Role of the observed long case in postgraduate medical training

The teaching of long case examination technique emphasizes case presentation, problem identification and discussion of management. It assumes that history taking and ability to perform a complete physical examination in a limited time are adequate. These can only be assessed by directly observing the long case examination.

To explore the usefulness of observing long case performance.

We used a structured assessment form to observe and evaluate the overall long case performance of 19 doctors in our physicians' training programme. Nine, group A, had received 6 months training, whereas the 10 in group B had only just commenced clinical examination training.

Ten (53%) passed their long case, seven from group A and three from group B. Thirteen (68%) passed the history and examination section. Three failed the history component and five failed the examination component. The groups had similar scores for observed history taking. Common problems included poor time management, excessive time required to take the history and lack of organization of questions. Physical examination was usually poorly organized, requiring the use of short cuts, particularly in the respiratory, musculoskeletal and neurological systems. Group A were better at presentation and discussion, with eight (89%) passing compared with four (40%) passing in group B.

These results reflect the emphasis in our training programme on long case discussion and management, rather than examination technique. The observed case allowed for detection of defects in history-taking skills and time management. Therefore, it is valuable in preparing candidates for their Fellowship examinations.