‘Is this going to be on the exam?’

I love teaching medical students; it’s an enjoyable part of my life that allows me to engage with the future doctors of tomorrow. It’s an opportunity to step outside of the clinic and apply my knowledge and skills to mentor and guide students. Whether I’m teaching students how to take a blood pressure for the first time (which seems routine for us but is quite the epiphany for new learners!), explaining why ordering hormone panels on everyone isn’t reasonable (an interesting conversation regardless of how many times one discusses it), etc.—being a clinical educator brings me great joy. At the same time, teaching medical students brings challenges and frustrations. There are, unfortunately, students who show disinterest in what they are learning, ones who show up late on a consistent basis, learners who insist on debating everything that I’m teaching and more. And while all these situations are irksome, there’s one question that drives shivers down my spine and makes my heart palpitate:“Will this be on the exam?”Read: Dr. Marina Malak: Burnout: is anyone listening?I like to think of myself as an optimist—I give others the benefit of the doubt. I’ll give excuses or reasons for behaviours and speech, when reasonable, to try to see the point of view of others. I strive to put myself in other’s positions so as not to make hasty conclusions about individuals when they say or do something that I disagree with or find unreasonable. So, as I’m wrapping up a teaching session and ask students if there are any questions, and learners asks me if what I just reviewed will be on the exam, I try to see it from their perspective: these students are likely overwhelmed with an abundance of content to learn, memorize, and master. It’s a human inclination to try to save brain space—to only focus on retaining what it absolutely critical to remember. If they don’t need to know the name of the clinical sign of periumbilical bruising (it’s Cullen’s sign, if you paid attention to the first-year medical school!), why bother remembering this piece of information (other than sounding smart and impressing others, of course!)? However, the exam question makes me sigh as I try to shake the feeling that the students couldn’t care less about what I’m saying unless it’s “testable.” My brain starts to review the entire teaching process—all the preparatory work that I put into this session, only to have the students focus on what’s testable; the fact that I even tried to be “a cool tutor” by sharing clinical snippets of my practice (which makes the session more practical); the fear that these students find me boring (is that a voice of insecurity creeping in?) and more. Moreover, I feel a hint of resentment, which I feel hesitant to admit: is the exam the only thing that really matters in medical school? Have we really reduced medical education to what learners get evaluated on, even if it doesn’t contribute to their growth as future physicians? Does it mean anything to the regulatory medical colleges if students know that the second heart sound is caused by the closure of a certain valve (yes, I didn’t name it because I forgot which ones!), but struggle with de-escalating a patient who presents to the clinic and displays aggressive behaviours? Have we made a culture in medicine that states we care about wellness and professionalism, but creates a culture that prioritizes medical jargon, witty clinical explanations, and perfect scores on anatomy bellringers?I don’t have a one-fits all solution—to start, though, I reply by giving my students the look. It’s a look that says, “I am so disheartened that this is what medical school and society has caused you to believe is the only thing that makes doctors effective.” It is also a look that says “is that all you care about? I hope you have been listening to the entire session.” The look also relays the blunt message, “does it matter if this is on the exam or not? Now you know a medical fact!”My verbal response is usually something along the lines of “I’m not sure; it might be. I would know it just in case. If it yes—great! You know it. If it’s not, excellent! Now you know it and you are a better future physician for it.” As the session closes and my students and I reflect on what went well and what we can do differently next time, I become joyful as the learners tell me that they had fun, that they learned new things, and that they feel closer to being a real doctor. They tell me that they enjoyed the “real patient stories” that I shared, which made the learning content more relevant. Inside, though, I still can’t shake the feeling that something must be done about this “is this testable” question. Who do I talk to? Universities? Curriculum planners? Fellow tutors?For now, I’ll keep doing what I’m doing, navigating the question with my “look” and succinct and honest answer. It almost makes me think—jokingly, but honestly – when interviewing clinical faculty, perhaps this should be an interview question:“How would you respond once you are a doctor to a medical student when they ask you, ‘is this going to be on the exam?’”Perhaps we should also start promoting “the look” as one that all medical tutors should master in response to “the question.”Dr. Marina Malak is a family physician in Mississauga, Ont.

‘Is this going to be on the exam?’

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