The “failure to fail” phenomenon in the clinical long case examination

Abstract

Introduction:

In the final clinical examination for undergraduate students, real patients are used to assessing the clinical competence of the students. Numerical scores based on a predetermined rubric are awarded to decide the status of the students. Subjective comments by examiners are encouraged to assess concordance. The aim of the study is to find out if the subjective comments match the numerical scores for the students undertaking the examination.

Methods:

This is a cross-sectional study for a batch of 106 students. The mark sheet was framed with standard criteria for a long case and examiners were briefed to give marks according to the criteria; they were allowed to give free comments. These were collected and thematic analysis was conducted. The categories used were “do not tally”, “tally” and “no comment”.

Results:

In medicine and surgery, 0% – 4.5% of the responses did not tally, whereas 38%-50% tallied. In the “no comment” category, all except two candidates passed. In paediatrics and psychiatry, 35%-50% of the responses did not tally, while 25%-50% were with no comments but clear passes. Obstetrics and gynaecology (O&G) and orthopaedics had 18%-30% responses that did not tally, and 18%-40% responses that showed concordance. The significant observation was 0% of “do not tally” in surgery and 0% “tally” in psychiatry.

Conclusion:

The disparity of subjective comment was lowest in medicine and surgery whereas it was highest in psychiatry. Paediatrics, O&G and orthopaedics have a cons