Tuesday, 29 July 2008

Medical student prefers court to revision

With logic like this I can't imagine why she hasn't passed her MCQs?

Patients also don't present as short answers questions, essays, clinical examination stations or OSCEs; however this doesn't mean that all these methods should be stuck in the waste paper basket.

"They don't let me express my knowledge,"

My heart bleeds.

Maybe I'm being a heartless bastard, but if you can't pass the exams then hard luck, you can't become a doctor, it's not as if the exams are harder than they used to be, in fact from what I've heard medical school exams have been significantly dumbed down especially at places like Peninsula.

Society has gone stark raving bonkers in my opinion, so much so that political correctness obliges that anyone should be allowed to do anything, completely irrespective of the fact that that person's attributes or lack of them may completely prevent them from doing their job properly.

For example should the job of a junior doctor be done adequately by someone who is deaf? I would argue not, as so much of the job involves communication and a lot of this is by telephone, making it impossible for large amounts of the work to be done. A blind pilot, a surgeon with a massive tremor, a maths professor who just can't do his times tables or a dentist with a phobia of teeth- you get the picture. Maybe I'm just discriminating unfairly in the eyes of the law.

One could argue that jumping words and reading much slower than other people might have some rather big implications for the health of her patients and her ability to be a doctor. Drug charts are not very forgiving for small errors, this is just one example.

How long are we away from thick people taking exam boards to court because they can't pass them?

Not far away it seems, everyone can get an extra few hours these days for some manufactured learning difficulty (if you pay a psychologist then anything is possible), and students can now get extra marks for their pets dying or getting the flu before an exam.

Bonkers I say.


PhD scientist said...

This does seem a bit OTT.

First off, you get extra time in University exams if you have a dyslexia diagnosis. Ten to fifteen extra minutes per hour of scheduled exam time is pretty standard across Universities. So she would have had this extra time in all her MCQ exams in recognition of her "processing words-on-page problems". She seems to be arguing that MCQs are uniquely disdvantaging to the dyslexic compared to other exam formats, which I find deeply unconvincing.

The second point is the one Mrs PhD Sci (the medical doctor in the family) always makes when we discuss things like this. This is that if the person has difficulties reading swiftly, or (one assumes) writing easily, then how are they going to perform in a job where they have to read (e.g. the notes) and write (forms, notes, instructions etc etc). Mrs PhD argues that people like this will pose a potential problem for employers and that, legislation notwithstanding, trusts will simply choose not to hire them.

I have taught a fair few dyslexic medical students, including some with quite severe problems, and the ones that impress me (and most other staff I know) are the ones who set out to show that they CAN cope with their own difficulties so that their education (AND that of other students around them) is not adversely affected. Put another way, instead of expecting the system to give them special treatment and allowances, and complaining that it is not fair if they encounter problems, they show they can manage and find work-arounds.

Note that I am not saying dyslexic students shouldn't get support, or even extra exam time. I am just saying that in (e.g.) a group tutorial, it is not up to everyone else to stop talking and wait for the dyslexic student to type his/her notes into his/her PC. It is up to him/her to learn to type, or do data entry on his/her special software, fast enough. And if the student doesn't participate in the discussion because they are too busy typing, again that is a problem for THEM to solve – not something where everyone else, and the system, has to make special allowances.

Anonymous said...

Whilst I agree with your point somewhat I'm a medical student who does quite well at exams, much better than people who will make far far better doctors than me. Additionally in medical school if you bunk off your clinical stuff and sit at home and revise you'll do much better in exams though arguably less well as a doctor.

Fx said...

Having had a quick word with dyslexic offspring, she and I both agree that one should be able to pass exams if one wants to be a doctor.

The main issue with dyslexia is that it means the person thinks differently - which may well be appropriate in areas such as mathematics, for example, but might cause an issue in medical science, which requires a particular mindset ... offspring giggled while indicating that "not this leg" might well be read "this leg" for example which suggests an issue around amputation ...

Personally, I've always encouraged dyslexic offspring to work harder. Despite a stubbornness which seems to be part of the condition ...

No One said...

You are right

School exam boards routinely allow lots of extra time for someone with a dyslexia label

Pushy middle class parents can get a dyslexia label easily, and cynically, so this extra time advantage is disproportionately awarded to certain sectors of society, many of whom several years later do not have a label of dyslexia, and many of whom will happily admit it was a tactic adopted by their pushy parents

Yep you will get extra marks if your hamster dies, this started as a not unrealistic attempt to help kids with a family tragedy close to the exam, its gone far too wide these days and its not just family its pets and friends they hardly know

And of course anyone who can get the school to appeal an exam result ALWAYS gets a regrade upwards, appeals to the exam boards hardly ever result in the result staying the same (and never going down)

This results in pushy parents having a much better chance of getting their kids onto their chosen course in the first place, and we all know being on the course is half the battle to passing it!

