The Illusion of Assessment

I thought I'd be productive with my time tonight and put aside the bullshit I've been feeling. How much have I retained in the last three years? Could it be that I am actually good at medicine without having to study that much? Have a retained the information I've been barraged with by every lecturer who thinks that we only need to know what they have specialised in?

The short answer is no.

Productivity is a constant reminder to me. A reminder that states bluntly that I am so far behind regardless of how much I progress. It seems that the road's end is no where to be seen and that's just how it will remain for the rest of my life as a practising clinician regardless of how much I decide to study.

Thinking about the mathematics of exponential growth, I remind myself that if, theoretically, I stopped all my clinical practice as a student, knuckled down for a year to catch up with the current literature, practices and management protocols, I would easily be behind by several years of research. Several years because the research of the current year had been instilled for the following years and prospective studies and their analysis would take more than a year before it modifies clinical practice.

Dissecting the concept of being behind by that much really didn't help. One of the things I was supposed to complete before I started the surgical rotation was an online assessment, which we call 'required formative'. This means that it is a required assessment, however the results would not be recorded on the system.

So I sat down at my computer and decided to do the 75 question assessment: 70 SBA-MCQs and 5 EMQs on various types of medicine: Cardiology, Respiratory, Rheumatology, Haematology and Laboratory studies. The joy was that I haven't done any of those in the past 10 weeks. My first four weeks were in Geriatrics and the final four in Gastroenterology; neither disciplines were examined and the fact that I'm on the Upper Gastrointestinal Surgery team didn't help either. I remember that some of my friends had their Cardiology, Nephrology, Infectious Disease, Respiratory and Haematology rotations already. They would be so many steps ahead of me already.

It really does drive me absolutely ballistic. I have been examined in the fields that I have not practiced in and the Faculty's response to that would be: "Well you've done in your first two years in lectures. That would have been more than adequate."


So I sat the test and some of the answers were obvious to me and others obviously required so much more knowledge on specific specialties than I would have dreamed to be exposed to in Geriatrics or in Gastroenterology.

At the end of it, I got my result of 53% and wondered, how much more would I have had to study before I even got close to 80%? Then I laughed, remembering that no matter how much I would have studied, it would not have helped anyway since I would have studied Geriatrics or Gastroenterology, rather than any of the specialties they wanted me to study.

No matter how hard I study, no matter how much I bend my back - even if it does mean I snap it - I will never be ahead of it. I will never know enough to help absolutely everyone.

I can never know enough medicine, never enough surgery. There's no such thing as studying enough, no such exam that could objectively test every medical principle.

Tomorrow we start at 0630 and the only thing I can think of is a saying in a movie:

"Just take comfort in knowing you never had a choice."

Somehow we always thought the road would always end since it does spatially

in our vision. But the truth is, parallel lines only ever meet at infinity... somewhere

we, as human beings, can never travel. Just take the road less traveled by, and

hope your decision was worth it. There's no turning back.