I don’t know who needs to hear this but changing your mind as a result of new information or perspectives doesn’t make you a hypocrite. It makes you a thoughtful person.

In Defense of Medical School Grades With residency application season getting underway, I've been thinking a lot about medical school grades, and why I wish we'd bring them back. As someone who reviews applications and interviews candidates for residency, I feel that we’re doing a disservice to students by removing all comparative performance benchmarks from residency applications. First it was preclinical grades, which admittedly makes sense, as performance in preclinical biochemistry is probably not a reliable predictor of residency performance. But then it was Step 1 scores. The purported reason was to reduce medical student stress — an aim I whole-heartedly support — but that simply kicked the evaluative can down the road to Step 2. When Step 1 was scored, if a student did not do as well as they hoped, they had a second opportunity to demonstrate their mastery of medical material on Step 2. With pass/fail Step 1, students only have one shot to showcase their abilities in an objective, comparative way. Since COVID, the new trend has been removing clinical clerkship grades. In lieu of a traditional transcript, schools produce lengthy Dean’s Letters that contain summaries of and excerpts from students’ clerkship evaluations. While the theory is that this allows for a more holistic review, clerkship evaluations are subject to the same linguistic arms race that plagues letters of recommendation. If every student is “excellent” or “outstanding,” and there is no grade to provide a more objective, comparative assessment, it is nearly impossible for an application reviewer to determine how a student actually performed in medical school. This concern over the purge of comparative metrics in residency applications also applies to schools that have grades but fail to use them in a meaningful manner. If an applicant receives all honors on their clinical clerkships, but the grade distribution for the school shows that 80-90% of students receive honors, I’m not sure how to assess that students performance — all I know is they weren’t in the bottom 10% of their class, which isn’t particularly helpful when trying to distinguish between many impressive, immensely qualified applicants. I’m all for reducing student stress and encouraging a more comprehensive approach to residency application review, but those efforts may be hurting medical students in the long run. Without more objective tools, I fear reviewers will focus on other, less meaningful heuristics, like the prestige of the applicant’s medical school or college. Utilizing more comparative metrics would be a win-win — applications would be easier to review residencies and medical students would have more opportunities to clearly demonstrate their academic achievement.

Can’t wait!

The pulmonary nodule avoiding my search pattern

As someone who is both a lawyer and an attorney, I think going after Katie Zacharia over the semantics of what to call someone who has graduated from law school but not passed the bar is juvenile and unproductive. There are so many legitimate criticisms of her and the administration — focusing on the technical definitions of lawyer vs attorney is inane.

Kelly Clarkson in the toy store but it’s me asking my attending how much the Barco monitor costs

When my dictation software is glitching

I can’t believe I agree with Matt Walsh

So many of the problems we are facing right now from climate change to the dismantling of our social safety net are because so many people clinging to positions of power have this world view. They have no ability to see beyond their own nose — no ability to empathize with others. They took advantage of economic conditions that allowed them obtain an inexpensive education, support entire families on single salaries, and amass immense wealth through equity in home ownership. Now, they feel no sense of obligation to pay those benefits forward to future generations. They got theirs, so no need to leave society or the world better than how they found it.

Curious how they are solving the liability issue. Are they intending to take on take on malpractice liability for mistakes their AI system inevitably makes? If they’re ready to profit from AI prescribing medication, they should be ready to assume the professional liability that comes with it.

Amazing to see tech people invent an office from first principles

I hate it when I get redundant clinical indications for a scan. Gross hematuria? Yeah dude obviously.

July interns putting on the long white coat for the first time

Blue Cross Blue Shield is mad that hospitals are using AI to max out their coding for patient care to increase revenue. I’m not saying anyone is in the right here, but it’s a little rich when insurance companies are using AI to batch deny claims.

Giants o-line arriving for game day

The attending when I ask which one is T2 again

I was born in snow and long commutes, grew up at Gillette Stadium, went to law school in Commies, and now my parents live on the Irish Riviera.

Political campaigns should have an option where if you donate a certain amount they won't add you to any mailing lists. Average donation would immediately skyrocket.