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  1. #1
    fossildoc is offline Moderator 518 points
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    on tests

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    This forum seems to be focused lately on scandals, so I thought I'd introduce a different subject for a change of pace. The subject is exams, what is and what should be. In the context of med school, of course.

    First, a little history. The Agricultural Revolution in the United States, generally regarded as occurring around 1750, was due to a change in farming methods that allowed for a greater production of food. It was fueled by new farming technology such as the seed drill and improved fertilizers. Like a colony of bacteria, the increased food supply resulted in a population explosion. At about the same time was the "enclosure movement" which was the consolidation of many small farms into one large farm, leaving many people jobless and homeless. These people would provide the workforce of the Industrial Revolution which soon followed. During those agrarian days, children were kept on the farm, where they were needed as laborers. Schools were one-room schoolhouses, like you saw on the TV series "Little House on the Prarie".

    The Industrial Revolution, which actually started in Britian and quickly spread during the first quarter of the nineteenth century, was driven by a revolution in energy use as manufacturers switched from animal power to water power. The steam engine is traditionally considered to be the powerhouse of the Industrial Revolution. There arose the giant textile and other factories in the cities, and mass production became the way goods were made. The teaming jobless throngs poured into the cities and brought their children with them.

    The Industrial Revolution wasn't just about smokestacks and textile mills. It was a general reform movement whose goals included temperance, education, peace, care of the poor, the handicapped, and mentally ill, the treatment of criminals, rights of women, slavery, and many more. An underlying theme of this and most reform movements was the idea that discipline and order is a Good Thing, and should be a part of every aspect of the reform. In education, the leading figure was Horace Mann, who pioneered the idea of universal free public education with common goals and curricula; the one-room schoolhouse was mostly church-run, with no curriculum common to all of them, but under the New Order government would chisel away at church-based aspects of the curriculum and create a more vocationally oriented and secular system.

    And so the schools that grew up around the factories were imbued with concepts of common goals and curricula, order and discipline, and mass production of graduates. The factory whistle blew early in the morning and late in the afternoon, and the school schedules were adjusted to accomodate parents going to work in the morning and dropping off their kids, and picking them up late in the day after the quitting time whistle blew. In the summer, harvest time on the big farms needed seasonal labor, and the school children were a ready pool; that's how the practice of a summer vacation came to be in the U.S. school system; it doesn't exist in other countries. Over the next hundred years, the model that drove the factory schools permeated institutions of "higher" education.

    And we've been cursed with it ever since.

    Every Education 101 class pays lip service to the futility of lockstep classroom methods, but nothing is ever done about it. The idea that a group of heterogeneous students of differing interests, intellectual ability, aspirations, and even genetics, could sit quietly with folded hands in rank-and-file desk chairs while someone in front of them babbles at them, is, well, ridiculous, and yet that is the essence of the System today.

    Experiments have been going on for decades, and continue today. At my local high school in Holmdel, New Jersey, just before I came to med school they were experimenting with open classrooms, sitting on the floor, sitting in beanbags, working in groups, working in solitary, substituting the Internet for lecturers, testing each other, testing as a group, substituting presentations for tests, exploring sources of knowledge beyond out-of-cost -control textbooks, using teams of teachers for each subject, going outdoors and sitting on the grass, enhanced use of field trips, exchange programs, and many more. I don't know the results of these experiments except that they gave up on open classrooms because the noise was too distracting.

    So here we are in med school. We sit quietly (sometimes) in rank-and-file desk chairs, with hands folded (sometimes), while someone babbles at us up front. We use out-of-cost-control textbooks, and follow a curriculum designed for a single vocational purpose: to prepare us for the USMLE1.

    Since everybody at school knows who I am, and since I know what's good for me, I better soften my comments with the following public service announcement: all the teachers at MUAB are student-friendly geniuses, all the administrators are educational visionaries who are so far ahead of their time that enumerating their virtues would be lost on the reader, and the curriculum is a finely chiseled sculpture under continuous reshaping by feedback from the field.

