT SAFETY ISSUES UNCOVERED? YES NO

If ‘Yes’ record how the patient safety issue will be resolved and whether a review of the Registrar’s
supervision plan is required:

SECTION 4 – SUPERVISOR AUTHORISATION

Supervisors Name:

Signature: Date:

Page 3 of 3