In University, coursework is a large part, and plagiarism is endemic now, with the advent of the Internet and all, its not usual for rich students to by paying someone else to be doing their coursework etc

And yes some of the exams are totally irrelevant, and nothing more than proving you have memorised a book, rather than showing you have a critical understanding of where the book is making poor arguments etc, this sure could be improved

Its not just medicine at all

Anonymous said...

Garthy - you are just grumpy cause you didn't have dyslexia :). This is my email to the GMC. In my view, her litigation is misconcieved. Moreover there are other more valid solutions. The GMC took up my suggestion to take up the Mencap report on Death By Indifference. Perhaps they will do the right thing with this medical student.

Hope you are well



----- Original Message -----
From: Rita Pal
To: GCatto@gmc-uk.org ; finlayscott@gmc-uk.org
Sent: Thursday, July 31, 2008 10:11 AM
Subject: Dyslexic student to launch discrimination claim against General Medical Council over multiple choice

Prof Catto,

I read the story of Naomi Gadian. You should advise her of Cox v General Medical Council which lost at the appeal courts.

1. A solution may be http://www.chromagen.us/ and Opticians http://www.dyslexia-help.co.uk/practitioners_uk.html
2. Zeidan Opticians http://www.zeidan.co.uk/html/dyslexia/dyslexia_intro.html

The above solution is the use of spectacles to improve dyslexia. It is a little known technique but often effective.

Naomi is clearly very young and naive. I don't believe it is in the best interests of the GMC to litigate with her. Instead, I think it is up to yourselves
to find a solution for her problem. The above is a potential solution to her difficulties. I am not sure that she has tried it. I think we should leave the litigation
to the older and more cynical doctors :).

Hope this is helpful.


Rita Pal

jayann said...

(if you pay a psychologist then anything is possible)

Universities too though can pay psychologists, and I assumed they all did. Such psychologists have been known to reject claims of dyslexia. (Rita, they do sometimes recommend the use of coloured filters for computer monitors.)

PhD scientist said...

Univs do "retain" educational psychologists (though probably on a contract basis rather than on permanent staff), but I very much doubt they would repeat an assessment of dyslexia already done by an ed psych. The sheer volume of kids reaching us now with dyslexia labels would make it completely impractical. The Univ would typically only contract for assessment of "new" cases (students who think they might be dyslexic but have never been formally assessed). If the student already has an assessment and a dyslexia diagnosis they will go straight to the "tailored support package" (which almost always includes extra time in exams on a standard formula, and labels on scripts to say "this person is dyslexic make allowance for spelling and grammar" - note not possible in an MCQ, which is where we came in).

Obviously the student who arrives with a dyslexia "label" does have to produce documentation showing they have been properly assessed. Incidentally, the main person in a Univ reading such previously done ed psych dyslexia assessments is likely to be some kind of "Disability Support Officer". This person will have some expertise and experience in reading the assessments but is very unlikely to be a qualified ed psych. I would think they would have an ed psych they could consult for clarification, but on resource grounds there is no way a Univ would repeat assessments. We simply don't have the money.

jayann said...

On a contract basis, yes.

I very much doubt they would repeat an assessment of dyslexia already done by an ed psych.

I knew one student who claimed a diagnosis of dyslexia and arrived with instructions for tutors, who stopped claiming it after being seen by the psychologist who assessed for the university. I also knew a student diagnosed with dyslexia who was assessed by the psychologist, who agreed with the diagnosis and wrote a lengthy report (which I saw). (I taught student 1, supervised student 2.) I dealt with other students with diagnoses of dyslexia and one who had simply been told he might perhaps be dyslexic: he was referred to the ed. psych. for testing but found not to be. (There were medical grounds for referral in that case.)

I do though see that such referrals may not always occur, and now, anyway, students can submit a report or reports for consideration by Disability Services (if I've read the new documentation for that university correctly).

some kind of "Disability Support Officer"

the ones I've known were really pretty good, fyi, they were not ed. psychs, no.

PhD scientist said...

Yes, it sounds pretty similar to the set-up at the Univ I work at, Jayann. Our experience has been that dyslexia diagnoses are on a rising curve.

There is an interesting contrast between the medical students and the bioscience students I teach WRT dyslexia. With the bioscience students we (academics) always get told about the dyslexia diagnosis and usually get a long list from the DSO of "special measures" to take.

