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Doctors 'Cheating' On Board Certifications
Maximum Prophet writes "After taking board exams, doctors have been routinely getting together to remember and reproduce as much of the exam as they can. These notes are then bound and reproduced. According to the American Board of Dermatology, the exams are protected by copyright laws, and any reproduction not approved by the board is illegal. While I have no doubt that the Board believes this, and pays lawyers to believe it as well, I don't think they understand copyright. Perhaps they should invest in better testing methods."
Keep it up and getting your MD degree will be worth about as much as most IT certificates. You can buy copies of most of those tests online from companies that somehow steal the cert test, probably using the same method these doctors are.
I would be surprised if the people taking the exam didn't sign something saying they would not disclose any part of the exam to anyone. These sorts of things are typical and are binding.
not just medical examination. it is just a co-incidence that the medical profession is one that is tangled with most examinations. speaking of examinations, though, the most important examination for us medical doctors are usually conducted in the oral style (viva examination) which allowed impromptu questions set immediately, testing the doctor on how they would handle a patient step-by-step. i'm not sure about the american system but that's true for most british systems.
Speaking as an MD, and posting anonymously through more proxy jumps than you can count, I can tell you that the ABR is a disgrace.
They have elected to ELIMINATE the oral exams. Whats next, calling us providers?
Humans are not computer problems, and solving computer questions is not an appropriate screening method for certification.
Bottom line: Oral Examiners should be PAID, CAREFULLY TRAINED, GRADED and only the BEST kept year after year... like NFL REFS !
Of course, the overpaid ABR administration might* have to take a pay cut to achieve this.... AND THEREFORE, THIS WILL NEVER HAPPEN.
A DISGRACE UPON MEDICINE
On the one hand I don't want doctors to cram for the exam or to "learn the test".
On the other hand, I've taken standards tests myself for technology subjects, and there's often a lot of inane questions that don't really apply to the actual day-to-day job.
I guess that many organizations are guilty of this. There are probably a half-dozen test-prep organizations for high school students, technical learning, non-technical government licensing, and the like.
Do not look into laser with remaining eye.
That if they just ensure they collect the exams at the end, and forbid copies, and forbid anyone talking about the exam, that they'll never have to write a new exam.
Doctors are high competitive on these tests and those with the best scores have the best opportunities. This means they can't have vastly varying tests or the results would vary creating an unfair advantage. This is easy to work with on the mathematical side, you just change the numbers and people have to know the formulas etc to make it work. However when you come to diagnosis questions etc... they have to be the same standard and overall difficulty to be a solid measure test.
I remember back in the day when people took the CAT. Some versions were much harder and graded differently. Do of course they protect the tests... but this is where they need to change their methods completely because they are outdated now. I wonder what will happen in the future.
so we're not treated by hacks that cheated on board tests...
this is a sign that the overall school / testing needs change and new ways to learn / test people. We need more apprenticeships / trades learning system and less end less classroom with test that people who can cram can pass and get rid of tests that have little to do with the real job.
I thought prohibiting students from sharing past copies of tests was a standard and acceptable method. Is it because they are using copyright to attack the practice?
The American method of 'learning' is mostly rote learning. This does not help. As Einstein once said, "Imagination is more important than knowledge."
How shall we as Americans be able to steer our future when what we mostly test is the ability to cram? As a former educator, one of my best times in class was when a student was 'teaching' me. Even when they were wrong, the dialogue enriched both of us and for the student, it was invaluable.
Multiple choice questions make matters worse. No wonder foreign kids beat us in math and science. It's not funny at all.
I had a chance to teach a group of refugees from an African country and it was amazing to see how they approached a problem. While our Americanized kids reached for their calculators, these kids internalized the problem in their heads, then wrote down the range of where they thought the answer would lie, then solved the question. 100% of the time, they were right.
I will ask my doctor what she thinks about this issue when I see her in a fortnight.
MD degree is to long and the school mindset may be to much drilled in to people. Going to med school do they really need a full 4 year BA with all the filler classes before med school? Why not 2-3 years and then Med school? Now I can see what that setting in a class room for years with lot's of tests and some stuff that you will never use can do to your mindsets. Testes become more about craning for the test then studying the full topics. Now some of this comes from poor tests and the other part comes from the tech the test idea.
This is old territory under U.S. copyright law; it is clearly a copyright infringement and there are many cases that say so (it was law school exams, but same thing). Not sure why anyone could say they don't "understand copyright" when the Board takes this position, they have a slam dunk.
They have elected to ELIMINATE the oral exams.
I thought oral exams were the whole point of, say, becoming a doctor of dental surgery. Even if (as I suspect) you meant the other meaning of oral exams, are oral exams offered in a sign language, or (as I likewise suspect) is hearing considered a bona fide occupational requirement?
Oral Examiners should be PAID
And I do so twice a year, so that I don't have to brush, brush, brush all the floors in Hyrule.
Copyright is a dumb way to protect a test.
A much simpler and easier way would simply be for the AMA to have test takers agree to a very simple NDA. You agree not to share specific questions from this test with anyone. Covers the actual problem, is enforceable, doesn't require twisting copyright law in crazy ways. What's the downside?
If the exam is copyrighted, and as the story states each question is reproduced "verbatim" and then reproduced, that is unquestionably a violation of Federal copyright law. /. needs to avoid publishing nonsense from people who clearly never went to law school.
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in most subjects i would agree with you, but i don't think i would want an imaginative doctor (at least not at the expense of a strong level of basic competence). some things damned well should be done by rote, based on centuries of hard-won experience.
some people do have to come up with the new stuff, but most doctors don't and shouldn't be trying.
"They were pure niggers." – Noam Chomsky
FAA testing is sort of the same. There is a master question bank containing thousands of questions covering pretty much everything there is to know about flying and flying rules. For each test for any particular certification (instructor or commercial, for example), the testing center picks a bunch of questions from the question bank that are applicable to the certificate being pursued.
There are tons of ways to study for this test, and most pilots use more than one method including ground school courses, "cram" courses that rely only on source materials, lengthy video courses that cover pretty much everything in detail, and focused test-based studying which pulls every applicable question from the master question bank. All of these are "legal" ways to study for FAA exams.
Some places even sell printed books with every known question, on the shelf right next to the manuals that have the source info. The idea is that most pilots will become intimately familiar with the rules/regs that apply to the kind of flying they do all the time, and they can cram to learn the other non-applicable stuff just for the test.
This isn't just an American problem. China, India, and surely other parts of the world have this problem as well. At least there are some decent upper education options in the US. In India and China it's even worse in upper education.
