DEBATE. Henrik Sjövall, Professor and Deputy Head of the Institute of Medicine, chronicles his picture of the consequences of scaled grading in the medical program.
A covert introduction of scaled grading in medical education is underway, in opposition to the largely unanimous, expressed wishes of the teacher and student unions. The argument for grades is, essentially, that “everybody else has scaled grading”, that “the excellent students must be able to show that they are excellent, that “people work harder if the bar is set higher” etc. Another common argument also is that “we will not get any international students if they do not receive any grades to take home with them!”
I don’t buy these arguments
I don’t buy these arguments and I will try to explain why. My starting point comes from a book I recently read, Excellent Sheep, by Bill Deresiewicz, a former professor of English, at Yale. The book is based on the observation that the American top universities (Ivy League) are a hotbed for producing a type of testing machine, students that are extremely good at “taking tests”, but in general, lack focus in life. Many of them lose their footing when their education is over, “Are there no more exams, what am I going to do?”. They have not thought through the major issues in life, they only view life as an eternal “exam”. As a rule, they are not just excellent in school, but they are also the captain of the baseball team, maybe a cheerleader, the chairman of the debate team, or the most popular date at the prom, etc. And when they get out into reality, many become depressed, others seek out new “competitions”, such as, politics. Deresiewicz concludes that one of the greatest problems with American politics is that the power elite are recruited from this exact group, that is to say, people with a mechanical view of humanity, without an ethical platform. His recipe? More humanities! According to his point of view, the humanities (“liberal arts”) concern ”the most difficult problems man has ever thought about”, and that such an education contributes to forming one’s personality and creating the conditions for the exact ethical platform he sees as missing, in many Ivy League students.
The main problem is that the students are unequal
How is this relevant to our medical education? I have worked with education, in varying degrees, for many years, and I firmly believe that the main problem is that the students are unequal, not that the average is too low. And this unequalness also exists within individuals, some students can recite page after page of rarities, but miss the common diagnoses, especially if they have been put under pressure. Some students can theorize, but cannot convert that information into something understandable to the patient or their family. Some students have difficulty handling the ethics of situational prioritizing, others lack the gravity it takes to convey difficult medical results. Testing memory-based knowledge is executable, it basically only requires asking enough questions, of which some have to be really hard. Identifying inequalities is trickier, the examples I have given do not always appear on written exams, but instead, require evaluation during “rigorous practical assignments” This is time consuming and places great demands on teacher competence. The time that we will now be forced to put into ensuring legally certain discrimination between the 80 and 95 percent levels for memorization capacity, will, by necessity, draw from the time for practical-based teaching and examinations.
Are examination machines what we want to produce or discerning doctors? First and foremost, should we be police or teachers?
