sBMJ | Make medical education more transparent

Make medical education more transparent

Why is it that important information-important enough to appear on an examination-is often withheld from medical students? As a student having just completed the two year didactic component of medical education, I have accrued countless examples of this absurdity.

At the end of the year, our practical skills in medicine are assessed by an objective structured clinical examination, an observed examination of clinical skills. We have to interview a patient, ask all the relevant questions about the presenting problem, and perform a physical exam. Examiners have a list and check off the questions as they are asked, and the physical exam manoeuvres as they are performed. The examination is worth half of our mark for the entire year, but lasts for only two and a half hours. These precious checklists, the criteria by which we are evaluated, are heavily guarded, tightly held secrets. If it were up to the faculty that runs the course, we would never see a checklist throughout all of our time at medical school. How useful would the lists be, however, if they were integrated into our lessons, and the importance of their questions and physical exam manoeuvres were emphasised? To me, the lack of transparency is an injustice and a disservice to our education.

Understanding medical students can help shed some light on a possible reason behind this practice. Applicants to medical school are already intelligent, hardworking, resourceful, and well rounded individuals. The application process further selects from these already highly competent people using various criteria, such as scores in the medical college admission test; essays; involvement in extracurricular activities; and interviews. The individuals selected from this process will one day become doctors; they do not need to prove they are hardworking individuals because they have already done this through years of hard work and self directed learning.

This again begs the question of why useful and relevant information is withheld from us. Is it so that we can further prove our work ethic, or show that we are capable of self directed learning? I think not. I believe it is because they wish to distinguish those people who would sacrifice their precious remaining free time to read up on a handful of esoteric topics and score a few points higher in the examination. Not only is this a waste of time, but it will also be detrimental to us, to our relationships with our family and friends, and to the wellbeing of our future patients.

Not learning every single fact in medical school does not by any stretch of the imagination mean that we can never learn those facts. I would rather not learn the lesson the hard way, however, by missing a diagnosis or by being slow to diagnose a potentially devastating and rapidly progressive illness.

PHOTOS.COM

Tell us what you want us to know and we'll know it. That way we'll be better off for knowing the information; our families and friends will be better off as we will have additional time to spend with them; and our patients will be better off because we are able to diagnose their disease and treat it quickly and correctly.

David Jason Holt, third year medical student, University of Toronto, Canada
Email: david.holt@utoronto.ca

Competing interests: None declared.

studentBMJ 2006;14:265-308 July ISSN 0966-6494

Responses published this month

Articles	Responses
REVIEWS Make medical education more transparent David Jason Holt (July 2006)	Dr. Satheesha Nayak B (July 3rd, 2006) Read this response

REVIEWS Make medical education more transparent David Jason Holt (July 2006)	Johanna Bryant (June 26th, 2006) Read this response

REVIEWS Make medical education more transparent David Jason Holt (July 2006)	Carl Meyer (August 9th, 2006) Read this response

	REVIEWS Make medical education more transparent David Jason Holt (July 2006)
	Dr. Satheesha Nayak B (July 3rd, 2006) Associate Professor of Anatomy, Melaka Manipal Medical College (Manipal Campus),Karnataka State, INDIA nayaksathish@yahoo.com
	Editor, I read the article by David Jason Holt "Make medical education more transparent" The author feels that medical schools hide valuable information like checklists of Objectively Structured Clinical Examinations (OSCE). I disagree with this feeling of the author. Even we, in our institution do not give the checklist to the students. It is simply for the reason that the students memorize the list and nothing more than that. The tendency of the students is to adopt shortcuts to learning. The students of the current day try to pass the exams in the easiest possible way. Anything which doesn't come in exams is not important to them. I had given a handout about slide identification points which was supposed to make their histology slide identification easier. The students tried to memorize two identification points and nothing about those slides. Even in the essay answer paper, when a histology question came, they wrote only two identification points and nothing more than that. The student community should not have the feeling that the institutions hide things from them. The teachers are not enemies of students. Teachers know what to give to student and when to give it. Students are like small babies and teachers are like parents. They know what to feed and when to feed their child. Teachers expect students to know maximum about a topic. The checklists are made only for the examiner who marks after observing the student performing a skill. This checklist is for uniformity in marking. Let us say the checklists are provided to the students, how many students will make an attempt to read more than that? All these checklists or answer keys are for objective evaluation and hence the students should not demand them. Students have to learn a procedure in detail and should be able to condense or summarize it in the given time. The transparency in medical education is in telling what type of exams are conducted and how is the evaluation done rather than telling what questions will come in the examination.

	REVIEWS Make medical education more transparent David Jason Holt (July 2006)
	Johanna Bryant (June 26th, 2006) Second year dental student, University of Birmingham jxb526@bham.ac.uk
	EDITOR- While Mr Holt raises some interesting points in his article 'Make medical education more transparent' it seems to me that is has missed the most vital. The field of medicine is diverse and it is precisely for this reason that today's medic must be equally dynamic and self-sufficient. The education that university provides is not exhaustive, it merely provides the prelude to continued lifelong learning. Lecturers are not there to provide the answers, partly because it is the responsibility of the student, but mainly because there are no definite answers. As Mr Holt mentions, all medics are intelligent and well-rounded individuals and are fully capable of balancing academia with a varied social life. 1 Examinations are not intended to cheat individuals, but to discriminate between those who merely learn lectures word for word and those who have a genuine interest, seeing lectures not as a means to an end but an opportunity on which to build upon. A deeper understanding entails a more mature approach; it requires the student to see that it is not the examinations that are of importance, but their future role as a healthcare professional. This role requires independence and motivation, after all; there is not always a 'checklist' when assessing every patient. A sound medical knowledge is, of course, fundamental to good practice, but this cannot be instilled by education alone. The distinction separating mediocre medics from excellence is passion and dedication. This can only come from the individuals themselves, and is far more important than any mark on an examination paper. 1. Holt DJ. Make medical education more transparent. studentBMJ 2006;14:265-308. (July)

	REVIEWS Make medical education more transparent David Jason Holt (July 2006)
	Carl Meyer (August 9th, 2006) Orthopaedic registrar, New Cross Hospital, Wolverhampton, England carlamandameyer@aol.com
	Sir It is extremely frustrating when the marking scheme of an examination is not made clear. A clinical examination aims to identify students with good core knowledge and well practiced clinical skills. If the marking "points" of an examination are sufficiently important, they should have been emphasized over the year. (This is of course what happens in revision courses). In an effort to provide uniformity (and to accommodate poorly skilled or inexperienced examiners) examination marking schemes have become increasingly prescribed. It is a poor clinical examination that can be passed just by knowledge of the marking scheme itself!