The long case: a case for revival?

Until 2003 the long case was the clinical component of the two summative examinations for the Membership of the Royal College of Psychiatrists (MRCPsych). This changed to an Objective Structured Clinical Examination (OSCE) format, initially for the Part I examination, and more recently to the Clinical Assessment of Skills and Competencies (CASC) at the end of 3 years of basic training. Although there are distinct advantages to the objective, competency-based assessment, questions remain on its validity. The expectation that formative workplace-based assessments would fill in the void left by the loss of the long case has not materialised. The options for retaining the advantages of the long case within the CASC framework while minimising the shortcomings of the CASC are suggested as a way forward.