Abstract
Formative assessments in medical education are crucial for improving students’ abilities in clinical practice. Among these assessments, the long case has been a traditional tool used to evaluate medical students’ clinical skills, judgment, and problem-solving capabilities. Recent studies, including those conducted by Claire S. Masih and Claire Benson, have provided insights into the views of medical students on the long case examination, denoting its impact on learning and skills development. This article delves into the significance, perceptions, and effectiveness of the long case as a formative assessment tool in medical education today.
Introduction
The long case, a comprehensive clinical examination in which medical students are assessed on their ability to manage a patient encounter from start to finish, has been a staple in medical education for many years. Despite its longevity, opinions on its utility and effectiveness have been mixed (Wass & van der Vleuten, 2004). With the evolution of medical assessment tools, there has been a growing interest in re-evaluating the usefulness of the long case from a contemporary standpoint. In a study published in the Ulster Medical Journal, Masih and Benson (2019) explored the views of medical students regarding the utilization of the long case as a formative learning experience.
Methodology
To ascertain students’ views on the long case, Masih and Benson employed a combination of surveys, questionnaires, and focus groups. Their research involved qualitative data analysis with an aim to gather in-depth understanding of the perceptions held by the students. This reflective approach is grounded in the educational assessment literature, recognizing the value of qualitative methods for capturing nuanced student experiences (Ponnamperuma et al., 2009).
Discussion
The long case is predicated on its purported ability to mimic authentic clinical scenarios where students must apply their knowledge, clinical skills, and critical thinking to provide patient care. It’s been supported by various theories of learning and professional development, advocating for real-world application as a catalyst for deep learning (Bleasel et al., 2016).
Student Perceptions
The research by Masih and Benson revealed that students value the format for its real-life application and perceived relevance to their future clinical practice. Students highlighted the long case’s role in bridging theoretical knowledge and practical experience, fostering a form of experiential learning that is deemed essential for professional competence (Van Der Vleuten, 1996).
Concerns and Challenges
However, students also aired concerns about the assessment’s validity and reliability (Norcini, 2001). They expressed anxieties related to subjectivity in grading, the pressure of performance within a time-constrained scenario, and the potential inconsistency in cases and examiners (Hill et al., 2009). These echo the broader discourse on examination standardization and objectivity in medical education assessment (Cookson et al., 2011).
Impact on Learning
Significantly, findings suggest that the long case can serve as a formative tool that allows students to identify their strengths and weaknesses, provided that constructive feedback is given (Wass & Jolly, 2001). The feedback loop, when properly utilized, can spearhead self-directed learning and intrinsic motivation, aligning with the underlying principles of adult learning stipulated by educational theorists.
Formative vs Summative
It’s essential to differentiate between formative and summative assessments. While the long case has traditionally been used as a summative tool towards the end of medical training, its incorporation as a formative element has been proposed to offer better learning dividends (Gleeson, 1997). As a formative assessment, it is intended to shape learning rather than strictly evaluate it, providing students with opportunities for reflection and improvement.
Modifications and Alternatives
Over the years, variations of the long case, such as the Objective Structured Clinical Examination (OSCE) and mini-clinical evaluation exercise (mini-CEX), have emerged as alternatives offering more structured and objective assessment formats (Harden, 2016). However, the role of these tools in completely replacing the long case is still a matter of debate (Price & Byrne, 1994).
Future Directions and Recommendations
As medical education continues to evolve, the debate over the best methods for assessing clinical competence rages on. A growing body of research suggests that a combination of multiple assessment tools, employing both formative and summative evaluations, may provide a more accurate and comprehensive picture of a student’s clinical abilities (Johnston & Hill, 2012).
Conclusion
The long case remains a contentious yet integral part of medical education. It offers rich opportunities for learning and development but also poses challenges that need to be addressed. The perspectives of medical students, as highlighted in the study by Masih and Benson, underscore the necessity for careful consideration of the tool’s implementation as part of a broader assessment strategy.
References
1. Wass, V., & van der Vleuten, C. (2004). The long case. Medical Education, 38(11), 1176–1180. DOI: 10.1111/j.1365-2929.2004.01956.x
2. Ponnamperuma, G. G., Karunathilake, I. M., McAleer, S., & Davis, M. H. (2009). The long case and its modifications: a literature review. Medical Education, 43(10), 936–941. DOI: 10.1111/j.1365-2923.2009.03443.x
3. Norcini, J. (2001). The validity of long cases. Medical Education, 35(8), 720–721.
4. van der Vleuten, C. (1996). Making the best of the ‘long case’. Lancet, 347(3), 704–705. DOI: 10.1016/S0140-6736(96)90067-6
5. Harden, R. M. (2016). Revisiting ‘Assessment of clinical competence using an objective structured clinical examination (OSCE)’. Medical Education, 50(4), 376–379. DOI: 10.1111/medu.12955
6. Wass, V., & Jolly, B. (2001). Does observation add to the validity of the long case? Medical Education, 35(8), 729–734.
7. Gleeson, F. (1997). AMEE Medical Education Guide No. 9. Assessment of clinical competence using the Objective Structured Long Examination Record (OSLER). Medical Teacher, 19(1), 7–14.
8. Hill, F., Kendall, K., Galbraith, K., & Crossley, J. (2009). Implementing the undergraduate mini-CEX: a tailored approach at Southampton University. Medical Education, 43(4), 326–334.
9. Johnston, J. A., & Hill, M. (2012). Resurrecting the long case. J Neurol Neurosurg Psychiatry, 83(3), e1.
10. Price, J., & Byrne, J. A. (1994). The direct clinical examination: an alternative method for the assessment of clinical psychiatry skills in undergraduate medical students. Medical Education, 28(2), 120–125.
11. Bleasel, J., Burgess, A., Weeks, R., & Haq, I. (2016). Feedback using an ePortfolio for medicine long cases: quality not quantity. BMC Medical Education, 16(1), 278. DOI: 10.1186/s12909-016-0787-8
12. Van Der Vleuten, C. P. (1996). The assessment of professional competence: developments, research and practical implications. Advances in Health Sciences Education, 1(1), 41–67.
13. Cookson, J., Crossley, J., Fagan, G., McKendree, J., & Mohsen, A. (2011). A final clinical examination using a sequential design to improve cost-effectiveness. Medical Education, 45(7), 741–747.
Keywords
1. Formative Assessment in Medical Education
2. Long Case Examination
3. Clinical Competence Assessment
4. Medical Students’ Perceptions
5. Feedback in Clinical Training