Medicine 2024 part 2

[mumsneedwine]

New thread. Hope the offers keep flowing in

@Mumofboys2006 I'd rock up on the offer holder day anyway. Even if can't join talks you'll be able to look round the campus, and some accommodation will be open to view. It's an open campus so can wander round any day.

@SBBTOL UCAS !! My phone now auto corrects to UCAT 😂

Thanks @mumsneedwine i was thinking of doing that. Just seems a long way to go to not be able to see anything…still annoyed they didn’t have enough space for all offer holders on the day! There is a virtual one organised.

To be fair BSMS also only have a virtual one but the communications have already been a lot more welcoming. Really reminds me of my experience of Sussex years ago - I can see why people choose it over Russell Group unis.

Thank you. From what you explained , there's no difference between getting reject or we withdrawing from Sheffield is that right? We're gonna firm and insurance soon after visiting offer holder's day so we can book accommodation. If there's no UCAS update, should we just withdraw it or is it better to email Sheffield asking them to update? Thanks

@SBBTOL just to be sure I'd email Sheffield before withdrawing. But I expect they'll reject next week.

This does seem to be the attitude DS is taking, but it does feel really unsettling to me as a non medic. For context, this year (2nd year), pass mark on the formatives (that don't count towards the end of the year, but I gather are supposed to give you an idea about how you are doing), DS was a bit below average on the first one, got 39.6 on the second (which was then rounded up to a pass, as the pass is always 40%), failed his third (32%), did realise that maybe he needed to work a bit harder (he has, IMHO, been doing way, way too many other things) and has just passed the most recent one at just below average score.

Next stop finals for the year, so we shall see, he knows he has a lot of ground to make up but knows it and is starting to crank up, and insists it will be head down (which knowing him, it will be, he knows he hasn't been studying that hard - hasn't really had time to be studying given what else has been going on, so if he does put his head down he would seem likely to pass).

But to me this feels really unsettling. I am not sure how I feel (as a non-medic this is my first encounter with medicine, no-one in our family is a doctor or has done medicine that I know of) trusting my life to someone who got 41% throughout their time in medical school (or even the 57% he just got on his last formative where average was 58%).

And periodically he says things like - Oh, I didn't bother learning X, you can't learn everything right? And I am sitting here going - do I really want to be seen by a doctor who maybe took that attitude to whatever it is that I have (or the background in a healthy patient that tells them that what I have is not normal)?

So it is interesting that you also seem to be taking the same attitude, but don't know whether to be reassured by it or not.

What do you call the medical student who comes bottom of the class ?

Doctor.

A pass is a pass. Then move on. Sure I've posted this before but ..

Yes I know, but nobody seems to be asking the question as to whether this is actually good. Should we be calling these people Doctor? Is it just that there is too much knowledge out there and it is impossible to properly train people to deal with it, so we call those with half knowledge Doctor to distinguish them from those with no knowledge?

I know this is how people "in the system" seem to think. My DS is being socialised to be in the system. That is what professional training does (all types of professional training). So will all those taking up offers in September. They will be taught to think like doctors and ask questions like doctors and respond like doctors. But sometimes it can be important that people outside the system, who have not be socialised to it - ask questions as to whether the socialisation is actually good or not. Once upon a time the socialisation was very much, doctor knows and makes the decisions. Then those outside the system (and some in the system, but let's face it, a lot more from outside the system) put a lot of pressure on those in the system, and there has (in theory) been a sea change whereby patients are supposed to be much more actively involved in their own treatment and give consent to the extent possible. My DF, now 86 and with Parkinsons, but still very much in command of his mental facilities, has found it interesting (if somewhat disturbing) to be the subject of what he lectured on for years - DF was a professor of law, specialising in torts (which includes medical negligence), which is where the grappling with questions of patient consent often end up when things go badly wrong. The medical professionals who deal with him by and large see an 86 year old man with Parkinsons and have absolutely no idea that they are being rated against standards of professionalism that were by and large formulated in legal cases with which DF is familiar but many of them clearly are not.

@Bimkom yes we should be calling them doctor. The amount of knowledge needed to even pass medical school exams is huge. As well as passing multiple OSCEs. No one can know everything.

Scores in exams do not make you better at being a doctor. They give you the knowledge that you then need but learning is constant throughout a career.

@Bimkom and please make sure he's seeing a doctor, not a PA

Don't worry. DF lives in Australia, not in the UK, and I am not aware of any PAs there. Law is very similar though, and originally derived from English law (with which DF is totally familiar).

@Bimkom I'm a bit confused at what law has to do with exam pass score ?

Medical school exams are also a bit more complicated as results are cranked. So, easier questions that you must know are worth more than speciality questions that can be quite niche.

