Marking

My discussion yesterday largely referred to the macroscopic system of passing a student and conferring the medical degree. A related and more commonly encountered problem is how we score our students during the examination.

I suppose most of you know the old traditional time-honoured system is impression marking, which, unfortunately, does not sound very scientific. In the recent years, both the Royal College as well as our own medical school switched to use a structured marking scheme. In other words, if the student could answer a certain point in the written paper or accomplish a particular area in the clinical examination, he scores a point, and the overall mark is the sum of those from all areas.

It sounds robust, eh ? The difficulty is, however, under this system, for example, a student could pass even if he says he would give cyanide infusion for his patient, or beats up the surrogate during the short case - provided that he answers and does everything stated on the marking scheme right.

(In reality, of course, it never happens. Many of us use impression marking to give the total score, and we work backward to make up all those sub-categories.)

PS. There are ways to get around with this problem. A commonly used one is the inverse marking scheme: A candidate score full marks at the beginning, and scores are deduced along the way whenever he commits a mistake - and the among of deduction depends on how bad the mistake is. One major error (for example, potentially life-threatening omission) would lead to failure.

You think this scheme innovative ? Not at all. The Olympic Games use it to score gymnastics for many decades. It is, as a matter of fact, the orthodox method to assess performance of practical procedures.