    Ahem. Okay, back to the main theme. There are students who are "morning people" and others who are "night people". In the med psych class I'm currently taking, we studied a class of sleep disorders called circadian rhythm disorders (not to be confused with those noisy cicadas that come out every seven years). You cannot teach anything to a night person in a class that meets at 8 am, and it's pointless to reason with a morning person at night. But there's not enough students to have three sections of every class -- one for morning people, one for night people, and one for normal people. Other students cannot learn from textbooks, and will never bother to read one, but they do great with lecture notes or PowerPoint presentations. Others are just the opposite. Some have Wernicke's Aphasia and can't encode a single word the lecturer says, but can memorize a stack of handouts without a problem. When it comes to testing, some are prolix ('gabby' for the vocabulary-challenged) and can perform well on oral tests and in presentations; some have superior recall memory and do well on essay exams, while others have only recognition memory and need multiple-guess tests to evaluate their retention. Some are so nervous during any type of testing that creative means must be employed to evaluate them.

    Assume for the moment that everyone has a superior IQ and is bereft of learning disabilities. What happens when you lecture and test with multiple choice, in an 8 am class, to a night person textbook-reader who has borderline recognition memory but great recall? A failing grade, that's what. Does that mean that person is a dummy? (No need to answer; it's rhetorical.)

    Let's get practical. To retain accredidation, lectures must be given for a certain number of hours for each academic credit, and eighty percent of them must be attended. There cannot be any giveaway grades without jeopardizing the status of the school. It is reasonable that tests be of the multiple-guess type because that is the format of the USMLE1, so people who have trouble with that paradigm are going to be in trouble, but may benefit from desensitization and immersion training. But there is no requirement that tests come at any particular time, such as soon after the completion of a course, or that they be interspersed at regular intervals during the semester. It serves only the convenience of the teachers and the administration to arrange things this way, and it is counterproductive.

    I call upon all offshore medical schools to adopt the following policies with respect to testing, none of which will jeopardize accredidation:

    1) For each course, present to the students a list of textbooks (probably one) and, if appropriate, a list of relevant chapters in that book, plus any additional material such as handouts, references to web resources, and the like, the mastery of which will insure passing the course.

    2) Conduct the required number of lectures and enforce attendance as you normally would, but refrain from introducing material not covered in (1). At the level of Basic Sciences, it is not reasonable to assert that there are no published sources adequate to prepare students for the USMLE1, such that "extra" material in the form of lectures is necessary. The lectures are for discussion, rounding out knowledge, and networking.

    3) Allow each student to present him/herself for one or more exams when s/he is good and ready, subject to some reasonable limit (in years). Yes, this means that a separate test must be constructed for each student. Difficult? Not at all; that's what computers are for. There are enough resources in teachers' manuals, online quizes, old exams, and lecture notes to create a giant database of questions for each course, from which a computer program could generate a unique test for each student. (Don't know how to do it? PM me -- I am retired from 32 years of computer programming. It's a piece of cake.) Extra cost? Yes, and the replies to this post will indicate how many students would be willing (or not willing) to pay a few extra bucks for the privilege of taking exams when the student is ready, not when it's convenient for the school.

    This system works in favor of the school. Less dropouts and fewer disgruntled students. We had a student at MUAB who blamed his/her failure on the school and came to hate everybody, but his/her real problem was that s/he couldn't "hack it" in the time frame allotted. Adopting the system outlined above could have salvaged that student.

    Everyone reading this, even those who will flame me, has identified with some aspect of this problem. I look forward to hearing how it applies to you.
    Last edited by fossildoc; 04-21-2006 at 12:54 PM.
    Brain surgeon to another: "Hey, this isn't rocket science".
    Rocket scientist to another: "Hey, this isn't brain surgery".

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  2. #2
    md90's Avatar
    md90 is offline Senior Member
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    Interesting..