So in effect you need to get 70% to end up with 50%. Hope that makes sense. I've had cranking explained to me many times and I'm still not sure I fully get it.

PSA exam is also not a straight % pass/fail. They do weird things with that each year too,

BTW just to add in case you get the wrong idea - that one of DF's bugbears was that the courts are often used to formulate ideas and deal with problems that really shouldn't be there - he was in favour of a national compensation scheme that would do away with a lof the fault issues that end up in the courts, so one can focus on better ways of dealing with where things go wrong. He has never been in favour of the courts being the best people to determine these sorts of matters. He felt fault should be separated from compensation.

😊 law is a world I don't really understand

Yes the cranking system is very interesting. The idea being that more weight is given to an answer that a competent doctor should have given, and less to one that an exceptional doctor will have given. It is an attempt to grapple with what is the minimum competence needed to qualify someone as a doctor.

It seems to be an acknowledgement of the level of complexity of the knowledge and the falibility of human beings, or at least most of them. The problem presumably being - if only a handful of people in the world were capable of qualifying as doctors, they would be amazing doctors, but not nearly enough to go around. So we have to lower the bar to get to the level that we can staff our hospitals, so we are setting a minimum competency level. And somebody in the medical school (or a group of somebodies) is determining what that is, and making it a pass. But obviously how that is determined is opaque to anybody outside the system, so we are kind of taking on trust that the pass mark is set at a reasonable level. And it should still presumably be the case that somebody who is able to answer the more challenging questions as well as just the minimum questions is likely to ultimately be more competent, what the pass mark is indicating is surely minimum competency.

But if my DS (let's say) is capable if he didn't do all his other activities of getting well above average, but he gets below average, but still minimum competency because he does do the other things, what should he be aiming for? For himself? For the NHS? Obviously for those for whom they are working as hard as they possibly can and only just hitting minimum competency, then we have to take on trust that the medical school has set the bar at the right level to enable us to have enough doctors with sufficient competency and it will have to do.

@Bimkom I have yet to meet doctor who I would not call competent. All have had to pass multiple, v v hard exams over 5 years, and then many more postgrad too. You're not going to be able to do that unless you're 'good enough'.

When you become a doctor you are constantly rotating, 6 different specialities in first 2 years. All require that knowledge from Uni as well as many more skills. You're not going to manage to pass F1 if you're not a v fast learner. F2 is a massive step up as now an SHO and responsibility is huge. Again, you won't last as won't pass the competencies unless good enough. All the while the portfolio has to be done and the skills signed off.

It's not just about those med school exams, although they give you the basic grounding. It's about the constant learning and proving you are 'good enough'.

@Bimkom and I think you're confusing speciality training and excellence. After F2 a lot of doctors will specialise and so an ENT doctor won't need to know about the uterus. So they'd be able to answer v complete questions on noses, but not much about wombs. Still an excellent doctor, just in their specialist subject,

@Bimkom The medical world is alien to me too, but I think an analogy can be drawn to other areas. For example, I am a lawyer - I studied law for 5 years and have practiced for many more. But I still don’t know the answer to many questions - what I do know is how to spot an issue and how to find the answer. I am assuming that in medicine it may be similar - e.g. in your exam you might not remember the name of some tiny wrist ligament, but what is important is that you know it exists and is prone to injury?

@Notcontent you put it so much better than me 😊.

I really must get back to marking these A level papers. Procrastination is my middle name today.

I totally agree - and would refer to a legal specialist in another area if somebody asked me (eg family law). But when I was studying law, there were no areas that were on a particular course or exam that I didn't cover because "nobody can know everything". I obviously didn't get 100% - I may not have thought of arguments or may not have phrased all the arguments well enough, or drawn on all the possible case law that was available (and certainly in our courses they didn't cover, or expect us to know, every judgment of relevance). But my hit rate was a lot higher than the statistics for the medical exams.

So if I was never going to work on the legal equivalent of wrist ligaments, I never studied them, I wasn't ever tested on them, and certainly never failed to answer a question on them. If/when I decided I wanted to specialise in the legal equivalent of wrists, I could then have taken a masters in them, whichwould mean I would have studied and known them in detail - or perhaps they might have been the subject of one of the optional courses that were part of my law degree (I didn't study family law, for example,, but there were optional courses in it). The odd thing here is this, those who set the tests think it is important to put a question on tiny wrist ligaments on the exams, whereas in my law courses, nobody was putting family law questions on any of the exams that I sat, because I didn't take a family law course. But of course they did for those who took the family law options.

