Guest McMastergirl Posted November 8, 2003 Report Share Posted November 8, 2003 This issue has come up amongst some of my classmates as we near the end of clerkship... there are a few people in our class that (in our humble opinions) should NOT become doctors!!! However, at Mac, we have very limited formal testing, and very subjective evaluations, which makes it easy for lazy charismatic people to charm their evaluators into a good eval. How does this work at other schools? Does anyone fail? Is there any remediation? Link to comment Share on other sites More sharing options...
Guest aneliz Posted November 8, 2003 Report Share Posted November 8, 2003 Well, at UWO it is 'theoretically' possible to fail...although it has yet to happen in my class and there are some people that should have failed *something* by now...they have been able to 'charm' their way into a good evaluation, talk their way out of a failing mark on an exam and even get around 'rules' about attendance at small group sessions - mostly because the instructor didn't want to go through the paperwork and hassle to fail them....mighty irritating to those of us that do the work and know our stuff... If you fail a course, you are required to do supplemental exams/remediation in the summer....if you fail a clinical rotation, you are supposed to repeat it during your elective time...but this is a rare occurence at UWO... There are definitely a few in my class that fall into the 'shouldn't be doctors' category...but how to deal with it, I don't know. I don't think that it is a problem specific to Mac's evaluation system though! Link to comment Share on other sites More sharing options...
Guest mydream88 Posted November 8, 2003 Report Share Posted November 8, 2003 Hi all, I hope you are having a pleasant Saturday . I was just curious in anyone's opinion (particularly those who are in med school if you don't mind!) what makes these people in your opinion unsuitable doctors-to-be. I am just curious! thanks, mydream88:p Link to comment Share on other sites More sharing options...
Guest moo Posted November 8, 2003 Report Share Posted November 8, 2003 At my school in the US, four people failed first year (out of 170). For first year we have eight exams (six written, one histo, one anatomy), and you are required to pass each one. If you fail one or two, you can remediate over the summer. If you fail the summer remediation, you repeat the entire year. P/F is usually two standard deviations below the mean, usually between 57-65%. If you fail three exams throughout the year you automatically fail the year. For second year, it's the same except you take the remediation exam two weeks after you failed it. So it's a bit harder. Interestingly, of the four who failed last year, one was an MD/PhD student. Hardly anybody fails clerkships, or if they do, no one knows about it. Link to comment Share on other sites More sharing options...
Guest McMastergirl Posted November 8, 2003 Report Share Posted November 8, 2003 To answer your question about the "unsuitables"... Immature, lazy (shirks work, doesn't prepare for tutorials), irresponsible (doesn't show up for things, doesn't answer pages, etc)... those are the main things. I'm not sure how they got as far as they have with their work ethic! Some people just don't take it very seriously... it's like they just want the MD to pick up chicks. :lol Mind you, there aren't very many people in med school like that, but I'm sure there are a few in every class. I guess it's like the old joke says... what do you call someone who graduates at the bottom of their med school class? ... Doctor! Link to comment Share on other sites More sharing options...
Guest toothy jr Posted November 8, 2003 Report Share Posted November 8, 2003 There was the anti-dentite Seinfeld episode where he was told the joke "what do you call a doctor who failed out of med school?" "a dentist!" boy, I'm gonna get my teeth pulled out by my colleagues Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted November 9, 2003 Report Share Posted November 9, 2003 This problem is endemic to every profession under the sun, not just medicine or dentistry. Just one more reason that shows no admission process will ever be perfect; and to not let the one bad apple ruin the barrel when forming an opinion about any profession. Link to comment Share on other sites More sharing options...
