The observed long-case in clinical assessment.

The University of Adelaide has developed a comprehensive approach to final-year clinical assessment through the use of ward ratings during student internships and the administration of an objective examination of clinical competence at the end of the year. The traditional clinical viva has been retained only to make pass-fail decisions on borderline students. Problems in making these decisions prompted a modification of the viva so that each student undertook two long-cases, each being observed by a pair of examiners. Better agreement among examiners and more effective decision-making seemed to ensue. The success of this approach led to the introduction of observed long-cases into the ward setting. This move has been strongly supported by staff and students. The opportunities for remedial action during the course were regarded as particularly valuable. This approach may offer a practical alternative to more sophisticated assessment techniques, such as those involving standardized patients, without the need for additional resources. However, psychometric studies will have to be performed before the approach can be fully recommended.