Suggestions would make examinations with real patients impractical

EDITOR—The paper by Sayer et al raises important issues for those responsible for developing and delivering undergraduate and postgraduate clinical examinations.1 Clearly most would want to include real patients, often alongside simulated patients, to enhance the validity of the examination, although obtaining suitable real patients has become harder recently.

No one would argue about the need to obtain informed consent or to ensure confidentiality of patient data. The issue of the available level of medical care, however, needs further consideration. If the source of patients includes inpatients then the environment in which the examination is conducted should offer nursing and medical support that would be available elsewhere in the hospital, and to a level appropriate to clinical need. Obviously the permission of the responsible doctor must be sought, and this should be granted only if the care available is adequate.

In many examinations, however, the patients may be outpatients, and this situation is quite different. There is …