Guest aneliz Posted November 9, 2003 Report Share Posted November 9, 2003 I'm not going to go into specifics of incidents because the people involved would be easily identifiable (ie there is no way to protect the guilty...) But, the 'incidents' fall into these major categories: 1. Either doesn't do the work because they can't be bothered or seems to be unable to do the work. The can't be bothered people are just lazy....that can be fixed...but the others that seem to be 'unable' to handle the work are usually great at memorising trivial facts like obscure epidemiology stats but mystified by the concept of differential diagnosis let alone how to even start coming up with one... 2. Seriously lacking in sandbox skills....these are the 'charmers' on the surface that have some serious issues either with motivation (here for personal gain...and very apparent when they take the 'charmer mask' off) or with dealing with people (can't play nice in the sandbox...don't understand why people are mad at them, etc...) Of course there are a couple of people that are so lacking in sandbox skills that a patient is probably going to actually swing at them (or burst into tears) during an interview at some point... 3. Mental illness....likely bordeline personality disorder... Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted November 9, 2003 Report Share Posted November 9, 2003 If that is the case, then they may make it through the system but they will still be held to the standards of practice by the College of Physicians and Surgeons of Ontario (or whatever province they are in). If they treat patients badly, all a patient has to do is write a letter to the CPSO and it will set a chain of events in place that can be quite unpleasant for the physician. The College is there to protect the public, more so than the schools who graduate doctors. Depending on the severity of the incident, the physician may have to take special courses, face suspension or outright loss of license if they abuse a patient. That is, if the patient is not so browbeaten that they are afraid to report the doctor. However, if a physician suspects that another physician is incomptetent or has abused a patient (as may come out in counselling or when they go to another doctor for whatever reason), there is a DUTY to report it to the College, which will set the wheels in motion. Failure to do so could result in punitive action against the doctor who uncovered the abuse by another physician, and does not report it. Of course, their is a lot of social disincentive for being a whistleblower and it may harm the reporting physician's status within the physician community to "snitch" on a peer. This is an obvious problem. So granted it is not a perfect system, but there is a system to weed out "bad" doctors that are in practice. Practicing medicine is a privilege, and it can be taken away. These are the mechanisms in place for practicing physicians. Unfortunately it is a "post hoc" method; that is they have to really screw up quite serverely before action can be taken. Innocent until proven guilty? As far a undergraduate students go, it seems to me that it is next to impossible to get kicked out. The schools (especially these days) have a conflict of interest in that there is pressure to graduate as many doctors as possible due to the shortage, and that each one of us is quite valuable to the school in terms of our massive tutition. Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted November 9, 2003 Report Share Posted November 9, 2003 It's pretty much like walking along a tightrope for med schools and the CPSO. On the one hand, you want to eliminate those who will be truly awful and/or dangerous physicians, at least those you can't rehabilitate or salvage within the educational program. On the other hand, you don't want your system of evaluation to induce fear, paranoia and unnecessary stress in students and/or physicians who are quite competent! Especially when your evaluation means are imperfect: fairly low quality MCQ and a hearing system that often boils down to "(s)he said, (s)he said" evidence. I think the latter two points has a large part in the current moves towards P/F curriculum in medical schools, and the fact the CPSO appears (from my perspective) to be fairly lenient with their sentences. And while I occasionally catch myself wondering about the competency of some classmates, I also have to honestly ask myself? How well do I know them? Am I basing my opinions on what they're doing in clinic or in social settings? And really. . . am I operating for a fair and unbiased perspective? BTW I was at a "mentorship" dinner last night - the hosts were married MDs from the classes of '75 and '76. . . they both mentioned that back then "you pretty much had to kill the dean to get kicked out." Just some thoughts. We've had a number of discussions about how easy it was to fail out of med school from the standpoint of being anxious of ourselves flunking out, but this is the first one that has tackled the tricky issue of whether being difficult to flunk out is entirely a good thing for med schools! Link to comment Share on other sites More sharing options...
Guest cracked30 Posted November 10, 2003 Report Share Posted November 10, 2003 How does aneliz know its so rare? Do you think people run around telling lowerclassmen they failed? It happens more than you know. We lost four to atrition in 2000. They failed clerkship. IMO thats quite a bit, everyone is smart in med school, no one should fail, the weeding out process is meant to be at the beginning with the MCAT and GPA. The dummies and incompetent don't get into residencies usually or never get their first choice. Link to comment Share on other sites More sharing options...
