Saturday, December 15, 2012


Today, I worked in the university I belong to as an examiner of school of medicine.

Japanese medical student has duty to pass several exams to get physician license. Before starting clinical clerkship program they learned about medical interview skill.
So we establish a committee to evaluate their skill and perform general examination (Objective Structured Clinical Examination; OSCE). I observed conversation between a trainee and a simulated patient in ten minutes and scored their performance according to grading standard fixed in advance.
The exam is highly structured and well developed. We made use of clinical skills center newly build. To avoid cheating, students are not allowed to equip mobile phone, and even if to get out until the exam ended. The memorandum they described is to be used at the next exam about writing medical record. To certificate equality of the students the process of exams is determined so strictly that valiance was minimized. We took good care of performing fair exams.

But, what is good examination is not a simple problem.
Obviously, the answer is different between selective examination and certifying examination.

The former, we regard fairness as very important matter. It is not good at all that some students have advantage upon others. Students differs one another, in age, sex, race, estate, and so on. The standard of selection should only due to his or her skills or intelligence. Otherwise the exam itself has no value.

However, certifying examination is not a competition. This kind of exam is to assess the student. When the student has specialized skill to be worth of a license he or she should pass the exam. Then it is a problem that what kind of skill is to be assessed.
For example physician license is very specialized privilege in Japan. To get the license you must enter medical school and learn about medical science for 6 years. Finally after graduating from medical school you must pass the national examination. But the skill of doctor is not the same to passing the exam. It is problem solving skill. It includes communication with patient, observation of the patient deeply, to hypothesize about what is wrong with the body and mind of the patient, and treatment. They are hardly assessed with an examination. On the other hand, if the physician has very few knowledge, when he are intimate with other authorities, he can consult another one. Human resource is one of real power for a physician. Nowadays social network enabled us to ask for help. So skills to use several tools are also important.

Traditional examination style in Japan is going to be out of fashion. I hear that searching via internet is allowed during exams in Denmark.

We have to consider new style of examination suitable to modern world.

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