    3) Allow each student to present him/herself for one or more exams when s/he is good and ready, subject to some reasonable limit (in years). Yes, this means that a separate test must be constructed for each student. Difficult? Not at all; that's what computers are for. There are enough resources in teachers' manuals, online quizes, old exams, and lecture notes to create a giant database of questions for each course, from which a computer program could generate a unique test for each student. (Don't know how to do it? PM me -- I am retired from 32 years of computer programming. It's a piece of cake.) Extra cost? Yes, and the replies to this post will indicate how many students would be willing (or not willing) to pay a few extra bucks for the privilege of taking exams when the student is ready, not when it's convenient for the school
    I like this one, but want to know if this includes what time and day that I could take the exam? and how I would take the exam? I don't like mornings and paper exams.. would prefer afternoon exams and doing presentations. Paper exams and time freak me out...

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    fossildoc is offline Moderator 518 points
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    on tests

    Quote Originally Posted by md90
    I like this one, but want to know if this includes what time and day that I could take the exam? and how I would take the exam? I don't like mornings and paper exams.. would prefer afternoon exams and doing presentations. Paper exams and time freak me out...
    Thank you for your reply.

    As to the format of the test, I stated that since the USMLE1 was a multiple-choice test, it is reasonable that course exams be of that format, since part of the mission of the school is to shape us for the USMLE. Some schools might see it differently, though; at MUAB, much of the fifth semester is devoted to "board review", which might include taking multiple-choice tests. In that case, course finals could be allowed in some other format, geared to each student. It's not my suggestion that schools cater to every whim of the student; some reasonable accomodation is required.

    The school could wait until a few students were ready for a test, so that a proctor's time wouldn't be spent on just one student.

    If the USMLE1 is typically given in the morning, then it's reasonable, IMO, that the school do it that way for course finals, unless morning exams become part of the "board review" process. The USMLE1 will definitely be a paper exam, but if the school is willing to do otherwise for the course, you should be able to negotiate what's best for you. The requirement is to demonstrate mastery of the subject matter, not mastery of a test format. At MUAB everyone knows each other, and things are rather informal, so if you can talk some staff or faculty member into babysitting your exam, you could probably take it at any time of the day or night in return for, let's say, a pepperoni pizza with extra cheese (disclosed, of course).
    Brain surgeon to another: "Hey, this isn't rocket science".
    Rocket scientist to another: "Hey, this isn't brain surgery".

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    md90's Avatar
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    I would re-structure how exams are given...

    If I had a say on how an exam was given, I would definitely re-structure..

    First, I would not want to take away the written exam entirely; there are students who prefer a written exam, and do excellent on those type of exams. I am NOT one of those students.
    Second, I would like there to be a choice: written or oral.

    The written exam would remain as is; whereas the oral exam would include:
    1. Like in the step 2 CS exam, the oral exam should be given in ONLY selected cities or the same cities as step 2 CS exam;
    2. Questions should be "Integration" questions, allowing the student to answer from various topics... want an example?

    What cells produce myelin? can be either oligodendroglia or schwann cells;
    Which one of the cells has a well-known tumor associated to it, and what is it? Schwann cells, Schwanoma
    What is the tumor called when associated with the cranial nerve 8? Acoustic neuroma
    What genetic disease is associated with this tumor? Neurofibromatosis
    What is the "key" sign(s) that one might see in this genetic disease? "cafe au lait" spots; Lisch nodules (more in type 1); neurofibromas

    3. The questions should be standardized, and not allowing the person who gives the exam to make up the questions.
    4. There should a time limit to how long to answer the question, and time at the end to add additional information if necessary.
    5. The exam would be for 8 hours (all day) with 30 minutes or one hour break.
    6. The questions and/or clinical vignettes would be posted on a screen, and there would be video camera projected on the student and professor recording the questions and answers;
    7. Like in the written exam, it would be in one-hour blocks.
    8. The student and/or professor could take breaks in-between the hours or choose to continue;

    I'm sure that there are more logistics.. but these are the ones that I could think of at the moment... I don't know about anyone else, but the oral exams would help me out tremendously... written exams, especially multiple choice, FREAKS me out! We, as students, learn differently. Should our exams reflect what we learn, and to do that, we should be given every opportunity to succeed in that goal!

    What do you think? I would love to hear your opinion and/or thoughts... thank you and good night
    Last edited by md90; 04-22-2006 at 01:02 AM.

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