With the medical students we usually never find out if a student is dyslexic. This is because the info is only "passed on" to the teaching staff if the student wants it to be and most of the medical students choose not to have it revealed. So I would only find out if a student tells me personally about their dyslexia.

jayann said...

phd scientist, I realise diagnoses of dyslexia (among students) have probably risen since I retired! (Changes in the law, changes in mores; a growth in the entitlement culture.)

Interesting difference between student groups. As we aren't naming universities, I'll say I found the process (re tutors being told) somewhat variable even within departments. In most cases (because of course I knew of more cases than the ones I've already mentioned) I found out because a student or supervisee told me, but if a supervisee did, I would memo the tutors. (Also I was i/c one set of exams so tended to have to do more.)

But I never enountered a student who expected special consideration beyond the standard extra time in exams and any 'assistive technology' the ed. psych. recommended (except for the one the ed. psych. bounced; and they stopped asking right away). Certainly there was never a suggestion a tutorial group should slow down because of a dyslexic. And I imagine you, like me, would firmly rebut any notion that we gave extra marks for a pet dying (!).

Note to Garth. If a student is ill on the morning of an exam and can prove that and they sit the exam and underperformance can be shown, then (ceteris paribus) it's reasonable to discuss that when discussing their performance as whole. The problem is not that such factors are considered but that different groups of examiners may give them different weight (wherefore, a set tariff of n points per specified event might make sense!).

PhD scientist said...

Quite, Jayann. The worst-case scenario, which sadly I have seen at times, is when a Disability Support Officer take the view that their job is primarily to crank out long “proscriptive” emails to academic staff saying:

“student X whom you teach is dyslexic and must thus be given the following support measures…”

…followed by a long list of things we are supposed to do, like “give detailed original lecture notes” (which of course most people haven't written out for decades), “give extra time to think about tutorial topics in advance” “give extra time in any tutorial exercise which requires them to speak and/or comprehend written material, e.g. in a presentation”.

These emails drive the staff mad.

Thankfully common sense (mostly) prevails and most academics take no action unless the dyslexic student actually comes to them and says “I cannot manage and I need XYZ” – which rarely happens, as you said.

I was talking about the Peninsula case today with a senior academic from another Russell group medical school. He told me that they had tried to allow extra time in exams and other assessments for medical students ONLY in years one and two (pre-clinical). The argument was that in (clinical) years (yrs 3-5) the exams were clinical assessments and that it was therefore up to students to show they could do them in a way that would make them able to practise effectively, which included being able to do them under normal time restrictions.

Apparently one or more dyslexic students took them to court and won, the result being that their dyslexic medical students get extra time in all assessments in all academic years of the course, including some OSCE stations that involve any kind of written comprehension or related skill (like IT).

Which once again begs the question: how does this turn out people that will be able to practise effectively if you give them extra time in EVERY assessment right up and including final degree exams? Are they going to get longer clinic appointment slots than everyone else when they are practising?

As I said before, the widespread suspicion is that students like this will simply have significant problems getting hired once they become doctors, simply because it will be obvious that hiring them will potentially slow down the clinic / department / hospital, quite aside from the other issue people like Garth have raised, e.g. safeness in prescribing if they cannot spell drug names correctly. Of course that may lead to more “discrimination” legal cases. Makes me glad I don’t work in the NHS.

jayann said...

long “proscriptive” emails

luckily I've never had one. Luckily because I -- as you say, like most people -- didn't have 'original lecture notes' in the sense of a lecture script, and would not have handed over my scrappy-looking preparatory, and extensive background, notes.

“give extra time to think about tutorial topics in advance” (etc.)

Absurd as students surely take time before coming to class to think about the tutorial topics (in theory, that is...). (Ideally Disability Officers would be seconded academics, who'd understand.)

their dyslexic medical students get extra time in all assessments in all academic years of the course, (etc.)

I was thinking about these issues while offline (it's raining cats and dogs here, it's miserable outside; it's an introspective/reflective day). I wouldn't sign up with a dyslexic GP who took extra time to read my notes -- and so on -- unless they also gave me extra time as a patient! And what practice would want a partner who timetabled longer appointments?

e.g. safeness in prescribing if they cannot spell drug names correctly. Of course that may lead to more “discrimination” legal cases

Yes, it could and it may. But it remains the case that people can be fired for being unable to do their job for medical reasons and their job applications can be turned down if they're unsuitable. So I don't really see a suit succeeding. Non-successful suits are though a nuisance, and a costly one at that.

Medical Revision said...

I'm not dyslexic, but I have a real trouble with drug names. Should I be penalised?

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