title: The long case.
abstract: BACKGROUND
  The long case has been gradually replaced by the objective structured clinical examination (OSCE) as a summative assessment of clinical skills. Its demise occurred against a paucity of psychometric research. This article reviews the current status of the long case, appraising its strengths and weaknesses as an assessment tool.
  
  
  OBJECTIVE
  There is a conflict between validity and reliability. The long case assesses an integrated clinical reaction between doctor and real patients and has high face validity. Intercase reliability is the prime problem. As most examinations traditionally used a single case only, problems of content specificity and standardisation were not addressed.
  
  
  CONCLUSIONS
  Recent research suggests that testing across more cases does improve reliability. Better structuring of tests and direct observation increases validity. Substituting standardised cases for real patients may be of little benefit compared to increasing the sample of cases.
  
  
  CONCLUSIONS
  Observed long cases can be useful for assessment depending on the sample size of cases and examiners. More research is needed into the exact nature of intercase and interexaminer variance and consequential validity. Feasibility remains a key problem. More exploration of combined assessments using real patients with OSCEs is suggested.
authors.affiliation: School of Primary Care, University of Manchester, Manchester, UK. walerie.wass@man.ac.uk
authors.forename: Val
authors.initials: V
authors.lastname: Wass
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
mesh_terms: D002983:Clinical Competence / Q000592:standards; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement / Q000592:standards*; D006801:Humans; D015203:Reproducibility of Results; D013337:Students, Medical