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SOME SAY THAT Ireland never had a summer until state examinations were invented.
As you might have gathered from the recent warm weather, the Leaving Cert is about to get underway. Thousands of students across the country will sit their first exams this week.
The nature of the exams and how subjects are assessed has changed both at senior level and in the Junior Cert over the years. This ranges from a more nuanced points system to some tentative continuous assessment.
But is the exam system fit for purpose? What changes are coming down the line?
Luke Saunders, co-founder and CEO of Studyclix, joins us on this week’s episode to give the lie of the land for anyone whose own memory of sitting the exams might be fading. We look at the lasting impact of the Covid pandemic on the exams and share advice for students and parents alike.
The Explainer / SoundCloud
This episode was created by Laura Byrne, senior producer Nicky Ryan and executive producer Sinéad O’Carroll.
My dad had a pacemaker fitted at a Dublin hospital, an overnight stay turned into 3wks as he was one of 3-5% who suffer pneumothorax during the Op. We honestly thought that we were going to lose dad due to the pain/suffering of having a chest tube inserted for 19days.
On the final day out of the blue the Consultant came to visit dad to give him the once over before discharging him. During this final examination the Consultant without prompting or being pressured offered a full unreserved apology for HIS personal mistake during surgery which led to dad’s pneumothorax.
He didn’t have to say a word and risked everything including a huge claim by admitting a mistake. We thanked him for his apology and not another word was spoken about it.
Always tell the truth.
There are some honest doctors.
@Martin Holohan: sorry is so important. An old boss once said to me: “the only way to avoid complications is not to do any surgery”. Complications don’t mean negligence. But, you have illustrated how important it is for care givers to just acknowledge what happened.
@Mrsuperiority: absolutely agreed and thank you for your comment.
@Mrsuperiority: absolutely agree but people/patients seems to forget that no matter how learned you are your still human and can make mistakes, and if you do your sued, and possibly end your career…wouldn’t do it!
@Martin Holohan: yes. Acknowledgement and accountability in most cases goes a very long way on so many levels.
Well said!
Unfortunatly we live in an age where people expect perfection and the media crucify you if you make a mistake.
@Brendan Cooney: even more unfortunate is we live in a country where the mortality rate post surgery is one of the highest in Europe
@Martin Hession: is that due to out poorer initial health, our unwillingness to take good medical advice?
@Martin Hession: stats please?
@daveyt: if you look up Ireland Post op death rate for non cardiac procedure we are the fourth highest in Europe, only doing better than Latvia, Poland and Romania! Our rate 6.4% in the UK its 3.2% and in Iceland 1.2%. Thats’s a lot of people. While everyone is obsessed with numbers on trolleys, these should be the figures we should be focusing on
@Brendan Cooney: I can’t speak for the thousands of other people who died post sugery (6.4% Ireland vs UK 3.2%) but I know of one case for certain it was neither.
@Martin Hession: the death rate following surgery in Ireland is not 6.4% or anywhere near that. That’s 1 in 15 patients. Again, please quote your source.
@Peter Moran: http://www.irishhealth.com/article.html?id=21091
@Martin Hession:
This mortality rate (6.4%) is incorrect and based upon an incomplete dataset. A separate study looking at the complete dataset on Irish patients during the exact same time period reported a mortality rate of 2.3%, well within reported international rates.
https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)62685-9.pdf
@Peter O’Leary: glad to hear that, I’m not someone who likes arguing on the Internet. But would the same criteria be used across all countries in the original study? Also interesting that when I put up the link not one
@Peter O’Leary: glad to hear that, I’m not someone who likes arguing on the Internet. But would the same criteria be used across all countries in the original study? Also interesting that when I put up the link not one
@Martin Hession: ^not one thumbs up, but when you posted the link that refutes the euro study four people gave it a thumbs up! So you have to ask did those people know about both studies or does it confirm a bias? But I do hope the Irish study for all Irish patients
Great article Dr O’Connor.
Unfortunately, many still won’t understand but I commend your effort.
Keep up the good work
@Disgruntled Doctor: I think most people understand the concept mistakes and imperfections in every field, even in critical areas like medicine. I think most doctors understand that family anger is the norm when things go wrong. And everyone understands fear of harsh blame. What we don’t understand is that the culture of denial and cover up is not being systematically tackled from within. In aviation, for instance , it’s all about ‘hands up’ from day one, and this is constantly pushed with reasonable success. If this became the cultural norm in medicine, insurance etc would have to adjust to a new business reality.
