A Handbook for Teaching and Learning in Higher Education Enhancing academic and Practice

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Teaching in the disciplines
to this potential. With the development of software to recognise ‘handwriting’, typed
prose short answer questions (SAQs) and indeed essays/projects may be computer
marked. An excellent guide to writing test questions is available online from the National
Board of Medical Examiners (2007).
With MCQs, single best answer (SBA) questions have become the gold standard.
At Barts and the London, UK, we have trialled the use of ‘contextualised SBAs’ which
incorporate several positive characteristics of SAQs and MCQs. These retain a
high reliability but allow greater flexibility than do conventional MCQs. MCQs
and SAQs are common to many disciplines, but EMQs have been developed in
medicine to assess higher levels of cognition, including diagnostic reasoning (Case
and Swanson, 1996).
Updating clinical assessment: (1) the short case
The description of the objective structured clinical examination (OSCE) (Harden and
Gleeson, 1979) heralded the demise of the long and short case. Since the early 1990s the
OSCE has become widely used in both undergraduate and postgraduate assessment.
Interrogating practice
Thinking about the characteristics of a ‘good’ assessment, what do you believe
are the advantages and disadvantages of using an OSCE?
Without doubt OSCEs potentially fulfil many of the criteria that form a ‘good’
assessment. However, their positive attributes must be weighed against their expense
(we have calculated that they are 50 per cent more expensive than the older-style
examinations), the resources required to run a single examination (venues, patients,
actors, examiners and support staff) and the time. Our experience is that people can
‘abuse’ the OSCE format; commonly, pass/fail decisions are made using too few stations,
the areas tested are sometimes unsuitable for OSCEs (and could often be more rigorously
tested using other formats) and stations may lack context and complexity due to poor
question setting or failure to increase the time needed.
Updating clinical assessment: (2) the long case
A more objective format of the traditional long case is the observed long case (Newble,
1991) and the objective structured long examination record (OSLER) (Gleeson, 1992).
All the candidates are observed by examiners, see similar patients, and identical aspects