I’m currently revising for one of the seemingly endless postgraduate medical exams we have to stump up the money for. This largely involves smashing ones way through online question banks, that you guessed it, are paid for separately. Over time, this becomes a question of identifying give away phrases that point you towards various diseases. For example, if you spend too much time around armadillos you can catch leprosy, restoring an old house turns into lead poisoning, and dipping your toes in Lake Malawi becomes synonymous with schistosomiasis.
Most exams have moved towards the Single Best Answer (SBA) questions, where there is an introductory stem, a question based on that stem, and 5 possible answers. The aim of these questions is to test clinical knowledge and reasoning, and often include two steps, such as asking for the initial treatment for the suspected diagnosis.
However, a common affliction amongst question writers appears to be the relaxation into lazy stereotypes in order to cue up a topic. Questions are written on absurd one-dimensional facsimiles of patients, not just targetting bird fanciers and koala huggers, but whole groups of society become indelibly linked with certain diseases.
This gentleman has usually recently returned from a business trip abroad, bonus points for Southeast Asia. What pray tell has he got up to apart from rigorous meetings? Unprotected intercourse with local sex workers of course! Because whatever the stem of the question, it is always some form of venereal disease.
The Student Nurse
Don’t worry, you don’t need to read the lengthy stem featuring nebulous symptoms, it’s Munchausen’s Syndrome. Whether they’re injecting themselves with insulin or stealing a patient’s medication, it’s apparently difficult to make it through nursing school without developing some form of factitious disorder.
The <Insert Nationality> Person
Time to pick the <insert nationality> eponymous disease of choice.
The Female Exam Student
Exams are stressful for everyone, including those slogging their way through postgraduate medical exam question banks. However, in the eyes of the question setters having an upcoming exam is a golden opportunity to snack on a relative’s miscellaneous tablets, especially those with well-defined toxidromes. Special marks go to female high achievers, because who can miss a chance to really hammer home that stereotype.
The Man Who Has Sex With Men
It’s HIV. Even when his presentation and symptoms have nothing to do with HIV, it is always HIV. Presents with a cough – it’s an opportunistic infection secondary to his HIV. New rash – oh boy, there’s a whole array of HIV-related skin diseases out there. Comes in with a new presentation of diabetes – his feelings about his new diagnosis of HIV has driven him to indulge, driving a metabolic syndrome and insulin resistance. Starting to get annoyed and cognisant that the treatment and cultural perception of HIV and MSM has come on leaps and bounds since the 1980s? Don’t worry, sometimes it’s HIV and syphilis.
If you’re starting to see a pattern emerge, you’re not mistaken. It’s a totally shock coincidence, but many of the targets of these stereotypes tend to be the same groups that haven’t historically been treated well by the medical establishment at various points in time.
These aren’t limited to revision materials, but feature in the exams themselves, for example the Royal College of Surgeons recently got into hot water for a question about blood-borne viruses in homosexual people. Given that doctors must sit these exams in order to progress in their careers, it doesn’t seem too far to say that we’re being trained to think in these stereotyped patterns.
I’m not trying to say that exam boards should ignore demographic as a risk factor in various conditions, but that they should be aware of the assumptions implicit in the questions they set, and the effects this may have on their trainees.