Tuesday, 15 January 2013

Good med students pass exams?

A few days back I was speaking with a relative of mine who I get on with very well. This relative is roughly the same age as me and is also an undergraduate student, though a non-medic. Whilst catching up and exchanging stories of the latest goings on at uni, they asked me how my latest set of exams (see previous entries) had gone and how I think I'd done. The conversation went like this:

Relative: So your exams are all done now eh?
Grumpy: Yep, thankfully, maybe I can start getting some sleep now.
Relative: When do you find out how you've done?
Grumpy: Should be within a few weeks or so I think.
Relative: How do you think you've done?
Grumpy: Erm, not sure really. I mean, I really hope I've passed, I spent a fair old while revising over Christmas so I feel like I put the work in, but you know, it's always difficult to tell...
Relative: Yes, I suppose so...I mean what happens if you don't pass?
Grumpy: Oh, nothing awful, these exams are formative, so you just have to have a meeting with some med school bigwigs who'll tell you to get your act together a bit more.
Relative: Oh, so you don't get kicked out or anything?
Grumpy: No. If you fail the summer exams and the resit, then you get told to leave.
Relative: Do you think that would ever happen to you?
Grumpy: I'm not sure really, I mean, I really, really hope it won't, but I haven't a clue what the summer exams will be like and they're supposed to be more difficult than the January ones...so I wouldn't like to say I'm going to pass with 100% certainty...
Relative: Oh I see. Well I suppose if you did fail it would be better if you get told to leave as you'd end up being a bad doctor...

Anyway, this conversation got me thinking about some things. Firstly, how exactly does one define a "bad doctor"? There's an old joke which goes: "what do you call a med student who graduates bottom of their year?" with the reply being "doctor" (ho ho ho). Is a doctor who scrapes a pass in finals automatically a "good doctor" whilst a med student who marginally failed finals did so deservedly because they would have become a "bad doctor"? I'm not sure it's that simple really. Looking at things from another angle, is a grumpy*, rude surgeon with top marks in med school and membership exams automatically "better" than a more academically average colleague who nevertheless genuinely makes their patients feel well looked after and cared for? Doc Martin is a great TV show, but would you really like Dr Ellingham to be your GP, despite his excellent academic credentials?

I sincerely hope there's more to being a "good" med student or doctor than doing well in exams, but unfortunately many members of the public don't see it that way. It's not that I have a massive thing with exams, but I don't like the assumption that "good" med students or doctors are those who pass exams and don't fuck up along the way. In a sense, the public can't be blamed for having these high expectations: in their minds a med student who fail an exam = more likely to be a rubbish doctor = more likely to make a mistake on the job. In most lines of work fucking up isn't really that much of a big deal (if you're a politican fuck ups are practically expected, nay encouraged, on a weekly basis), but in the collective mind of the public "medical mistakes" immediately evoke memories of news stories on botched operations and lethal prescribing errors. Medical mistakes can clearly be much more serious. However, it's also worth bearing in mind that many of the doctors involved in these incidents were actually perfectly competent students and junior doctors, which again makes me wonder just how much of one's performance ought to be judged by exam results.

Let me put it another way: this relative of mine knows that I failed two modules during my BSc. They know that I failed them, not because I was stupid or lazy, but because a few years ago I just didn't know how to revise and work efficiently. They also know that I later resat those exams and passed. And that ultimately that I did well in my degree. At no point was it suggested that I was a "bad BSc student" for failing those exams, because failing exams is a normal and common occurence for many BSc students, and everyone knows this. But there seems to be a whole other level of expectation for medical students: even if, like me, they're just as inexperienced as a first year BSc student is with their BSc. My relative didn't actually say I've been a bad med student (I haven't even done summer exams yet), but I'm just trying to examine a train of thought here. It was actually a very laid back conversation which we had if you want to know the truth, despite how seriously I'm taking it all here.

But at the same time, it seems that some non-medics think that if you're smart enough to get into medical school that therefore you're smart enough to be able to cope with anything which gets thrown at you and still pass with flying colours. Never mind if it's all totally new and unfamiliar to you, that there's a lot to learn and not that much time to learn it in. All of these grittier details aren't known by them; they assume that since their GP is confident and smart, that therefore they were like that right from their first day at med school and anyone who isn't like that clearly doesn't have a decent future ahead of them anyway. In actual fact however, for all they know, their GP (like lots of other medics) might have screwed up an exam here or there along the way. And in my opinion, it's still perfectly possible to mess up exams and go on to be a good or even great doctor.

In my opinion medical school (and the formative stages of a doctor's career) are all a massive learning experience, both from an academic and a personal perspective, and whilst exams are, to an extent, a useful method of assessing someone's understanding of a subject, they shouldn't be seen as some sort of yardstick against which medics are measured. Becoming confident in learning and applying medical knowledge and practical skills is something which takes time, and not everyone adapts to learning these new skills straightaway. I don't think that makes someone necessarily a "worse" medical student, I think it means that they need to reflect on what they're going to do to address the problem and then fix it, and there's nothing wrong with that in my opinion. But ultimately it's hard to try and explain this all to people who have never experienced medical school.

*Yes, I know I'm grumpy on here and often sometimes in my personal life too, but I won't be grumpy with patients. Mainly because I've had a few doctors who were irritable at me in the past, and I know just how "not cool" it is.


  1. I have come across a number of eminent, highly respected academic doctors and surgeons who have admitted to failing parts of their exams in medical school and having to resit years. They often say that it is one of the best things to happen to them, as you learn a lot more from failure than success.

    If anything, as people move up medical school, the general opinion (here at least) amongst fellow students and staff isn't how successful you are in exams at all, but more more focussed on what sort of person you are. Exams have to be difficult to separate people out, but an average academic performance doesn't mean you will be a bad doctor at all. In fact a very strong academic performance is probably more likely to suggest you will not be a great doctor.

    I am sure Rainman would be fantastic at revising for medical school exams, which just need you to remember lots of facts, but I cannot imagine he would make a very good doctor (though perhaps a fine surgeon :P )

  2. I hope you talked about what you wrote here with your relative...

  3. I'm sure you'll be an excellent doctor!

  4. @IO: Thanks for the comment mate, it's good to get some insight from someone with more seniority and experience than I. You (and your mentors) are right: I too think that it's more how you reflect on your mistakes and improve on them which matters and which makes one a good medic rather than simply being naturally exceptional. Very few people are naturally exceptional, I think having the capacity to learn from setbacks is much more important.

    Haha yes, either that or an excellent radiologist :P

    @Anonymous: Yep I did, and I think my relative understood what I was getting at, however, I do think that until you're actually in med school it's very difficult to fully appreciate what I'm saying. The title "doctor" or "medical student" carries such a great deal of expectation and significance by the general public (for good reasons I might add) that at times it can be very hard for them to appreciate that a medical student is, well, just a student, and therefore prone to screwing up just as much as anyone else.

    @Medic Wannabe: Thank you! At the moment I'd be happy just to be a little more comfortable in my abilities and less overwhelmed as a medical student, though I'd certainly aspire to be an excellent doctor too.