British Journal of Medical Practitioners, December 2012, Volume 5, Number 4 BJMP.org BJMP 2012;5(4):a537 3 years on: Examiners’ and candidates’ views on the CASC (Clinical Assessment of Skills and Competencies) Rajkumar Kamatchi, Saugata Bandyopadhyay, Ashok Kumar Jainer, Bettahahalasoor Somashekar, Marek Marzanski and Steven Marwaha ABSTRACT Aim and method: The Clinical Assessment of Skills and Competencies (CASC), introduced in June 2008 is the new and only clinical examination in obtaining membership of Royal College of Psychiatrists. Although there is evidence of strong validity and reliability for OSCE (Objective Structured Clinical Examination) - type examinations, the acceptability, validity and reliability of the CASC is open to challenge. We conducted a national online survey of candidates and examiners to obtain their views and aimed to evaluate whether the CASC fulfils its purpose. Results: The survey showed that 48% of the candidates (n=110) and 59% the examiners (n=22) agreed that the CASC examines the required competencies to progress to higher training. However only 15% of the candidates and 18% of the examiners accepted that CASC examines all the advanced psychiatric skills compared to the previous Part 2 clinical examination. Nevertheless, only a third of the candidates and examiners considered replacing the CASC with traditional long case as the best way forward. Implications: Although CASC scenarios may reflect real-life situations and its content covers most skills in piecemeal, it lacks the holistic ethos underpinning the bio-psychosocial approach unique to psychiatry. The findings of the survey suggest that the current examination method requires further systematic evaluation. Post- graduate medical education in the United Kingdom has seen numerous dramatic changes in the last decade, with the introduction of structured training programmes and changes in assessment of skills driven by Modernising Medical Careers. 1 Overall these new developments emphasise a competency based curriculum and assessments. Alongside and contingent on these wider changes in medical education, psychiatric trainees have faced major transformations in their membership (MRCPsych) examinations. The MRCPsych examination was first introduced in 1972, a year after the Royal College of Psychiatrists was founded. There have been various modifications in its structure since its inception but a radical change occurred in the last decade with the introduction of an OSCE in 2003 and the CASC, a modified OSCE in June 2008. The CASC is considered as a high- stakes examination as it is now the only clinical and final examination towards obtaining the membership of the College. The MRCPsych qualification is considered as an indicator of achieving professional competence in the clinical practice of psychiatry and has the main aim of setting a standard that determines whether trainees are suitable to progress to higher specialist training. 2 In his commentary to Wallace et al 3 , Professor Oyebode describes the aims, advantages and disadvantages of the various assessment methods used in the MRCPsych examination and conclude that the precise assessment of clinical competence is essential. 4 Traditionally, assessment of clinical skills involved a long case examination since it was introduced in clinical graduating examination by Professor Sir George Paget at Cambridge, UK in 1842. This has been followed by most of the medical institutions worldwide and remained as the clinical component of the MRCPsych examination until 2003. There are some shortcomings with this assessment method and the outcome can be influenced by several factors such as varying difficulty of the cases, co-operation of the real patient and examiner- related factors. The reliability of assessment of clinical competency with a single long case is low and it is necessary for the candidate to interview at least ten long cases to attain the reliability required for a high stakes examination like MRCPsych. 5 A fair, reliable and valid examination is necessary to overcome these difficulties. The OSCEs proved to be one of the answers to these difficulties. One important aspect of assessing the validity and acceptability of assessment methods is asking the opinions of examiners and candidates about their experiences and views about the examination once it has been rolled out. As far as the authors are aware there has been one previous published survey of CASC candidates’ views on this method of examination and this was based at a revision course. Whelan et al 6 showed that approximately 70% of the candidates did not agree with the statement “there is no longer a need to use real patients in post- graduate clinical psychiatry exams”. In addition, only 50% of the candidates preferred the CASC compared to previous long case and the other 50% remained undecided. This raises doubts Research Article