@Greg Blake: aviation and medicine are totally different, I know what you are trying to say that check lists and double sign off are gold standard which is fine with an aircraft of 300 healthy people and where the pilot and copilot are ultimately responsible for everything, they coordinate everything they do with a computer not a human being, if something goes wrong they can turn off the computer and fly by themselves, in medicine you have no computer (other than the windows 98 version that has never been updated) and each patient is different, with different signs and symptoms and very much different expectations not your bog standard 737 which pretty much takes off and lands by itself. And if pilots mess up they rarely have to deal with the consequences as they die with their passengers
I work for a gastroenterologist (NOT this one), some doctors can and do make errors, being so pressurized and overworked it’s almost inevitable…people forget they are human FFS, wouldn’t do the job for love nor money, the responsibility would wear me out!
@Jun Stone: then cut the salary and have more people.
@Conor Kleaver: you’ve done it! You’ve solved the consultant recruitment crisis. The answer was there all along – reduce the salary even further. Genius! Get this man into politics.
@Conor Kleaver: A figure of 6.4% mortality for noncardiac surgery is totally incorrect. The rate would only apply to the most dangerous procedures in the sickest patients,
@Conor Kleaver: Cutting the salary has not worked very well for Irish general practice.
@Vincent McDermott: http://www.irishhealth.com/article.html?id=21091
@Conor Kleaver:
Why cut the salary? And have less incentive for people to do an already highly pressurised, very difficult job a majority wouldn’t do? You make no sense.
thanks for speaking out. excellent article
@Joan walsh: Agreed. And like others above my son, as a baby, was in a certain unnamed hospital where he suffered a medical error leaving him with a small scar. The paediatric consultant sat my wife an I down from the outset and told us what happened, apologised profusely, and told us we had the right to take legal action if we so wished. We didn’t. We both felt they had saved his life and this was unwarranted.
No right thinking person goes to work with the intention of doing a bad job, no matter what their profession. Sometimes you just lose thought or get distracted and that small lapse in concentration will come back and bite you. Pressure and over work can kill/ ruin a job.
A really interesting read on this subject, ‘black box thinking’ by Matthew Syed, compares the medical and aviation approach to analysis of errors, worth a read
The report misses the wood for the trees. All the major errors were caught by the audit . Therefore a second blinded reading of the scans would have prevented all these errors. This is the most obvious conclusion of this review. Yet they scapegoat the radiologist because they can’t deal with the truth.
@Martin Schranz: the audit was actively looking for mistakes and given the time to look for them, 46000 scans is a monumental amount of scans to report on in a year, try looking at 46000 children’s paintings and see if you are 97% accurate at what is depicted, the human body like a child’s painting is different to everyone that reads it, there’ll be stuff you see and stuff you miss, the hope is that you see the detrimental signs to the patient, after all the patients health is all we are in this business for
@daveyt: thats why all scans should be double read. To protect the patient but also the radiologist. Wasn’t that my point ?
@Martin Schranz: my point was that the workload was ridiculous and if you want it to be double read then we need more radiologists, but that is not in our governments priority of providing mediocre health care at minimum instead of maximum health care as a basic human right
@daveyt: That is what I am saying , the HSE should be accountable for not double reading the scans. While this will be expensive it will still be much cheaper than running reviews and paying out compensation, and would safeguard both the radiologist and the patient.
@Martin Schranz: I am a radiologist in a hospital where we double read mammography and CT Colonography. The former because of the frequency of breast cancer, and the frequently subtle findings, the latter to keep up expertise. Despite that we have not achieved perfection. In the case of UHK where there were 11 significant misses out of over 46,000 interpretations, and there is a shortsge of staff to read studies even once, there is no possibility of recruiting enough staff to do this. There is an international shortage of radiologists with 10% of posts in Northern Ireland and 8% in the U.K. vacant.
Even if you instituted such a policy, I can guarantee there would still be a rate of misinterpretation. It would be a profoundly wasteful deployment of resources.
As for the usual cry of “This much never happen again”, I can guarantee you, it will, for the reasons detailed in Anthony O’Conner’s fine article, with which I completely agree.
@Martin Schranz: I can guarantee that the audit also missed some findings. Because that’s the nature of the business. I have occasionally reviewed studies I previously read and made a new observation. Same study, same radiologist, different date. Once while working in the US I picked up a difficult to see lung cancer hidden behind the heart on a chest X-ray, that had been missed by a number of radiologists. A few days later at a meeting with the clinical team, they asked me to review a chest X-ray and I thought it normal. It was the same X-ray on which I had detected the cancer a few days previously….
These things happen when you are working at the edge of human capabilities.
The best policy is to come clean from the very start.
I bet none of these hospitals are short of managers or the latest IT equipment.
Good piece
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