The Faculty of Paediatrics of the West African College of Physicians has been using the long case as a major clinical examination for Membership candidates since the early 1980s. Many training institutions also retain the long case examination. Over the years, the Faculty made far-reaching changes in this method of examination geared towards the improvement of its performance indices of reliability, validity and fairness. The current paper traces the modifications that have taken place so far including the use of a structured, weighted grading format. It also discusses the need for further modifications including observation of the candidate during the "clerking" period and the practicality of video recording. Use of formats like that of the West African College is recommended for institutions still using the long case. Each institution should weigh the practicability of specific suggested modifications in the light of its circumstances.
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