Centre for Medical Education, University of Dundee, Dundee, UK.
Med Educ. 2009 Oct;43(10):936-41. doi: 10.1111/j.1365-2923.2009.03448.x.
This review provides a summary of the published literature on the suitability of the long case and its modifications for high-stakes assessment.
Databases related to medicine were searched for articles published from 2000 to 2008, using the keywords 'long case', 'clinical examinations' and 'clinical assessment'. Reference lists of review articles were hand-searched. Articles related to the objective structured clinical examination were eliminated. Research-based articles with hard data were given more emphasis in this review than those based on opinion.
Eighteen articles were identified. The main disadvantage of the long case is its inability to sample the curriculum widely, resulting in low reliability. The main advantage of the long case is its ability to assess the candidate's overall (holistic) approach to the patient. Modifications to the long case attempt to: structure the format and the marking scheme; increase the number of examiners; observe the candidate's behaviour, and increase the number of cases.
The long case is a traditional clinical examination format for the assessment of clinical competence and assessment at this level is important. The starting point for the majority of recent research on the long case has been an acceptance of its low reliability and modifications to the format have been proposed. Further evidence of the efficacy of these modifications is required, however, before they can be recommended for summative assessment. If further research is to be undertaken on the long case, it should focus on finding practicable ways of sampling the curriculum widely to increase reliability while maintaining the holistic approach towards the patient, which represents the attraction of the long case.
本篇综述对已发表的文献进行了总结，评估了长案例及其改良形式在高风险评估中的适宜性。
检索了 2000 年至 2008 年与医学相关的数据库，使用的关键词包括“长案例”、“临床检查”和“临床评估”。同时还查阅了综述文章的参考文献，并排除了与客观结构化临床考试相关的文章。在本次综述中，更强调基于研究的文章（具有确凿数据），而不是基于观点的文章。
共确定了 18 篇文章。长案例的主要缺点是其无法广泛地对课程进行抽样，从而导致可靠性较低。长案例的主要优点是它能够评估候选人对患者整体（全面）的处理方法。对长案例的修改试图：构建格式和评分方案；增加考官人数；观察候选人的行为，并增加案例数量。
长案例是评估临床能力的传统临床检查形式，这种水平的评估很重要。最近对长案例的大多数研究都基于其低可靠性的假设，提出了对格式的修改。然而，在推荐这些修改用于总结性评估之前，需要进一步证明这些修改的有效性。如果要对长案例进行进一步研究，应重点寻找切实可行的方法，在保持对患者全面处理方法的吸引力的同时，广泛地对课程进行抽样，以提高可靠性。
