The death of the long case?

The long case has tested the clinical skills of students for many years, yet inherent problems preclude it from being the sole source of decision making For most of the past century the long case has been an essential tool in the evaluation of clinical skills, being used to make important judgments about the education and practice of doctors throughout the world. Despite its widespread use and rich tradition, the long case has major flaws, making it unwise to use it as the sole basis for making decisions of consequence. In this article I describe the strengths and weaknesses of the long case and report on some of the modifications that have been introduced to improve its performance. #### Summary points The long case has been an essential tool in the assessment of clinical skills It evaluates performance with real patients and enables students to gather information and develop treatment plans under realistic conditions Problems have been found with the reproducibility of scores generated by the long case The long case can be improved by increasing the number of encounters, examiners, or aspects of a competence assessed Organisations responsible for high stakes testing are increasingly abandoning the long case or using it only in combination with other forms of assessment Although there are numerous variations on the long case, traditionally a student is given unobserved time with a real patient in a clinical setting. During that time the student conducts an interview and performs a physical examination as appropriate. The student then presents his or her findings and plans to the examiners, who ask about the patient and related topics enabling them to judge the quality of the student's …