Friday, 13 June 2008

Results Are Out...

So, results came out today.

I guess you're going to want to know how I did right?

You're going to have to keep scrolling.

Click here to find out:

Wednesday, 4 June 2008

Training a Bunch of Monkeys

Because a) I've got nothing better to do, b) I quite enjoy it and c) the £40 will pay for a takeaway, today I volunteered yet again as a patient for the 3rd year OSCE exam. It is the 5th or sixth time I've done so but each time I learn something new about the whole process. Today I had aortic regurgitation and 39 candidates did their best to impress the examiner as I laid there watching the ducks out of the window.

Now I should say that I think OSCEs are a very important assessment of a medical student's abilities. However, they aren't, certainly at my institution assessed effectively in my opinion. I recognise the difficulties in running a fair exam but when you're trying to do so simultaneously at 4 sites, with different equipment and different examiners in the morning and afternoon but supposedly the same stations it must be impossible! You might think that it all averages out in the end, and perhaps it does eventually but there are huge inconsistencies. I would have thought some methods are employed in an effort to standardise the marks but it would be almost impossible to do this for every conceivable variable. Blah, blah, blah, I could moan about this all day long.

Lets take today for example, admittedly I only saw a snap-shot of what went on, just 1 out of 13 or 14 stations. We started in the morning with one examiner, who's marking was rather erratic. There was one student who was a country mile above the rest who scored average to below average whereas others who were average at best were scoring higher. It doesn't help that the mark scheme leaves things very open to interpretation by the examiner but what can you do? An open mark scheme is too open to subjectivity but a more rigid mark scheme makes it more difficult for students to score consistently. Overall that examiner was fairly generous. In the afternoon, same station, different examiner. This time, a much more consistent marker but at the same time, much harsher with the marks (perhaps rightly so). Next we should consider the students, frankly, overall they weren't that great but I'll get to that in a minute. For no particular reason that I could see there was a significant variation between the morning lot and afternoon lot. The morning lot were on the whole, ok (remember they also had a generous marker) whereas the afternoon lot were, apart from one, not as good (and also had a harsher marker). I might not have explained that too well but what I'm getting at is that there was more than one variable affecting each group skewing the distribution of marks further between morning and afternoon.

As for the students themselves, let me explain what I thought was wrong. This might sound a little harsh and hypocritical (I was exactly the same when I was a 3rd year). Neither is it really the students fault. Every student was able to make a decent effort at completing a cardiovascular examination. But, you could teach a monkey to do a textbook cardiovascular examination. Very few students looked like they were actually looking to elicit signs. Perhaps the main issue here is that it is such a fake situation and the students are expecting a normal volunteer to examine therefore there won't be any signs so it doesn't matter. I spoke to the examiner about this and he agreed, he had previously examined a thyroid station where students had all done a textbook examination but 5cm above where the thyroid actually is. They are only 3rd years, perhaps it is unfair to expect them to elicit signs at such an early stage. You can clearly tell the students who've examined real patients and who are actually trying to elicit the signs from those who are just going through the motions, the former group generally score higher, I believe rightly so.

During finals for instance we had 6 stations of real patients, these were not only the most difficult but were the most interesting and dare I say it, enjoyable stations from my point of view. Why not have a few real patients for earlier years? Yes, it would take more organisation but patients are usually quite willing to spend a morning being examined. We're not trying to train monkeys, we're trying to train competent, dynamic doctors who're able to think on their feet so why aren't we assessing this properly?

My experience of OSCEs from both sides has led me to the following conclusion:
Performance = 30% luck in each and every station + 30% examiner subjectivity + 30% confidence (or false confidence) + 10% knowledge

Clearly, luck makes up a rather large proportion and this is what needs to be eradicated if possible. How we do this I'm not quite sure. Perhaps having more stations 30, 40 (as some other medical schools do I believe) to average things out, or improving the consistency of marking by reducing the subjectivity.

I love to get my hands on a chunk of results data to run some of my own statistical analysis on. Although the chances of that happening are about the same as winning the lottery.... 4 times. If I asked for it, I'd just be ignored.... again.

One other thing from today; what is with all the all black stethoscopes? At least half the students had them and yes they might look quite cool but they sure as hell don't make you any better at using them!

If you've not already done so check out my latest, and probably final post here:

Sunday, 1 June 2008

Everyone Wants My Money

After 5 years at university accruing several tens of thousand pounds of debt I suppose it should come as no surprise that the final few weeks are full of costly expenses. I suppose I should get used to it, things are only going to get worse, I should really count my lucky stars that I didn't have to pay to sit my final exams.

Among the expenses, GMC provisional registration (£135), MDU (£20 approx), graduation robes (£37) was a colourful leaflet from the BMA listing all the potential benefits of being a BMA member as an F1. I am a student BMA member and enjoy my regular sBMJ so I figured I'd probably keep my membership up as an F1. I looked all the way through this colourful leaflet and couldn't find anywhere how much its going to cost me, something tells me it won't be cheap.

Becoming a doctor has always been an expensive process but it really doesn't come at the best of times towards the end of student life.

Perhaps, rather than medical school I should taken up a life renting graduation robes. Lets do some maths. So my graduation robes are going to cost me (well, hopefully my parents) £37 to rent for a couple of hours. There will be over 400 people graduating from the medical school alone, that is the best part of £15,000. Multiply that up for all the students graduating throughout the country and I'm fairly sure it will come to a very substantial amount.

Whilst I've got my chequebook out, who's next?