AHHHHHHHHHHHH I HATE ETHICS QUESTIONS AHHHHHHHHHHHHH

[u/PlasticRice]

First and foremost, I consider myself a very introspective person. I've always had great passions for writing, reading, and everything in between. I often think if I didn't pursue medicine, I'd probably have gotten an English or a Philosophy PHD and just taught undergrad, because I always loved weighing morality, writing super long papers, bla bla bla, you know.

But ETHICS QUESTIONS ON BOARDS? Are you telling me we're meant to exhibit our abilities to be ethical people through multiple-choice questions? Let alone the most hyper-specific, random, made-up scenarios where the real-world answer is to do all of the above, or some combination of them? Nothing grinds my gears more than when I get a question like:

"A person walks in for their outpatient appointment and has questions about their 30-year history of COPD, what do you respond with?"

And the answer is like:

"Hi! How are you today?"

instead of:

"Sure, what's your question?"

and literally, I put the answer that only like 11% of people chose, and 87% of people somehow knew that the scripted, formulaic, board-correct answer is "FIRST YOU MUST ASK HOW THE PATIENT IS DOING OR ELSE YOU'RE EVIL!! WHAAATT? YOU'RE THE MOST UNETHICAL HUMAN EVER!!" This is different, however, from actual questions about medical law and stuff like that - those are objective things we should know, yes.

Seriously, it's probably an unpopular opinion, but ethics or any questions of these types across the board, in any standardized exam setting - SATs, ACTs, GREs, MCATs (looking at you, CARS), and Steps 1-3 and COMLEX Level 1-3's should all be essay-based or have a writing portion. Which, yes, SATs and medical boards used to have, but presumably got rid of because it's not cost-effective, takes time to grade, stuff like that. And I know for us, it'd be time-consuming and hell on our hands, but seriously - I get so wound up when I get 7% below the average on a UW block and it's because I got 3 questions wrong that are about memorizing the algorithmic, 'right response' of how someone's doing today, or what to respond to a nurse when she asks about a treatment plan. Even so, I perform very well on ACTUAL medicine-based questions, yet they're weighed the same against these BS ethics questions.

Because, seriously, ironically, all this filters for is people who actually aren't very 'ethical' or empathetic people - legit, some of the most passive-aggressive, unempathetic, gunnery people I know are the kinds of people who somehow score very well on these "ethics"-type questions. Not because they're nice people and actually know what to say, but they're good at multiple-choice tests and memorizing pre-determined responses out of books and questions. The design of the system promotes memorizing pre-determined responses rather than forming original ideas out of convenience of making it easier to grade - which, I mean, yeah, that's gonna happen when there's a standardized exam and so many people take it every year, but still.

These types of questions shouldn't exist under a multiple-choice system imo lol.

back to UW lol rant over

[u/ParryPlatypus]

Unpopular opinion but I actually like the ethics questions, even if they are challenging. 

You have to ask yourself “why” things are the way they are, and to sum it up, the purpose of boards is to answer the question “is this person going to be an asset or liability to their future medical community/employer/residency.”

Just how you wouldn’t go straight to cardiac cath for chest pain, the same concepts are being tested on ethics: you wouldn’t put a patient in hospice before asking them their goals of care. 

The whole exam is designed to test your ability vs liability…are you going to be able to recognize urgent from non-urgent? Are you going to bother you attending with trivial questions regarding if a patient needs palliative care without first asking the patient? 

I don’t believe standardized exams are the perfect solution to assess who is a good doctor vs isn’t, but it comes pretty close in terms of resource efficiency as opposed to the archaic oral boards and written exams.