Perceptions of medical students and lecturers on the long case practices as formative assessment in internal medicine clerkship at Makerere University

Abstract

Introduction; The long case is used to assess medical student’s competence in carrying out clinical tasks and is a good tool for formative assessment. In formative assessment, it is intended to provide feedback on performance to improve and accelerate learning. The long case is perceived as beneficial for formative assessment in literature despite the numerous dissensions with it. In Makerere University Department of Internal Medicine, it has been in use for many years to assess clinical competence both as formative and summative assessment. However the practice of the long case as a formative assessment has not been evaluated among both students and lecturers at the university. Objective: To explore the perceptions of Medical students and lecturers on the practice of the long case as a formative assessment in undergraduate clerkship in internal medicine at Makerere University Methodology: a qualitative study design was used. The study participants were third and fifth-year medical students and lecturers. A purposive sampling method was employed to recruit participants. Data was collected via six students’ Focus Group Discussions and five lecturers' Key Informants Interviews. The qualitative data was transcribed and analyzed thematically. Results: Six themes emerged from the study; 1) the environment for the long case 2) case presentation, 3) the strength of the long case, 4) learning support for the long case, 5) marks in formative long case, and 6) feedback given in long case. The study found that long case as formative assessment is good due to its authenticity and enable growth from novice to an expert in patient care and promote development of professional identity among medical student. Effective supervision, feedback and marks were found to have influence on learning from long case. However, lack of orientation into the long case format, super-specialization of the teaching hospital, big students to lecturer ratio, pressure on clerking patient, pressure to chase for marks, and poor feedback practices were the main challenges identified. Conclusions: Generally the study found the long case as a formative assessment good and beneficial supporting its use as an assessment for learning. However, to maximize its role and impact, we recommend proper design and implementation of the practice to enable exposure of students to a variety of cases and enhanced supervision by lecturers to provide adequate opportunities and experience for each learner to present and be corrected.