Intended for healthcare professionals

Views & Reviews From the Frontline

The memory class

BMJ 2010; 341 doi: (Published 01 September 2010) Cite this as: BMJ 2010;341:c4761
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

    Sunday night, and the exams were still two weeks away. It was Songs of Praise on the television or a Dickens period drama in 50 nail grating episodes. Bored, we played cards. We had no money; playing for matchsticks being pointless, the only option was playing for forfeits. So pouring cooking oil, salt, and curry powder into our five chipped mugs we salivated and sweated in fear of failure. We, the academic elite, all had great minds of memory; indeed one of my flatmates could visualise any word and read it backwards in his head. But he wasn’t any good at cards. I heard him retching in the toilet throughout the night.

    The regurgitation of knowledge is the key to power. Knowledge is the stock and trade of the professional classes. We might not be able to peel a potato, but we can remember facts, and we sell them for a high premium. Even now during selection for medical school we still choose the academic “brightest” with a minimum three As at A level. Today’s profession may look more diverse, but in many ways it is unchanged—we are all memory machines. But testing memory through examination is deeply confounded by education, home life, opportunity, and class. It is little wonder then that the profession has remained stubbornly middle class, because we are selecting our own, with the exam system geared in our favour.

    Today there seems little need to have an encyclopaedic memory, however, because an 8 year old with a smart phone can access millenniums of medical knowledge in an instant. Knowledge is losing its premium. And pure academic ability is often a proxy for the concrete, inflexible thinker, a dangerous characteristic in a rapidly changing world. And as in all disciplines medicine needs attributes other than total recall, such as problem solving, integrity, caring, kindness, coping, and, above all, creativity. Some universities are tackling such concerns by using the UK Clinical Aptitude Test, which seeks to test for aptitude rather than knowledge. The reality, however, is that this is becoming yet another exam for the already advantaged to be tutored.

    Surely it is important and desirable that the profession be diverse and representative. But the lowest social class remains hugely under-represented and we, the memory class, hugely over-represented. Do we need to rethink our biased obsession with factual ability? Do we need more geezers and fewer geeks? In defence of traditional exams, however, they are at least a measure of hard work, a medical fundamental. There is no perfect medical selection process, and it seems that change is forever unlikely. Perhaps we should try something different—a game of cards with forfeits might be the answer.


    Cite this as: BMJ 2010;341:c4761

    View Abstract

    Log in

    Log in through your institution


    * For online subscription