What happened? by
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Prompted By Cheating

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“What happened?” The woman in charge of Introduction to Clinical Medicine seemed concerned.  I had failed the course’s written exam.  “I don’t know.”  And really, I didn’t.  I had never failed an exam.

We second-year medical students had been farmed out in small groups to assorted ophthalmologists and ENT physicians in practice to learn eye and ear exams, with the classic DeGowin and DeGowin physical exam book for reference. I assumed any exam would be based on our clinical experiences and assigned text.  The questions on the multiple-choice test seemed to have come out of nowhere.

After we had ruled out failure to show up, pay attention, personal crisis, substance use or other breakdown, she finally asked with wonderment—hadn’t I studied the old tests?  I was shocked.  Wasn’t that, umm, cheating?  Oh no—everyone does that.  You must look at the old tests.

Turned out, they were indeed on file in the library.  As expected, the topics had not been covered in my small group or reading. I dutifully studied the answers, retook the test, and passed no problem.  So that was how the game was played.

I was disillusioned.  If that was what passed as education, who was being cheated?



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  1. Dunno the answer Khati.
    But I do remember taking the Graduate Record Exam in English Lit. The old exams understandably had at least one question or essay (?) on The Bard.

    So I spent a lot of study time trying to get a handle on all the plays and sonnets.
    That year – not one Shakespeare question.

  2. Marian says:

    Very scary that this was in med school, Khati. Now I have another thing to worry about when I see physicians. And you are right, what are people actually learning? Maybe that’s why colleges are no longer requiring the SATs and GREs, because what do they measure, really?

    • Khati Hendry says:

      Yes, that class was the worst. There is LOT of on-the-job training, and the learning never stops. I have been involved in some teaching myself and been happy to see movement to place more emphasis on learning on how to learn and problem solve. That is good because so much changes so quickly, and lifelong learning habits become paramount.

  3. Suzy says:

    Wonderful story, Khati, and very well written! I loved your line to the woman in charge: “Wasn’t that, umm, cheating?” And her answer: “Oh no—everyone does that.” Which of course doesn’t necessarily mean that it isn’t cheating. But if that was the expectation, and that’s what the questions were based on, it would have been nice if they had told you! I agree that it is troubling that you weren’t being tested on your clinical experience OR the assigned text.

    • Khati Hendry says:

      I have to admit that I appreciated my college education when compared to subsequent experiences. I think the worst question I ever got was how long the DNA would be that would cover the head of a pin. Insane, but amusing to compare that question to the medieval religious debates about the number of angels that could dance on the head of a pin.

  4. Dave Ventre says:

    I well remember the sick feeling of looking at an exam that you had anticipated you would ace with ease, and realizing that you must have been attending a completely different class for the last six weeks….

  5. Mister Ed says:

    How maddening to get an exam that could have been written years ago for a different class. Clearly, you needn’t have shown up for the class. But perhaps your patients were better off if what you studied was actually put to good use.

    • Khati Hendry says:

      That is certainly how I have rationalized my approach. It is how I have tried to teach as well. I remember that a medical professor stressed that the reason we were studying was to “strive for excellence in medicine”. That sounded like the emphasis was self-centered on our careers, while I had thought we were there to strive to help people have healthy lives. It leads to different decisions.

  6. John Shutkin says:

    Interesting analysis of what constitutes cheating vs. preparation. And, to be fair, “studying to the test” has long been a viable concept, at least in terms of taking the test, if not necessarily learning the topic. That was certainly the case with the New York bar exam; reviewing the old test questions — even though you knew you’d never get the exact same ones — was standard operating procedure; indeed, the bar examiners made them available for just that reason (I’m sure it is all on-line these days).

    That said, as you properly note, is this really education or just test taking?

    • Khati Hendry says:

      Absolutely, studying to the test is common, and if you know what you are expected to learn, it makes sense. My experience was odd because the material was largely only covered in the test itself, given how loose farming out teaching to different preceptors turned out to be. And I had never heard of such a “curriculum” that assumed we would all just look up old tests. Live and learn. Since then I have signed up for review courses that would use versions of old exams in order to prepare for the periodic re-certifying exams, just as you describe for the bar, as a useful way to review topics and get familiar with the formats. Ironically, for someone who vowed that the SAT was the last standardized test she would ever take, I have probably taken more of them than 99.9% of people on earth. I wish taking the tests really translated into useful knowledge.

      • John Shutkin says:

        When I was studying for the NY Bar in 1974, I similarly swore that it would be the last standardized test I would ever tak. So I studied like crazy to make sure I passed it the first time. And, happily, that has been the case, since I have been able to qualify to practice in other states through reciprocity and the NY continuing legal education requirements only involve attendance at courses, not passing tests. So I’ve retired undefeated.

  7. Laurie Levy says:

    I totally agree with you. But I also know this was common practice for medical students, as I was married to one. Perhaps this was an introduction to how the system works?

    • Khati Hendry says:

      All I can say is that fortunately it wasn’t common practice for all of them. I went into medicine to do things differently, and found many like-minded folks in community medicine and family practice. Just as there are lying cutthroats in any profession, it doesn’t have to mean they are all like that. But terrible when they are.

  8. Betsy Pfau says:

    Short and to the point, but what a horrible example of teaching! As Suzy points out – what was the point of studying if the material wasn’t covered in class and you HAD to look at old tests in order to be prepared. Cheating indeed. Who WAS being cheated?

  9. So interesting, Khati. Thanks! “Cheating” means we think we know the rules, and either do or don’t break them. Expanding the rules–is that the same as thinking outside the box?

    • Khati Hendry says:

      Good question. Cheating is culturally determined and relates to a sense of ethics I believe. Dishonesty and unfairness seem to be related topics. Thinking outside the box might be creative and either fit or not fit into a given ethics framework. Interesting how a number of the writings on this prompt deal with examples that might be interpreted in different ways, depending on your point of view.

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