21 August 2009

The computer says *!**&

How do you think they mark medical students' final exam papers? The extended matching questions are marked by computer. The students use an HB pencil to give their answer and a computer dishes out the marks accordingly. Do you think the computer might get it wrong? Do you think they might have had a problem with the computer in Cardiff? Do you think it could be that they have had recurrent problems with the computer in Cardiff? No, that cannot be the case because if they had had problems before they would be sure to mark them manually. There is no way a faulty computer could have been the cause of the Cardiff catastrophe. Or could it?


Anonymous said...

Possible Dr G, but that then also highlights the unfairness of having too many syllabuses, varied assement methods and differing sets of rules between one medical school and another. In effect, you stand a better chance of graduating if you are at one of the top London schools than if you were studying out of the capital. In particular, if you are a student at a new-er medical school, where students have been thrown from pillar to post every time they sat an exam with schools constantly threatening to terminate them!

Take the 'General Practice' module for example, it only consists of a 20 minute practical in a top London school, while it entails writing a long essay AND having to sit a written exam that can and will ask any question on GP in a new-er school! If a student does not do well in the London school, they first get a viva, then be allowed a resit, then chance to repeat the year, while you only get one chance to resit in the new-er school then termination follows!

After 5 or 6 years of study, a student is terminated with an award of a 'BSc ordinary', a degree matching an ordinary sub-class diploma at best!That's the reward for straight As at A level students with proven track record of excellence all their lives. It is in effect a termination of their aspirations for the bright career prospects they rightly deserve because they are too old to start studying anew for another proper degree! It is cut throat harsh to treat bright youngsters in this dispeccable way! A proper disgrace! And so very unfair! CRUEL!ydrier

Anonymous said...

I don't know how old Anonymous 20090821 23:24 is, but I suspect they're a yoof of some sort.

Give it a few years, certainly once you're 50+, & you'll have realised that:

a) Bad things happen to good people every day.

b) There's nothing special about medicine, doctoring or anything else in the example you give. There must be many people who have failed to make the grade as wheeltappers, shunters or whatever. They have all had to deal with not achieving their ambition.

c) Words such as 'fair', 'rights' and so on are meaningless except to some windbag politician on the make.

d) KYAGYOYO is a good lesson to have learned by the age of 23 or 24. Old enough to be a grown up, young enough to start again.

Anonymous 23.34 said...

I am 50+ Anonymous 13.59 but I do not accept the defeatest approach you seem to readily accept as status quo. If we all did the same, we'd be still living in the stone age. I like 'hope' and the energy this gives you to always get up and go make things better and this issue is one that does need our attention.

Let's hope :-)

Anonymous said...

Dr Grumble, Why would Cardiff need a computer to mark their exam papers? They have a foolproof system which involves handing out exam papers which have both the questions and the answers printed - this saves a great deal of time and effort when it comes to marking, and no chance of computer failure.

Dr Grumble said...

But only half the class were given the answers, the other half had to manage without which is hardly fair.

Do you think they told the GMC?

Dr Aust said...

Did they really hand out the answers to some of the class? Oops.

University experience suggests this will probably mean some lowly admin functionary having to walk the plank. Don't expect anyone terribly significant in the system to suffer such consequences, though.

Is this the same exam as the other, erm, "mishap"? I would like to Cardiff (or anyone else) try and rescind passes on the basis of marks in an exam where some of the class had been handed the answers. That one would positively scream "lawsuit".

On a different tack, I am rather with Anon 22nd 13.59. We have to accept that medical school admission procedures are not perfect - obviously they cannot be. A certain no. of students will thus always be admitted who are not going to make the grade.

A personal view is that some of the problems at FINALS arise because it is incredibly difficult for Univs to "cut adrift" failing medical students after 1,2 or even 3 years in the system. With automatic resits and especially appeals for "mitigating circumstances" it is now very, VERY difficult to exclude medical students who will not accept that they aren't quite up to it. Stories of people who have not yet passed yr 2 five or six yrs after being admitted to medical school, but who keep getting interrupts and re-tries for mitigation, are commonplace. The system (in the opinion of most staff) errs a long way on the side of accepting any excuse.

Now, at yr 5, with the prospect of the marginal student who is passed through heading out to treat your granny as a newly minted doctor, the view taken is perhaps a bit different. And I somehow doubt there are many students failing in yr 5 who do not have failures on their record from previous years.

It is a hard truth to accept, but it might serve the whole system, and some students with this kind of history, better if they were "cut loose" earlier, say with a B.Sc. after 2 yrs medicine plus an intercalating yr. That way they would be on a level footing with other "got a degree after 3 yrs study" students.

I think it is possible that harder line policies at the newer schools on the progression stuff (if they are really that much harder line) are to address / avoid this kind of perceived problem in the more established schools.

Dr Grumble said...

Is this the same exam as the other, erm, "mishap"?

