A modest proposal.

What follows is something #1 Son wrote recently. He was apparently pretty fed up with his professor's method of teaching medical ethics. Although this is long and extremely polysyllabic — in the manner of college and graduate school materials everywhere — careful reading may yield some humor to the reader.

A Modest Proposal for the Refinement of Regurgitationist Ethics

 No reasonable observer could deny that the Bioethics Program has made significant progress in recent years.  Continuing to foster ongoing collaboration between the ABC Graduate College and the XYZ School of Medicine, the Bioethics Program has now granted 31 MS degrees in the discipline of bioethics, and its faculty have made and continue to make significant contributions to current research in the field.

 However, the part of the program’s work that will have the widest impact on the broader community of the health professions is, arguably, the basic instruction in medical ethics provided by Professor BlahBlah to each succeeding class of medical students at XYZ.  Medical ethics is an algorithm that clinicians can follow to avoid being sued, and physicians therefore constitute the clientele of the medical ethics profession.  Thus, as future physicians, it is imperative that medical students be taught this algorithm so that they may protect themselves against future liabilities.  The success of this work can be ascertained from the written responses to real-world clinical ethical dilemmas that medical students submit at the end of their second year.  In the past two years these responses have improved immeasurably.

 In the early iterations of this assessment of two years of ethical training, Dr.  BlahBlah noted with great concern that many student submissions were “abysmal” in the sense of being at variance with her own opinions.  In the great tradition of innovation for which this medical school and this medical center are so rightly renowned, the professor conceived of an innovative methodology for improving the accuracy with which medical students regurgitate her own ideas back to her.

 Suspecting that existing regurgitative error was due largely to either the time elapsed between instruction and assessment or to the inherent difficulty of applying abstract principles to concrete cases, she resolved to precede the assessment with a special lecture introducing the actual exam questions.  In this lecture, she first explains the ethical dilemmas that will appear on the assessment and then outlines the minimal elements that any student response which conforms adequately to her own opinions must necessarily contain.  This program of Direct Instruction in Desired Answers, or DIDA (“dye-duh”), is unique among medical school bioethics programs.

 The implementation of the innovative methodology of DIDA has significantly enhanced the faithfulness with which students passively reflect the ethical opinions of Dr. BlahBlah, and both the professor herself and the Bioethics Program as a whole can rightly take considerable pride in this important amplification in the fidelity of reproduction.  However, the initial supposition that regurgitative error descends principally either from student forgetfulness or from confusion regarding the applicability of general rules to specific cases has proven to be fundamentally inadequate. 

 A moment’s reflection reveals that several other sources of error may still interfere with accurate regurgitation even in the presence of a DIDA lecture.  Students may misunderstand the medical facts of the case.  In the time between the DIDA lecture and the actual writing of their responses, some students may forget some of the answers that Dr. BlahBlah has so carefully instructed them to paraphrase.  Perhaps most dangerously, some students might actually disagree with the approach to ethical questions mandated by Dr. BlahBlah.  Such students could consequently decide to think for themselves and would thus ultimately fail to arrive at the one right answer to the particular ethical dilemma under consideration.

 Whether such chutzpah arises from a particular religious or familial upbringing, from personal philosophical speculation or simply from ignorance and error is not important.  What is important are two indisputable facts.

 First, all of these sources of error inevitably degrade the fidelity with which the ethical opinions of Dr. BlahBlah are transmitted, disseminated, and reproduced.  Second, although the recently implemented DIDA lecture has markedly improved the signal-to-noise ratio in student responses, none of these loci of infidelity can be completely eliminated so long as medical students continue to constitute a segment of the transmittatative apparatus.  The solution, as simple as it is obvious, and as innovative as it is efficacious, consists in the replacement of medical students by digital voice recorders.

 While these devices range in price from approximately $30 to nearly $200, even the cheapest digital voice recorder would be capable of reproducing ethical opinions with substantially greater fidelity than all but the very best medical students.  A quite substantial improvement in the coefficient of regurgitative efficiency, or CRE, could clearly be gained thereby.  Furthermore, given the need of purchasing approximately 140 of these devices, some sort of bulk discount could presumably be obtained from the manufacturer.  Although the initial outlay would represent a substantial sum, roughly comparable to the cost at which the 13-01 lecture recording system was installed, one must emphasize that this would be a one-time, non-recurring capital expenditure that would over time pay for itself simply in terms of fidelity enhancement, to say nothing of the potential simplification of professorial staffing redundancies to be explained below.

 Once this upgrade has been successfully installed, Dr. BlahBlah can then Digital-voice-recorder deliver her DIDA lecture nearly as before.  However, before the lecture begins, each student would place their assigned digital voice recorder on the desk in front of them.  When Dr. BlahBlah begins to speak, the students would push the “record” button and then silently exit the lecture hall so as to avoid interfering with the accuracy of the recording process.  After the DIDA lecture, Dr. BlahBlah can then listen to her lecture played back by each of the digital voice recorders and grade each of them according to the fidelity with which it reproduces her words.

