Wednesday, June 10, 2015

When "Pretty Good" Doesn't Seem Quite Good Enough

with thanks to Bobby Flay

I missed a 2-point question. It was a totally cheap-shot useless question about ranking reasons that barium enema x-rays are no longer a preferred method of diagnosing appendicitis. Seriously, it was a totally futile question designed to trip people up for no good reason other than perhaps pure meanness. It would have been OK to have asked which statement was NOT a reason for barium enema x-rays no longer being used regularly as a diagnostic tool in determining the presence of appendicitis. It would even have been acceptable to have asked under what circumstances the barium enema x-ray might still be useful in determining appendicitis, or to have asked us for a comparison of the efficacy of the barium enema x-ray against one or more of the newer diagnostic tools. Asking for some arbitrary ranking of reasons why it is no longer widely used as a diagnostic tool for that purpose, however, was absolute chicken shit. 

Everyone in my circles also missed it. It wasn't in any of our notes or textbooks, and one girl in my study group is arguably the most meticulous note-taker on the planet. Among those in my study groups, we all knew all the reasons - just not their relative rankings of significance. It's in no way important that we have that ranking committed to memory, and , furthermore, it is somewhat arbitrary and the opinion of the professor who wrote the test item.

I noticed about six people with gloating-like expressions on their faces. They had note cards with the reasons listed in order. I wouldn't say it is impossible that the professor in question told them the specific test questions he wrote. In the grand scheme, it probably doesn't matter much, as it was a mere 2-point question out of 100 points. If the test were a competition, which it theoretically isn't but in reality is, those students who benefited (if they indeed did have prior knowledge and it wasn't my paranoia projecting the looks of superiority on their faces and the pertinent note cards in their hands), the few points that they gained on the rest of the group from the inside knowledge of any test items (only one of which tripped up the rest of us) would not have been sufficient to put them in ranks of those who are likely to have maxed the test out minus the trick question.

98% is still an acceptable exam score, I suppose, but I don't like it. (On a couple of  exams we had an opportunity for extra credit, but there was no opportunity on this test.) My sole consolation is that the two students who are the ones I'm relatively sure outscored me on the MCAT also missed the test item. It's not that I feel such a sense of competition between myself and the two who are smarter than I; it merely makes me feel better that if anyone as smart as they could miss it, maybe I'm not a complete moron for having been tricked. I suspect everyone did except the few who (in my opinion) had inside knowledge.

Today's test was the paper-to-pencil test for "The Practice of Medicine."  tomorrow is the practicum. I was already told that the prof who wrote the bogus question will not be one of my evaluators for the practical final. He and I had a run-in earlier that I talked about at the time but won't go into right now. The other professors agreed that he could not be objective in regard to me. 

It's possible that the professor in question never tipped anyone off to any answers even if the other students had prior knowledge. They may have come across the material without his having directly supplied it to them. I'm trying to be rational and consider the possibility that there very well might not have been some sort of massive conspiracy theory involving a professor. I'd like to believe the professor is a jerk but not necessarily corrupt.  Where the students are concerned, however, I refuse to believe they weren't in the know on a few test items prior to the test. Again, I may sound paranoid, but if you saw them joking amongst themselves -- it it was the way they were joking more than the mere fact that they were joking about it -- I suspect you would understand of what I speak or write. The last laugh will be on them, as there was no indication from their discussion that they had any special knowledge of any portions of the test other than the items written by the professor in question. Their scores will be mediocre at best

Tomorrow I need to simply focus on my practical exam. The profs evaluating me will be on my side and will want me to do well, which will have an enormous impact upon their respective views of how I actually do. Moreover, I feel qualified to nail tomorrow's test.

Following the entire cohort's completion of tomorrow's test, I have two options. The first is the most obvious, which is to let the whole thing go and take the 98%. The second option is to approach my adviser with my concerns regarding both the one question in particular and the likelihood of a particular social group which does not even comprise or derive from a particular study group correctly completing the test item. What are the odds that they, of all students, would nail that particular question while the two certified geniuses in the class (of which I am not one, by the way) would miss it?

I'm willing to venture that there was a likely breach of the honor code involved in this situation. Most likely I'll leave well enough alone and allow Karmic forces to right the universe without my assistance, although I may bring it up to my adviser long after the fact in a most subtle and hypothetical way early next year.  

Some standardized tests designed primarily to measure how well elementary and secondary schools are doing their jobs as opposed to assessing the achievement of individual students insert plant questions into the tests. Such are questions that are not part of the curriculum of the grade level or of any surrounding grade level and that students of the particular grade level being tested should have no way of knowing. (For example, ask second graders the atomic number for radium and who was our nation's fourteenth vice-president. Ask third-graders to name and tell where, when,  was the largest amphibious invasion ever to have taken place. ) Of course there could be some random reason for an extremely  small portion of the testing population knowing the answer to one or more of the plant questions, but if too many students from a given class, school,or district were to get the answers right, it should be a tip-off to the state or agency that administers the test that irregularities are happening and that certain districts or schools need to be monitored much more closely for rampant cheating. One would think educators would be too intelligent to fall for this ruse, but such is not always the case.

