Monday, May 30, 2005

Where Do You Draw the Line?.....
From Overlawyered comes a link to this story from the Boston Herald concerning a lawsuit against the NBME over how it conducts the USMLE. The story is archived, but hey, it only cost four bucks:
Med student's dyslexia plea: I need time to pursue dream
By J.M. Lawrence
With an IQ higher than 99 percent of the population, Heidi Baer's school days should be a breeze. But the Quincy woman says she fought through reading disabilities and dyslexia to graduate from Milton Academy and barely get into med school.
Now her dreams of becoming a doctor like both of her parents could end next week unless a federal judge orders a national board to give her extra time for her fourth attempt at passing her second- year exams, her attorney said.
"Not to give her the extra time would be testing her disability, not her mastery of the information on the test," her attorney, Bret A. Cohen, said yesterday. Baer is suing under the Americans with Disabilities Act.
The National Board of Medical Examiners, however, says messing with the test would compromise standards and might even "put patients at risk."
The board's attorneys this week asked U.S. District Court Judge George A. O'Toole Jr. to reject Baer's request for time and a half to complete the May 5 test, which she already has flunked three times at Drexel University in Philadelphia.
"They make it seem like the world will come to an end, as if she's going to operate the next day," her attorney said. "All this does is let her go on to her third year of school."
Cohen said the 30-year-old woman should be commended for her struggle but noted her previous failures on the exam always will be reported to hospitals where she seeks internships.
The medical board's experts rejected claims by five doctors and a psychologist who found Baer has learning disabilities. The board's Dr. Joseph E. Bernier, who reviewed Baer's testing histories, declared her reading abilities average and pointed out that she managed to do the SAT without extra time.
After failing the medical school entrance exam, she was given extra time in 1999 and passed.
Baer is now taking an intensive test preparation course in Chicago for her second-year exams and could not be reached for comment yesterday. Drexel officials usually impose a three-strikes rule on med students but are giving Baer another try.
The judge is expected to rule in the case next week.

So this young lady wants accommodation to retake the USMLE I for the fourth time.
So what's next? I find the "no big deal"line amusing as well: "They make it seem like the world will come to an end, as if she's going to operate the next day," her attorney said. "All this does is let her go on to her third year of school."No "all this does" is set up a precedence so when it come time to take step 2 or 3 or her board certification she will be able to demand special accommodation.
I'm sorry but the ability to process information under pressure is a key component of the practice of medicine. During a code you can't get a "do over". As this Virginia Postrel article points out not all accommodations are created equal:
Over the past decade students with learning disabilities have gotten used to having extra time on tests and, in some cases, separate rooms to reduce distraction. In many cases that makes sense. Giving a dyslexic third grader extra time on a standardized test makes it more likely that his answers will show what he knows rather than how fast he reads.

But a sensible accommodation for little kids can create a misleading double standard for adults. How much you know isn't the only thing that matters in school--especially when you're training for a demanding professional job. What patient wants a genius doctor who can't focus in a distracting environment, reads so slowly that she can't keep up with medical journals or tends to misspell drug names on prescriptions?

There are, of course, excellent physicians with learning disabilities. But they succeeded the hard way, without special accommodations. They demonstrated that they could work around their problems.
And we all know physicians like that. They worked through their disability without the need for accommodation.
The lawsuit ignores the nature of medical training, which is notoriously grueling for a reason. Patients' lives depend on physicians' ability to perform under pressure. If learning-disabled students can't do well on a timed test, maybe they aren't suited to be doctors.

Irrelevant, says Tollafield. "The MCAT is not a test that's designed to predict how you would do as a doctor. It's designed to predict how you'll do on other tests in medical school and the grades that you'll earn."

That argument denies the fundamental reality of professional schools. No matter how theoretical their classes, these programs aren't about learning for learning's sake. They're trade schools that prepare and certify people for demanding jobs. In those jobs, performance--not intelligence or knowledge--is what matters.
Another good point:
Besides, the disability rights people have no objection to the most blatant form of educational discrimination: the prejudice against people who, thanks to the genetic lottery, aren't exceptionally bright.

For an aspiring doctor, average intelligence is a far greater handicap than dyslexia or attention deficit/hyperactivity disorder. Why do some brain attributes matter more than others? Why, to use the trendy jargon, should we "privilege" intelligence?

"Wow," says Tollafield. "That's a big policy question. I don't know that I'm capable of answering it."

Sorry to say, but not everyone is cut out to be a physician. Some find this out during undergraduate when organic chemistry gets too hard, others when the MCAT doesn't go their way, some drop out after gross anatomy. The system has a way of "weeding out" those that don't have the talent or temperament to practice medicine. Medicine, like aviation for example, is different than many other professions in that mistakes can be costly. Our critics point out the sometimes poor job we do of policing ourselves. If the NBME doesn't do it, who will? The specialty board? A hospital credentials committee ten years down the road?
The future safety of patients trumps any "dream" that this young lady may have.
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