Undergraduate surgical examinations: an appraisal of the clinical orals

The aims of this study of examinations in the final year of undergraduate surgery were to determine whether the long case, short cases/orals reflected students' knowledge of surgery effectively, whether their performance indicated the goals of the medical course relative to surgery were achieved, and whether these examinations gave a good and fair appraisal of student clinical skills. To test validity of these examinations, the scores of the long and short cases/oral were correlated with the aggregate score for the medical course, to the final-year total score, the final-year surgery mark, the written examination mark and the final-year internal medicine mark. Whether the surgical goals of the medical course were achieved was assessed by questionnaire to the surgical examiners, and whether there was a good and relevant appraisal of student clinical skills was assessed by questionnaire to students. The response rates to the questionnaires were 100% and 98%. The results showed a poor but significant correlation between long and short cases/oral (rho = 0.24, P = 0.01). The correlation of the long case and short cases/oral to internal medicine was rho = 0.45 and rho = 0.33 (both P < 0.001), and there was a better correlation of short cases/oral to the aggregate medical course score (rho = 0.53 vs. 0.42, both P < 0.001). The long case and short cases/oral had no correlation with the written paper (rho = 0.10 and 0.69, respectively). The goals of the medical course were considered achieved, but less so with assessment of the injured and acutely surgically ill; students considered the long and short cases/orals as a good and relevant appraisal of their clinical skills. The distribution of short cases marks shifted to the left, indicating lower scores for this part of the examination. In conclusion, this study has demonstrated that the long and short cases/orals tested different aspects of student's skills, and so reinforces the importance of retaining the short and long cases in undergraduate surgical examinations. It is suggested that a single long case may be insufficient to distinguish between adequate and inadequate performance.