Guest McMastergirl Posted November 10, 2003 Report Share Posted November 10, 2003 I know that the *obviously* incompetent people will end up with remediation somewhere down the road (or at least I hope so), but I am more concerned about the people who put on a great show for faculty but fellow students know the truth... there is the odd person in my class who can just charm the pants off of everyone and get great evals, but turn to a fellow student in rounds and whisper "What's a left shift?" near the end of clerkship !!! Obviously this lack of knowledge will be more apparent when your school has tests that actually count for something, unlike Mac... (disclaimer: I am not bashing Mac, after all I go there, but I think this is one of the problems with the programme) Link to comment Share on other sites More sharing options...
Guest marbledust Posted November 10, 2003 Report Share Posted November 10, 2003 3. The crazies....all I have to say is borderline personality disorder...and most of us are pretty sure that we know one.... Are comments like this really necessary? I realize that this comment may have been written tongue-in-cheek (or maybe it wasn't). It seems to be a tad bit rude, insensitive, and unprofessional. Link to comment Share on other sites More sharing options...
Guest aneliz Posted November 10, 2003 Report Share Posted November 10, 2003 Hey cracked.....failing at UWO is pretty rare...how do I know? 1. ALL of the marks are posted on the wall for all to see....doesn't take a genius to scan the list and see that nobody failed. 2. ALL 133/133 classmates are back for second year...same with the 2005 class....they have lost NOBODY (other than for personal reasons that have nothing to do with academic performance) in the past two years.... when you know everyone in your class and 90% of the people in the class above and below you, it isn't hard to 'keep track' of where people are....a missing person would be pretty hard to miss. 3. At UWO, if somebody DOES get behind their class, they drop back into the class behind...again pretty easy to see people that move between classes. And it has only happened with TWO people...both of which took a year OFF for non-academic personal reasons and returned the next fall to start where they left off (but with the class behind them). Marbledust....the borderline personality comment was meant as a specific comment on the state of my class at UWO...it was not meant to be offensive to you or anyone else....and it was inspired by many true incidents....I am not going to go into the back story on it...if you are interested send me a private message. Link to comment Share on other sites More sharing options...
Guest marbledust Posted November 10, 2003 Report Share Posted November 10, 2003 Aneliz, I'm not really interested in the story behind your comment, and I am sure that you didn't mean it to be offensive. However, I would just ask you to consider the possibility that there may be people who read this board who live and struggle with mental illness, specifically borderline personality disorder. These people truly suffer, as do those who are close to them. I would have found it no less insensitive if you had substituted "schizophrenic" or "bipolar" in your comment. The stigma surrounding mental illness in undergrad and med school is enormous. It would be nice not to add to the stigma with comments like this, even if they are made in jest or refer to situations that the majority of readers are not aware of or understand. Marbledust Link to comment Share on other sites More sharing options...
Guest PerfectMoment Posted November 11, 2003 Report Share Posted November 11, 2003 man, some people are very PC Link to comment Share on other sites More sharing options...
Guest phantom8 Posted November 11, 2003 Report Share Posted November 11, 2003 I'd have to agree that mental illness still seems very taboo. It has nothing to do with this being "PC" or not, but rather the fact that this taboo nature can get in the way of good patient care. I've had patients who seemed ASHAMED of the fact that they were taking SSRIs when telling me about the medications they're taking. That's telling me there's still problems with the way mental illness is perceived by the general public. Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted November 11, 2003 Report Share Posted November 11, 2003 Yeah, that's absolutely ridiculous that someone would be ashamed of using an SSRI. Unfortunately, those feelings are also probably warranted by the stigma that exists within medicine. I've heard NUMEROUS medical students, residents stigmatize and CONSULTANTS stigmatize in particular borderline personality disorder, bipolar disorder, PTSD, histories of abuse, and chronic pain syndromes. From some of the stuff I've heard said, I'd bet many of them don't know anything of these syndromes past the 30 to 60 minute lecture they had on it years ago, and a few bad experiences with patients with these disorders. I know Aneliz personally and don't think she bears any ill will against these groups in any ways. Unfortunately I think aneliz has been misinterpreted as I think she was not trying to slight those with mental disorders (I'm still unsure whether borderline personality disorder is best described as a mental illness) but rather trying to allude to a specific example that a few of us know about, without using any specific identifiers. Link to comment Share on other sites More sharing options...
