Today I am reflecting upon a concept proposed by Cate in the article “What happens to the student?” I was particularly intrigued by the argument that it is impossible to measure the effectiveness of medical education strictly by evaluating student performance on tests. The main reason for this, as discussed in the article, is based upon the students’ ability to compensate for poor medical education, simply by increasing the time spent studying and learning outside of the classroom. Conversely, exemplary medical education may result in less time spent studying for an exam. The end result is similar student performance on tests and exams, despite possible discrepancy in educational quality. While I had never actually given any direct thought to this theory, I absolutely subscribe to its fundamental philosophy, based upon my experience with undergraduate medical education.

I would argue that the impact of this phenomenon might even be underestimated in this article. While based only on my own anecdotal evidence, it seems as though compensation is compounded through repetition. After hearing from upper year students about a particularly difficult exam, my fellow peers and myself would make sure to spend extra time and effort in preparation for said exam. Of course, this means that attempting to infer the quality of medical education based on the results of this exam would be even more misleading than before.

Given these insights, Cate proposes that perhaps we should be investigating how the student behaves after medical education, in preparation for exams and clinical encounters, as a better predictor of the effectiveness of medical education. While this seems like a reasonable solution, it may be hard to collect this type of data, and relies heavily on self-reporting measures, which are not always accurate. It is possible that further work in this field would elucidate superior methods for collecting this data and evaluating the effectiveness of medical education as a whole.

-AS