No. This was a separate cock up. As far as I know about one third of the class was given the answers. They marked the papers of those who had not been given the answers and set another exam for the unfortunates that had the answers. But those given the answers then complained that that was unfair and just how they sorted it out in the end Dr G really doesn't know. The details may be inaccurate. Dr G heard this on the grape vine.

Dr Aust said...

Hmm. That sounds like a nightmare.

Like many medical schools these days we "grade on the curve" for MCQ/EMQ exams, certainly in the preclinical years - in effect we look at the low end of the class distribution and set a fail / borderline / pass boundary on the basis of N SDs below the mean.

As a student, if you are thus "borderline" in one bit of the assessment for the year, but OK in the others (some of which may be marked by what the jargon calls "criterion referencing", typically true for OSCEs and SSCs), you probably won't resit anything. If you are way off in one thing you must resit and pass that. If you are continuously "low end of borderline low" in everything you may well end up resitting the lot. Finally, if you are bottom 5% or so of the class across multiple semesters and across different kinds of assessment, and resitting components each year, you will end up in front of the progress committee.

In a scheme like the above, it would not be too horrendous to have bits of the year group sit DIFFERENT MCQ/EMQ knowledge tests, as the different tests would be subjected to the same "processing", though obviously the sample size would drop.

Of course, if you try and define a standard pass mark (e.g. 50%) then it is much more of a problem if one exam you set returns a mean of 61%, and the other one you set returns 67%. So I would predict that if this really did happen in Cardiff, they would have to process it by "grading on the curve", even if that meant a one-off fudge compared to what they would normally have done.

Dr Grumble said...

Dr Aust, can you explain to Dr Grumble how we know that the standard for graduation from one medical school which may be relatively easy to get into is the same as that required by a medical school that is known to be rather difficult to get into?

Dr Aust said...

Now that is a tricky question, Dr G, though it mirrors the wider question about the comparability of University standards.

I can't really talk about medical school graduation standards (yr 5) with any particular personal knowledge, as I have never been involved with a medical course beyond (preclinical) yr 2. But my knee-jerk reaction would be that without a national exam you simply can't really tell - at least from a hard evidence POV. Having said that, external examiners do do their best to tell schools/Univs what is, or isn't comparable, and to work to broadly common standards. In the life sciences that, plus "academic consensus", is largely the reason why most Russell Group academics would tell you Russell Group B.Sc. degree standards (for instance) are almost certainly broadly comparable. I tend to assume something similar operates for medicine. In my "large civic", the external examiners for the medical degree (throughout all years) typically come from other large civics, inc. the London schools, though I don't recall meeting many from Oxbridge.

My impression, based on trade gossip and on very limited encounters with national med ed bigwigs, is that people like the Heads of Med Schools Ctte (and the GMC?) simply do not think all medical schools churn out an exactly comparable "product" (i.e. student). I also think they don't really view this as a major issue, though they usually couch it in terms of "good at slightly different things" rather than "different standards". If you said "Oxbridge clearly turns out more academically faster-striped medical graduates than other schools", I reckon they would just smile and say "and...?" Some of the new medical schools have been fairly upfront about how they expect to train more future GPs than teaching hospital specialists, how they do not expect to be training many future surgeons if they don't offer DR-based morbid anatomy, or that they are generally trying to train "rounded future clinical practitioners with lots of hands-on patient experience by graduation time" rather than people who will pass MRCP in less years. So I think the off the record view at the GMC / Heads level may be "horses for courses".

All completely airy opinion-izing, of course. Since you asked the Q, what do you think?

PS On the broader subject of Univ degrees in general ("standards", mass higher ed etc. etc.) this opinion column in the Times Higher gives a view close to that of many Univ staff I know. But of course a lot of this does not exactly apply to medical courses.

Dr Grumble said...

Since you asked the Q, what do you think

Dr G thinks your analysis is spot on.

Anonymous 23.34 said...

Thank you for the valuable explanation Dr Aust but I assure you, not all medical schools, especially the new-er ones follow the same procedure to rate a student's progress or how a student is assessed then removed if need be. I personally know of a school whose lecturers told the students that they need to exclude some more of them than previous years! I have heard this from many of them spanning three academic years! So the information was reliable.

"Some of the new medical schools have been fairly upfront about how they expect to train more future GPs than teaching hospital specialists, how they do not expect to be training many future surgeons if they don't offer DR-based morbid anatomy, or that they are generally trying to train "rounded future clinical practitioners with lots of hands-on patient experience by graduation time"

And this is very unfair too; to entice unsuspecting high fliers into a medical school geared to the production of cheap sub-graders who will have no hope of progressing beyond a certain pre-determined limit! This is deciet that should not be allowed. Such information should clearly be printed in the said school's brochure so that applicants know where they stand before entery. At the moment, all students think they have the same future prospects as other medical schools when clearly they don't! Welcome lifelong frustration at age 24! To who's benefit is that?! Definately not the patient! Or the once high flyer now frustrated and very bitter doctor with a cieling above their head!

Freightening stuff

Dr Aust said...

