Help Wanted: Test Taker

Cutting edge technology, medieval education.

Help Wanted: Test Taker.
Employee sought for taking standardized tests.  Applicant must demonstrate superior aptitude for constant memorization.  Independent thought, real-world solutions and people skills not required.

This help-wanted ad has never appeared in any newspaper.  In fact, when written out it looks ridiculous.  Which is a problem, because standardized testing represents exactly what we have assumed to be our highest educational goals.

I remember an out-of-town friend approaching me and another physician about our thoughts on choosing a primary care doctor.  She said she was going to look at where each candidate got his degree, and what his grades were.  My friend and I both said that probably wouldn’t be a very good tactic.

But it’s clear that’s what we think we want:  “My doctor graduated at the tip-top of her class from the very best medical school in the whole damned world.”

Think about what that means. “Tip-top of her class” means she scored the highest on her standardized tests, which almost exclusively targeted memorization.   And the way she got into “the very best medical school in the whole damned world” was by doing exactly the same thing in her undergraduate studies, memorizing for standardized tests.

12 AWARDS. We have a dogmatic commitment to test taking. This book describes why we are so given to blind dogma. Click image for more information.

One of my medical professors attempted to address this problem by giving us brief case histories and supplying five possible diagnoses.  Rather than simply pick the right one, we had to eliminate the four wrong ones with a brief explanation.  His approach emphasized analysis over memorization.^[1]I had middle-of-the-road grades through medical school but I have to say, I scored well on those parts of his tests.  Now, it’s important to note that this was at Tulane, which at the time was ranked among the Top 25 medical schools in the world.

Nevertheless, you should have heard some of my classmates howl.  The ones who complained the loudest, of course, were those maintained very good grades by studying and memorizing constantly.  As one of my classmates quipped later about the test-takers, “It’s not like patients come in with multiple choice questions tattooed on their chests.”

But that was the only professor that I can remember in four years of medical school who gave exam questions requiring understanding and analysis.  All of our other exams were mnemonic regurgitation.  I have been out of medical school some years, so it is possible that the examinations have changed.  Considering that memorization has been the basic approach to education since the Medieval, however, I would doubt it.

I should note that after graduation, once physicians enter internships, residencies and fellowships, critical thinking skills become more important.  But even here, rote memorization makes for a pretty good fake book that will succeed with most patient management.  Problems with this approach do not appear until a patient presents a confusing picture.  As I like to say, “Diseases don’t read the books.”  In these confusing situations I have seen otherwise excellent physicians caught flat-footed.  The better ones start reading and calling colleagues, and the very best sit back and actually think about what’s going on.  But too many of them simply continue to bluff their way through the situation with what they already know.  (Me?  I punt.  I send them to someone with more experience in the needed area.)

I have worked with doctors who were excellent at standardized tests, who graduated very highly in both college and medical school, but who were not very good practitioners.  Some of them were downright dangerous.  I have also known MDs with mediocre grades who were excellent physicians.^[2]“What do you call the person who graduates last in his medical school class?”
“Doctor.”

Now consider that we are talking about medicine here, regarded as one of the most difficult  and most prestigious curricula one can pursue, where the graduates are responsible for understanding enormous amounts of information in order to manage life-threatening situations.  The educational metrics for that lofty discipline, however, are based on memorization and standardized tests.  If my comments here are valid, those tests are outmoded for the modern world, and for critical, independent thought.

Given that insight, what more – or perhaps what less – should we expect of the rest of education?