“Like all victims of the single best answer syndrome, (the doctor) ordered tests in wild profusion because, in his experience, every question had an answer and a test that would get you there.”

We have become a society where test scores are associated with success so it is not surprising that this has become a controversy in physician education.
Recently an article in the New York Times http://www.nytimes.com * noted: “My young friend had just finished the last months of his medical training. He had faced down many multiple-choice tests and triumphed over them all.”
“Starting with the S.A.T.s and ending with a series of medical licensing exams, including all the prep courses and practice exams, he probably had tens of thousands of single best answers under his belt. Now they were all burbling up to the surface.”
He went off to evaluate an older patient with neck pain. It hurt when she turned her head. It had been going on for a few days. “Wouldn’t hurt to get a cardiac work-up,” he reported back. “Stress her, get an echo. Neck pain, you know, tipoff for heart disease. Gotta remember: In old women, heart disease will have unusual symptoms.” “True enough, occasionally. But not in this woman, who had a stiff neck and probably needed a new pillow.”
“Medical educators have been contemplating this possibility for years. But the problem particular to medicine may be the sheer volume of these tests, and the standard hysterical preparation they engender, which constitute a form of training in itself. Educators may not actually teach to the test, but students think to the test, in linear multiple choice.”
“They learn to recognize key phrases (neck pain) and stock situations (older woman), and they live in dread of unlikely worst-case scenarios. (Dies from heart attack while buying new pillow. You are sued.) Sometimes the actual, three-dimensional patient is not real enough to eradicate all her paper iterations.”
*to read the full NYTs article, “The Real World Is Not an Exam”, by Abigail Zuger, M.D., highlight and click on http://well.blogs.nytimes.com/2014/02/10/the-real-world-is-not-an-exam/
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