Anon 23.34

I don't think the idea is that if you go to the new schools you are excluded from being any kind of doctor; some of them are consciously sited in areas of the UK where doctors are scarce, so the idea is clearly that they will funnel into training in those regions across all specialities. And I would imagine the best graduates from the new schools are probably competitive with the best nationally. It is more an "on average..." sort of argument. But I guess it is fair to say that if you go to Cambridge, Oxford or UCL, do all your clinical years at a major teaching hospital, get a 1st class Hons intercalated B.Sc. including a research project in a well-known lab, elective for a famous Professor etc etc then you may have a head start into an academic medical career, if that is what you want.

I wonder whether someone with that record might also have bit of a leg up for hospital speciality careers, but I suspect that was always true, even before the new schools started up; there has never really been a totally level playing field. For instance, it used to be widely believed outside London that the London Teaching Hospitals preferred their own London graduates. Now, this may be medical myth, but a lot of junior doctors I knew believed it. Of course, the universally loathed MTAS/MMC was supposedly designed in part to "equalise the system", and we know how well that turned out.

There has historically also been an indirect equalising effect of medical graduates tending to stay in the same areas they did their junior doctoring, or medical school, in; thus I would predict the consultant ranks in (say) the NW of England will contain a high proportion of people who were on the NW speciality training schemes, and that will (at least historically) have contained quite a lot of people who had done junior doctor jobs, and perhaps even been to medical school, in the NW of E. All regions used to want to hang onto their best students / trainees, naturally enough.

BTW, don't let the GPs hear you call them "cheap sub-graders". As a read of Dr Crippen or the Jobbing Doctor will reveal, it ain't true.

Anyway, the pitch for the new schools was "more of some bits, less of others". In the old days, tales of academic high flyers who arrived in the hospitals incapable of anything practical were commonplace. I guess it is implicit in the idea of rather more "vocational" syllabuses that if people who go through those ones want to "add on" academic elements later, then they can if they are determined enough. The buzz-word the GMC and Medical Schools Council types always use is "diversity". Now, whether it pans out in practice in the way that they say they intend is a different question.

Pre all the MMC changes, the view I had received from Mrs Dr Aust (a hospital doctor and thus my main connection to the world of medicine) was that it was how you performed as a junior hospital doc (House Officer and SHO years as was) that most determined where you were likely to end up. The University you had attended wasn't really seen to make as much difference as where you were seen to figure in the distribution of "usefulness" (shorthand for skill+knowledge+judgement+drive).

** PS - Since I originally wrote most of this, Dr G has added a new post that makes sort of this same point en passant **

Despite the changes, one would hope that this (i.e. that your ability on the job was largely how you are judged) was still true. But Dr Grumble would know better than I.

Dr Grumble said...

Despite the changes, one would hope that this (i.e. that your ability on the job was largely how you are judged) was still true. But Dr Grumble would know better than I.
The new system is so new I do not yet know how well it will work. I have seen it succeed in weeding out hopeless doctors and once or twice in elevating good doctors so, perhaps with some tweaking, it will work. Unfortunately it demands time that none of us has. We were told the online systems could be done between patients as part of our normal work but that has proved to be nonsense. Last week I spent 90 minutes helping junior doctors fill in their online gobbledegook. Much of this they should have done themselves but they have not yet caught up wit the required buzz words so Dr G gives them a helping hand. But there are more important things he could be doing with them.

Anonymous 23.34 said...

"BTW, don't let the GPs hear you call them "cheap sub-graders". As a read of Dr Crippen or the Jobbing Doctor will reveal, it ain't true."

I did not mean it this way. I think a school that does not prepare it's students for the full spectrum of careers without letting them know this was the case in advance is letting it's students down. Schools of that nature should clearly state their motives in their prospectus - that its education is specifically geared twoards the production of one type of doctor only; GP - or otherwise. Because they currently don't and so,a non-suspecting but aspiring would be hospital doctor will, due to the lack of preparation by the time they graduate, end up in a go-no-where hospital medicine sub-grade instead of the brighter future they deserve in the specialty they prefer, where they would have had a better opportunity had they gone to other schools as you very nicely explain.

And, The GMC has recently introduced a student guide that holds medical students accountable, even for the years from before entry to medical school, and gives new powers to exclude students, even to the GMC to refuse registration of graduate doctors if the deem fit!

Well, that's one sided and is thus very unfair. And so, for the sake of proper accountablity and transparency there needs to be a national curricullum, a national exam, and all medical schools should have a charter to be given to each medic and states the school's mission, duties and obligations as well as stats about it's pass/fail % for every academic year including graduation as well as the destiny of it's graduates and how many students get excluded and why? .. Everything about the school made transparent and published for all prospective and current students to see .. same with the deaneries too!

Time to hold the medical schools, and deaneries accountable for their conduct towards their students too! Remember Scot Junior?! Cases like that should be history!

And thank you again for the invaluable information Dr Aust :-)

Dr Grumble said...

The latest is that the GMC has called for an investigation.

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