Why Do Strange Questions Appear In Oral Exams?

I often get frequently asked by candidates as to how and why weird and random questions appear in summative examinations. A recent candidate for example told me that her case-based discussion about asthma went something like this:

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“What are the complications associated with steroid use associated with asthma?”

“Diabetes mellitus is one of them”

“And why is that?”

“Steroids induce a state of insulin resistance which then causes a hyperglycaemic effect”

“Yes but what is the physiology of the Kreb’s cycle?”

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Needless to say she left rather upset, and rather surprised! The obvious question then is why does this happen?

To answer this fully, you need to delve into the psychology of examinations. An exam is designed to test a candidate against an arbitrary defined standard, and uses a curriculum to assess against as the scaffolding of testing. To this it needs examiners - both those who oversee the program, and those who do the actual marking. In order to keep the reliability of exams high, the marking examiners need to be trained to assess consistently. Whilst standardisation is consistent across MCQ and OSCE/clinical exams like STAMPS, at times it can be not as rigorous with formats like case-based discussions and other formats (like the MiniCEX).

Now consider who tends to do the examining - often clinicians with many years expertise, often very senior, often towards the ends of their careers. Many examiners have a genuine desire and belief that they are giving back to the medical and broader community by imparting their wisdom through examining. And as the curriculum makes mention of the pathophysiology of illness as being of core knowledge, the above question is technically in scope, even if it is grossly unfair. Once you frame it in this lens, the logic behind this line of questioning becomes a little clearer, even if you might vehemently disagree with it.

So why does all of this matter? The answer is twofold:

-You should expect to receive a random question at some point - once you know this, you can anticipate it and prevent it.

-Should you be asked a random question, you can use proper examination technique to score highly, even if you have absolutely no idea what the physiology of the Kreb’s cycle is.

Noting that this sort of question should never appear in any form of oral examination, if it does at least you will know how to approach it.