Continued from part one, here.
Gone are the days of stringent oral examinations where a board decided whether you were worthy of the title ‘Doctor’ based on your clinical performance and your basic medical knowledge. It’s been replaced by right-or-not MCQs that don’t take marks away for wrong answers (which is what happens in real life) and which offer no feedback, so you don’t even know which questions you got wrong.
You get a letter grade, which isn’t even reflected in your degree. How fair is it for a C student and an A student to be propelled into the public without distinction when the difference in quality of care will be considerable?
I won’t allow for people who are “bad at exams” because, let’s face it, all of medicine is an exam. Every patient is a test, and you either pass or fail. If you can’t handle the pressure in medical school, you sure as hell won’t be able to handle it when a patient is coding in the middle of A&E and you’re the intern or, God forbid, the senior resident on call.
A tighter hold needs to be kept on the keys to the medical profession.
Please don’t feel like I’m elevating medicine to some pedestal. For one thing, it’s already on a pedestal. For another, every profession should demand high standards of their workers. It’s only unrealistic to expect that to happen because then all the substandard people would just be living on the streets.
Standards are there for a reason, and they ought to be upheld. I don’t like the wishy-washy mass-produced MDs that are currently flooding the market, but until the powers-that-be are backed up against the wall and held accountable we probably won’t have any kind of change in medical school output.
At the end of the day, don’t we all want (to be) good doctors?
well read robin 
I’m really scared of responding to this post because sometimes I feel like I am a substandard medical student. In South Africa, our exams are stringent oral exams though (my recent surgery OSCEs for example were the scariest damn thing I have ever done). On the odd occasion that we have written exit exams (half of the ophthalmology rotation, for example) we do have marks deducted for wrong answers, though.
However, I don’t get great results. Some days I think it’s because I’m stupid, but the truth is that I have chosen to prioritise wellness. In my second year I survived on four hours sleep a night, and studied so hard, and my marks were BAD. These days I refuse to get less than 6 hours sleep a night, because I refuse to burn out again. (Except when I’m on 24 hours calls of course.) And my marks are actually better now, but certainly not top of the class either.
Thing is, I’ve had a fabulous six years. I’ve traveled, I’ve served on student government, and I haven’t made medicine my life. But I certainly don’t want to be just a “good enough” doctor. Probably part of the reason I’m freaking out about graduating in 9 months.
Although my comment isn’t really making any concrete points, I’d like to point out that the written exams may have an honourable beginning: the wish to standardise. Because the way that I’ve been watching and experiencing medical school for nearly six years, the one thing I know is that our evaluation is all but standardised. Objective Structured Clinical Examinations could more accurately be called Subjective Unstructured Clinical Circuses. At least, in South Africa, where we don’t have the resources to pay for actors to be the same case for all students, etc.
For example, last year, one of my friends in their final year got a case of Takayasu’s for her internal medicine OSCE. The examiner was a rheumatologist new to the faculty and asked questions that even she admitted were “on specialist level”. Another friend got a beautiful case of IHD from an old professor who very clearly understood the scope of undergraduate training. It is very clear that the two students certainly did not have equal opportunity nor objectivity.
Anywho, I hope my very unstructured comment contributes somewhat to this. Certainly agree that it seems medical professionals are slipping. I think the scarcity of doctors (at least in my own country) and the various modern difficulties of the profession could be contributing to the fact. Furthermore, we can’t afford to have small focused classes in med school – and I definitely think we would all be more passionate and knowledgeable students if we could have been in classes of 20 students rather than 200.
Thanks for an insightful post!
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Thanks for an insightful comment!
That situation certainly isn’t unique to your country. We can’t afford actors either, so medical students are examined on actual patients – and you know how reliable patients can be. But our grading sheet is standardized so that we get marks for completing certain tasks and answering specific questions.
I sometimes feel like I’m not a very good student – but that’s when I only look at my grades. The truth is, being a medical student is about so much more than your GPA. It’s not all studying through the night; it’s more about your dedication to patient welfare. Once you’ve got that drive (and you know the standard basics), you are on your way. At least that’s what I tell myself, haha.
I’d much rather graduate with excellent clinical skills and average MCQ grades. :)
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[…] Part One of a two-part post on instant gratification medical school. Read part two here! […]
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A huge contributor to the decline in great doctors aside from ever expanding classroom size is the separation of the pre-clinical and clinical phases. As a result, some schools are changing their curriculum to provide joint exposure. This in my opinion is a tremendous step in the right direction to improving the grades and clinical skills of medical students aka future doctors. Medicine should not be taught or learnt in isolation.
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So true! But then then matriculation requirements would have to be stepped up, because a lot of first years in our medical school are fresh out of high school with only a relatively basic knowledge of the biological sciences.
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