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Saturday, 18 February 2017

Thoughts on MBBS Merit / Distinction Award

For the MBBS course at many universities, there is a Merit or Distinction award which is given every year to students who are in the top 10% of a particular batch based on the assessment scores. Students who are awarded Merit/Distinction will often receive a partial refund of the study fees for that year, and their Merit/Distinction status will be made known to all students. The award may have different names in different universities. For example, it is called the Merit award at Newcastle University Medicine (NUMed) Malaysia, Newcastle University UK and Cardiff University, while it is called the Distinction award at International Medical University (IMU).

As you probably have expected, quite a significant percentage of medical students aim for the Merit/Distinction award. In order to be in the top 10%, they have to work very hard to score as high as possible in the assessments, hoping to be better than 90% of the students. However, this is not the case for me. I have never aimed for the award since my first day of MBBS, and I will never aim for it. In my opinion, no medical student should aim for the Merit or Distinction award. Here, I want to jot down some of my thoughts on the Merit/Distinction award so that you may better understand why aiming for the award is a very bad idea. Let me explain.

First, success isn't defined by getting Merit/Distinction.

The definition of success is the accomplishment of an aim. Our main aim of studying MBBS is so that we can become a doctor. In order to achieve our ambition of becoming a doctor, we need to pass all assessments in the course and that's all required. So technically, passing is already considered success. Of course, getting just a minimum pass won't make us feel very good and it may indicate that we are at risk of failing our next assessments if we don't work harder, so we probably want more than a minimum pass. It is definitely good for us to aim for a reasonable higher score than pass.

But whatever our aim is, it should all be about our own performance and not about performing better than other people. It is what we ourselves do that determines success, not what others do. If we aim for Merit, we will need 90% of the other students to perform less well than us in order to achieve the aim. Whether or not we get Merit is determined by other students' performance which we have no control on, so it is wrong to define success as getting Merit. Also, by defining Merit as success we are essentially saying that 90% of medical students in the university will be failure no matter what, since only 10% of the students can get Merit even if every one aims for it. This is definitely not right.

Second, Merit/Distinction doesn't mean better doctor.

All medical students should aspire to become good doctors. There are certain qualities that good doctors have. While having good knowledge and clinical skills is important, what's more important is to have good attitude towards patients and have a genuine intent to help the patients. This kind of good doctors is what the society needs now. Just having good knowledge without good attitude is useless. For example, a doctor who knows a lot about Medicine but is money-minded and never respects the patients is definitely not a good doctor.

When determining the students who get Merit, the university usually takes into consideration the written examinations and the OSCE. The Merit award only indicates the recipients' excellent knowledge and clinical skills, it doesn't indicate anything about their attitude. The OSCE can't actually assess the students' attitude because it is just a snapshot of the clinical encounters and any student can just act with good attitude in the OSCE. Also, if we are awarded Merit, we probably spent a lot of time studying for the examinations. If we just study all the time, we probably won't have good communication skills. Therefore, getting Merit has got nothing to do with being a good doctor.

Third, aiming for Merit/Distinction causes negative attitudes.

As doctors, we should always be willing to share our knowledge with our colleagues. This is part of team working which is an important quality every doctors should have. When we share our knowledge, apart from our colleagues benefiting from the additional knowledge they gain, we too benefit because we often understand something better when we explain it to and discuss it with others. Indirectly, the patients benefit as well because there are more doctors with more knowledge to treat them better.

Unfortunately, when we aim for the Merit award, we become less willing to share our knowledge with others. Since Merit requires us to be in the top 10% of students, we have to make sure that we are better than others. We are worried that if we share our knowledge, others may become better than us causing us to not get Merit. This kind of attitude is known as 'kiasu', a term which originates from a Chinese word that means 'scared of losing'. 'Kiasu' is a very negative attitude associated with selfishness, we definitely should not have this attitude. In contrast, the world would be a better place if every one is willing to share knowledge with others.

Fourth, aiming for Merit/Distinction makes life harder for other students.

