Doctors Scandal - fambondi

[ArchivalUser]

OK, I know everyone is busy with match preparations etc but just a little something to break the routine.

Perhaps some of you may have come across this article concerning a complaint filed by a resident over the use of 'recall' questions in test preparations for the American Board of Radiology certification exams.

http://edition.cnn.com/2012/01/13/health...index.html


The use of past questions for examination prep is a grey area, what constitutes cheating? where does one draw the line? If I use sample questions posted by the NBME or Uworld or Kaplan to prepare for an exam, would that be considered cheating? How do these companies get their questions? How do we explain the similarties between these questions and those found on the boards?


Opinions are highly divided on the issue, but I feel that it will result in drastic changes in the utilization of multiple choice questions in future board examinations.

I think a fundamental flaw in the use of these board exams is the fact that MCQs are not the best test of one's knowledge/competence in a particular field. Initially, they may be effective in assessing recall, but given the extensive depth and breath of the examinations, the exam eventually selects for good test takers (to some extent).

[ArchivalUser]

I just wanted to clear something .... i have seen that lot of people say people who memorize are bad students and you should not memorize but should do it with reason and not by recall ..........

Be very clear ... medicine is not philosophy ... u cannot reason ... u cannot somehow intuitively know that the heart has 4 chambers u have to memorize it ... u can't intuitively know which antibiotics goes to which organism ... u have to memorize that too .... so it's all facts and not philosophy

MCQs are best used becuz they can be standardized ... if u had to be asked to write an essay on something ... how can everyone be rated equally .. it's such a stupid thought

and more over i love the usmle mcq steps ... it's not like they are asking what is the breadth of the heart or the length of ur ear canal .... they test the application of your memorized facts ... which i think is perfectly suited to test physicians

[ArchivalUser]

Fact: MCQs are the only reason many indians pass

[ArchivalUser]

@categorical ... lol wat is that supposed to mean ?

[ArchivalUser]

Clinical medicine is by and large memory. MCQs test memory. They don't mean you'll be a great practitioner, but are not a bad indicator at all of your future prospects. Yes there are people who do bad on USMLEs who go on to be great doctors, and people with 99s who are horrible doctors, but these are the outliers in my opinion.

In respect to these radiology residents - it is unfortunate but we all know the rigours of training in residency and I feel there is no way these guys can go through all of residency and only pass the boards because of recycled questions. They are taking the easy path by using old Q's and memorizing them simply because that option exists. It doesn't disqualify their knowledge base.

Categorical: You're wrong. MCQ exams are a much larger feature in western education than in Indian education. I think the Indian/Pakistani doctors are far more used to essay-style answers than westerners are.

[ArchivalUser]

@doc.12345 You have addressed some aspects of the whole debate on the appropriateness of MCQs for assessing physicians' competence.

I think those who advocate for absolutely no memorization are wrong because, as you rightly said, some things cannot be understood, they need to be 'memorized'- granted.

The issue in question in the article has to do with the tendency for candidates to 'memorize' questions and regurgitate them for subsequent candidates to use in their examinations; now that constitutes cheating.

Board certification is meant to assess competence as a physician in real life situations, not as a student with good test taking skills. In fact how often do we see patients that look like what we see in the boards? This raises the question about how much weight should be placed rote regurgitation of factoids in determining the competence of a physician in these exams? Like I said, it is a grey area, with time, there will need to be a diversification in evaluating competence that incorporates other aspects-

I beg to differ with your view that 'medicine is all fact' actually, there is a lot more to medicine than factoids. In the words of the Canadian physician Sir William Osler- “Medicine is a science of uncertainty and an art of probability.”

[ArchivalUser]

5pani et al : Yes they have essay style exams but are asked to regurgitate material in those exams!! It is not their fault, it is the educational system/style. They are no doubt very smart, but have just learned the memorization technique as a way to learn. That's why logic problems etc are challenging. How else can you explain 99ers not being able to write a simple thank you letter and instead coming to the forum for "a sample"

[ArchivalUser]

I think they're just being extra cautious, that's all. I'm sure most of them can write a letter spontaneously if they had to - they simply want to make sure they are writing the best letter possible. FMGs place way too much importance in these thank you letters though.

Perhaps with the emphasis in India on rogue memorization, very average students are able to overachieve by working 10x harder than others. They then begin residency and are not as proficient at problem-solving and adapting to clinical scenarios. I don't know if this is true, I'm just thinking out loud. It appears some of you have more experience with the Indian IMGs than I do.

[ArchivalUser]

valid point and worth the discussion, repeating questions of which can be passed to subsequent exam takers of which they would do well, may not be reflective of true assessment of a physician. so the need to reevaluate.

this is true, has been the practice for years. exams are passed from one to the other and so are learnt by hard by subsequent exam takers and so appear to have good scores and so forth. so the need to re-evaluate this assessment.

well doc.12345 has a point.
another would be, with mcqs a vast area of medicine can be questioned. since it be a mark each for a question, and so the topic of question be broad, and so exam takers are to study about everything and would not want to miss out a topic. there are about 300+ mcqs, this means that about 300 topics of medicine would be covered. so no one gets to leave a topic non-learned.

however despite all these, there comes the competency, which may not go together with the grading. so the thought that the questions are passed from one to another and so with good scores yet with average or below average in clinical practice. this be a major concern, it be defaming for the exams and the reputation it upholds. so there needs to be a counter balancing assessment to ensure that the good score is not merely a result of exam questions passed from one to another

[ArchivalUser]

I think simply having a massive QBank pool and giving each candidate a different exam solves many of the issues.