The Bristol Clinical Data Exam (BCDE)

Andrew Levy, Nicki Cohen

Research output: Contribution to specialist publicationArticle (Specialist Publication)

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The ability to make a diagnosis or formulate a differential diagnosis by observing and listening to the patient’s testimony is an essential and profoundly satisfying clinical skill that is difficult to standardize and evaluate using current assessment formats.

What was tried?
Over a decade we have developed and refined an assessment in which candidates select the best on-screen answer option after watching edited movies of real patients talking about their experiences. Common conditions such as angina pectoris, epilepsy, pulmonary embolism and Bell’s palsy, as well as less frequently encountered conditions such as malaria, scleroderma and Stokes-Adams attacks, are presented. The BCDE is a perfect platform for evaluating the recognition of clinical signs such as cranial nerve palsies, muscle fasciculation and relative afferent pupillary defects which are difficult to present to students reliably within clinical examinations. The BCDE lends itself to assessment of the investigation, diagnosis and management of basic medical and surgical conditions, as well as dermatological, rheumatological and psychiatric conditions.
The BCDE is a self-running, computer-marked exam delivered directly from computer in a lecture theatre using KeyNote on a MacBook Pro. Universal movie subtitling can accommodate students with hearing difficulties and additional presentations with run times increased by 25% and 33% are straightforward to construct for candidates with other special needs.

What lessons were learned?
A high quality movie bank of patient interviews collected (with consent) over twenty years using a small hand-held video camera has proved an indispensible and critical resource (see examples in the app ‘Clinically Speaking’, available for iPhone and iPad). Option lists have been progressively refined and reduced from up to 26 alternatives to best of five for each question. These are projected alongside the image and enable psychometric assessment of cohort and question performance. The assessment requires a small number of administrative staff to lead groups of students to and from various quarantine locations during the day. A minimal number of invigilators is required to attend the assessment itself, as the run-through format does not permit questions from the floor or other interruptions.
Pre-publishing alphabetic compilations of the option lists provides a revision curriculum for students. The assessment generates statistical data to identify non-discriminatory questions and areas of the curriculum where students’ teaching and learning needs to be reviewed. Standard setting using a modified Angoff approach is straightforward and the assessment lends itself to optical marking and analysis using associated statistical packages.
Assessment using the BCDE invariably elicits complements rather than complaints and appeals from candidates, who recognize the importance of the knowledge being assessed and appreciate the equity and educational value of the process.
Original languageEnglish
Number of pages2
Specialist publicationMedical Education
Publication statusPublished - 22 Oct 2015


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