Those in Australian Med School circles may be familiar with the current project and surrounding controversy at the University of Queensland: Med Students writing their own exam questions.

Dean of the School of Medicine (SOM), Prof. Wilkinson has promised both first- and second- year students that a quarter of the marks for their end-of-year exam will be student generated. This has been met by both skepticism and enthusiasm, in what I'd suggest as fairly equal measures from within the school, and markedly skeptical feeling from the greater medical community. Bastion of conservative journalism, The Australian, recently published this article, espousing the ridiculousness of it all.

Having 'volunteered' as a guinea-pig for this project, I'm going to throw in my two cents. I am (surprisingly) for this idea. There are two major pieces to this puzzle. Firstly, where does the SOM get its existing questions from? And, secondly; How the hell would students know how to write a half-decent exam question?

As Head of Years 1 & 2 in the MBBS programme, Dr Vaughn Kippers is well known to students for his 'Examination Review Sessions'. These involve a few statistics about how many students have aced the exam and other such nonsense. Invariably, questions are asked regarding specific questions, and the reply is along these lines;

"At UQ we are members of an international consortium of Medical Schools with access to an assessment database. Each year we must contribute a number of questions into this database in order to maintain our membership. Access to this database is held on one computer only somewhere in the depths of the medical school. We are also under strict terms that prevent us from releasing questions from this database to you. For this reason, we cannot provide you with past exam papers or model answers and cannot specifically discuss questions in such open settings as this. If you find that when you review your paper in person, there is a discrepancy with the adding of marks or similar, please feel free to discuss it with myself or Dr Saleem Barbri (assistant-head of years 1&2)."

This is all very comforting, but it doesn't mean much. Every student with a few friends and half a brain can easily get their hands on a number of past papers. Model answers, are of course, another story entirely. However, explanation of why this is all so difficult is really hidden in the process by which it is learned in the first place.

At UQ, learning is based on the Problem Based Learning (PBL) system. It's in groups of ~10 and it's great fun. I reckon it works and apparently so do a bunch of studies. Whatever. The key to the whole PBL thing is 'Learning Objectives', which is basically a nice way of listing everything a student needs to learn in the two pre-clinical years. This year, the school's been nice enough to break the LOs into a week-by-week scenario (rather than the previous month-by-month option). LOs come from all the domains, including Anatomy & Physiology, Clinical Skills, Biochemistry, Ethics, Social Sciences. As Medicine is a broad course, this schema works well to define the greater aspects.

What that means, though, is the school shouldn't be able to crank out obscure, 'Pub Trivia' style questions exams. Which was exactly what happened at the mid-year. The question was part of a paper on Tuberculosis. Not a major disease we'd covered, but one of the four or five mentioned in one particular week of respiratory block. Still, thirty-five or so marks of 180 on a disease that, well, by my impression was under-'taught'. Nevertheless, it wasn't anything unfair, out of the ordinary or unexpected. But, on page three of the paper, this question;


So, that's the current situation; fluffy learning objectives, mysterious resources and modes of learning and ridiculous questions. Thus, the new format of writing our own questions would ascribe a bit more control, more sense and more testing the important stuff.

How the school has gone about this is designed to be empowering; give each PBL group a topic for a question, and get them to design one short-answer question (SAQ) and one multiple-choice question (MCQ) on the topic, each with answers. Regarding the SAQ, we're asked to give examples of a good answer and a poor answer, with justifications. Then, they'll show us all the questions we've written on the SOM portal for a month or so prior to the exam. Of these, a select number will be in the exam.

As far as being able to write a decent question, the SOM has provided us with stacks of examples, and each group has elected a question coordinator and it's quite all well organised. Some groups have even been given specific LOs that their question topic relates to. My PBL ain't so lucky; we've just got a topic: Encephalitis [Clinical skills].

Either way, I'm going to learn about encephalitis. It's just that I'll know maybe a wee bit more than someone from another PBL. Hey, they'll know more than me about epilepsy. At least, at the time they write their question. Just like in clinical practice, one person might know more than another about a particular thing. No big deal; we've all gotta answer the same question.

Anyway, what I'm getting to with all this is that essentially this is all good for our learning, and only a few idiots are going to do it wrong. After 18 months of Med School, you'd hope that most students have a good, firm grasp on what's important. That essential stuff like cardiovascular disease, neoplasia and the like; the stuff that occupies the majority of what we'll one day practice.

And to foil the wankers who go out of their way to write ridiculously hard questions, the answers are there for everyone. This will hopefully prevent aimless Zebra-hunting as an effective means of study (It's been pretty effective so far).

What's so bad about all this? Is it now folly to think that maybe, just maybe, Med students know what they need to know?

To all the nay-sayers out there, get some perspective. Medical students do have some ability to predict what they'll need to know, and crikey, we want to be tested on it. I'm looking forward to the end-of-year exam.

I'm going to be asked things I'll need to know; not pub trivia.