What is a Long Case in clinical exams?

by | May 18, 2021

A Long Case is a form of clinical examination where an undergraduate student, trainee or junior professional discusses a specific case with a senior professional. Following on from the name, Long Cases typically last for at least 20 minutes per scenario and can last for any duration that is deemed appropriate for specific cases.

Each Long Case scenario will look to replicate a consultation with a patient in an outpatient setting or a clinical assessment of an inpatient and both standardised patients and real patients are used within Long Case scenarios. 

Within a Long Case, traditionally the allocated time will be broken into 3 distinct segments: history taking, a focused examination and a discussion with a senior healthcare professional to summarise findings and discuss a future management plan for the patient.

The research shows that reliability can be a key consideration with a Long Case when taking into account there is only one scenario to complete. One area that reliability can be increased for the Long Case is by having multiple assessors observe and score each candidate’s performance and combining the scores and feedback comments for each candidate. 

However, reliability will not be possible to the same degree as in an OSCE where candidates get the opportunity to perform across a large number of scenarios with different assessors. The Long Case is therefore best used as part of a wide range of assessments such as OSCEs, MCQs, Short Cases and essays. 

Case Study - Using an assessment tool for a Long Case

An Irish university successfully ran their Long Cases for final year students in 2021 for the first time using Qpercom Observe. Traditionally paper assessment forms were used for this assessment but as OSCEs have been examined digitally using Observe for the past 13 years, the Long Case was seen as an exam that would be very suited to digital scoring also.

There were 6 Long Case stations running concurrently across 2 days with each student getting 20 minutes with a patient while being observed by two assessors. After the 20 minutes completed, assessors were given 5 minutes to consider each performance and complete inputting their scoring and comments on Observe before the next student entered each station.

On Observe , individual stations were created and assessors assigned to each to access student lists for each particular station. Unlike an OSCE setup where students are added to groups where each student will be seen by each examiner on a circuit of multiple stations, for the Long Cases students were added to Station based groups and assessors worked through their list as each student entered their station with each assessor completing a unique assessment form per student.

With Observe, all scoring activity and examiner comments were available in real time for the exam team to monitor and as soon as all the students in the year had been examined all results were instantly available giving the exam team a full dataset to run analysis on and send personalised feedback reports to students if so chosen. 

To find out more about the assessment of Long Cases in a clinical exam situation, get in touch below. 

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