A literature review of the long case and its variants as a method of assessment

Objective: The purpose of this literature review is to review the evidence base for the long case and its variants as a reliable method of assessing medical students. Method: MEDLINE, PubMed, EMBASE, Blackwell Synergy, Ask Eric and Google Scholar were searched for articles published between 1991 and 2011 using the keywords ‘long case’, ‘OSLER’, ‘clinical assessment’ and ‘clinical examinations’. Result: 29 articles were identified, 13 original research articles and 16 review articles and commentaries. The majority of studies are single centre cohort studies, providing relatively weak evidence. The strengths and weaknesses of the long case are discussed with a review of the literature. Conclusion: Despite it being viewed as a relatively authentic examination, concerns regarding reliability of the long case examination has led to its use being discontinued in many UK medical schools. However, there is evidence that with simple modifications, the reliability of the long case can be improved to be as good as, if not better than alternative clinical examinations such as the Objective Structured Clinical Examination (OSCE).