A Paradigm Shift - Reflections from Blinded Assessment of Online Learning Portfolios of MBBS Students

Another academic year has passed and a fresh batch of interns has arrived, and with each passing year, I feel 'academically older' and feel like I'm from the distant past. Inconspicuously, I have found myself wearning rose-tinted glasses on my hindisght and see my yesteryears as 'those glory days'. However, system 2 thinking takes over and I quickly realise that I was (and am) as the current crop of students are - incomplete, yearning to learn, with some sense of fear and insecurity as to what the future beholds.

I was recently invited, along with my dear wife Dr. Madhavi Latha, to provide a blinded assessment of 32 students who just took their final MBBS exams, by assessing their long case, short case and seeing their performance recorded on video (only some students' videos were reviewed). The goal of this project is to compare their performance on their learning portfolios, to their university marks/assessment. The paradigm shift is in how we've moved from an offline, possibly unaccountable grading system to an online, open access system.

The Good

I'm a staunch proponent of data continuity and precise data documentation and I was impressed to see all 32 students understanding the value of precise documentation and some of them were exceptional in their committment to precisely document the medical history of the patient - in symptomatology, in their daily routines and gleaning out the factors which may have contributed to the presenting disease. Most students demonstrated clinical signs very well and it takes some guts to openly demonstrate clinical signs on video and posting them on open access platforms. Kudos to the students! Documentation of lab data too was precise and most students demonstrated an understanding of these labs, albeit very few showed competency in interpretation of these data.

The Bad

I believe that an MBBS curriculum must be designed to churn out competent doctors or practitoners and I believe that the central pivot to this is - coherent critical thinking with a healthy dose of skepticism and to scrutinise the evidence and literature with minimal bias. Central to this idea, is the freedom of expression without fear and to step out of groupthink. Also, out of the box thinking should be encouraged. I felt this is where most students fell short. Most students performed well in the domains of history, physical exam, lab data interpretation and case analysis, singly. However, I felt that there was a conspicuous lack of coherence in linking these domains sequentially. Quite a few historical points were irrelevant, the clinical exam was sometimes overly templated and not driven by the hypothesis generated in the history. The lab data was not married to the history and physical and the diagnosis in most cases was wayward and spoke past the other three domains.

While I'm confident that with time and repetition, these young students will see the light of the day on coherent critical thinking, I'm equally pessimistic, that the design of Indian Medical Education may engulf them in chasing outcomes which may not necessarily benefit them or their patients. There are several nodes which are currently not in communication with each other and these have to be connected.

The Ugly

Plagiarism remains a key problem, which needs to be tackled. It is symptomatic of chasing outcomes instead of developing 'first principles'. I also noticed diagnostic inertia, where quite a few clinical conditions were attributed to a particular cause, which may not necessarily be true. This is not directly linked to the students themselves but more a collective failing of all healthcare providers.

All in all, it was a privelege and honor to have graded these students. Some students really took ownership of their jobs and demonstrated critical and out of the box thinking too. Their results are published below.