Most of the world's education systems are still based on the outdated methods developed in the 1800s, where they were basically designed to produce workers for industrial revolution conditions. Computers and other automated systems take care of most of that now, it's obviously time for a radical change.
I would imagine that changing the system is extremely difficult though. Just imagine what a meeting of hundreds of authoritarian educators trying to reach consensus must be like. PTA meetings are bad enough...
The American method of 'learning' is mostly rote learning
Overall? No. I'd say the US has been much better in this respect than many other countries. (Though "No Child Left Behind" has done its damndest to screw that up by encouraging teachers to teach-to-the-test.) However, it is like this for premeds, and that's what matters!
Why? The stakes are too high. Push up the stakes high enough, and people don't think; they memorize. Indeed, when faced with very high incentives in psychological studies, people bomb IQ tests. You can't think when something as important as a career as a doctor is on the line. (That's why classes need to be exactly as hard as necessary -- and no easier -- but also no harder!!)
It's also how biology is taught in college. "Go memorize this arbitrary chemical pathway. No, we won't talk about 'why.' Yes, you can forget it later. We all know this class is just for weeding, anyway." Partly because it's all premeds. (And partly because there's no helping the fact that, compared to physics, biology is much more about facts than principles. It's messier. Such is life.)
The first 2 times I ran into this, at about the same time, was for FAA & FCC (Federal Aviation Admin., Fed. Comm. Comm.).
You used to have to have at minimum a 2nd Class Radio Telephone license from the FCC to be a broadcaster in radio. You could actually have a 3rd class only to talk if the station had someone else on duty with a 2nd class to actually run the equipment. The stations often didn't want to pay for a 2nd person with the higher level license, so...
For FCC testing back in the 60s & 70s, there used to be outfits that came to cities periodically that would guarantee passage after a weekend course (12 hrs per day) during which you would be taught the answers to the test questions. The way they got the answers is what is talked about here. It had likely been going on for some time already when I found out about, but the 70s is when I was working on my FAA & FCC licensing, so that when I knew about it.
There was the same thing for FAA written tests and I seem to remember hearing that the FAA stuff came first. This may be the actual reason for calling them "Airplane Tests".
I went to school in Austria (Alps, not kangaroos) for a year after having grown up in the US school system (Wisconsin, so a good part of it), and I have to say I disagree with your assertion that the US is more about rote learning than Europe. And my wife (Hungarian) was amazed at how much better the university experience (grad school) than anything she saw at home. And her limited experience with grade schools really amazed her at how interactive the classes were.
It is not that we here in the US fall back on rote learning that is causing us to suffer so badly in math/science education, but rather I think it is the following things:
1) Those test scores are not always as comparable as you might think. One big problem in comparing test scores between the US and Germany/Austria is that in the US everyone takes those tests, while in Germany/Austria only the "Gymnasium" (college bound) students do. Sometimes the tests can adjust for this, but I have seen may that don't.
2) We in the US look down on teachers with phrases like "those who can do, those who can't teach", and channel all of our best students away from teaching. That we have so many great teachers willing to take the small salaries that they get, the total lack of support from the communities (in some cases), and the political abuse that the Republican party has been hurling at them for a generation now just shows how dedicated those people are.
3) The amount of time and effort that parents put into making sure that their students do well in school has bottomed out in the US. Since the parents don't care (or don't have the time to care working two jobs) their children learn that it is not important to do well. Compare this to the Asian stereotype (which has some truth behind it), and you can realize how much an up-hill battle many teachers are facing.
4) Teachers Colleges are badly organized, and heavily weighed towards liberal arts. So of course their graduates tend to have less skills in math/science. There are a lot of people in those organizations who want to do better, but the spark still has not been lit of a renaissance there.
5) There has been a cultural war waged by social conservatives to undermine science because they dislike evolution. You can't teach the scientific method effectively when the student's parents then dismiss the science out-of hand. A similar argument is just as valid in the global warming conversation.
6) Our popular media has been portraying scientists, and smart people in general, in a negative light for a long time now. Part of this is because most of the people who write for the popular media probably identify themselves as "liberal arts" people (they are writers after all), and so re-enforece the hierarchy that has them above the "nertds". So of course they are going to tend to portray their heroes as people like they envision themselves.
I live in India, and such Notes are very common here for almost every branch of Higher Education. In some cases of post-graduate and doctoral courses, the question papers are legitimately distributed by the University to students after an examination. For tests where the board does not distribute question papers, several companies which claim to be vestigial 'education' and 'training' companies pay examinees for reproducing or recollecting the questions. It is also common practice in India for corporates to hold screening examinations prior to fresh candidate intake. These question papers are also reproduced, solved by a team of experts and a key is published before the next examination. A good example is FreshersWorld.
This also happens for NCERT, Medical Entrance Examinations, Engineering Entrance Examinations among several others. No Legal action has been taken in the recent past to stop such recollection, despite the fact that it merely promotes rote learning, textual recall or fundamental pattern matching. Interestingly, in India, no one has referred to this practice as cheating, although it is. It is only in the past two years that Computer Aided Tests which shuffle questions and stagger timelines are being introduced to avoid this practice. Enforcement of legal sanctions in India especially across Educational boards, Varsities and Corporate Testing groups have not been easy.
Question papers, by themselves for any test are never copyrighted officially. Most Board question papers in India, Pakistan, Sri Lanka, Bangladesh and Nepal do not come with any Copyright notices. Boards and Academic members have until recently been in the dark about 'Copyright Law' and have little idea as to how it is enforced. A vast number of books published are not registered for copyright, nor do they have ISBN assigned to them.
Part of the issue is the inability to enforce exclusivity on 'recalled' or 'reproduced' testing material. Another part is ignorance of the full extent of 'Copyright Law' itself, though this is significant in nations like India and China where their implementation has only now begun.
No Greater Friend, No Greater Enemy! (Lucius Cornelius Sulla)
Lucky there was not a accident or stuff got stolen from your car http://it.slashdot.org/story/07/12/11/2144255/ohio-plans-to-encrypt-after-data-breach
Now having a unpaid intern driving there own car is a legal minefield for both sides.
Some of us don't need to cram ...
Truth is, I took so many tests in school I got to the point where I could outsmart the test. There was one contest I participated in where I knew none of the material (I hadn't taken the course yet, but no one else at the school wanted to represent the school so I took the test anyway) and came in fourth out of participants at that testing center. Okay, maybe only a couple of hundred people took that test at that location, but I think that's pretty good. In fact, I did better on that test than I did the one in my real subject area ...
