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.