Grading on the Curve

In college I never fully understood the "bell curve" grading system. I do know that no matter how poorly the best person did they still got an A and no matter how well the worst person did they still got an F. This seemed somehow unfair to me. I always thought and still feel there should be fixed standards. If everyone in the class got between 80 and 88 percent then everyone got a B. At least you knew the standard.

Then there was the topic of the retest. If you failed the first time you could always study some more and take the retest. I have on occasion been forced to use this option.

Lastly there was what I called the PE grading system. In the PE class everyone passed because it was assumed that everyone tried their hardest. I never understood why trying hard in Math didn't count the same as trying hard in PE. In math I tried my hardest and still got C's and D's and in PE I got A's. I tried to show my math teacher the light but he didn't bite. With my PE teacher I left well enough alone lest I should actually be graded on my skill level.

Then, after all my higher education, I got a real job and learned the truth about grading. Life gives you the test on an unannounced schedule and grades strictly on the results of your performance. There is no retest and on occasion the test comes before the subject matter has been presented or studied. There is no professor to appeal to and no certificate of achievement is passed out. The subject of cheating is seldom broached because life's tests are given on an individual basis with no one else around. The grading system is not always fair but it is always final. The paradox is that the outcome is not always relative to your performance.

Our profession in particular passes out unscheduled tests with no guaranteed previous training or learning opportunities. While this is unfair it is however a reality. What's to be done? The answer is training and evaluation. The buzz words are Continuous Quality Improvement, CQI for short. The CQI cycle goes like this. Train- Perform- Evaluate- Adjust/Retrain- Perform- Evaluate- Adjust/Retrain. Let's break this down and look at the individual aspects of CQI.

Training:

Training is the initial phase of any learning experience. It involves the didactic sessions which establish the cognitive framework of our tasks. In this phase we should become intimately familiar with the concepts, precepts and nuances of the subject matter. It also involves practical sessions where in we learn the motor skills which are required to manipulate the patient and equipment during the subject event. Included in this should be plenty of repeated practice sessions designed for true mental and physical mastery of the skill.

Performance:

Performance of the total skill set is the next step in the process. This occurs when a crew is assigned a task / skill set and required to complete it in a set time parameter and an acceptable proficiency level. The Traction splint is a good example of this concept.

Evaluation:

Once the task is completed the instructor evaluates the performance based on the time standard and performance parameters. Any deficiencies noted in the time standard or performance standard indicates a need for an immediate remediation session. In addition the instructor should take the initiative to improve the performance any way possible by giving tips which he has gleaned from his experiences.

Adjust and Retrain:

This is where we work the bugs out of our system and establish and fine tune our individual practices. We retrain until we have consistent high quality efficient operations across the board.

But how do we train for the unscheduled test which so often comes our way in the form of bizarre events or events which are considered low frequency / high risk events.

Let's start by discussing a few realities involved in these tests.