No, you can't fake essay questions or orals or stuff like that - but those actually require people to grade them, not computers (as in, too expensive).
Depends on the field.
Historian? Get a few dates/names wrong and you'll look like an idiot but no harm done and you can always correct yourself.
Writer? Its going to look really bad if you can't proofread your own work, but I guess thats what experience is for.
Law? Even though everyone knows the field is more a matter of experience, don't expect to be able to keep up if you can't hack a couple years of cramming in school.
Engineering? I don't want to drive across a bridge built by someone who doesn't know basic metallurgy
Medical field? If you don't know the human anatomy, theres no way in hell you should even be holding a scalpel.
> /. needs to avoid publishing nonsense...
Half the articles would vanish (and 3/4 of the comments).
Warning: this article may contain humor, sarcasm, parody, and perhaps even irony. Read at your own risk.
well we need tech trades to take the pressure off of the old higher education system.
Now the tech schools are a good start but they need to be better / offer apprenticeships.
I say a real apprenticeship and not just interns no a mixed classroom / apprenticeship system. with a real counting education system that higher education is poor at offering.
That nurses do this as well. 30 of us would be standing out in the hallway post test saying things like,
"How did you answer that question about disseminated intravascular coagulation?"
"Ohhhhh".
If there was something of note, one of us would make a note about certain questions where our line of thinking was incorrect to go over later in study group. This sounds more formal than what we did, but I don't think there is really anything different about it aside from the level the MD students take it to, then again, with the level of knowledge required, a couple of notes here and there probably just doesn't cut it.
The American method of 'learning' is mostly rote learning. This does not help. As Einstein once said, "Imagination is more important than knowledge."
Really? As a Canadian living in Romania, I have to strongly disagree. The education system here appears to be heavily based on rote learning (much moreso than I saw in Canada or attending American schools in my childhood). The folks I have hired have had excellent imagination, in spite of, not because of, their education (and have generally been the ones who skipped a lot of classes at university and taught themselves the required material).
That said, I previously worked (in Canada) as a physics researcher in a hospital, and we would regularly "joke" about the MDs not being "real doctors" (in contrast to how most people view PhDs), since their main skill appeared to be rote memorization. (See also Richard Feynman's story about his diagram of cat anatomy when he gave a presentation to some med students.) Of couse, as a sibling post says, most medicine comes down to reproducing what is already known (as it should be).
I now look at doctors the way I look at lawyers. To get in, you don't need to be creative (and in fact, you probably shouldn't be, or should suppress it until you've already proven yourself), you just need to know the existing "case law" very very well. Mostly, your job is to identify stuff that has been seen before (taking into account quite a lot of subtle data) and go directly to the most successful known solution. If you want to be imaginative as a doctor, you can go the MD/PhD route (which, in my opinion, makes you a superstar), I suppose, or run the risk of losing your job by doing something no one else has done before (and hence is not "approved").
Teachers Colleges are badly organized, and heavily weighed towards liberal arts. So of course their graduates tend to have less skills in math/science. There are a lot of people in those organizations who want to do better, but the spark still has not been lit of a renaissance there.
Canadian here, so I'm not sure if this applies to the US, but here our teachers' colleges select largely based on university grades with no consideration to major. At the university I went to 50% was a pass pretty much school-wide, but most science/engineering students required a 60-65% minimum average to stay in their program, while most arts students required a 75%, and the class averages reflected this. That is, the arts averages were about 10-15% higher than the rest of the school because the requirements were higher. Of course more arts students will get in when the top of their bell curve is placed in a different place than the technical subjects.
Comment removed based on user account deletion
There is a lot of confusion among people who aren't physicians about what, exactly, is meant by "boards" and "board certified". Just remember: medicine is populated entirely by people who are good at tests. They may have other skills, and they may not. But they're all good at taking tests.
When a physician is described as "board-certified", that means that s/he has taken a specialty examination given (in almost all cases) by a member of the American Board of Medical Specialties. In some fields, this only has a written component; in others, especially surgical fields, oral examinations are standard as well as the writtens. These examinations serve to certify that you know that particular specialty. They are not required to practice medicine, and physicians are not limited by law to practice only in areas of medicine for which they have received formal training. Insurers providing coverage and hospitals allowing privileges outside of your area are a different matter, but as a matter of law, a general-practice MD can perform neurosurgery in his office.
A permanent, unrestricted medical license in the US is predicated on passing the US Medical Licensure Examination Steps 1, 2, and 3 (unless you're an osteopath and you take the COMLEX, but that's a small number of people and in any case the principle is very similar). Furthermore, you will have to do at least an internship (the first year of residency after medical school) in order to be granted a permanent, unrestricted medical license. (Graduates of non-US/Canada medical schools may have to do two or even three years of residency.)
So yes, people do get together and discuss things. In particular, memorizing questions serves the purpose of identifying what the question-makers think is important. This is not always trivial; as medical specialties have moved their written examinations onto computers in recent years and K-type (Choose A if 1 and 3 are right, B if 2 and 4 are right, C if 4 only is right, D is 1, 2, and 3 are right, and E if all are incorrect) questions have been eliminated, there has been a significant influx of new questions from younger examiners. Like all examiners, they tend to submit questions from their own interests rather than just covering a broad enough base to be sure that the examinee is capable of practicing safe medicine. The line between pass and fail has to fall somewhere, and if you're academically relatively weak, knowing the likely subject matter (or the likely rare association between two things) can make the difference between pass and fail.
The USMLE 1/2/3 all have prep courses and study books with sample questions, just like the SAT. If you don't study how the questions are asked, you are unlikely to do your best. However, the base of knowledge is just immense - Step 3 considers anything that you might encounter in a general practice to be fair game. To pass the test, you're going to need to know the stuff.
The specialty board examinations don't take anyone who couldn't 1) get a residency in that specialty and 2) pass their way through it (which is not a given - people fail out of residencies all the time). Dermatology, the subject of this article, is populated exclusively by people who gradated in the top 5-10% of their med school class. Their intelligence and drive to study isn't really in question. What's happening is mostly a matter of pride; even though only a vanishingly small percentage of people who take the test will fail, it is incredibly embarrassing to be the one who does.
Rote learning used to be very important. Knowing something could save a lot of time looking things up, which is important when you're a doctor in an emergency room ("it it one leach or two to cure whooping cough?"). And testing knowledge is much easier than testing ability so guess which one got tested. These days finding information quickly is a solved problem so keeping raw information in your head is less important (although that's not an excuse to keep your head empty :)
I'm curious why you are a "former educator"? Seems a pity that someone who appears to have some passion for teaching isn't doing it anymore...
