Medical Teacher
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Graduate Medical Education in Europe James Parkhouse To cite this article: James Parkhouse (1979) Graduate Medical Education in Europe, Medical Teacher, 1:6, 303-303 To link to this article: http://dx.doi.org/10.3109/01421597909014341
Published online: 03 Jul 2009.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [Deakin University Library]
Date: 11 November 2015, At: 23:07
LETTERS
Downloaded by [Deakin University Library] at 23:07 11 November 2015
Tulp’s Dissection Madam: I was interested to see that you used Rembrandt’s picture of Dr Nicolaas Tulp on the front cover of the July/August issue of Medical Teacher. As an anatomist and teacher, I am always rather surprised at the regularity with which this picture appears in journals of medical education, for several reasons. In the picture, not one of them is looking at the dissection: indeed, Dr Tulp himself is not doing so. The colouring of muscles and tendons is superb, but unfortunately the superficial flexors of the fingers come from the medial and not the lateral epicondyle as depicted. The flexor digitorum superficialis also has a radial head; this is not shown. All the points I raise are very well known and are immortalized in Wood Jones’ classical book The Anatomy of the Hand. Ruth E. M. Bowden, D.SC, MB. BS, FRCS Professor of Anatomy Royal Free Hospital School of Medicine 8 Hunter Street London W C l N lBP, UK
Assessment in Medicine-The Multiple Choice Question Controversy Madam: I read Dr Marshall’s letter published in the July/August issue of Medical Teacher with considerable interest. Dr Marshall raises a number of points that are concerned more with the detailed aspects of MCQ than with the principle, and perhaps I could be allowed to comment on them. I entirely agree that the formal assessment of factual recall should be only part of the overall assessment process in medicine. In.our own Final Part I1 examination the multiple choice Medical Teacher Vol 1 No 6 1979
paper contributes 16 per cent to the final score, and contributions also come from in-course assessment during the final year, clinical examination and oral examination. I think I made it clear in my original paper (Medical Teacher 1979, 1 , 37) that although the MCQis the most efficient and objective method we have of testing ‘knowledge’,it cannot and should not be allowed to replace alternative assessment techniques that test different skills -even though the MCQ format can test a good deal more than simple knowledge of facts. I agree with Dr Marshall that the inclusion of trivia in MCQ is largely a fault of the construction of the question by the author, and if questions are reviewed by an impartial but experienced Board of Examiners before they are submitted to candidates, this fault can be remedied. Like Dr Marshall’s group, we also review all questions after they have been used, utilizing Pearson’s ‘r’ correlations, the KR20 formula modified for + 1, -1, 0 marking, and individual item analysis. Such a review of the questions is vital and tells the examiners a great deal, not only about their candidates’ abilities, but about the effectiveness and emphasis of teaching, and often something about the personality of the examiners themselves. However, I think the most important point in Dr Marshall’s letter is made in the last paragraph. My own view is that candidates should be encouraged to reason out answers that are not immediately apparent to them, using their basic store of knowledge and their experience. We do not encourage guessing. Guessing is not a practice to be recommended in clinical medicine but the courage to say “don’t know” is a very worthy attribute -provided that the candidate (or the clinician) then says “but I will find the right answer as soon as possible”. In this way, the MCQ technique can indeed be valuable in an educational sense. There is, of course, all the difference in the world between guessing, arriving at an answer with a reasonable degree of certainty by deduction and the application of basic knowledge, and saying “don’t know”. Dr Marshall’s objection to the multiple true/false format can readily and easily be overcome by providing the candidate with the opportunity to say “don’t know”. In the standard Newcastle computer program, which is widely used both in undergraduate and postgraduate examinations in the UK and overseas, the candidate has the opportunity of selecting an item as being either true or false or of indicating “don’t know”. Whilst this will never completely inhibit
the candidate who is prepared to chance his arm and guess, it certainly encourages him to be honest with himself and I think that this format overcomes almost completely Dr Marshall’s objections. The relative advantages and disadvantages of the various MCQ types available such as multiple true/false, 1from-5, relationship analysis etc., etc., provide a wide and fruitful field for study that may, at some time in the future, form the basis of a publication in your Journal. Suffice it to say that all three of the types mentioned are of considerable value, provided they are used in the right way and that the questions are very carefully set. However, the selection of a particular question-type follows on from the more important primary decisionthat the MCQ technique is valuable and has much to offer, not least because of its versatility. John Anderson, MB. FRCP Academic Sub-Dean and Senior Lecturer in Medicine The Medical School University of Newcastle upon Tyne Newcastle upon Tyne NEl 7RU, UK
Graduate Medical Educatioi. in Europe Madam: Your editorial comments on the WHO Study on Graduate Medical Education in the European Region are much appreciated (Medical Teacher, 1979, 1 , 117). We drew attention in the original report to a number of the problems which cause difficulty in comparing one country with another. T o begin with, there are well over 100 medical specialties in the various European countries, and it is often difficult to know exactly how each is defined. It was partly for this reason that the short first supplementary report was purely factual; expressions of personal opinion were deliberately avoided. We did, however, ask for suggestions, for improved presentation or concerning information and specialties, which might usefully be included. We should particularly welcome such suggestions at present, since the second updating exercise is currently being planned. Perhaps, as the author, I might even be tempted to express some opinions! James Parkhouse, MB. CH.B. FFARCS Professor of Anaesthetics University Hospital of South Manchester Withington Hospital Manchester MZO 8LR, UK
303
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Graduate Medical Education in Europe James Parkhouse To cite this article: James Parkhouse (1979) Graduate Medical Education in Europe, Medical Teacher, 1:6, 303-303 To link to this article: http://dx.doi.org/10.3109/01421597909014341
Published online: 03 Jul 2009.
