App Review: Quest

I am one of those supremely unproductive people who frequently spends hours researching distraction free writing programs and other workflow micromanagement with zero sense of irony. Nothing helps.

Anyway. One app I do use extensively is the Apple’s default Reminders app, which I’ve long used as both an actual todo list as well as a repository of other random tidbits, blog post ideas, things I want to read and buy etc. I’ve researched (and tried) several todo list apps, but none have stuck. Reminders is ugly, but it’s free, it works quickly, and has the features most anyone really needs.

That just changed last week, because now I’m using Quest.


The overall scheme is similar to Clear (okay, it pretty much copies it), which I didn’t fully embrace, mostly because I thought Clear was colorfully ugly and I didn’t feel like importing all of my items. But Quest is cute app with great idea: it gamifies the to-do list, letting you “level up” for checking off items, with adorable graphics and simple gameplay elements superimposed on a solid todo list app experience.

questQuest allows you to organize your tasks into multiple lists as well as add time-sensitive reminders (just like to Reminders app). The main missing feature it lacks is contextual location reminders, which is a feature of the default Reminders app that has always sounded like a fantastic idea but that I’ve never actually used (e.g a reminder to give your wife a hug that activates when you get home).

My biggest feature request is the ability to grade the difficulty of your ‘quests’ — just as not all monsters are of the same difficulty to vanquish, completing your grocery shopping or calling a plumber doesn’t deserve the same experience/reward as crafting a thoughtful blog post or finishing a research manuscript. But I’ll still keep using it for the adorableness/nostalgia factor alone.

Making MS3 Clerkship Study Schedules

This is another reader request and companion post to Studying for Third Year NBME Shelf Exams.

Let me start by saying that I’ve never personally utilized a detailed schedule as a binding contract. My ability to master my personal will with regularity is limited, and the day-to-day variability of a clinical workload makes strict planning difficult. You never know when you just don’t have it in you to work another moment.

That being said, there is some utility to making a rough outline in order to give yourself an idea as to how much time you have to complete various tasks, how many resources you can reasonably get through, and particularly, how much time to allot for dedicated question review at the end of the rotation prior to the shelf exam. You do not want to shortchange your time for questions. The details of your personal schedule will vary based on your clinical workload, the make-up/pain level of your clinical sites, and rotation length. Some schools do surgery in 8 weeks, others in 12. Length matters. Talk to students in the class above yours to get an idea of what kind of schedule to expect rotation to rotation.

Making your schedule

The first step is to determine how many UW question sets you think you can do a single evening, assuming you’re working a normal schedule and are trying to achieve a measured pace and not kill yourself. I prefer to do tutor mode, and you may decide that you can reasonably achieve two full sections  an evening with time for detailed review. Extrapolate based on your experience study for Step 1 to know what your speed and stamina can stomach.1

Let’s say you want to budget for 1 UW section (~44 questions) a night.

  1. Divide the number of questions in the relevant subject of the Step 2 CK qbank by 44 to determine the number of days it will take you to complete the relevant questions.
  2. Then multiply this number by ~1.5 to determine the amount of time you need to give yourself total including time review the questions you missed.
  3. Then subtract this number of days from the total number of days you have in the rotation. This gives you time remaining you have to dedicate to reading books.
  4. Don’t forget to allow yourself some days off from studying. You might only “budget” on studying four or five days a week, because this will give you a cushion if you get behind, get tired, or get busy.
  5. Pick your resources (I have my recommendations here), and then split your remaining time accordingly. You can divide this time by the relative length of each book (keeping complexity and page density in mind).
  6. Then divide the number of pages of each book by the number of days you plan to spend reading it to get your daily allotment.

An example:

Let’s say you have a six week psychiatry clerkship.

  • At around 150 questions in the UW set, if you do one section a day, you need around 3 days to get through the UW questions.
  • Multiply by 1.5, and you should give yourself 5 days to master the UW material.
  • Round up and that gives you a week, leaving you five weeks to get through Case Files (477 pages) and First Aid Psychiatry (240 pages).
  • If you give yourself two weeks for Case Files, that’d around 47 pages daily for 10 days of reading (with weekends off). Give yourself another three weeks to read First Aid twice and you’ll read about 30 pages a day. Very doable.

This method will also allow you to determine what number of resources is reasonable/doable for you given your particular restraints. You can figure out if you have time to read a book twice or how to account for your desperate desire to read every book your classmates have mentioned. And while some days you may read more and others less, this method can help you keep on pace. Just make sure that if you start to get behind that you trim the fat: It’s more important to finish a single good resource than to pick away at parts of several, and you always need to give yourself time for questions.

  1. If you can’t remember, then pay attention during your first clerkship!

Veterans decide CT lung cancer screening will help them continue to smoke

Linkbait-y title aside, JAMA Internal Medicine has an interesting new too-small too-ungeneralizable study of 35 veterans across multiple VAs. In it, 49% (i.e. 17 patients) admitted that the availability of CT lung cancer screening reduced their motivation to quit. Reportedly, quitting is hard and CT scans are easy.



Of course, hunting for and even finding lung nodules isn’t going to prevent you from dying from cardiovascular disease or COPD, which together are responsible for over half of all smoking-related deaths. Nor will it touch the various other cancers smoking causes, like squamous cell carcinomas of the head and neck, which I see all the time. CT lung cancer screening for high risk individuals is a no-brainer, the data are substantial, but quitting or never-starting need to be as well!



Radiology’s continuing PR problem

A couple of months back, JACR published an article with the self-evident conclusion that patients would prefer to hear the results of their radiology studies from their doctor (the ordering provider) instead of a radiologist. Duh! Who wants to hear they have cancer from a stranger who then may never see you again nor have any role in your future care?

Buried in that revelation is far more interesting a depressing data. While many patients don’t really understand the difference between ophthalmologists & optometrists and psychiatrists & psychologists, a substantial portion of patients essentially have no idea what a radiologist even is. The surveyed patients believed radiologists are techs who actually operate the machines and not physicians, and they comically underestimated the length of training:

While 88% of patients were confident they knew what a radiologist is and what one does, 79% thought they were technologists (misplaced confidence!). Only 56% knew radiologists are physicians, and even fewer, 31%, believed that radiologists perform image-guided procedures. On average, they believed that the speciality requires an average training of 6.8 years after high school. Respondents at community hospitals estimated even less time, 5.3 years, which would make radiologists second year medical students.

So even though I think it’s clear that patients would (and probably should) want to hear their results from the ordering physician, it’s even less surprising that they’d want the news that way if the alternative is to hear the results from a nonphysician who just finished their first year or medical school.



Explanations for the 2015-2016 Official Step 2 CK Practice Questions

Here are the explanations for the updated 2015 (effectively 2015-16) official “USMLE Step 2 CK Sample Test Questions,” which can be found here.

Overall, there are a solid 41 new questions when compared with last year’s set, which I’ve marked with asterisks below. For those who have done last year’s set, a list of the new question numbers is in this footnote1. The explanations for last year’s set can still be found here.

Continue reading

  1. 1, 2, 5, 6, 7, 8, 13, 14, 15, 16, 17, 19, 33, 45, 47, 48, 50, 51, 52, 56, 58, 60, 61, 90, 91, 92, 95, 97, 106, 108, 111, 113, 124, 126, 130, 131, 135, 137, 138, 139, 140, and 141.