In Australia, teaching is heavily unionised so any attempt to reward teachers who do a better job than others is shouted down, and pay is basically just a function of years of service. The alternative leads easily to the system being gamed but what we're doing now isn't working...
Biology can be fun when taught by a competent teacher. My anatomy class in high school had one of the best, and she'd obtained a grant which she used to buy crazy supplies to supplement her lessons. Pool noodles became striated muscles and we spent a food amount of time shoving the noodles in sort of an interlaced pattern while she shouted "Calcium uptake! Calcium ion release!" I guarantee you ever single student in that class is fully aware that it is the calcium channel that moves striated muscle, to this date, even though that class was 15 years ago.
Occasionally living proof of the Ballmer peak.
*A good amount of time. We may remember the calcium, but we still do not always proof read...
Occasionally living proof of the Ballmer peak.
Forbidding students the use of old tests seems to be very counterproductive. I am studying physics at a university in Denmark, and here old exam questiens are an integrated part of the teaching. It is a great way to make certain that you have understood the subjekt. Of cause it might make a difference that we have proper written and oral exams where you have explain why and how every step of the way instead of just giving the answer.
The disadvantage is that the teachers have to spend a lot more time making and grading the exam. So if your only goal i to process as many students, as cheaply as possible, a multiple choice exam makes more sense.
...those with the best scores have the best opportunities. This means they can't have vastly varying tests or the results would vary creating an unfair advantage.
There is a very simple solution to this: make the test pass or fail. If medicine is similar to research then, once you get over a certain level of competency it is motivation and interest that is most important not whether you scored 80% or 90% on an exam.
Even if you want to keep public scores you can build up a large question bank of previously asked questions for which you know the difficulty and then randomly choose a few of these questions to put in an exam, along with new questions. This lets you normalize the difficulty level and each exam's new questions get added to the question bank making it harder for anyone to learn all the questions.
Back when I was a chemistry major thinking I wanted to be a chemist, I laughed at premeds for their memorizing, don't-care-why, grade-grubbing ways. Then I realized I didn't like being a chemist (thankfully before I graduated) and decided to go to med school. When I got there, I realized that all those premeds had spent four years acquiring skills that were actually adaptive in the med-school environment. Everyone there is smart - not gobsmackingly brilliant, and often fairly conventional in their thinking, but definitely smart. They're all motivated. They all study hard. And so the only way to distinguish yourself in that crowd is to be able not only to know all the basic stuff but to know all of the minutiae as well. The why is unimportant, because professors who don't have TA's can't (or won't) grade 100+ essay exams when the expected turnaround for scores is 2-3 days. You won't be tested on why. (If it really matters, you'll learn why later.) But you'll be tested on the drugs nobody has used in 20 years.
Then you can have their firstborn if they breathe a word of the exam o>O
So it's okay to plagiarize or cheat on exams, as long as there is a BSD or GPL on the crib sheet? Hahaha.
more apprenticeships / trades learning system
More than 80 hours/week in residency? Of that, no more than about 5 hours/week is direct didactic learning.
The real dirt is this: there are now "Board certifications" which don't even require a doctor to have down a full multiyear residency training program. The "Consumer" (oops, I mean patient) can't tell the difference because the diplomas all look snazzy
#2 I have normally seen that applied to college professors. I haven't seen it applied as much to lower-level teachers.
#3 That is the key.
#5 Most conservatives I know, would STRONGLY disagree here. Maybe disagree with Evolution, but don't discount ALL science because of that. Especially the ones that are atheists. I would say the fundamentalist nut-jobs fall under your broad stroke, but not main-stream social conservatives.
# 6 You write what you know... With a very limited scope... well, you see what happens.
The American method of 'learning' is mostly rote learning
Overall? No. I'd say the US has been much better in this respect than many other countries. However, it is like this for premeds, and that's what matters!
I have to disagree with you here, TerranFury.
It's not just premed that is taught in this fashion, it's everything up to and including premed.
The US education system was specifically designed to prevent the development of critical thinking skills and logical analysis.
Unfortunately, by the time students reach premed/grad school it is too late for them to start developing these skills.
You gave a perfect example yourself,
It's also how biology is taught in college. "Go memorize this arbitrary chemical pathway. No, we won't talk about 'why.' Yes, you can forget it later.
This type of education is not teaching the student anything other than how to memorize and follow someone else's directions without question.
I wrote a rather long comment here about exactly this issue.
To summarize it, I'll just copy the pertinent paragraph here.
Our system works well at doing one thing, creating content, bored, consumers.
Our Current education system is strongly based on the principles of a man named John Dewey, feel free to look up information of the phonics vs whole word method online, but I'll try to summarize it for you.
Basically the whole word method is a method of teaching via rote memorization instead of with critical thinking.
Instead of giving a child the building blocks to sound out the parts of a word (via latin roots etc) the child is taught the entire word as a single chunk, and never shown the underlying methodology.
This method is consistently repeated throughout our educational system, with students being given subsets of data and told to memorize them. The same information is often repeated through multiple semesters and even years, but the student is never shown the actual underlying reason for why the data is what it is. (another good example is history classes, how many teachers proved a timeline or list of dates to memorize, but don't go into detail on the social motivations for the events?)
A big side effect of this method is that the student never learns the methods for independent thought/study and critical thinking is left out of the curriculum completely. Why?
Because teaching critical thinking skills creates people who can think for themselves and are less likely to follow the status quo.
It should be pointed out, though, that Einstein was a scientist. Not a medical doctor. I want an MD to tell me what is wrong with me based on the symptoms, be correct, and tell me what I need to do. I do not need the MD to come up with an imaginative solution or diagnosis, it should be based purely off of statistics, studies of what worked, and more statistics. While we like to think of ourselves as unique snowflakes, that's our brains, not our bodies. My liver is pretty similar to every other liver out there of the same age.
I don't need much imagination from my doctor, I need him or her to know facts.
As an update to what you wrote:
At this point the FCC makes freely available all test questions and answers. They have also done away with the oral portions of the exams as well as the morse requirements for every license except radiotelegraph operators. This makes the cram method especially prevalent. Some of the companies that you refer to still exist but now they simply publish the questions and answers with some minor bit of explanations; some also publish practice exam software. 1st, 2nd, and 3rd class radiotelephone operator licenses have been done away with and are now replaced by the General Radiotelephone Operator License (GROL) which, as I understand it, is the (from a technical knowledge standpoint) equivalent of a 2nd class radiotelephone license. The broadcast endorsement has been done away with and is no longer required for commercial broadcast radio. DJs certainly don't need it though I imagine that getting a job as an engineer with a radio station without a license is probably pretty difficult even if not legally required. Commercial licenses are still required for operation and repair of nautical stations and equipment and for repair (but not operation) of domestic aeronautical stations and equipment.
On the FAA side, they used to publish both question and answer pools like the FCC but came under fire for it a few years back and no longer do this. They do release a few sample questions but the vast majority of the pools are not available so you end up with a situation much like these doctors where people will remember what was on the test and forward the questions and answer options on to prep companies. Some do a really good job of creating a curriculum where the student actually learns the material, others do just like the FCC prep companies and publish books of questions and answers with some bit of explanation. The FAA retains the oral portion so in theory, an applicant who has memorized the written exam could still be caught by an examiner when asked to explain the theory of a given topic. And, obviously, the FAA also retains the practical exam as well. Of course life is not perfect and some students only want to study for (and some instructors are only too happy to teach for) the tests and nothing else.
As background: I took my Extra Class amateur radio license test in 2007 and private pilot tests in 2010. I am currently studying for my GROL and instrument pilot tests.
While it's good that lessons were engaging enough that many students learned how muscles work, it's just a mostly useless fact. Science classes need to be about more than just memorizing facts. Encourage them to experiment and to apply the scientific method, even if it's nothing too complicated and make sure that they know it well enough to apply it to other parts of their life. Science isn't just a collection of facts, it's a process and something that can be applied to just about any discipline.
My wife is a doctor and is extremely sharp; she graduated top of her class (top 15%) in med school.
She can reason and learn concepts very quickly, but I don't know anyone better than her at memorizing, recalling, and implementing volumes of factual data. Her memory is quasi-photographic, and she 'reads' data later on. She literally can recall what we ate for dinner on any random night four months ago--I picked about 4 evenings just to see. She seems to use reasoning skills primarily to sort through massive amounts of data and conceptual knowledge. Kind of like a walking encyclopedia that thoroughly understands and interrelates the concepts.
But she doesn't care to be creative. Honestly, almost not at all. Being a diagnostic doctor (radiology) is a perfect career for such a mind.
The smart and highly creative sorts can thrive in different career fields or choose the MD-PhD route.
Any doctor or potential doctor caught cheating on their board certs, or caught aiding another cheating on their board certs, should be barred from serving as a medical doctor for the entirety of their lives.
Your lament against rote learning begins with a quote you imagined? or memorized?
Paraphrasing is paraphrasing. Copying is copying. And tests are valuable only when they test what they are designed to test, and not rote memorization(*)
(*) Apologies to any pharmacology majors who have to memorize more than most people memorize in their life.
There is a new approach to evaluate doctors based on their ability of the physician to do the procedure, diagnose the disease, etc... This is done during training and is superior to other Test based processes. Some spend ~ 1 yr studying to pass a test and score v high on their exams but have little or below average clinical skills. Neither over education nor over testing will improve health-care. A single doctor will spend ~ 7 yrs to get his MD, ~ 4 yrs for his basic specialty residency training and sometimes a couple of years for sub-specialty all in "accredited" programs during which they are actively trained and evaluated; that is a v long time... How much do you think a one or 2 day exam that costs ~ $ 3000 will help in filtering out bad physicians? No written or oral exam is anywhere significant compared to the training years.
Oh, to have mod points...
I don't think I'd be where I am now if I didn't excuse myself from group learning at primary and go do my own thing (which was usually lots of reading, playing with numbers, craft materials or involved the computer in some way). When everyone around me is stuck for what to do next, I'm already nearly finished. I'm glad I was one of the very few students who had both the brass neck and the foresight to do this instead of sitting there and chanting out multiplication grids to 12...
Operation Guillotine is in effect.
Braindumps. It has been in existence for a long time, started by the IT industry.
Twitter: @dainsanefh
Why did you choose the name Joe_Dragon? Is it because "Idiot Obsessed With Apprenticeships" was already taken?
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
Any halfway intelligent students in any field will contribute to such efforts. The task of the examiner is to know this and make new exam questions every time. In fact, as an examiner, I have bought such collections to get an idea what kind ow questions and difficulty level the students actually expect. Very helpful.
Now, that said, examiners that do recycle exam questions unchanged or, worse, use "test-banks" from textbook makers are lazy scum and should be fired.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
The bodies that come up with the certifications say that they don't repeat questions. Well, if that were true, the Doctors couldn't come up with study guides by recalling questions.
LK
"Hi. This is my friend, Jack Shit, and you don't know him." - Lord Kano
In my case it was a particular group who seemed to have "secret study guides" for some of the licensing exams. It became apparent when one of my classmates failed an exam and would have to retake it. Other classmates happened to be taking the exam at the same time and when they heard he had failed, offered him their study "secret" guide. I got a chance to look at the guide and it had ALL the questions from the exam almost word for word.
This particular group made up a fairly large percentage of my class and they all scheduled such tests as a group. I think they were assigning specific questions to each person (you take the first 5, you take #6-10, etc.) to memorize and then getting together after the exam to compose a new study guide to be passed to others taking the exam later. This is all speculation, but it seems to fit the facts.
I don't approve of the formulation of such study guides, and I think the people who are putting them together and using them are cheating, but I also think that it's an inherent flaw in the way the exams are given. If each exam were created from a sample of a much larger set of questions, this sort of activity would be much harder to pull off. The exams are given by computer, so it should be very easy to implement a complete sampling/order scrambling system.
In this case, I know the people who were involved and know from working with them that patients are not being put at risk. These were not unqualified dopes- all were well trained and highly skilled. They were all very smart people who are inherently risk-averse and figured out how to minimize the risk of having to take an exam over again. I don't think that any of these people will pose an ethical threat to their patients (at least, I hope not), though the creation of the study guides is definitely unethical.
I teach university biology to premeds. In particular, I teach Anatomy and Physiology. From this experience, I've come to understand a few things:
Premeds will jump at the opportunity to do well on these tests, including by cheating. Overall, I can count the number of students who cared about *understanding* anything on the fingers of one hand, but they will always, to the very last one, want to be sure ahead of time a) what will be on the exam, and b) what answers to give to get the points (frequently verbatim). If I don't provide that information, they pursue it however they can, up to and including the tedious task of rewriting sections of their book or lab manual to help them reproduce the text verbatim on quizzes and exams. (What's in said text, they don't know. They just expect the question to refer to a given block so long as the "magic words" match.)
No topic in A&P (or, really, anything else) is important enough that students will care about learning what it actually is. Because so many of these courses get taught to large numbers of students (as in, course enrollment >100) without necessarily having a lot of grading support, exams frequently end up being true/false or multiple choice. Students generally don't care about what's in the question or the answers so long as they remember the magic words to associate to get the right answer. More time and effort will be spent on learning the association of magic words than their meaning or implication. (Doing homework with the help of the textbook ends up being a lot of fun with this crowd -- one student in particular took the time to highlight and scan an excerpt of the General Physiology textbook and explain that the question given in the homework must be incorrect, because she could not find an answer that agreed with the highlighted language. The actual problem was not with the question, but her inability to continue to literally the next sentence in the paragraph.) In many schools, failing out of major courses in undergrad simply reflects an inability to match magic words properly.
Premeds will assume that anything they take in undergrad is a weed-out course, including Anatomy and Physiology. As one student in General Physiology lab told me, "I'd rather be doing this stuff in med school, because at least I want to be there." Again, nothing is important enough to get them to give a damn. Of course, there are (blessed) exceptions, but students largely think of undergrad as being a way of marking time until they get the red carpet rolled out for them at the door to med school. Or something.
Reducing the amount of information to learn on a test is of paramount importance. More time and effort will be spent on negotiating (or attempts at negotiating) the terms of the assessment than dealing with the material and preparing for the assessment itself. It starts with students breaking into lecture to ask "Do I need to know this for the test?" (My stock reply is, "You do now.") It continues to whether or not they need to know everything in the handouts *and* lab book for their lab exams and quizzes. It goes on yet further to students becoming outright mutinous at the suggestion that they should be familiar with the lab exercises in the manual in their possession before they walk into the lab. Last week I even had a student argue with me that I needed to change the lab for him because he didn't think he needed to read a three-page syllabus to see what the lab this week was. Again, these are premeds, and my darling Dr. Schweitzer there is hardly an isolated case.
These kids are coming from a culture of teaching to the test, and time and again, we're seeing that it's making instruction life difficult when the "best of the best" at gaming the high school assessments think their goal in life should game assessments until they sail to their MDs. I don't get to spend time helping students who really do care, because those students fade to the background while the "aces" demand more time and attention to help them keep from knuckling down and
Oh, I had fun with the premeds in college. I was an electrical engineer studying neurophysiology, and paying for college by working ambulance. Most of them had never studied anything larger than a cell in a book, much less things that dripped body fluids on the lab bench. We had a fabulous instructor who did case studies and explored how biological systems worked together, and expected analysis from us, not just rote learning, and they were stunned.
The instructor did his flat out best to get them involved in analysis and actually gathering the necessary data, linking it together, but they'd all been pre-drilled into years of rote memorization to keep their grade points up to get into medical school. I drove him nuts because I already had some of the most critical skills, but refused to go to medical school. (Couldn't afford it, and I had medical issues that were getting worse and would make internship very, very hard.)
The crowning moment was when we did a lab on the cardio-vascular system of dogs. It actually caused several students to quit the course, realizing they'd have to do the same sort of thing on people and hadn't faced it. Now me, I exchanged notes with the cardiac surgeon helping out on how to get blood stains out of clothes. (He walked into a hot shower with his clothes on: I'd never thought of that!)
The entire point is that they are not. The US "health" system is really an insurance system. Now do you see why the rest of the world is laughing at those idiots in the USA that got sucked in by the PR campaign from the insurance companies about doing a tiny bit to shift it back to healthcare again. Leave the doctors alone and complain to those in politics that over the years colluded with insurance companies to take health care away from them. Vote out your local idiot that was bribed to help keep the insurance profits high.
If you're basing the diagnoses off of statistics you're going to end up with dead patients. Diagnostics is following a decision tree. Trying to shortcircuit that process by "going with statistics" will simply end up with wrong diagnoses.
In that regard, MDs can easily be replaced by expert systems. Where these systems fail, and where humans are still needed, is in the identification of symptoms. The presence or absence of symptoms lead to a diagnosis.
Beta is broken and the link to classic doesn't work. Stop wasting our time or there won't be anybody left here.
What I care about is that professionals who claim to be concerned about the health of the population are doing their damndest to end-run the certification process so the incompetent can become doctors.
That's freaking SCARY.
I do not fail; I succeed at finding out what does not work.
If you have crammed every possible question, and the questions have been set properly, then you have the required knowledge. The point of exams is to try and get people to learn all the facts and avoid testing them on everything.
As a resident radiology, in my country (in europe) we can take the test questions home afterwards for studying purposes.
This newsstory; this is not cheating. Everywhere where school is, people try to obtain info from previous tests to know what kind of questions will be asked. Radiology is a vast field of medicine and a trillion questions can be formulated for testing purposes. If they always ask the same questions THAT would be a problem, and the Am. Board of Radiology would be the problem, not the residents. And if they always ask new questions, studying old questions would NOT be a problem, but just a study tool. So where is the problem?
Claiming copyright is just childish here, and reflects the current spirit of our days, SOPA/PIPA etc.
he American method of 'learning' is mostly rote learning.
I suspect you have little or no experience with other countries' educational systems. It's been my experience that people from Asian countries (India and China mostly) are very good a rote memorization, because that's how they were taught. But faced with a new situation in which they haven't been told how to solve the problem, they're stuck. Americans tend to be much better at innovation.
It's not just premed that is taught in this fashion, it's everything up to and including premed.
Hmm... I do guess that's true.
Me, I'd been comparing engineering education in the US to engineering education abroad -- but that's mostly in college. The American students consistently have more practical experience, have done more projects, and have been more frequently required to invent creative solutions to problems, than many of their Indian and Chinese peers. Not because the Americans are "inherently" better -- whatever that means -- but because engineering school just works differently here.
But elementary school? I think I agree. I think it's highly variable (e.g., there are good public schools in high-property-tax areas, and private schools like Montessori Schools), but I think I agree that, even when they are good, it's only by overcoming a tradition of rote learning which still dominates -- in practice if not necessarily in theory. I am also under the impression that, until 'No Child Left Behind' emerged, elementary education had improved significantly over that of two or three generations ago. Nevertheless, yes, elementary education is definitely as much about socialization as it is about academic learning -- for both good and ill.
Finally, there is an element of tracking in education. If you were a "smart kid," if you got into honors classes, you probably were able to have a high school experience that avoided some of the rote learning that other kids were subjected to. That was my experience, at least. But, again, it doesn't happen until high school.
I'm almost at a loss as to how to be informative on this post because it's so lacking in facts or actual observation.
1. Doctors are primarily (with a few notable exceptions like Kaiser-Permanente and the military health system) small partnerships of under 5 physicians. They don't run "big operations with high margins."
2. Hospitals are generally not-for profits (again some exceptions) with net excess revenues less the 5-7%, about the cost of capital replacement.
3. Doctors do expect compensation for the 4 years of college, 4 years of medical school, and 3-8 years of internship, residency, and fellowship, since they give up 7-12 years of post-college years of income generation for the same life expectancy. However, huge salaries for a few do not equate to massive salaries for all. Just like baseball players, a few get the big bucks, but many more play in the minor leagues. Check out the National Bureau for Labor Statistics data.
4. Some doctors make lots (neurosurgeons, for example), but then they also pay millions of dollars (YES, MILLIONS) of dollars in malpractice insurance because people expect perfection from doctors, not acknowledging how complex and variable human biology is.
5. The most complex part of the healthcare system is the insurance system, which is completely out of the control of the medical professionals.
6. AMA is not a union, has no collective bargaining rights, and has as its membership AT BEST maybe 10-15% of all physicians. It's a voluntary professional membership society.
7. The major evolving complexity in the state of healthcare in the US is the federal government, which through tax laws, federal mandates, and regulatory actions, have created a never-ending chain of requirements, complexity, and frustration. The decades long effort at vilification of the medical profession and poor financial management coupled with government regulation will give you increasingly lower quality of medical care delivered by less trained salaried employees.
8. On the plus side, technology can assist in improvement in the application of scientific knowledge to the delivery of care, but not if legislated and dictated by Congress and political forces.
The IT profession (at least NOT YET) doesn't have state regulated boards, mandatory licensing, bureaucratic payment policies, and direct government intervention in almost every aspect of your professional career.
captcha: digits (At least a triple entendre)
That is a test in somebody's ability and willingness to function without sleep - not in their ability to practice medicine. The two don't need to be synonymous.
That's why I'd never enter a medical profession, even though most likely I'd make a lot more money if I did so, and I think I'd be pretty good at it...
Biochemist here, and I couldn't agree more on memorizing pathways, periodic tables, or whatever. Stuff I use I have memorized, stuff I use less often I understand and I know where to get it. I was at the top of my class both in undergrad and grad school (at a top-tier school).
The Kreb's cycle is next to incomprehensible until you've taught people what an aldol condensation is, and that typically doesn't come until the second year of college. Sure, you can memorize it, but that's about it. If you want to teach the general concepts about how cells use this reaction pathway to oxidize sugars and various intermediates along the way are useful for various other things, then that is something you can teach in first year. Making people regurgitate reaction diagrams is a pointless exercise in following tradition. I'd rather they spent more time on the principles behind why it works, and get more into some of the less-taught pathways than have students spend a lot of time cramming the structure of a-KG and memorizing the names of a dozen enzymes.
We lose the forest for the trees in education...
Yup - though I never actually got my license I did study the question pools for the amatuer novice license ages ago (they were officially published by then), and they basically read like the question was the first half of a regulation, and the answer was the second half. If you memorized the Q&A's then you basically had all the regulations memorized, and a half-decent amount of radio theory.
80 hours = six 13-hour shifts with a little bit of staying late. It's hard work, but not insane. Most weeks are more like 60-70 hours. And it's a pretty interesting job that pays well.
I had a major that required many of the same courses as PreMed. In chemistry, they would suck HCL into the supposedly distilled water supply. They would rip pages out of the only copy of a reference everyone needed to write a term paper., etc, etc. It' no wonder they cheat when they become doctors.
Having clear, nationally-comparable test scores is much more meritocratic than....
This is only true if there is a clear correlation between how good a doctor is and their score on the test. However I would argue that this is not the case because part of being a doctor involves interacting with patients and a doctor with an appalling bedside manner and no interest in the patient is not a good doctor no matter how high their exam score might be. While I'm not a doctor myself this is an opinion I have heard voiced by several GPs and agrees well with my own experience in selecting grad students - above a certain competence level exam scores are not a good indicator of success.
So by all means use the exam to select candidates who know enough but for the rest you need to use reference letters and interviews. Afterall if they cannot perform well in an interview how are they going to successfully interact with patients?
it's bizarre, civil servants do not need massive malpractice insurance-why do physicians need it? With all of the regulation imposed on physicians by HMOs you'd think that malpractice would have disappeared. But in fact it continues to grow. As HMO s continue to restrict paying for care, why are they not the targets of lawsuits? Somehow our society has managed to to turn the medical profession into a collection of outcasts that are constantly in fear of punishment. Enrolling in medical school is like asking to enter a concentration camp.
Why do you need to keep your teeth clean to play the harmonica does it affect the tone? Just curious.
If you play after eating or drinking coffee or soda, you'll get an acidic buildup on the reeds and valves. Chromatic harmonicas have little plastic flaps (mine are teflon) over the reeds, which prevent them from vibrating sympathetically, somewhat like a damper on a piano string. Enough gunk on the reed and it deadens the tone, requiring more air to make the reed vibrate and eventually will alter the pitch.
You'll hear pro harmonica players saying that once they brush their teeth and tongue before a gig, they won't drink anything but herbal tea. On the other hand, I've watched blues harmonica players here in Chicago drinking beer or whiskey during a gig and they still sound just fine.
I guess it's just a matter of best practices.
You are welcome on my lawn.
I think Feynman said it all when he was lamenting the sad shape of education in Brazil. It's an old problem, and it doesn't want to go away. Some systems of education just fake the whole process, it's a perfect cargo cult.
A successful API design takes a mixture of software design and pedagogy.
As an MD having successfully passed board exams in Internal Medicine (House like stuff) and Emergency Medicine and an undergraduate major in Chemical Engineering I will attest that engineering takes more brains to pass the exams but medicine is harder to do. My Medical Board exams tended to have questions with no correct answer, only a choice of the least bad among a bunch of losers. Then during the inevitable after exam impromptu meeting in the airport lounge we could not help comparing notes. And as previous posters have noted, we all are good test takers with fantastic memories so reproducing the exam is easy. I don't condone reproducing the test for resale. Tests typically change only about 20% of their content from year to year so having an old test is a leg up. However, the real test is at the bedside, at the exam table, or in front of a computer of some type. A couple of failures there during training is a career ender.
He he... I was thinking of Sonny Boy Williams mouth....
I once got 1st place in economics in the local academic decathlon. Surprised the hell out of me, as I thought I didn't know anything about that subject.
If corporations are people, aren't stockholders guilty of slavery?
If only it were as simple and predictable as that. In fact, most residencies will include one on-call shift every four days. This isn't IT call; you are actually residing at the hospital and entails getting to the hospital at your normal start time around 6 am to pre-round on your patients, then working straight through until around 12 or 1 pm the following day. You may catch an hour or two of uninterrupted napping around 3am on the second day of that shift, but only if your load is light and the nurses don't run into problems. So that's a 30-hour shift in between 10- to 12-hour shifts.
(And if you're a surgical resident, that schedule is the one you use to lie on your time tracking reports, because you've likely worked 40 hours more than that in a given week.)
As for 'it's a pretty interesting job that pays well', it may be interesting, but per hour it pays slightly better than shift manager at a fast food restaurant.
I think your definition of insane is a bit different than mine. I prefer to see my wife at 8AM and 6PM on most days, and not work on the weekends. Oh, and there's a little bit of staying late involved? On top of six 13-hour shifts in a week?
Why is it that doctors can't work normal 40 hour weeks? Just increase the supply to compensate...
I can see how a doctor doing a complex surgery might have to put in a long day (not like you can punch out in the middle) - perhaps with two days off to compensate.
I'm sure this lifestyle is fine for some, but certainly not for me. If we want to lower healthcare costs I suspect that making the field more accessible to more workers is going to be part of the solution. Somehow I doubt that doctors are working 70 hour weeks in France...
I'm an anesthesiologist, I know what residency is like, but the new rules for interns more or less demand that they work shifts. I had assumed the upper-levels had changed to match.
Why is it that doctors can't work normal 40 hour weeks? Just increase the supply to compensate...
It has to be covered 24/7, but the work load isn't evenly distributed over the hours. That's why. I go to work at 6:30 every morning except when I'm on vacation or post call. I'm almost never there at 3 AM. Call is how we do things because it's preferable to paying people to work night shifts in our situation.
Remember, most doctors are not hospital employees (and have no interest in becoming hospital employees). They don't get paid if they don't produce. I was called in at 3:45 the other morning for a potential bad situation - mother with twins, first had delivered, second was breech and stuck. I drove like a bat out of hell to the hospital and ran upstairs as fast as I could. When I got there, the OB/GYN had gotten baby #2 out safely. I turned around and went home. Neither I nor my group received a penny in compensation for that. While I'm glad both kids are fine, that's ultimately why doctors take call rather than shifts: nobody will pay us for our time, only for our services.
Keep it up and getting your MD degree will be worth about as much as most IT certificates. You can buy copies of most of those tests online from companies that somehow steal the cert test, probably using the same method these doctors are.
i had a brilliant friend once who was paid very well for memorzing the real estate exam questions and thereby providing prep companies with real questions in a changing profession. as long as it was current data, it did help all of us pass the exam..then again, we were not dealing with human life...just dirt wood and concrete. photographic memories are a boon to these people; yet can an exact answer provide real solutions to any dx. i doubt it. maybe this is why so many physicians disagree with the fact they uncover on tests. its too bad this has become a way of the wills and ethics has taken a back seat to money.
I deeply apologize to all on behalf of the cowards and dishonest despicable representatives of my profession that engage in this behavior. I do believe it is a minority, but ANY of the is reprehensible. I'm now retired, but don't recall this sort of thing when I was in training. As a former assistant professor of medicine and fellow in the American College of Physicians I'm deeply troubled by this. Federal regulations that have limited time in training at the med school and residency level as well as hands on procedural training have already resulted in much poorer quality doctors coming out of med school/residency in the last decade I was in practice. And cheating to the mix coupling with the insurance and government inducements to limit care and I fear there will be no reason any more for a patient to trust a doctors judgment or believe what they are being told as in their best interest. I'm terribly chagrined and see the only way out of this mess as a complete repeal of the Afforable Care Act, a complete reversal of government intervention in medicine, stopping all HMO's and a return to private insurance with competitive shopping by consumers to keep costs down and preserve a patient-physician relationship. In the last 32 years that has been destroyed by government predominately and the insurance companies following suit. I only wish I could get socialist minded people to understand how dangerous government control of health care really is.
There was virtually no insurance and NO governement at all in heatlh care until LBJ started Medicare and Medicaid in the sixties. Prior to that hospitals were charitable county and religious institutions. Doctors provided services to everyone regardless of ability to pay and costs were absorbed by the religions, communities, and philanthropists. People paid their own bills and fees were relatively low. THE GOVERNMENT instituted the idea of fee for service with Medicare and Medicaid NOT insurance companies. Some unscrupulous doctors being charging exorbitant fees and THE GOVERNMENT paid without question. Insurance companies then saw money to be made as THE GOVERNMENT had begun pricing the common man out of the health care market with the aid of some (predominately surgeons) doctors. Insurance plans then started and prices skyrocketed until the 80's when THE GOVERNMENT instituted prices controls in the maximum allowable actual charge or MAAC amount. The have since steadily price controlled Medicare and Medicaid to the point of now paying doctors less than operating costs of their offices and this is why virtually no private practicing physicians will see government pay patients any longer. Again insurance companies followed suit with HMO's (government subsidized or they would have failed), PPO's and other instruments to control prices and destroy patient - physician relationships. NOW, the very instrument of the destruction of health care, THE GOVERNMENT, wants you to believe they will 'fix it'. Already since "Obamacare" has passed insurance premiums have increased about 20% and there's been and INCREASE in uninsured, not a decrease. Sure it doesn't go into full effect until 2014, but the cost is ballooning and is costing hundreds of billions more than projected. BOTTOM LINE, THE GOVERNMENT IS THE PROBLEM, THE INSURANCE COMPANIES ARE LIKE PILOT FISH ON THE SHARK AND DOCTORS ARE HUMAN AND ACTED GREEDILY WHEN GIVEN AN OPPORTUNITY. Answer: Get the government out of medicine!!!!!
Let's take your analogy and apply it correctly then. Remember the shark gets everything but the scraps, so that's not the government is it.
I'm wasting my time, you guys have been brainwashed to think the worst bits of your system are equivalent to the best bits and entirely fail to notice that some of the best bits are "socialist medicine".
The insane thing is that fixing it used to be a Republican policy until the big bribes came out.