What it is
A CCR is a reflective learning log entry about a real patient you saw yourself, in any post: GP, hospital or out of hours. It shows your reasoning, what you learned and what you will do differently, linked to the capabilities and clinical experience groups it genuinely shows.
The numbers by year
| Requirement | ST1 | ST2 | ST3 |
|---|---|---|---|
| Clinical case reviews (CCRs) | 36 per year 18 per review | 36 per year 18 per review | 36 per year 18 per review |
| Every capability evidenced in each review period | 13 of 13 per review | 13 of 13 per review | 13 of 13 per review |
Full time, per training year unless stated. Less than full time: per-year totals stay the same and each 6-month review needs a pro rata share; 6-monthly ESRs and 12-monthly certificates are not pro rata. Check with your deanery and educational supervisor.
Notes on these numbers
- Clinical case reviews (CCRs), LTFT: Pro rata: e.g. 60% = 36 per training year spread over 20 months, about 11 per 6-month review.
- Every capability evidenced in each review period, LTFT: Same rule per 6-month review period (not pro rata).
A CCR in five headings
- What happened (2 or 3 lines): age band, presentation, the key point.
- What I thought and did: your reasoning, differential and the decision points.
- What I learned: what you read, asked or realised, naming the source.
- What I will do differently: a concrete change, and how you will know it worked.
- Capabilities and groups: up to three capabilities, one line each on why; one or two groups.
The 20/80 rule
About 20% of your words on what happened, 80% on thinking, learning and change. A useful test: delete the case description; does the rest still show learning?
How to do it well
- Choose cases that made you think, not routine ones: routine cases make dull logs.
- Write within days, while the reasoning is fresh.
- Name the source you checked and what it said, in your own words; do not paste guideline text.
- Make the change specific and checkable: "I will review my next five..." rather than "I will be more careful".
- Hospital cases count: add a line on what the patient will need from their GP after discharge.
- A case used for a COT or CbD can also be a CCR, as long as the CCR shows your own learning.
Worked example
Chest pain. 58-year-old man with chest pain for 2 days. Examined, ECG normal. Gave advice and told to come back if worse. Learned that chest pain can be cardiac or musculoskeletal. Six capabilities ticked with no reasons.
Intermittent chest pain: when a normal ECG reassured me too much.
What happened: A man in his late fifties with two days of intermittent central chest tightness on walking uphill, settling with rest. Smoker, treated hypertension. Normal resting ECG.
What I thought: My instinct was to reassure because the ECG was normal. On reflection I was anchoring on the test rather than the story, which was typical of exertional angina. My trainer pointed out that a normal resting ECG does not exclude it.
What I learned: I re-read the NICE guidance on recent-onset chest pain, including which presentations need same-day assessment rather than outpatient referral.
What I will do: Treat the history as the main test and a normal ECG as one piece of information. I will check my next three chest pain consultations against a one-page summary and review them at tutorial.
Capabilities: Decision-making and diagnosis (recognising anchoring and acting on it); Data gathering and interpretation (a normal ECG in context); Clinical management (the right pathway and safety-net).
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Common ARCP pitfalls
- Descriptive summaries with no reflection.
- Bunching just before the ESR.
- The same 2 or 3 capabilities every time.
- Identifiable data: names, dates of birth, hospital numbers, unusual details.
- Counting CPD or teaching entries as CCRs.