I might suggest to my adviser that our honor system has more flaws than most of the professors and even most of the students would care to admit, and that several plant questions left in places where students are not supposed to be but sometimes gain access to, which could then be randomly inserted into exams,  might give the administration an idea as to at whom to start looking for those who do not take the honor system as literally as do the rest of us.

Seriously, even Matthew came out of the class commenting on how ridiculous the test item was. When Matthew doesn't know something, he typically assumes, correctly, that it was something he forgot to study. When even Matthew knew there was something wrong with the exam item, it was a clear indicator of something bizarre having been asked of us.

@$^&()$^!!! I got a freaking 98% on a test I should have maxed.

I know her pain I am this girl right now.


  1. I understand your annoyance and frustration. On the bright side, I guarantee that is a question that will never trip you up again. Nobody's perfect. You got a 98%. Enjoy it!

    1. the best analogy I can create is that, if in a pop culture course in which the text materials did not even touch the subject and the teacher hadn't lectured about it, a test item was "Name in order the seven most significant songs in rock and roll history." Not "as based on rolling Stone's recent ranking" or anything similar, but simiply read the professor's mind and rank the seven most significant songs in rock history. Don't offer your explanations to justify your position.; Merely read the professor's mind.. I have a prblem with a test item of that nature. (There is no consensus as to aaany ranking. The reasons would be that insertion of barium into the colon of someone who had symptoms of appendicitis would be most uncomfortable and potentially dangerous, that enough gas is in the bowel that it would be easy ton miss an inflamed appendix, that the pressure required in the exam would be uncomfortable and potentially dangerous, that it exposes the pateitn to radiation that probably outweighs the benefit, that with an obese patient, it's virtually uselesss, and that it's not nearly as relaible, even with an elevated WBC, as several others measures. i knew all the answers. I ranked them in what I thought was a logical prioritization, (not the order I listed here) and even gave justification for my rankings those who ,mysteriously had the note cards with the profs reasons listed in order got credit with not explanation or justification, and no one knows where the info to create the note cards came from. the Taiwanese-American girl in my group would have caught it had it ever been even hinted at in lecture, and it would have been in her notes.) The guy was just being a bully. There shouldn't be a place for that in medical school.

  2. Alexis, like everyone you are looking for peace. But it does not lie in the physical world. By looking for it there, you will get frustrated. It lies inside of you. So when you get professors that are not as smart as you, there will be disagreements and you will lose since they are the professor.

    Try to feel some empathy for William James Sidis. Many consider him to be the smartest guy who ever lived, ever! At age 10 he was ready to go to Harvard, but they said that he was too young. So he went to Harvard at age 11.

    I am telling you this since it applies to you. So this kid was much smarter than his teachers (he became a professor at age 17). But he only got Cs in his classes since his teachers and him did not see things the same. Both his parents were physicians. So if you get higher than a C, you are doing better than he did.

    These 2 certified geniuses will probably end up being good doctors. But you could end up being the greatest POTUS (President of the United States) ever. I just saw the new Disney movie-- Wonderland. In school they were teaching about all the problems in the world but not about the solutions. So there was a group that were looking for "dreamers" since they are the only ones that can help the world.

  3. So is the above professor the same one that said that you killed a fake patient or is that another bane? This blog is about them, not you (the Many Banes of My Existence). Bane-- a cause of great distress or annoyance.

    Generally the smartest people become doctors. Ron Paul is a physician and was a congressman when he ran for president. Jill Stein is a physician and ran for president in 2012 under the Green Party. Both the above had no thoughts of being in politics when they became doctors so you need not think about it now. Neither of them were not also lawyers.

    So do your best in medical school and life but do not let these things get you down. Here is my advice for this time in your life (I am so un-original), but we both like this song.

    "Another turning point, a fork stuck in the road
    Time grabs you by the wrist, directs you where to go
    So make the best of this test and don't ask why
    It's not a question but a lesson learned in time

    It's something unpredictable but in the end is right
    I hope you had the time of your life."
    Good Riddance or Time of Your Life

  4. Knotty's right. Take solace in the fact that you will never forget the answer to that question!

  5. What no one seems yo acknowledge is that it was a non-answer. if it were an actual answer to a for-real question, it would be a fact that embedded itself in my mind permanently. It was almost as if the professor asked us to ranks his favorite colors of the rainbow in order. It's about equally pertinent to the study of medicine as that question was. it's about HIM, not about medicine. I asked five other professors the question. They all thought it was stupid in the first place, but they all also had five different answers. he might just as well as plucked a card out of a deck, looked at it, put it back, then graded us on our ability to guess what card it was that he saw.

