Abstract:
CONTEXT This review provides a summary of
the published literature on the suitability of the
long case and its modifications for high-stakes
assessment.
METHODS Databases related to medicine were
searched for articles published from 2000 to
2008, using the keywords ‘long case’, ‘clinical
examinations’ and ‘clinical assessment’. Reference
lists of review articles were hand-searched.
Articles related to the objective structured
clinical examination were eliminated. Researchbased
articles with hard data were given more
emphasis in this review than those based on
opinion.
RESULTS Eighteen articles were identified.
The main disadvantage of the long case is its
inability to sample the curriculum widely,
resulting in low reliability. The main advantage
of the long case is its ability to assess the
candidate’s overall (holistic) approach to the patient. Modifications to the long case attempt
to: structure the format and the marking
scheme; increase the number of examiners;
observe the candidate’s behaviour, and increase
the number of cases.
CONCLUSIONS The long case is a traditional
clinical examination format for the assessment
of clinical competence and assessment at this
level is important. The starting point for the
majority of recent research on the long case has
been an acceptance of its low reliability and
modifications to the format have been proposed.
Further evidence of the efficacy of these
modifications is required, however, before they
can be recommended for summative assessment.
If further research is to be undertaken
on the long case, it should focus on finding
practicable ways of sampling the curriculum
widely to increase reliability while maintaining
the holistic approach towards the patient,
which represents the attraction of the long case.
