Saturday, July 07, 2007

Jerome Groopman: How Doctors Think, Learn, And Train

Some of my friends have sent me articles that are of some interest.

Standardized Patients
- This Slate piece describes what the standardized patient (SP) experience is like from the SP's point of view. While comical and realistic, I hope people do not mistakenly think that medical students are all bumbling idiots. The physical exam that one is required to do on an SP is much more nerve-wracking than the ones students do all the time on patients. First off, no one really ever does a complete history & physical in real life on every patient. Second, in reality, the order is not so important as long as you cover the relevant areas. However, with SPs, sometimes they nitpick about such things, which would obviously make students more nervous than they would be otherwise. Regarding Dr. I in the piece... heh, yea, and sometimes, we med students just are bumbling idiots.

The Successful Match - This article on SDN was intriguing for several reasons. First, its central thesis is that core clinical rotation grades, not USMLE Step 1 scores, have more importance for residency matches. This intrigued me til I noticed the author names. One of them is an asst prof of dermatology at my med school. Clearly, in her case, she must have had good grades and a good USMLE Step 1 score. The article forgets that people self-select, often based on step scores. Therefore, within any specialty pool, residency directors will turn to secondary characteristics, like clinic grades. Think about it: most people applying to things like plastics or derm will already self-select and have Step scores > 240 (I'm guessing). If so, then of course directors will look at clinical grades because everyone will already have approx the same step score! Okay, I may not be completely right here, but I still think USMLE Step 1 score matters more.

How Doctors Think - A book review on NPR, this article describes one physician's questions about how doctors think. I think he raises some valid points, especially about the pitfalls of evidence-based medicine (EBM). However, I think the article actually proves the opposite point. The failure here was not of EBM itself, but its application. I find it appalling that after 15 years of a woman who is clearly having malabsorption, that no one had done an endoscopy. Even as a newly minted MS III, I could guess this woman's diagnosis halfway through the article. Sure, the article gave some big clues, but come on! The fact that this woman's diagnosis took so long is not a failure in the practice of medicine, but rather of its practitioners.

Updated 2015-12-06

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