Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Tests in medicine and public schools: What do they really measure?

Shirie Leng, MD
Physician
May 10, 2015
Share
Tweet
Share

Humans are social creatures who naturally evaluate where they stand in relation to those around them. I have no idea how this evaluation process evolved, but at some point we noticed that some cavemen brought more food to the cave than others. The idea was born that some people are better hunters than others. We’ve been trying to decide who is “better” ever since.

The origin of the word “test” comes from Middle English, and referred to a vessel in which metals were assayed. That is, the test determined what kind of metal was present in the vessel. So a test functioned as an identifier, similar to the way certain medical tests identify specific bacteria. Today most people, when they hear they are being tested, don’t think about the test as just a source of information. People think of testing in terms of evaluation or comparison, a judgement about some aspect of their knowledge or abilities. Someone is better, and someone else is worse.

Here is how Merriam-Webster defines test:

  1. A critical examination, observation, or evaluation.
  2. The procedure of submitting a statement to such conditions or operations as will lead to its proof or disproof or to its acceptance or rejection.
  3. A basis for evaluation.
  4. An ordeal or oath required as proof of conformity with a set of beliefs.
  5. A procedure, reaction, or reagent used to identify or characterize a substance or constituent.
  6. Something (as a series of questions or exercises) for measuring the skill, knowledge, intelligence, capacities, or aptitudes of an individual or group.

Notice the terms “critical,” “ordeal,” “measuring,” “evaluation.”

We have tests for everything. And people are getting sick of tests. Observe the growing backlash against public school testing in New York. Observe the questions arising about medical testing. Observe the pushback from physicians over maintenance of certification exams.

Some tests are good, right? A blood test to identify HIV is good. Quizzing yourself after reading a difficult passage in a textbook is a good test. Covering up the multiplication tables and seeing how much you can do by memory is a good test. Testing the gem in your engagement ring to make sure it’s diamond and not cubic zirconium is a good test. What makes a good test? The Center for Public Education says that test should be “valid, reliable, and free of cultural bias.” Essentially, a good test reliably measures what you want to measure, and, presumably, doesn’t measure what you don’t want to measure.

Let’s take an example. The PSA test evaluates the blood for a prostate-specific antigen that, in high amounts, can be an indicator of prostate cancer. So it measures PSA. That’s all it does. It does not measure how much time a man has left, or mortality rate, or rate of prostate cancer growth, or what the man will eventually die of. In short, it gives you a number that you can’t use. People think a PSA will tell you if you will die of prostate cancer. For that, you’d need a good test. Like a crystal ball.

Here’s another example. Common Core tests kids as early as third grade. The problem with these tests is not that you don’t get useful information. It is that the information you get is not what you want to measure. The test is supposed to measure knowledge but instead tests memorization. It is supposed to measure learning but measures test-taking ability. And actually it isn’t supposed to measure knowledge or learning, but teacher quality. But the test is not administered to teachers, so the test not only doesn’t measure what you want it to but tests the wrong subjects. The result is that students and parents think the test measures the intellect and worth of the student, and school districts think the test measures the intellect and worth of the teacher.

The same problems exist for the maintenance of certification (MOC) exams in anesthesia and other specialties. The tests are time-consuming and expensive and measure memorization and test-taking skills that have nothing to do with quality care.

By some unbelievable miracle, the American Board of Anesthesiology has just announced that they are getting rid of the MOC tests, largely in response to vocal backlash by physicians. Hopefully, a similar outcry from a growing number of parents can effect a similar change in the public schools. It would take a miracle.

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.

Prev

Grandparents who spend their old age raising their grandchildren

May 10, 2015 Kevin 0
…
Next

Why should doctors use Twitter?

May 10, 2015 Kevin 1
…

Tagged as: Primary Care, Surgery

Post navigation

< Previous Post
Grandparents who spend their old age raising their grandchildren
Next Post >
Why should doctors use Twitter?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Shirie Leng, MD

  • The choice between medicine and nursing

    Shirie Leng, MD
  • New technology might help us become more empathetic to others’ suffering

    Shirie Leng, MD
  • Does practice really make perfect?

    Shirie Leng, MD

More in Physician

  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Mastering medical presentations: Elevating your impact

    Harvey Castro, MD, MBA
  • Marketing as a clinician isn’t about selling. It’s about trust.

    Kara Pepper, MD
  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • How art and science fueled one woman’s path to medicine

    Amy Avakian, MD
  • In a fractured world, Brian Wilson’s message still heals

    Arthur Lazarus, MD, MBA
  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Recent Posts

    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • It’s time for pain protocols to catch up with the opioid crisis

      Sarah White, APRN | Conditions
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How locum tenens work helps physicians and APPs reclaim control

      Brian Sutter | Policy
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Recent Posts

    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • It’s time for pain protocols to catch up with the opioid crisis

      Sarah White, APRN | Conditions
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How locum tenens work helps physicians and APPs reclaim control

      Brian Sutter | Policy
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...