 Some might conceivably object that, assuming all the purchased digital voice recorders to be of the same make and model, this would result in 140 identical recordings and thus 140 identical grades.  However, in actual practice the digital voice recorders would each be placed in slightly different areas of the lecture hall, each with slightly different acoustic characteristics and each at slightly varying distances from both Dr. BlahBlah herself and from the overhead speakers that amplify her voice.  This positional variation would inevitably result in variation in the precise air vibrations arriving at each individual microphone, and thus also in the fidelity, the sound quality and the coefficient of regurgitative efficiency, or CRE, of each recording.  It is these differences that would then constitute the basis of variation by which a grading curve could easily be constructed, and by which those digital voice recorders that fall more than two standard deviations below the mean could be assigned a failing grade and required to re-record the DIDA lecture.

 Once this system has been in place for one year, two additional advantages will come into view.  First, if Dr. BlahBlah’s DIDA lecture is recorded not only on the small digital voice recorders but also on the main 13-01 lecture recording system, then it will be unnecessary for her to give the same DIDA lecture in the following year.  Instead, the students can simply set up the 140 digital voice recorders as outlined above, locate the previous year’s DIDA lecture on the hard drive of the side room computer, and play back that recording through the 13-01 overhead speakers.  This will obviate the need for Dr. BlahBlah to speak to the digital voice recorders in person.

 Second, because Dr. BlahBlah’s grading assessments of the fidelity of each individual recording depend on the human ear and are thus inevitably inexact, this system of grading could in time be upgraded to a software modality.  Computer programs for the testing of audio fidelity are commercially available, and in this case the task would be to make a digital comparison between each individual “audience” recording and the master recording made directly from Dr. BlahBlah's clip-on microphone.  As any variation between the binary sequences of these files must by definition represent a loss of fidelity, the software can compare the degree of deviation among the 140 different “audience” recordings and then grade them accordingly.

 Finally, if the annual ritual of laying out the 140 digital voice recorders and then subsequently re-collecting them becomes tiresome, it may be possible to simulate the entire process electronically.  The idea, at this point still conjectural, would be to instruct a computer to take the original DIDA lecture and make 140 copies of it, all differently imperfect.  The degree of infidelity in these copies would vary individually and stochastically, and the program would grade their flaws automatically as soon as it generates them.  While it is still unknown whether this pedagogic modality is feasible with any software at present commercially available, if such an arrangement could be put into practice it would allow the current system of instruction in regurgitationist ethics to be reproduced in all its essential details with the single push of a single button.

 Needless to say, complete pedagogic automation of this type would render any direct staff involvement almost entirely unnecessary.  If in the end it proves impossible to automate the pedagogy this fully, then even the intermediate modality of audible playback to physical recording devices would, at least after the first year, render entirely superfluous the continued employment of Dr. BlahBlah for instruction in ethics.  The resulting rationalization of redundant salary expenditures could, in a very few academic years, cover the entire initial cost of purchasing the digital voice recorders and then begin to accrue a positive financial benefit to the medical school as a whole.

 While the focus of this proposal has been on the teaching of medical ethics specifically, it cannot be denied that other projects in similar vein could in the future prove invaluable to medical faculty engaged in the teaching of several other subjects that also depend upon the unthinking regurgitation of painstakingly memorized minutiae, most notably pharmacology and gross anatomy.  While the design and implementation of innovative modalities in those fields must of course be left to their practitioners, this proposal offers a way forward for instruction in medical ethics that is entirely consonant with the basic logic of the discipline as it is currently taught.

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0 Responses to A modest proposal.

  1. Bullwinkle says:

    ‘…loci of infidelity …’ /snort
    Did he actually submit it? Or just creatively vent? (Oh how I wish I could vent so well!)

  2. tinebeest says:

    Oh, so I’m doing all my teaching wrong by encouraging students to think something different… Hm. Must address that…

  3. gayle says:

    Love the DIDA lecture…
    My daughter nearly failed an art history class because she thought it was more of an objective subject than a subjective one. The “correct” answers were those that echoed the professor’s opinions, no matter how far off base he was. (Example – one of his interpretations of a painting hinged on the ‘Chinese’ writing in it. My daughter incurred his wrath when she pointed out that the writing was actually Japanese (her minor, so she knew the difference.) He blew up at her in that how-dare-you-contradict-ME way and shouted that it was all the same anyway, rather than examine the facts and reconsider his conclusion.
    And he put it on the final – the “correct” answer was his opinion in all its misinformed glory…
    (Imagine taking a multiple choice final in which all the choices were wrong, and there was no E: None of the Above.)

  4. Helen says:

    I love the that the initial premise of the class seems to me, a lawyer, wrong. Ethics should not be about what will keep you from being sued. It should be about what balances the patients’ needs for honesty, confidentiality, accuracy, etc with the doctors’ needs for complete information, objective distance, sleep…
    But I’ve been in those classes too.
    I get it in some courses. But in ethics courses….?????

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