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| SHORT COMMUNICATION |
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| Year : 2021 | Volume
: 9
| Issue : 1 | Page : 42-43 |
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Scope of long-case examination as an assessment tool among medical students and the way forward
Saurabh R Shrivastava1, Prateek Saurabh Shrivastava2
1 Medical Education Unit Coordinator and Member of the Institute Research Council, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Chengalpattu, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Chengalpattu, Tamil Nadu, India
| Date of Submission | 15-Dec-2020 |
| Date of Decision | 04-May-2021 |
| Date of Acceptance | 10-Jun-2021 |
| Date of Web Publication | 17-Aug-2021 |
Correspondence Address:
Dr. Saurabh R Shrivastava
PGDHHM, DHRM, FCS, ACME, Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jihs.jihs_35_20
Assessment in medical education remains the key driving force for learning and ensures gradual progression by means of bridging the lacuna among medical students. Bedside teaching and assessing the same with the help of either long-case or short-case examinations is a well-known and frequently employed practice in clinical training. Although long-case examinations have been in use for multiple decades, we have to accept the drawbacks of these assessments that include allocation of marks on the basis of unstructured questions, the presence of inter-case variability, and non-adherence to the blueprint which, in turn, results in a haphazard selection of cases for examination. Further, the possibility of a strict or lenient examiner and the simultaneous presence of factors like patients (cooperative or non-cooperative patients or nature of illness in the patient) or students (liked or not liked by the teacher – the issue of being biased) complicates the entire process of assessment. Despite the presence of these constraints, long-case examinations generally have high face validity and give the opportunity for the student to evaluate the concerns of patients from all dimensions. In conclusion, long-case examinations remain an effective tool to assess the skills of medical students. However, we should aim to minimize its limitations and then use it for the benefit of medical students, and thus, direct observation and use of a standardized checklist have been advocated.
Keywords: Assessment, long-case examination, teachers
How to cite this article:
Shrivastava SR, Shrivastava PS. Scope of long-case examination as an assessment tool among medical students and the way forward. J Integr Health Sci 2021;9:42-3 |
How to cite this URL:
Shrivastava SR, Shrivastava PS. Scope of long-case examination as an assessment tool among medical students and the way forward. J Integr Health Sci [serial online] 2021 [cited 2023 Jun 2];9:42-3. Available from: https://www.jihs.in/text.asp?2021/9/1/42/323955 |
| Introduction | |  |
Assessment in medical education remains the key driving force for learning and ensures gradual progression by means of bridging the lacuna among medical students.[1] Conventionally, the assessment of the cognitive component has been carried out with the help of essays, short answer questions, multiple-choice questions, and viva voce. These tools are quite effective to assess various levels of the cognitive domain, once they are standardized and used as per the existing blueprint document. However, the assessment of the psychomotor and affective domain has been significantly undermined, and even in those settings in which it is being done, it lacks direct observation from the assessors.
Considering that it is difficult to assess all the learning domains consistently using a single tool, a combination of assessment tools (assessment toolbox) has been envisaged.[1] Assessment of the performance (psychomotor activities) and attitude in the field of medicine is extremely crucial as we aim to ascertain not only about the knowledge component (in terms of remembering, talking, and writing the information) but also ensure that the student is able to perform a specific skill with empathy and professionalism.[1],[2] Bedside teaching and assessing the same with the help of either long-case or short-case examinations is a well-known and frequently employed practice in clinical training.[1]
| Long-case Examinations | | |
In a long-case examination, the medical student is expected to elicit relevant and complete history and follow-up it with a thorough general and systemic examination on a real patient selected from the inpatient or outpatient settings.[2] The students are generally given a time span of 30–45 min and the student carries out the task usually in the absence of an examiner. Subsequently, the teachers assess these students through unstructured questions while they present their case, clinical findings, and discuss with teachers about the clinical diagnosis and management of the patient.[2],[3]
| Constraints in Long-case Examinations | | |
Although long-case examinations have been in use for multiple decades, we have to accept the drawbacks of these assessments that include allocation of marks on the basis of unstructured questions, the presence of inter-case variability, and non-adherence to the blueprint which, in turn, results in a haphazard selection of cases for examination.[3] Further, the possibility of a strict or lenient examiner and the simultaneous presence of factors like patients (cooperative or non-cooperative patients or nature of illness in the patient) or students (liked or not liked by the teacher – the issue of being biased) complicates the entire process of assessment.[1],[2],[3]
| Merits of Long-case Examinations | | |
Despite the presence of these constraints, long-case examinations generally have high face validity, as the clinical interaction happens between a medical student and a real patient, which is very much similar to routine clinical practice.[4] Such assessments are capable to assess whether a student can apply the learned knowledge into practice and benefit the patients. Further, long-case examinations give the opportunity for the student to evaluate the concerns of patients from all dimensions (and not restricts only to one specific thing such as in short case examinations) and make the student competent and confident to manage complicated cases as well.[4]
| Improving Long-case Examinations | | |
Further, a range of modifications have been proposed to deal with the inherent flaws of long-case examinations. These modifications include observing students while they are eliciting history or performing a physical examination. The presence of an observer during assessments gives a lot of inference about the clarity of thoughts, communication skills, examination techniques, establishment of clinical findings in the right manner, and the approach adopted by the student.[2],[4] It has also been recommended to use a standardized checklist to streamline the process of assessment and eliminate assessor bias. In fact, the assessment tool of objective structured long-case record has gained immense importance and is being used in different settings to standardize assessment.[1],[4]
At Shri Sathya Sai Medical College and Research Institute, a constituent unit of the Sri Balaji Vidyapeeth, Deemed-to-be University, Puducherry, multiple sessions have been conducted either as a standalone programme or as a part of the Revised Basic Course Medical Education Workshop and all the faculty members have been exposed to the ways in which a long case examination can be streamlined and conducted in a non-biased manner.
| Conclusion | | |
Long-case examinations remain an effective tool to assess the skills of medical students. However, we should aim to minimize its limitations and then use it for the benefit of medical students, and thus, direct observation and use of a standardized checklist have been advocated.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Masih CS, Benson C. The long case as a formative assessment tool – Views of medical students. Ulster Med J 2019;88:124-7.  |
| 2. | Ponnamperuma GG, Karunathilake IM, McAleer S, Davis MH. The long case and its modifications: A literature review. Med Educ 2009;43:936-41. |
| 3. | Chierakul N, Danchaivijitr S, Kontee P, Naruman C. Contribution of examiner subjectivity and patient heterogeneity on long case examination. J Med Assoc Thai 2012;95 Suppl 2:S83-6. |
| 4. | Nithyanandam S, Joseph M, Vasu U. Can conventional long case examination be improved? Indian J Ophthalmol 2012;60:333. [Full text] |
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