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The long case: a case for revival?

  • Albert Michael (a1), Ranga Rao (a2) and Vishaal Goel (a3)
Summary

Until 2003 the long case was the clinical component of the two summative examinations for the Membership of the Royal College of Psychiatrists (MRCPsych). This changed to an Objective Structured Clinical Examination (OSCE) format, initially for the Part I examination, and more recently to the Clinical Assessment of Skills and Competencies (CASC) at the end of 3 years of basic training. Although there are distinct advantages to the objective, competency-based assessment, questions remain on its validity. The expectation that formative workplace-based assessments would fill in the void left by the loss of the long case has not materialised. The options for retaining the advantages of the long case within the CASC framework while minimising the shortcomings of the CASC are suggested as a way forward.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Ranga Rao (ranga.rao@slam.nhs.uk)
Footnotes
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See commentary, pp. 382–383, this issue.

Declaration of interest

A.M. is a College Examiner and Training Programme Director, General Adult Psychiatry, East of England Deanery. R.R. is a College Examiner and was a member of the Examinations Subcommittee until 2012.

Footnotes
References
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The long case: a case for revival?

  • Albert Michael (a1), Ranga Rao (a2) and Vishaal Goel (a3)
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eLetters

Work Place Based Assessments

Yasmine A. Nasr, CT1 Psychiatry
22 January 2014

Despite their many criticisms, I am in favour of work place basedassessments (WPBAs). They do, in theory, assess a range of important skills and do this outside of stressful examination conditions, thereby allowing trainees to perform to their greatest ability. The Assessment of Clinical Expertise (ACE) in particular covers many of the same skills assessed in the long case but avoids the snap shot examinationoften criticised of the latter. The ACE overcomes this by assessing patients across multiple specialties with varying patient groups and attempts to minimise examiner bias by requiring completion from a number of different trainers. It also supersedes the long case by allowing full observation of the patient encounter and so in addition to assessing diagnostic and management skills, provides a more reliable means of assessment of communication skills and the ability of the trainee to develop a rapport with their patient.

As a trainee, however, I can clearly see that WPBAs are not without their problems. The main concern for myself and many trainees alike is notwith their format or the skills they assess, but rather the rating and feedback. There is lack of consistency amongst trainers in completing these forms with no standards of reference to work to and so there is great subjectivity in their completion. Perhaps the introduction of external assessors who have received further training could be a step forward in overcoming such inconsistencies.

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Conflict of interest: None declared

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