The long case versus objective structured clinical examinations

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7340.748 (Published 30 March 2002) Cite this as: BMJ 2002;324:748

The long case is a bit better, if time is equal

  1. Geoff Norman, professor
  1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada L8N 3Z5

    The examination of graduates of medicine to ensure competence has a long tradition predicated on the historical right of self regulation bestowed on the professions. While many may wish to replace such summative and frequently punitive assessment with softer assessment to facilitate learning, this amounts to a shirking of social responsibility. A consequence of the importance attached to such examinations is that considerable research has been devoted to establishing the reliability and validity of these examinations.

    One truism in educational research is that few self evident truths are true. Historically, it has seemed self evidently true that an experienced physician could, by active questioning around a case, determine whether a candidate was or was not competent—the long case. Unfortunately this assertion was challenged by evidence showing that the reliability of the long case was insufficient to justify decisions about competence to practice.1 The replacement of the long case by objective structured clinical examinations was predicated on a second self evident truth—the promise of truly objective clinical assessment using checklists, which should self evidently …

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