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The @TheRACP Physicians Exam Debacle as a Teachable Moment for Future Health CIOs

Yesterday the Royal Australasian College of Physicians @TheRACP held its’ annual written exam, a 5 hour long barrier exam for progression to the viva voice examination that progresses the candidates to advanced training in medical sub-specialities. For the first time the college chose to use computer-based assessment rather than written assessment and engaged @PearsonVUE to undertake the process. It went spectacularly wrong with the software essentially seizing up towards the end of the first half of the examination. The problem has been attributed to an as yet unknown glitch. The exam was called off and is now re-scheduled as a paper based test on the 2nd of March. This was also not the only problem with a process that included inconsistent supervision, inconsistent mobile phone policy, misinformation, failure to take into account the needs of the candidates (like expressing breast milk) and lack of a back-up plan. The consequences are manifold. Trainees planned holidays immediately after the exam and these are now put on hold, no doubt with financial loss. Extra time off the wards will be required. There may be interruptions to other training events scheduled a year in advance and recruitment that commences in August/September for the subsequent academic year could in theory be disrupted. This is all not to mention the psychological distress caused by the most important test of their lives (apart from the viva).

Can any good come of all of this?

All of these future physicians are entering an age of completely digitised medicine. In fact they are the first generation where all hospital based records and prescribing will be undertaken electronically and private practice is fast moving in the same direction. Some of these future physicians will hold titles in their healthcare organisation like Chief Information Officer and hold higher degrees in health data management and analytics. I think for those candidates who suffered the events of yesterday there is a teachable moment. Just as the RACP simply cannot afford for the digital assessment system to fail as health care providers we cannot afford for our digital systems to fail. Downtimes in the electronic health record (EHR) are a bit like the computer aided flight systems on a plane failing. Cyberattacks or power-outages might results in critical system failure. How can we look after a patient if even for short periods of time all their health-related data is not accessible? People will have infusions running when computers crash. Operations will be underway. Critical life-saving information could be unavailable. Patients lives might hang in the balance just as trainees sitting the exam might see their futures hanging in the balance.

Trainees who experienced the digital failures of 19/2/18 who go on to take responsibility for digital healthcare will reflect on their experience with terror. They will manage the risk and work hard to ensure that their digital health care environment is as safe as possible. Catastrophic failure is never 100% preventable but due diligence, user testing, good risk management and risk mitigation could have prevented these calamitous events.

“We’re doomed” – C-3PO – the pending end of the world as we know it – or not

Clearly marriage equality will lead to the end of civilisation through devastating disruption of the social fabric of society. This will be the final straw. After all think of all of the other things that have led to society’s demise (in no special order):

  • The Pill
  • Martin Luther’s list nailed to the doors of the Catholic Church
  • The Steam Engine
  • The Internal Combustion Engine
  • Women voting
  • Non-landowners voting
  • Native title
  • Rock and roll
  • Jazz
  • Atonalism
  • The miniskirt
  • The swim suit
  • Abolition of slavery and apartheid
  • Women in the workplace
  • The forty hour work week
  • Abolition of child labour
  • Paid parental leave
  • The old age pension
  • Genetically modified food
  • Solar power
  • In vitro fertilisation
  • Counter-culture
  • Free love
  • Divorce
  • No more white Australia policy
  • Nationalism (well that actually came pretty close -still might)
  • Abolition of rule by hereditary monarchy
  • Women on the battle field
  • Dissolution of Empire

As you can see from the following graph – marriage equality is new to the game but we’ve been overcoming the end of civilisation for centuries.

Martha Argerich – The Complete Recordings on Deutsche Grammophon – Discs 24-33

Disc 24 – Schumann Violin Sonatas with Gidon Kremer (1986)

Robert Schumann

Sonata for Violin and Piano No.1 in A minor op.105

Sonata for Violin and Piano No.2 in D minor op.121
Disc 25 – Beethoven Violin Sonatas with Gidon Kremer (1987)

Ludwig van Beethoven

Sonata for Piano and Violin No.4 in A minor op.23

Sonata for Piano and Violin No.5 in F major op.24 “Spring”
Disc 26 – Bartok, Janacek & Messiaen pieces for violin and piano with Gidon Kremer (1990)

Bela Bartok

Sonata for Violin and Piano No.1 Sz 75
Leos Janacek

Sonata for Violin and Piano
Olivier Messiaen

Theme and Variations for Violn and Piano
Disc 27 – Beethoven Cello Sonatas with Mischa Maisky (1991)

Ludwig van Beethoven

Twelve Variations On “Ein Madchen Oder Weibchen”from Mozart’s opera The Magic Flute op.66 in F major

Sonata for Piano and Cello No.1 in F major op.5 no.1

Sonata for Piano and Cello No.2 in G minor op.5 no.2

Seven Variations On “Bei Mannern, well he Liebe fuhlen” from Mozart’s opera The Magic Flute WoO 46 in E flat major
Disc 28 – Prokofiev Violin Sonatas with Gidon Kremer (1992)

Serge Prokofiev

Sonata for Violin and Piano No.1 in F minor op.80

Five Melodies for Violin and Piano op.bis

Sonata for Violin and Piano No.2 in D major op.94a
Disc 29 – Beethoven Cello Sonatas with Mischa Maisky (1993)

Ludwig van Beethoven

Sonata for Piano and Cello No.3 in A major op.69

Sonata for Piano and Cello No.4 in C major op.102 no.1

Sonata for Piano and Cello No.5 in D major op.102 no.2

Twelve Variations on a Theme from Handel’s oratario Judas Maccabaeus WoO 45 in G major
Disc 30 – Shostakovich and Haydn Piano Concertos (1994)

Dmitri Shostakovich

Concerto for Piano, Trumpet and String Orchestra op. With Guy Touvron on trumpet
Joseph Haydn

Piano Concerto in D major Hob.XVIII:11

The Wurttembergisches Kammerorchester Heilbronn under the baton of Jorg Faerber
Bonus Track: Pytor Ilyich Tchaikovsky

Piano Concerto No.1 in B flat minor op.23

Berliner Philharmoniker conducted by Claudio Abbado (1995)
Disc 31 – Bartok and Ravel with Nelson Freire on piano (1994)

Bela Bartok

Sonata for Two Pianos and Percussion Sz 110
Maurice Ravel

Ma Mere l’Oye (Mother Goose) for Two Pianos and Percussion

Rapsodie espagnole for Two Pianos and Percussion 

With Peter Sadlo and Edgar Guggeis on percussion 
Disc 32 – BeethovenViolin Sonatas with Gidon Kremer (1994)

Ludwig van Beethoven

Sonata No.6 for Piano and Violin in A major op.30 no.1

Sonata No.7 for Piano and Violin in C minor op.30 no.2

Sonata No.8 for Piano and Violin in G major op.30 no.3
Disc 33 – Beethoven Violin Sonatas with Gidon Kremer (1995)

Ludwig van Beethoven 

Sonata for Piano and Violin No.9 in A major op.47 “Kreutzer”

Sonata for Piano and Violin No.10 in G major op.96