    1. Yeah I understand what you are saying and agree it's totally ridiculous. Not quite the same thing but I took a class in undergrad where the first test had an average of a 60% or something horrendous because in my opinion the test was extremely poorly written and you had to know the professors opinion about everything. (It was a humanities class surprise surprise). When we complained she refused to agknowledge any problem with the test and told us to study harder next time. I promptly dropped the class because I refused to get a non A grade in a class that I didn't absolutely need to take for graduation and wasn't dying to take. Best decision ever.

      I will say that as annoying as it is to not get a perfect score because of something as dumb as this completely out of your control, I bet that the rest of the faculty noticed this abnormal question and that the top performers all ended up with 98s instead of 100. I'm guessing that this faculty member is probably no ones favorite and is generally disliked. I'm also guessing that this will have no bearing on how you are perceived and eventually ranked among the rest of the faculty because I'm sure they know. If you must I would bring it up casually or better yet have Mathew bring it up since it seems like he may get less backlash if he is the one (something about jock type complaining vs small super smart girl complaing, believe me I was the small smart girl who people liked to ignore excessive complaints).

    2. i think i will have Matthew bring it up in one of about four faculty-led study sessions in which we'll be required to participate. That is a very good idea. I've not conplained before, but i get the sense that if I did, it would be perceived as Dr. x's kid, who thinks she's more important that any other student because she's Dr. X's kid. where Matthew wouldn't be perceived that way at all, or would laugh it off if anyone did suggest such was the case.

  6. I can sort of relate to this. I COMPLETELY froze on my Political Science final. Like, embarrassingly froze. I have this terrible habit of being the last one still sitting taking a test. I believe it is because I write more than others do. That was a bad day for me, and it was with the professor that called me anal retentive. He was sitting at the front of the room, and I was still sitting there writing, and I was getting paranoid because I didn't want to keep him there more than what was allotted. Anyway, I knew this material like the back of my hand. I had discussed the material, I had written about the material. I knew it, I've known it since middle school for crying out loud. However, I totally flubbed up on the order of the Civil Rights Amendments ... basically I said that the 13th Amendment gave slaves the right to vote, and the 14th Amendment abolished slavery ... which obviously makes zero sense, but in my angst I mixed them up. It is incredibly embarrassing, and I am pretty certain that I probably messed up a bunch of other things due to test anxiety, but it didn't end up hurting me at all grade wise. I think he curved ... and my scores were second best in that class, second to the guy that is a history major.

    Anyway, I understand the frivolity of that question. Why do you have to know something that is never ever going to come up now that medical technology has advanced? It's irrelevant. I mean what year is it? 1975? Why would anyone elect to put a patient through a rather invasive test (I've done gastrografin enema to look for fissures ... they literally stand you on your head. I am not talking about Trendelenburg, either!) when you can order a CT and diagnose the problem without the mess (Because in a normal person ... I don't even want to think about it! I am saying this as someone with bowel paralysis.)

    I've ingested enough Barium in my life ... it is absolutely dreadful. Up the ass is probably better but that stuff gets hard if it isn't passed right away. I had a barium contrast study done in April (I emailed you scans since they have perplexed Dr. B and radiology, and I thought you'd be interested in seeing something that my doctors thought was unusual.) It took a few days for it to all leave my stomach through my G tube. First off, the doctor who did it lied and said that they only put 25 ml in. The report I received said 50 ml. Which, isn't really a lot, but it stayed in my stomach and I had to deal with it clogging my tube. I have a strong opinion about barium contrast studies, and after my last experience I will fight like hell not to have to do it again.

    Another thought I am having; It is said that this was one of the causes that led to Elvis' death. I'll let you read it for yourself. I am slightly suspicious of the source, however it makes sense.

    Soon enough you will be on summer break, enjoying your free time with Andrew and the new baby girl. My summer break is quickly coming to a close. I follow up with Dr. B next week, hopefully we have a plan for my stomach "deformity" (that's what he's calling it, I think that's a strong word ... Although my pylorus is practically next to the bottom esophageal sphincter ... I guess that's deformed?) and then I have 6 weeks of classes and psych research that I am assisting with for my psych class. I am not sure how glamorous that is going to be, seeing as I am only a sophomore, but I am excited for the opportunity.

  7. Assisting with research is pretty exciting regardless of your grade level status. I envy you, If I'm really lucky I'll be slightly involved with research by the end of next year.

    I probably didn't see emails because it was between 2Q finals and the Claire thing. I'm going to look for them. It is interested. I'll end up in pathology or radiology, so it's something with which i'll need experience.

  8. If you haven't heard this before, you will on your psych rotation, should you elect to do one: You may be paranoid, but that does not
    negate the possibility that someone is really out to get you.
    Glad the other profs recognized this.

    1. I try hard not to be paranoid, but there is wisdom in what you say.