Formative Long Case (10 week Medicine Block)

As part of a students' assessment during their 10-week Medicine block in Year 4, Educational Supervisors will arrange for them to complete a formative objective long case that replaces the Mini-CEX and CBD in the second half of their attachment.

This long case is designed to test skills of history and examination as well as the students’ ability to integrate the findings, and to summarise this to the observer. The student will also be asked to offer a problem list, differential diagnosis and describe a plan of investigation and management plan. The assessor will directly observe the student taking a history and performing an examination on a patient. This will be divided into sections: details of the marking schedules are included. This will usually involve interviewing a patient on a medical ward. Scoring should reflect the performance that you would reasonably expect for a student at their stage of training. We ask the assessor to grade the complexity of the case and then to grade your performance in each section.

Complexity of the case:

  • Low Complexity – Uneventful encounter, few demands made on student by patient
  • Moderate Complexity – A few difficult aspects of the consultation evident
  • High Complexity – Difficult due to unusual findings or demanding patient

The long case should be undertaken as follows:

  • Meet the student on the ward, introduce yourself, and take them to meet the patient.
  • Ascertain that they have not met the patient before.
  • Inform the student that the total length of the exam is no greater than 60 minutes. 
  • Inform them that you will let them know when 20 minutes have passed and that you will interrupt them after 40 minutes (if they have not already finished).
  • Instruct the student to 'perform a long case clerking (history and directed examination) on this patient'.  Add that you will be observing them throughout - they will be expecting this.
  • Make sure that you are present for the duration of the exam. The student may wish to spend the last 5 minutes of this time preparing their thoughts.

You should then spend 15 to 20 minutes on the following questions:

  1. Summarise this case and identify the main problems.
  2. Describe and justify your differential diagnosis, ranked from most to the least probable.
  3. Describe the investigations required to confirm your diagnosis.
  4. Describe the management and/or therapeutic measure you would take for this patient. 

Debriefing and Feedback:

This should take about 5–10 minutes. It should be conducted in a suitable, quiet environment immediately after the assessment and should be constructive and helpful.  Please remember that virtually all students strive to do their best during assessments and are keen to know how to do better. The assessor should expand on the reasons for any ratings “Below Expectations” and make practical suggestions for any remedial steps if appropriate.  Care is needed to ensure that feedback is appropriately critical but not unpleasant.  You should grade each section to give guidance as to areas needing attention.

View the Student Guidelines for the Objective Long Case
View the Objective Long Case Assessment Form
View the Objective Long Case Feedback Form

For any enquires about the 10 week Medicine Block Long Case, please contact the Year 4 Curriculum Support Administrator: