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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."
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
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.
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").
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I want to go to a doctor who studied a year of molecular biology as an undergraduate. I don't want him to get his education on the job from the drug company salesman.
I believe in a liberal education. I also want a doctor who took a few courses in English, poly sci, economics, history, etc. I want a doctor who can write a coherent sentence and read a well-organized article. I want a doctor who knows when the American Medical Association is trying to put one over on them. I want doctors who know when their politicians are trying to put one over on them.
Right now the Obama administration is making promises and assumptions about the value of health care IT that are (sometimes) patent nonsense. I want doctors to know enough about IT to understand that.
There's always the question in medical education of, "How much is enough." I'd rather err on the side of too much. Especially when that doctor is applying a sharp object to my testes.
It's saddening to see that the overall intent of a university curriculum, which is to both nurture the well-roundedness of the student through exposure to a number of, potentially disparate, disciplines and also impart some measure of domain-specific knowledge, is being unjustly frowned upon and criticized by many such as yourselves. Instead of dismissing the courses outside of your major as unnecessary, you should view them as an opportunity to not only try and expand your capabilities and views, but also bring a fresh perspective to those fields that may end up being of use to others.
As an example from my own life, I ended up taking a handful of philosophy and cognition courses, as a sort of stress relief, while finishing up the dissertation for my maths Ph.D. Thanks to my years spent, as a doctoral candidate, pouring over thousands of manuscripts, I was able to propose some rather interesting ideas/theorems focused on a nonlinear dynamical system standard of thought. Had I not opted to take those humanities classes, I probably would have never considered merging the concepts together; at the same time, those in the class would likely not have come to view maths as an excellent tool for building up their own theories.
As a molecular biologist I have to ask: how would that matter? The MDs that have patients don't really need to be thinking about ATPases or the Michaelis–Menten equation. The MDs that are taking basic research and putting it into the field seem to be getting their PhDs which can't be easily faked. And the just regular PhDs are in theory doing the really basic research that involves knowledge of mobio, we don't go to med school or see patients.
Having gotten my Ph.D in the basic research wing of a major medical school, I can concur that MD's typically have only a vague understanding of mechanistic biochemistry, and that the Ph.D's designing future treatments have only a vague understanding of human physiology. Exactly how is this a satisfactory state of affairs?
If you were ill with some condition that presented in an unusual way, (say, a borderline metabolic deficiency), would you prefer your M.D. to actually be able to figure out on their own what's wrong with you, or just blindly follow diagnostic recipes they memorized from the New England Journal of Medicine?
The only reason I can see for wanting a premed student to take molecular biology is to add another level of selection to deter the weakest students from becoming doctors.
You are aware that intro molecular biology is now taught in the second year of any standard biology major, or sometimes combined with biochemistry in your third year? My wife is an ecologist and she took it. Pre-vets take it. Nurses take it in nursing school. Heck, my dentist took advanced biochemistry as well. So why are you against pre-meds taking it? You think a doctor doesn't need to be as capable as a nurse, vet, or dentist? It's not exactly quantum physics, and it's extremely useful since you may only get the abbreviated "molecular medicine" type of crash course in med school since they assume you already took it as a premed.
Interestingly, I've heard that the major that scores the highest on average on the MCAT is actually not premed, biology, or chemistry. Philosophy majors do the best on the MCAT. Granted, there's a lot of self-selection going on there, they probably make up at most 1% of the MCAT takers, and the MCAT is not necessarily an indicator of who will be a good doctor.
You can see a list of the topics covered on the MCAT below which covers (surprise!) molecular/cell biology and biochemistry. Unless the philosophy majors are cheating, they must have at least self-studied the material to score so highly, but more likely than not they took a course or two. I'm really puzzled what you are trying to prove here.
https://www.aamc.org/students/download/85566/data/bstopics.pdf
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.
Well, it wasn't always this way. Used to be, you didn't need a B.A. to enter medical school. Heck, you didn't even need to have any contact with real patients before you set up your own practice (i.e. no residency or clerkships). Medical schools used to be giant diploma mills that would take any paying student. Accreditation and board certification were a complete joke.
Then the civil war came along, many of those doctors were drafted to help the army, and to the horror of wounded soldiers everywhere, it soon became clear that your chances of survival were often *better* if you were not treated at all than if you were allowed to be operated on by one of these diploma mill graduates with no real qualifications.
Since then, all medical schools have required a bachelor's degree.
I entirely agree one could theoretically teach all the relevant pre-med material in 2-3 years, nothing is stopping anyone from simply finishing a B.A. a year early if they want. Most pre-meds I knew could have too, they just chose not to because they wanted to live a little before going to med school, or buff their resume and get into a really good one.
And sure, you can always argue pre-meds are being weeded out with only slightly relevant material (yes, orgo II, I'm looking at you). But, you know what? I aced that class without really understanding it and all it took was applying a few key chemical concepts and a fair bit of rote memorization. If you can't hack that, I don't want you interpreting my MRI scan or prescribing me an immunomodulator that might or might not interact with my heart medication.
Yes, but did the guy reading the slide HAVE to do all those other things?
I got an ECG a few years ago and it was interpreted by an MD (a cardiologist). No doubt a hospital generates so many of these in a day that you could easily employ somebody full-time to do nothing but interpret them. However, instead of giving somebody a year of training and turning them lose for $60k/yr they instead send them to a team of cardiology MDs each taking maybe 10% of the load and being paid $200k/yr easily.
No doubt the MD who read my ECG could have done a holistic evaluation of my situation and provided all kinds of recommendations, and they no doubt do that for other patients all the time. However, they weren't doing that for me. What they did do is render a few sentences of opinion purely based on the test, perhaps with a recommendation for follow-up. I'm not convinced that this couldn't have been done FAR less expensively by a technician.
Now, we'll always need generalists, and we'll always need the occasional House for the 0.1% of cases that truly boggle the mind. However, the problem with our medical system is that we make everybody a generalist and we don't triage cases well. Everybody who wants to gets to see House, and House is so busy that he probably doesn't get to spend adequate time on the cases that really do demand his expertise. I know a diabetic who was treated by a well-respected endocrinologist and it took the guy two years to get her blood sugars under control, and then only poorly with a bunch of side-effects. It took another two years to really get things working well, and in the meantime there were numerous cardiovascular complications (you name it). The problem was that the guy was so popular that he was overbooked, and he didn't spend more than a single 15-minute appointment per quarter dealing with her. So, he'd prescribe something, then review numbers 3 months later (maybe fasting sugars have dropped from 250 to 220), then adjust medications, and repeat. If the guy had handed things off to a nurse who followed-up one week after a medication switch they could have probably titrated her meds in a few months at most. I'm sure reimbursement structures don't help - doctors don't have much incentive to do things between periodic appointments unless you're in a hospital.
A triage-based system with less doctor involvement would greatly reduce costs and potentially increase access to care. A nurse who can check in on a patient biweekly is probably a lot more useful for the average patient than a doctor who can check in twice a year. Sometimes the simple stuff matters most when it comes to things like compliance and spotting problems.
Doctors are an important part of the system, but right now they're a one-size-fits-all solution.