Wednesday, July 15, 2009

I wrote this up after noticing that critical thinking, which is pretty much all you do in grad school (and sometimes do in medical school) pretty much ruins your ability to take any arguments from laypeople seriously. Our culture has a thinking problem. More specifically, our culture has a lack-of-thinking problem. The scientific thought process, which will become your life in the grad years, makes you painfully aware of this.


I want to briefly ramble about a bane of the first two years of medical school which, as I have emerged from my cocoon of WUSM II, I have also noticed a great deal in popular media:

The scourge of plausibility

In med school (especially 2nd year), you go through some pretty specific and complex physiology and pathophysiology. You often find yourself trying to reason through complicated questions imposed by other students trying to figure things out, especially in topics like cardiology, nephrology, and neurology. Instead of wading through pages of text, you might find yourself coming up with an answer and justifying it with a plausible mechanism that you derive from other knowledge that serves as “common sense.” One example I remember is as follows (skip if you don’t care):

A friend and I knew from lecture that acidemia causes hyperkalemia, but we didn’t understand why. We thought that the increased acid secretion by the kidney would go hand in hand with potassium secretion… but this wasn’t the case. So, we tried to back-reason mechanisms for this apparent paradox. Here’s the scourge:

We had some pretty interesting solutions, all sounding “plausible” with our medical knowledge at the time, and all totally wrong. Once we got it straightened out, I felt a little silly. This happened other times with problems that were much more difficult to resolve.

Here’s a real world example: I am going to make a pair of contradictory statements, and back them up using stereotypes that you probably have. If you read only the first or only the second, you might believe either.

1. Heavy online video game players (think World of Warcraft addicts) are generally overweight. Their constant grazing on high calorie foods and soft drinks, in addition to their sedentary lifestyle, shifts their average BMI well into the overweight range.

2. Heavy online video game players (think World of Warcraft addicts) are generally underweight. Their constant inactivity, nutrient-poor diet, and low sun-induced vitamin D synthesis leads to muscle and skeletal atrophy and shifts their average BMI well into the underweight range.

These statements might invoke images from your memory ( from South Park, the mac guy/ hacker from Live Free or Die Hard), enforcing your belief in the “truth” of each statement. But which is right? I don't know, but a really fast pubmed search found this which seems to suggest that neither is (clinically) true.

The popular media, I’ve been noticing, is HORRIBLE with this. Anything sounding plausible is reported as fact, especially under the pretense of stereotypes/generalizations. It’s gotten to the point where I just stopped believing anything vaguely “scientific” that I haven't read in a true scientific publication*. This is especially true when it comes to health, psych, or behavioral research. If you hear anything, and I mean ANYTHING, in the health/news/tech newsmedia, don’t believe it. Don’t even regurgitate in bar chatter with friends unless you’ve looked into it further.

If you want to know if it’s true or not:

- go to the article/news story

- find the researcher mentioned or interviewed

- go to their lab page or do a lit search

- find their most recent article pertaining to that topic

- skim the abstract and conclusions or, better yet, read the whole thing

If you don’t care enough to at least glance at it like this, it isn't interesting enough for conversation fodder anyway.

And I swear, the next person that says something like “I heard about a neurological study that shows that facebook and myspace are actually making kids stupid” is going to get chewed out.

*: Journal, review, textbook, book, or (with caution) science reporting outlet.

Thursday, June 18, 2009

USMLE advice you won’t get anywhere else

Once I started studying for the boards, I found that most of the advice I had heard was crap. Not that it was bad advice in its own character, really; it just didn’t apply to me at all. I just don’t think I learn the same way the average med student does. Maybe this is why I went MSTP instead of MD. Anyway, here’s my list of unorthodox strategies that I found helpful while studying for the USMLE.

1. Learn excel. Learn it really, really well.
Let’s say (in theory) you somehow got your hands on an electronic copy of First Aid or some other boards review book and you really want to make some flashcards. If you know excel really well, you can just highlight the columns of the table in Acrobat, paste into Word, run your cleaning macros (Oh, BTW, learn Word programming really well, too), and paste into excel. Repeat this with all of the columns from the First Aid table and you have reproduced it. Then just write some formula like:
Fill down, copy all the results, paste into with “<>” as the line break indicator, and you’re done. Seems like a lot of work, huh? Well it isn’t; you just made 100+ flashcards in under 10 minutes. All you need to do this is really solid knowledge of excel functions and how to link them together. I’d go into this more, but it’d be really boring pretty much everyone but me.

2. Get flashcards on your iphone/ipod touch.
I used Mental case despite not having a Mac. I bought the premium version, too. Worked great with all those sets. Now you’re studying while in line at the grocery store or bank. Awesome.

3. If you’re not one to burn out, don’t think you’re going to burn out.
Everyone I talked to from the class above said things like “after 2 weeks, I couldn’t read any more” or “anything after 3 weeks is useless as you’re going to burn out anyway.” I never thought I was a burning-out kind of guy, but I believed them. Well, turns out I don’t burn out. I got a little wobbly a few days before exam, but that was due to the number of days remaining opposed to the number of days behind me. Not everyone burns out, so just go with what you know about your work ethic.

4. You don’t NEED to take a break first.
Everyone and their mother seems to believe that in order to survive the USMLE, you MUST take at least a few days, and as much as a week off between 2nd year finals and studying for the boards. Nope. I suspected that I’d rather start right away and get more days off at the end. I was spot on. Turns out that advice was crap.

5. Nearly everything anyone tells you about the boards is anecdote, not fact.
Duh, right? This should be obvious, but soooo many people spout advice and stories like it’s all absolute Truth. “The test doesn’t really mention X or Y” “You need to study by doing Z” etc., etc. Well, their words apply to them and maybe a subset of everyone else, but you can’t be sure it works for you.

#5 is the most important one here. It tells you that #s 1-4 of my post are complete crap. They are! Those things applied to ME, and I am an outlier (and that is an understatement). I would be shocked if any of it proved useful to more than 1 or 2 people. If you seek advice from SDN forum members or classmates already done with the USMLE, take it all lightly; you are a different person. It’s like a vacation: if someone you know has been to Venice and tells you about it, you wouldn’t assume that their Venetian vacation is the only right Venetian vacation, right? It’s just like that, only the vacation sucks.

Tuesday, June 9, 2009


I am in the throes of the USMLE right now. I have oodles to spew forth on the interwebs once I have the time, but for now I need to keep at this. For the record: my last post (where I said I was studying for the USMLE already in December) makes me laugh. I did that for, like, 3 days. Some good that did.

Topics to come:
- buying a home as an MSTP (with your own money!)
- USMLE advice you won't get anywhere else (alternatively titled: Why >80% of the USMLE advice I received did not apply to me at all)
- USMLE advice you likely will get somewhere else
- MSTP0 - MSTP2: how it changed what I thought about science/medicine/intellectualism
- Rants! I have 1 or 2 things I just need to rip to shreds.

I'm sure I will come up with more as I go. I promise, before I hit "publish", I will make sure I keep the wishy-washy nonsense to a minimum and keep things as short as possible.

Until then