So the medical knowledge and exams are structured quite differently to what we as lawyers are used to. And the whole kranking idea is supposedly linked to competency (which we also never had explicitly, although perhaps mentioning leading cases was basic competency whereas rounding out with a range of other case law that was more detailed and on point might be higher competency). But I never went into an exam with the mindset that is being advocated for in medical school, and I would be very surprised if you did either (and if you did, it was because you had prioritised your social life or other things going on in your life, not because you thought that was the ideal way to study).

Doctors get a broad based training then specialise. The amount of knowledge in that broad based training is huge so will be limited when there is a problem outside your speciality. So as a psychiatrist I am trained to think about physical illness as well, advise re tests/ clinical exam and liaise with GP/ other specialists. But if some one with depression also has a kidney problem I need to think about the kidney problem in treating the depression and make sure they see a kidney expert
medicine is about so much more than knowledge. Good doctors always research/ take advice/collaborate and know their limits. Our communication skills/ ability to take decisions/ empathy/ leading a team / commitment are all not knowledge based but the skills that give excellent care. The number one complaint from patients is around communication not the doctors knowledge.

Doctors get a broad based training then specialise.

Agreed, but this is true of many other professions that don't teach like this. The more standard way I would have thought is to teach people what is considered essential to know as a generalist, and make sure they know it well (so the exams are structured to target that, and if you know all that is required at that level, you can do well), and then offer specialist training later or in parallel. While the strategy here, as best I can get it, is to give everybody everything including the kitchen sink, and people sort of select the bits they can manage, and so long as you can manage enough bits, you pass (with weightings for certain bits that are considered more critical than others), but you could in theory have one person who answers the first half of the exam and nothing on the second half and another person who does it the other way around, and their knowledge would seem, if I am understanding this right, not to overlap in terms of content, but not only do they both pass, this is considered correct and OK, not that either were borderline inadequate or slacking. Not aware of it happening in another generalist taught subject. Maybe it is all about asking the right questions, and it doesn't matter which bit of the content you pick to study, and clearly it is a deliberate choice so there must be reasons medical courses are taught like this, but as an outsider it is noticeably a strange way of doing things.

@Bimkom medics have to deal with a lot of stuff that can be quite draining emotionally. EG, dissecting a cadaver, learning how to tell someone their 2 year old is dead. It's much much more than just about exams. So some 'playing' is required to stay sane.

And no one goes in to exams aiming to get 50%. That's not the mindset. They study like crazy to make sure they get the best grade possible (up to last year this was v important as determined ranking for F1). It's just that if they get 50% (really more likely 70%) they are deemed to have enough knowledge to pass to the next stage.

All you lovely consultants, please look after your lovely juniors. My DD has been so lucky with her mentors and it's made such a difference (especially at 2am when the Med Reg fell ill).

Hope everyone’s DCs are able to focus on a bit of revision now.

Before all the focus was on getting an offer but now the hard reality has hit! They have to get some pretty good grades!!!

Just for information, any exams at exit level (what students still refer to as "finals"), as well as many/most exams at lower levels are standard-set to decide the pass mark. There are different forms of standard-setting but the most commonly used one is called Angoff: usually applied with some modifications but generally proceeding as follows.

A group of "experts" - defined as practitioners who are familiar with the knowledge/skills required by F1 doctors and, if appropriate (in lower years), for successful participation in the next year of the course - look at each question and judge what proportion of just-competent F1s (or students in the next year up) would answer it correctly. These are people who also supervise F1s, so they have a realistic expectation of what is essential. They take into account how commonly they would be expected to encounter it, how much synthesis (as opposed to recall) is required and how complex the case in the question is. Given that questions are usually in single best answer format and have 5 options, it should be possible for 20% of people to get the correct answer by guessing randomly. The experts will therefore allocate a number between 0.2 and 1 to indicate the proportion of just-competent students/graduates who should be able to answer the question correctly. A question that assesses basic knowledge (e.g. the correct drug to prescribe to a patient with a textbook presentation) might have a proportion close to 1; one that assesses multi-stage reasoning in a patient with multiple co-morbidities might have a proportion below 0.3. These proportions for individual questions are then added up to give the pass mark for the paper.

So, for example, if there are 200 questions in an exam and the experts' average proportion for all the individual questions is, say, 0.67, the pass mark for the paper will be 200 x 0.67 =134 (67%). Pass marks are usually much higher in final year than in earlier years, as there is much more that is required for even a minimally competent F1 than for a just-passing year-3 student. Some medical schools use progress testing, where the same exam is sat by students in all years and the pass mark becomes progressively higher as they move up through the years of the course.

I have been involved in medical school assessments for over 20 years and have never heard of "cranking" or "kranking". I'm not sure what these are.