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

Aiming at improving the assessment of senior medical students a standardize d and structured modification to the traditional long-case examination is p roposed. Students are presented with a sequence of two long cases, with eac h case being observed by a different examiner. After approaching the patien t, the student is interviewed by the examiner who uses a set of four standa rdized questions. A 10-item checklist covering five groups of major clinica l skills was delineated The time frames for bath patient approach (25 minut es) and student interview (10 minutes) were standardized After the examinat ion, immediate feedback is given to the student. Preliminary results obtain ed with the first 27 students taking the exam showed that none has failed a nd 20 of them had combined marks higher than 8.0 (range: 6.6-10.0). Failing performances on individual checklist item were more common in physical exa mination and less frequent regarding communication with patients. Agreement between different nr 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 clin ical competence.