Saturday, August 7, 2021

Workflow for the MD university final case based viva summative assessment

MCI guidelines for Clinical / Practical and Oral Viva examination quoted below verbatim from their website PDF document linked below:

"(i) Clinical examination for the subjects in Clinical Sciences shall be 
conducted to test the knowledge and competence of the candidates 
for undertaking independent work as a specialist/Teacher, for which 
candidates shall examine a minimum one long case and two short 
cases.

(iii) The Oral examination shall be thorough and shall aim at assessing 
the candidate knowledge and competence about the subject, 
investigative procedures, therapeutic technique and other aspects of 
the speciality, which form a part of the examination.
A candidate shall secure not less than 50% marks in each head of 
passing which shall include

(1) Theory, 

(2) Practical 
including clinical 
and viva voce examination."

MCI examination guidelines PDF linked below:


Now coming to the most important part of the actual workflow for the exam please take a look at the university supplied format here with marks distribution : http://medicinedepartment.blogspot.com/2020/06/lets-first-look-at-pre-covid-status-of.html?m=1 which was meant for a pre pandemic offline audience and even now in this pandemic with a predominant blended online and offline format of the examination, we shall still abide by letter and spirit of the exams as the university intended it earlier. In the above link if you notice in the first columns to the left there are 100 marks allotted for one long and 100 marks allotted for two short cases and 100 marks allotted for the viva with some brief  instructions subject to examiner interpretation. 

To achieve a collective consensus on the interpretation of the traditional university supplied format, we propose that :

1) The candidate begin with the long and short case presentations as currently accessible to them locally in the hospital or even from OPD or telephonic interview (follow up) and they make sure they share their case history (patient events in sequence) and clinical findings images as well as investigations as in the samples below :

Current case :


In traditional case presentations, the case discussion is generally expected to be prepared after a reviewing the literature around similar cases globally :




As well as locally :




If we again review the viva competency assessment 100 marks distribution in the link here: http://medicinedepartment.blogspot.com/2020/06/lets-first-look-at-pre-covid-status-of.html?m=1 we realize that most of them will be covered in the case presentation and the discussion will mostly be centred around the candidate's competency to resolve the diagnostic and therapeutic uncertainties in the case using evidence based literature review as well as prior general knowledge. 

A paragraph here about pedagogy is important as the traditional university document mentions it in the marks distribution : Pedagogy is a natural learning process that can be demonstrated through the candidate's discussion of the case that originates in the pedagogic questions raised. I quote from the article linked below. Pedagogic understanding derived from case based learning, "imparts relevance to medical and related curricula, is shown to tie theory to practice, and induce deeper learning." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736264/

More quoted from:  https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-1969-0 around the case based pedagogic approach, "Case-based learning (CBL) is an inquiry-based pedagogical approach that prepares students for clinical practice through authentic cases to develop their clinical decision-making skills.
CBL can foster students’ learning in terms of knowledge acquisition and application, intrinsic motivation [8], patient assessment [11], problem-solving [12], and critical thinking [13, 14]. Moreover, pictorial information in the case materials induces intuition, and objective and quantitative information induces analysis [15]."

The other items in the viva such as thesis and logbook can be represented by the candidate again in an evidence based manner by sharing the links to her thesis such as here :




And log book such as here :








We shall need each candidate to prepare their separate deidentified roll numbered case presentation log, 

three year worklog (E log book mentioning their personal summary of their competencies attained) and thesis log for the examiners to go through. 

Each of these three separate logs will be deidentified and candidates identified only with their roll numbers. 

Informed consent has to be taken from each case being presented, which can be downloaded from here : 

Here is a detailed link :



to the last similar blended online examination conducted this year in the same manner for the PGs passing out this year and below is another link 


to the last similar blended online examination conducted for UGs this year in the same manner although for lesser marks  as it was for UGs but even they had to present one long and two short cases. The difference was that they were interviewed for shorter time as opposed to the PG interview where the mandatory time allotted for each of them is one hour. The difference in long and short cases again lies in the fact that they are time bound into long and short time frames where the entire sequence of patient events (history) is thoroughly discussed in the long case and a quicker decision around the diagnosis is achieved through certain findings alone. 

Hope this explains our current evidence based stance on the conduct of the assessments and further inputs in the form of queries are welcome in the comments section below. 

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