Submit your article to this journal
Article views: 8
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [Deakin University Library]
Date: 11 November 2015, At: 23:07
LETTERS
Downloaded by [Deakin University Library] at 23:07 11 November 2015
Tulp’s Dissection Madam: I was interested to see that you used Rembrandt’s picture of Dr Nicolaas Tulp on the front cover of the July/August issue of Medical Teacher. As an anatomist and teacher, I am always rather surprised at the regularity with which this picture appears in journals of medical education, for several reasons. In the picture, not one of them is looking at the dissection: indeed, Dr Tulp himself is not doing so. The colouring of muscles and tendons is superb, but unfortunately the superficial flexors of the fingers come from the medial and not the lateral epicondyle as depicted. The flexor digitorum superficialis also has a radial head; this is not shown. All the points I raise are very well known and are immortalized in Wood Jones’ classical book The Anatomy of the Hand. Ruth E. M. Bowden, D.SC, MB. BS, FRCS Professor of Anatomy Royal Free Hospital School of Medicine 8 Hunter Street London W C l N lBP, UK
Assessment in Medicine-The Multiple Choice Question Controversy Madam: I read Dr Marshall’s letter published in the July/August issue of Medical Teacher with considerable interest. Dr Marshall raises a number of points that are concerned more with the detailed aspects of MCQ than with the principle, and perhaps I could be allowed to comment on them. I entirely agree that the formal assessment of factual recall should be only part of the overall assessment process in medicine. In.our own Final Part I1 examination the multiple choice Medical Teacher Vol 1 No 6 1979
paper contributes 16 per cent to the final score, and contributions also come from in-course assessment during the final year, clinical examination and oral examination. I think I made it clear in my original paper (Medical Teacher 1979, 1 , 37) that although the MCQis the most efficient and objective method we have of testing ‘knowledge’,it cannot and should not be allowed to replace alternative assessment techniques that test different skills -even though the MCQ format can test a good deal more than simple knowledge of facts. I agree with Dr Marshall that the inclusion of trivia in MCQ is largely a fault of the construction of the question by the author, and if questions are reviewed by an impartial but experienced Board of Examiners before they are submitted to candidates, this fault can be remedied. Like Dr Marshall’s group, we also review all questions after they have been used, utilizing Pearson’s ‘r’ correlations, the KR20 formula modified for + 1, -1, 0 marking, and individual item analysis. Such a review of the questions is vital and tells the examiners a great deal, not only about their candidates’ abilities, but about the effectiveness and emphasis of teaching, and often something about the personality of the examiners themselves. However, I think the most important point in Dr Marshall’s letter is made in the last paragraph. My own view is that candidates should be encouraged to reason out answers that are not immediately apparent to them, using their basic store of knowledge and their experience. We do not encourage guessing. Guessing is not a practice to be recommended in clinical medicine but the courage to say “don’t know” is a very worthy attribute -provided that the candidate (or the clinician) then says “but I will find the right answer as soon as possible”. In this way, the MCQ technique can indeed be valuable in an educational sense. There is, of course, all the difference in the world between guessing, arriving at an answer with a reasonable degree of certainty by deduction and the application of basic knowledge, and saying “don’t know”. Dr Marshall’s objection to the multiple true/false format can readily and easily be overcome by providing the candidate with the opportunity to say “don’t know”. In the standard Newcastle computer program, which is widely used both in undergraduate and postgraduate examinations in the UK and overseas, the candidate has the opportunity of selecting an item as being either true or false or of indicating “don’t know”. Whilst this will never completely inhibit
the candidate who is prepared to chance his arm and guess, it certainly encourages him to be honest with himself and I think that this format overcomes almost completely Dr Marshall’s objections. The relative advantages and disadvantages of the various MCQ types available such as multiple true/false, 1from-5, relationship analysis etc., etc., provide a wide and fruitful field for study that may, at some time in the future, form the basis of a publication in your Journal. Suffice it to say that all three of the types mentioned are of considerable value, provided they are used in the right way and that the questions are very carefully set. However, the selection of a particular question-type follows on from the more important primary decisionthat the MCQ technique is valuable and has much to offer, not least because of its versatility. John Anderson, MB. FRCP Academic Sub-Dean and Senior Lecturer in Medicine The Medical School University of Newcastle upon Tyne Newcastle upon Tyne NEl 7RU, UK
Graduate Medical Educatioi. in Europe Madam: Your editorial comments on the WHO Study on Graduate Medical Education in the European Region are much appreciated (Medical Teacher, 1979, 1 , 117). We drew attention in the original report to a number of the problems which cause difficulty in comparing one country with another. T o begin with, there are well over 100 medical specialties in the various European countries, and it is often difficult to know exactly how each is defined. It was partly for this reason that the short first supplementary report was purely factual; expressions of personal opinion were deliberately avoided. We did, however, ask for suggestions, for improved presentation or concerning information and specialties, which might usefully be included. We should particularly welcome such suggestions at present, since the second updating exercise is currently being planned. Perhaps, as the author, I might even be tempted to express some opinions! James Parkhouse, MB. CH.B. FFARCS Professor of Anaesthetics University Hospital of South Manchester Withington Hospital Manchester MZO 8LR, UK
303