The pass threshold for the MBBS written examinations in many universities is not fixed, it changes from year to year. The examiners determine the pass threshold for each examination based on the difficulty of the questions and the performance of students in the examination. The pass threshold will be set higher if the questions are easier or if the students performed better. Every student must get a score higher than or equal to the pass threshold in order to pass the examination, otherwise they will fail. Ideally, the pass threshold should be around 50%. However, the pass thresholds have sometimes gone very high, exceeding 60%.

This happens mainly because of the students who aim for the Merit award. To get Merit, they try to score as high as possible in the examination. Due to their high scores, the grade thresholds are being shifted higher. In my opinion, a pass threshold of 60% or higher is definitely way too high. In 2016, the pass threshold for the Stage 3 written examination in Newcastle University was as high as 65%, and many students failed just because of that and have to repeat the entire year as their final attempt. Many of them scored between 60 and 65% and are quite knowledgeable from what I see. It is unfair to not let them pass. To prevent an excessively high pass threshold, we should not aim for Merit. As doctors, we should think of others as well instead of just ourselves.

Fifth, aiming for Merit/Distinction brings unnecessary stress.

The difficulty of MBBS course means that it can be quite stressful. Sometimes, even if we are just aiming for a minimum pass, we still feel stressed because we are worried of failing. When we are very stressed, we probably won't enjoy the course as much as we should. Since we have decided to study MBBS, it is important for us to ensure that we really enjoy the course. Too much stress can also negatively affect our health and social life. So, we should always try to relieve our stress. Apart from studying, we should have reasonable amounts of free time for leisure activities such as video games, sports, movies, hanging out with friends etc. This is a very good way of relieving stress.

If we are aiming for the Merit award, since we need to be better than 90% of the students, we can never be certain whether or not we can achieve our aim until the results is released. We may have revised very long hours daily, but others may still be better than us. The uncertainty will increase our stress. In addition, after revising long hours every day, we will only have little time left for leisure activities. The lack of leisure activities will definitely make our stress worse. The course is already stressful, so why should we let ourselves face additional stress when we could have avoided it simply by not aiming for Merit?

Sixth, there is no good reason to aim for Merit/Distinction.

There are a few common reasons given by students on why they aim for the Merit award, but I think none of them are good reasons. Some students aim for Merit because of the money, they want to get the 10% refund of the study fees. Some aim for Merit because they want to be more famous among students. I have to say, we study MBBS because we want to help the patients with genuine intent, not because of money or fame. If we are looking to be rich or famous, then we probably shouldn't be studying MBBS.

There are also students who think that getting Merit will improve their chances when applying for specialist studies in the future. This is not true. As I have stated in my second reason above, Merit doesn't mean good doctor. In specialist studies applications, the admission team is looking for qualities of good doctor, and interviews often play a major role in assessing this. Getting the award or not will have no effect on the application.


As you can see, aiming for the Merit/Distinction award has many negative effects and it gives no advantage at all. This is why I don't aim for Merit/Distinction and why I think nobody should aim for it. Since its existence does nobody any good, I believe that the Merit/Distinction award should be abolished completely. If you have not been aiming for the award, that's great and hope you don't change. If you have been aiming for it, I hope you will reconsider that aim after reading this.

Of course, even if nobody aims for Merit/Distinction, it will still be awarded to students in the top 10%, unless it is abolished. In the case where we are awarded Merit/Distinction without aiming for it, this doesn't matter actually. As long as we don't aim for the award, there won't be any negative effects. Lastly, let me share a quote from Jack Ma, the founder of Alibaba Group:
"I told my son: You don't need to be in the top 3 in your class. Being in the middle in fine, as long as your grades aren't too bad. Only this kind of person has enough free time to learn other skills."

I would like to apologise if you feel offended by this article. I do not intend to offend any one, I just want to give my opinion about the Merit/Distinction award.

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  1. Hi there! I recently found your blog and I wanted to ask if you actually really enjoy Biology? And like if that's why you took medicine? Or was it because you liked a challenge?

  2. Hi, good read! Love your blog. Thanks.