A standardized, structured long-case examination of clinical competence of senior medical students

Abstract

Aiming at improving the assessment of senior medical students a standardized and structured modification to the traditional long-case examination is proposed. Students are presented with a sequence of two long cases, with each case being observed by a different examiner. After approaching the patient, the student is interviewed by the examiner who uses a set of four standardized questions. A 10-item checklist covering five groups of major clinical skills was delineated. The time frames for both patient approach (25 minutes) and student interview (10 minutes) were standardized. After the examination, immediate feedback is given to the student. Preliminary results obtained with the first 27 students taking the exam showed that none has failed and 20 of them had combined marks higher than 8.0 (range: 6.6-10.0). Failing performances on individual checklist items were more common in physical examination and less frequent regarding communication with patients. Agreement between different examiners on the assessment of the various skills of the same student was 89%. It is concluded that modifying the format to the long-case examination increased its value in the assessment of student clinical competence.