Exams

[Guest MACbetty]

Hi everyone,

 

I've been reading through the stream entitled " A day in the life of a Mac student." Good stuff. What i haven't read anyone discuss is the topic of exams.

 

I was told that there are no exams at Mac. Instead, students are expected to self-evaluate during and at the end of each unit. Is that correct? If not, what's the deal? Do you have multiple choice tests, oral exams, etc...?

 

cheers

Macbetty

[Guest gucio93]

Although Mac does not have "exams" in the traditional sense, we are evaluated quite extensively.

 

1. At the end of each tutorial (twice a week) each person evaluates herself/himself and the group.

 

2. Half way through each unit (there are 4 units, each lasting 3 months) we have a lengthy (usually around 3 hrs) evaluation as a group, where we again evaluate ourselves, each other, and our tutor. Based on this evaluation we receive a midunit progress report.

 

3. At the end of each unit, we have another lengthy evaluation session (as above), based on which we receive a qualitative, written statement of our performance during that particular unit.

 

4. During each unit we have clinical skills. Each unit covers three body systems and the clinical skills sessions (held weekly) correspond to the body system being studied. At the end of each "subunit" we receive a written evaluation (based on scales for standard criteria) of our performance from our preceptor.

 

5. Three times per year we write what is called a "Personal Progress Index", which is test based on 180 questions from any domain of medicine. All of the years write the same test on a given date, the idea being that your individual scores are compared to the scores of peers from your year as well as to the scores of colleagues from previous years at the same learning stage. This identifies to you and the school any areas of weakness you may have and redflags those who struggle, sot that they can be offered help to strengthen their areas of weakness.

 

6. At the end of each unit we write what is called a "Reasoning Exercise." It is basically 18 situations/scenarios, based on the body systems studied, and requiring a short answer explaining the mechanism behind the scenario. For example:

 

Question: After a polar-bear swim in 60 deg F water, I find that a) my skin is pale and my fingertips and toes are blue and I'm shivering. Explain.

 

Answer: In an effort to avoid a drop in core temperatue, the CNS produces a reflex vasoconstriction in the vessels to the skin and extremeties, thus decreasing the heat loss to the environment. This results in pallor and peripheral cyanosis. The CNS also produces reflex muscle contraction (shivering) in an attempt to produce thermal energy from kinetic energy,

mobilizing ATP stores in the muscles.

 

Comment: there are several points in the answer - role of the nervous system, muscle contraction producing heat, consumption of ATP etc. Note that the response can be reasoned out if you know something about how the

body reacts to environment change; what is the purpose of the system and what is the system's repertoir of responses?

 

Here's another question:

A 65 year old woman with end-stage liver failure who has not eaten in the last 24h has a seizure and is found to have a blood glucose level of 1.8 mmol/L (normal 3.9 - 6.1 mmol/L). Provide an explanation for her hypoglycemia.

 

Answer:

In the absence of dietary (exogenous) glucose, serum glucose is maintained through a) glycogenolysis - the breakdown of glycogen stores in the liver gluconeogenesis - the synthesis of glucose de novo, in the liver, from protein. Both mechanisms take place in the liver, under the control of glucagon, a hormone released by the pancreas in response to low levels of glucose. In disease states involving the loss of liver tissue, these mechanisms fail and thus the patient must rely totally on exogenous sources of glucose.

 

7. Starting in clerkship, there is a test each clerk must pass (like in any other school) at the end of each core rotation.

 

So as you can see, we are evaluated to death, even in the absence of "exams"

[Guest batman]

:rolleyes woah....that sounds like a hell of a lot of evaluation, plus stuff at the end of each tutorial - do you guys get sick of it after a while, or does it just become routine?

[Guest Carolyn]

While I'm almost finished and can say that all of that evaluation is very helpful and much more helpful than any number I ever received... I very much am sick of it

 

Take care.

[Guest gucio93]

I'm afraid I'm with Carolyn (and I'm only half way through . . .) But, while being labourious, it is indeed quite helpful overall.

[Guest MACbetty]

thanks for the detailed answer about exams. Like batman said: that's a lot of self-evaluation at the end of three years. Still, it seems much better than a tonne of multiple choice tests where all get you get are cold, hard numbers instead of personal feedback.

 

cheers

MACbetty

[Guest smg]

I find this evaluation style quite interesting and wonder how I might react under this system. I think it would really allow me to relax and enjoy learning rather than fretting about how I stack up to everyone else based on a number. However, I've heard that Mac grads, b/c of this evaluation style, tend to know certain areas extremely well, but have gaps in their knowledge. Is this true? Do Mac grads feel that this style properly prepares them for residency, etc.?

[Guest Carolyn]

I believe it really depends who you talk to -- I have yet to meet a Mac grad who doesn't feel that they were prepared for residency -- I've been told that you can often tell what school people come from by their style of answering a question and how they go about solving the problem.... meaning that a Mac grad may be more likely work from the basics to answer a problem but that another grad may riddle of the list of 10 for a differential diagnosis of a green left ear... neither is a wrong approach and really depends on your style.

 

You will hear of people 'dis' mac for a variety of things but you will also hear of people 'dis' every other school for just as many other things.

 

I think it is important to recognize that people 'fall through the cracks' at all schools -- I believe that you can come out of Mac as an exceptional physician but also you can have made it through the cracks enough and be a poor physician. This happens at every school -- I have met some very very poor residents from some other schools. When you get one of those people from Mac, people seem to base it on our system (which they usually don't understand -- assuming that it is just like their schools version of PBL -- likely very different) instead of blaming it on the person themselves.

