Oi, Mush!!!

I apologise in advance if this week’s rant is a bit down in the dumps, but my brain is mush. I’m slap bang in the middle of my SNOMED-CT final exams and my head feels like it’s going to explode.

Let me set the scene:…

SNOMED-CT goes live across the NHS in April of next year (although it’s pseudo live just now through the hard work of some software vendors) and I want to pass this course in order to give some street cred to my development work in hunting down disease through what I’ve termed data detective work. In my day job, I do two things: I write software and I ride my bike (while thinking about writing software): in pretty much that order.

SNOMED-CT is very, very heavy duty gear, and this course, the (advanced) implementation course, is all about implementing software systems to use the de facto global standard in clinical healthcare. I’ve come at this from a background in software development with zippo experience of all the medical jargon.

The course has six modules, and to keep the numbers easy, let’s say there are ten presentations in each module. It’s all done by distance learning in your own time, and at the end of each module, you have to sit an exam in which you have to score 70% or more to stay on the course. I had one or two close shaves along the way, me having no medical background etc, but I made it through the final Module F exam on Tuesday, which got me into the playoffs for the big prize: a course certificate!

The collateral damage of being on this gig is that I haven’t been the easiest person to live with these last few weeks, and for that I apologise. This course has been as difficult as any that I’ve ever undertaken, and while a wee part of me is whispering “why are you putting yourself through this at age 64, another part of me is shouting ‘just keep the heid’…”

So to the final exam: it comes in three parts, and they count for 8%, 4% and 8% of the final course mark. But the same constraint that applied all the way through the course, that 70% benchmark, also applies in the final exam. You have to average 70%+ out of those three exams to pass the course. The fact that you actually made the playoff final in the first place is because you’ve proved all the way through the league programme that you can knock off these 70%ers, but this final hurdle comes with a special twist…

Each exam that came at the end of a regular module had 20 questions in it, and of course it covered just the material that you’d studied in the most recent block of the course: so you knew from the off that the answer to each question lay deep within one of those ten or so Powerpoint presentations that you’d sat through, and taken notes from (of course you took notes!). In every one of those exams (bar one, I recall), you had four hours to answer the questions, submit your attempt, and cross your fingers that you’d done enough. You always had the option of a re-sit if you failed to get the required 70%, but the rules of of the game have always been that your final attempt (of two) would be the one that counted. So in the case where you scored, say 72% and wanted something higher, you really were risking it for a biscuit if you did a re-sit because you’d know way of knowing where you’d lost 28% and 72% is way too close to the trap door to take the chance. So basically you took the hit and moved on the next round.

There’s one thing to remember from that wee story: 20 questions in four hours, based on ten presentations of source material.

Cue part one of the final exam yesterday: ten questions, covering the whole course, ie drawn from around sixty source presentations, to be completed in one hour.

Panic attack!!!!

I kid you not: I went out on my bike after the first attempt, in a state of shock. I reckon I must have spent a good two to three minutes per question, just searching through the source material just so I could make reference to the relevant theory stuff. And that was after I’d translated all of my notes into one giant spreadsheet so that I could do keyword searches to save time. I reckon I must have used up at least thirty of those precious sixty minutes hunting for stuff: so that meant I had to wing my way through half of the answers.

The result of that, of course, is that you can expect a truly rubbish score, which is precisely what I got (but nowhere near as today’s rubbish in the practical exam, I can assure you). But get this: you have up to three attempts, each of one hour, and your final score from that exam is the average of your attempts.

So… for the league programme (the six regular modules): twenty questions in four hours based on ten presentations. For the play-off final however, it’s ten questions in one hour based on sixty presentations.

Now do you see the fear in my eyes?

Strategy plays a massive part in this game: you get to see the questions in attempt one, and you screenshot them. You get a rubbish score because your eyes are constantly drawn to the clock when you should be thinking, and then you go away to do your research offline and come back for another go.

Remember you get a maximum of three attempts, and all you get at the end of each attempt is a score: you’ve no way of knowing which of your answers are right and which are wrong. It’s entirely down to your own judgement.

So suppose that in your first attempt, you get 60%. Remember you need to average 70+ to stay in the game. You go away, armed with the questions, change the answers that you think are wrong, then come back for another bite at the cherry. Say you get 75%. Now what do you do? You’ve already done your homework and changed a load of answers, but you’ve only gone up by 15% and your average is still under the trapdoor. Do you change some more, ones that you thought were right from the first time, and risk slipping back down a snake, when actually you’d like to climb a ladder? No, what you do is you get scared, change as little as possible and throw your well researched attempt back in again as attempt three. Defensive, but needs must. 60% plus 75% gives you an average of 67.5% which is in the relegation zone. 60%+75%+75% averages out at 70% which keeps you in the game.

The numbers were fictitious, but the strategy is not. This has suddenly become a game of survival and I’m not enjoying it one bit. It feels like six months of hard study has descended into a game of rabbits in headlights. If I fail to get the required 70% average from the final three assessments, I will fail the course: that much is simple. The fact that my cumulative score for the course overall is already above 70% counts for nothing.

If I was a football manager who was doing a press conference right now at the end of a game in which he disagreed with the way things had gone, I’d be saying “y’know, I think we were a bit hard done by out there today”. Anyone that knows me knows that I like to do my research, take my time, even knock up a spreadsheet or two, then state my case. If I’m right, then good, but if I’m wrong, I’ll take it on the chin and move on…

I don’t feel comfortable with a system that encourages guessing the answers against the clock, then playing catch up at your leisure. It feels fundamentally wrong. I would much rather the FIFA of clinical systems had given us the questions as an open book assignment and said “there you go, go away and do your research: you get one shot at the answers”. Or in the instance where they want to persist with the one hour rule (which is a joke because attempts two and three take five minutes because you’ve done all the work offline), then just take the final attempt as your score.

I may well fail the course, because of a wee clock ticking down in the corner of the screen, that I can do nothing about. But you can be sure as hell that between attempts one and two after today’s dismal showing, that I’ll be researching (and repeat researching) before I press the big submit button on the second take. I desperately want to stay in the game till the fat lady comes on stage.

But alas, tonight, my brain is pure mush….