Why declining test scores may reflect obsolete standards, not lazy doctors

Reuters

Harper College Instructor Jennifer Kittler talks with nursing student Delia Nedeleanu about providing a patient with a pain management pump in the community college's virtual hospital in Palatine, Illinois, February 21, 2013.

A short piece in today's  Health Care Blog reveals (albeit unintentionally) why so many outside of healthcare think the medical establishment still doesn't get it.

The post, written by a general internist and residency program director, asked why an increasing number of internal medicine doctors are failing their internal medicine board exams.  The pass rate has reportedly declined over the last several years from 90% to 84%.  (Disclosure: I passed this required test about a decade ago.)

His differential included two possibilities:

(1)    The test is getting harder - The testing agency said this wasn't the case.

(2)    Millennials lack the study habits of their elders, and have become great "looker-upers." - The author suggested this was a key factor, and several commentators enthusiastically agreed.

The basic thesis here that in the Days of Giants, doctors worked harder, learned more, and were better.  Nowadays, doctors are relatively complacent, less invested, less informed, and are generally worse - which is what's reflected on the board exams.

Let me suggest a third possibility - perhaps today's doctors are providing better care to patients than their predecessors were a generation ago.  Maybe today's doctors have figured out that in our information age, your ability to regurgitate information is less important than your ability to access data and intelligently process it.  Maybe what makes you a truly effective doctor isn't your ability to assert dominance by the sheer number of facts you've amassed, but rather how well you are able to lead a care team, and ensure each patient receives the best care possible.

In other words, what if the problem isn't the doctors, who are appropriately adapting, but rather the tests (and the medical establishment), which may not be?

I've previously expressed concern that healthcare workers in general are subject to a series of expensive exams that are viewed as assessments of, and then proxies for quality, yet which are rarely correlated with any meaningful quality measure.  They remain an important source of money and status for the societies (guilds) that develop and administer them.  To the extent that we attach value to certification measures uncorrelated with quality, we are enablers, part of the problem.

I've not always seen eye to eye with technologist and investor Vinod Khosla, yet he's absolutely right when he points to the rapidly accumulating amounts of medical information available in the world, and the absurdity of expecting any individual person to truly master it.

The doctor of the future should have the humility to understand her own limitations, and know how to use technology productively to find what she needs.  She should be comfortable enough with technology so that it's used in service of patient care, and not in place of it.  She must also recognize when to distrust technology, and perhaps most importantly, know when to set it aside.

If board scores suggest young physicians aren't learning the currently required material, it may not be test-takers who are failing.

 

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About the Author

 

David
Shaywitz
  • Dr. Shaywitz trained in internal medicine and endocrinology at MGH, and conducted his post-doctoral research in the Melton lab at Harvard. He gained experience in early clinical drug development in the Department of Experimental Medicine at Merck, then joined the Boston Consulting Group’s Healthcare and Corporate Development practices, where he focused on strategy and organizational design. He is currently Director of Strategic and Commercial Planning at Theravance, a publicly-held drug development company in South San Francisco. He recently wrote Tech Tonics: Can Passionate Entreprenuers Heal Healthcare With Technology? 

  • Email: davidshaywitz.aei@gmail.com

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