Guest Kirsteen Posted November 11, 2003 Report Share Posted November 11, 2003 Hey there, I'd hope aneliz wouldn't bear any "stigmata". Ouch! (Have there been any solid medical hypotheses for their appearance, by the way?) Cheers, Kirsteen Link to comment Share on other sites More sharing options...
Guest marbledust Posted November 11, 2003 Report Share Posted November 11, 2003 I know what Aneliz was trying to say, I simply commented on the way she said it. My comments were general ones, requesting that a little thought and sensitivity be used when posting messages. I have no doubt that she meant no harm or offense by the comment. But that fact that some might find the comment hurtful or offensive warranted my reply. I would think that some might find it offensive to refer to a quadriplegic confined to a wheelchair or a person who is developmentally delayed in a manner that could be construed as "inappropriate." By the same token, referring to borderline personality disorder suffers as "crazies" is, in my opinion, not necessary on this board nor appropriate. It also has nothing with political correctness. This is the last thing I am going to say about it. Peace :hat By the way, if you don't think borderline personality should be considered a mental illness, what do you think it is? If you discount it as one, then you have to reconsider the criteria for mental illness in general. If behaviours such as self-mutilation don't qualify as a mental illness, then what does? The problem is, as I understand it, borderline has become an unfortunate label that is put on many "problem patients" that don't fit neatly into some other category. There is a diagnostic criteria, but the illness itself remains ill defined. Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted November 11, 2003 Report Share Posted November 11, 2003 It's just a personal opinion over semantics, and not a statement meant to "discount" borderline personality disorder as a mental illness with all the implications that involves, but rather I prefer to consider borderline personality disorder as, well, a "personality disorder" which I consider to be something to be related to but not exactly like the core mental illnesses such as schizophrenia and bipolar disorder, which seem to have some sort of definable organic brain chemistry and/or genetic etiology. I am very much NOT saying people with personality disorders should be blamed for their disorders because of their different etiology. And I repeat that though personally I see a difference, I don't think treatment or public perception of these entities should be altered in any ways And these definitions are very much not clear as obviously bipolar disorder and schizophrenia both are multifactorial diseases, and there very well could be some organic componenent to personality disorders. Here we very well could be getting into a which came first, the chicken or the egg sort of argument: person with a personality disorder has certain organic brain chemistry findings, but are those findings causative or caused by the personality disorder? Here's another question to warp your mind around. . . do personality disorders exist in and of themselves, or are they merely groupings we have arbitrarily labelled and are we now simply applying gestalt phenomenon to pigeonhole different personalities we think or observe to be pathological? It is really rather a fascinating area. A whole lot of gray areas. I'll admit I'm no expert and I believe officially personality disorders are considered mental illness. I'm just not sure I 100% agree with that demarcation. Link to comment Share on other sites More sharing options...
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Guest Unknown </username> <dateline>1118448480</dateline> <title>Unknown</title> <pagetext>(This Posted June 11, 2005 Report Share Posted June 11, 2005 (This post is missing and can not be restored)</pagetext> </post> <post> <thread>N</thread> <threadtitle>Does anyone fail?</threadtitle> <threadviews>0</threadviews> <threadsticky>0</threadsticky> <poll></poll> <username> Unknown </username> <dateline>1118448480</dateline> <title>Unknown</title> <pagetext>(This post is missing and can not be restored) Link to comment Share on other sites More sharing options...
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