 

I think it is very important to really understand the system of PBL at Mac before you accept here - if you don't think it is a system that will work for you then you really shouldn't come - it would be a very frustrating time for you, your peers and your future patients. If the system appeals to you then it can be an amazing experience and you are right about being able to relax and enjoy learning.

[Guest smg]

I guess it's true that there are some bad apples in every basket. In your opinion, what type of people tend to thrive in the Mac environment? Any suggestions for how to go about determining whether Mac is right for you? Is the Mac web-site useful for this?

I'm a social science student with little science background. I'm also a people person who learns best through verbal communication (i.e. lectures, seminars, discussions, etc.). I'm a procrastinator, so I thrive under deadlines. I realize in the end the decision is mine, but do you think I would be suited to Mac?

[Guest Carolyn]

Well I wouldn't say that from that explanation you would sell yourself well on an interview!! However, just because that has been your experience so far, doesn't mean that it won't work for you. It really does come down to how well you learn in an environment such as Macs... Small groups, from peers, on your own, without a lecture, from a variety of non-traditional resources, "on the job", and how well you can motivate yourself to learn - that is why the questions were as they were -- if you had to lie to answer the questions than you should think long and hard about attending mac... (I'm not saying YOU smg are lying -- I meant more of a hypothetical "you")

 

One of the hardest things is that many undergrads have never had the opportunity to learn in those circumstances -- I would suspect that is why there has traditionally been an older age of matriculants at Mac.

 

I think talking to the Mac students at the interview as well as thinking about any experiences you've had both academically and non-academically will tell you whether you think the system will work for you.

 

Carolyn

[Guest smg]

I haven't yet applied to Mac -- will be doing so this fall -- so I haven't messed anything up yet. I have read through the questions (I assume you're refering to the 15 autobiographicals) and found I could easily come up with some good answers and examples from school and elsewhere. I would never fathom lying on something of this importance. If one needed to lie to get into this career, then they really shouldn't be pursuing it.

 

Your point about serious and truly honest introspection is well taken. I was reading through some of the resources on the Mac web-site. They are quite informative and helpful and have really excited me. Although my last post may not have been very well worded, I do think I would enjoy the Mac environment and would be suited to it in many ways, particularly to the peer/small group and "on the job" learning and more comprehensive, on-going evaluation. Nevertheless, I will continue to evaluate and seek out as much info as I can before taking this step.

 

Just out of curiosity, have you found much gender differentiation in the PBL (i.e., women like it or do better than men or vice versa)? I know that Mac has a pretty high percentage of female students. In your opinion, is this at all influenced by PBL? Thanks Carolyn. Your posts have been very helpful.

[Guest MDWannabe]

Hi Smg:

 

Speaking as a guy (who may or may not be in touch with his feminine side), I have not found the gender issue to be an issue. I have been in two groups of 6, with 10 women and 2 men in total. It definitely sounds lopsided, but I haven't found it to be a problem or challenge in any way (too many other inherent challenges to worry about!).

 

Speaking only for myself, AND NOT FOR THE PROGRAM, my life experience has been that women are, on the whole, more open and willing communicators than men. I recognize that this is a broad generalization and far from universally applicable. A willingness to share and be open and honest really comes through in this program and is key to the ongoing success of Mac. We learn much from the diversity of others, but you can't learn much from that diversity if the benefits aren't shared with others. Based on this, it was not surprising to me to see more women than men at Mac. That being said, the men in the program are equally up to the task, and there are certainly a lot of men out there that fill the bill. Among those here, I have not seen gender to be a significant issue in the ongoing dynamics of our class.

 

If you have the skills and background experience, you will fit in (and people are more willing to help bring you in than in any other program I've experienced) - your gender is irrelevant once you are in.

[Guest macmed04]

I'd also describe myself as a person who thrives under deadlines and is a BAD procrastinator. I have a clerkship tutorial tomorrow afternoon and have done no work for it yet. Guess that means another late night for me!

I always learned well from lectures in undergrad (Engineering, not much in the way of science except for the basic prereqs), but also really enjoy reading up on things on my own and discussing them later on with others to make sure I got it. I certainly like the freedom Mac gives me. I would go nuts if I had to sit in large group sessions (aka lectures) for more than a couple hours a week, and Mac lets me learn at my own speed, while leaving me plenty of time for different electives (during the pre-clerkship period).

I actually really like the evaluation system too. I was one of those stressed people in undergrad who was really focused on marks (partly because I really wanted to get into med school), so I like not having "exams" as such. The reasoning exercises are my real kick in the pants to review what I've already learned.

I don't know that there's one particular type of person who thrives at Mac. You have to be self-motivated, flexible, and be able to figure out where to go to find resources. I was worried that I'd never be able to do that before coming here, but found that it's really not as hard as I thought. I made the right choice in coming to Mac, and have had a basically stress-free experience so far. Sure I could be working harder, but I'm very happy with my life! The exam stress and long hours of lectures at other "traditional" schools would have driven me up the wall by now.

And now to get on with that psych homework...

[Guest macdaddyeh]

Hey there MACMED2004:

 

Where DO you find the resources that you need for PBL? What if you can't or don't find all the "answers/solutions" to your weekly tutorial assignment?

[Guest jmh2005]

You will always find resources...there are a mound of texts on reserve (and at home if you are a crazy textbook purchaser like myself..., a tonne of e-resources (journals, medicine on-line resources, on-line textbooks), they give a list of Physicians in every possible area/speciality in each unit/subunit you can call at any time, they give you a resource list of articles, A-V, anatomy, people resources with each health care problem...really, it is not a problem in the least! No worries...I was very pleasantly surprised as I used to search for hours for things during my last PBL degree...at least the MD programme realizes that yes, you need the basics on searching (which you'll get in Unit 1), but not to waste tonnes of time in the library during your 3 years!!

: