Review: Proscan’s MRI Online

MRI Online is an advanced (MRI focused) online radiology video platform offered by Dr. Stephen J Pomeranz, who is primarily a musculoskeletal radiologist. Just one dude. This in contrast to most online offerings in radiology, which are typically recorded board reviews or CME lectures from the big popular courses at places Stanford, Hopkins, Duke etc. Multiple folks talking about multiple topics. Those production values tend to be relatively low because they’re typically recorded from normal in-person talks with the best of intentions (but without the best of audio engineering).

I was recently offered the chance to check out MRI online. I had the intention of spending time with it to help with studying for the certifying exam, but then I ended up not studying. That’s a separate story.

Anyway.

Content

There are several different kinds of content: “Mastery series” lectures are divided into digestible 5-10 minute chunks. “Lecture series” are more typical hour-long lectures (some of these are a bit older). “Courses on Demand,” which are recordings of in-person case reviews (my least favorite). And lastly, “Power Packs,” which are interactive PACS-integrated cases with questions and explanations (but no video).

Platform

MRI Online uses the Teachable platform, which is basically what every new course you’ve seen advertised on Facebook uses. Teachable is simple to use, especially well-suited for video courses, and produces a clean product, so there’s no secret why.

There are pre- and post-tests available, but these tend to be short little multiple choice deals (often text-only). Nothing special there. This is definitely not aiming to be a q-bank.

More importantly, Teachable videos have the ability to be sped up, so you can pick your pace accordingly.

What separates MRI Online from just about every other product out there is that the case review components are integrated with an online PACS. You can review the cases (scroll through stacks, multiple sequences, window/level, etc.), read them cold, and then essentially go through them with Pomeranz or with a written explanation. It’s interactive. It’s practical. It’s reflective of real practice. It’s basically like being a resident or fellow, except that you’re on your own pace, the cases are carefully curated, and your teacher isn’t too busy to teach. It’s pretty neat.

Pricing

Pricing is a bit of a mixed bag.

The in-training price is actually pretty reasonable ($50/month or $500/year). In particular, if you have plans to do an MSK mini- or real fellowship, going through MRI Online would be a great introduction and much less painful than Requisites. For cost reasons, I think any trainee is probably going to buy on a month by month basis when they have time and not to fork out for the year.

(Talk about responsive, the price for fellows used to be $100/month. When I commented that fellows don’t really make significantly more than residents, they dropped the price a week later)

While there’s also a lot of content for neuro (and some prostate), I think most people probably wouldn’t need to buy more than a month if your focus is non-MSK. Proscan tells me they’re adding tons more non-MSK content this year, so I imagine that’s likely to change.

The price for folks out in practice gave me a bit more sticker shock at first: $150/month or $1500/year. That said, you do need CME, lots of practices do provide CME funds, and course reviews and conferences are generally even more expensive and not amenable to pajamas. MRI Online provides real ACCME CME credits, which for the price are actually a bargain depending on how hard you pound your subscription.

I wouldn’t pretend to have the ability to compare and contrast any of the huge number of course reviews that exist in radiology, but MRI Online is definitely better than a lot of conference talks I’ve gone to at RSNA, ASNR, WNRS, ABCD, and WXYZ.

Here’s where the usual negotiated discount/affiliate stuff comes in:

Code BW_TRAINEE gets you 10% off ($45/month or $450/year) and BW_ATTENDING gets you 10% off ($135/month or $1,350/year).

The annual subscription also includes a free MRI anatomy atlas as well as free attendance at a 3-day MSK MRI course held annually in Cincinnati. They tell me the vast majority of subscribers are annual, not monthly.

Free Samples

There’s a free online MSK mini-course with a sample of cases (that you would need to sign up to take).

There are also sample videos for each course (e.g. shoulder, hip) that you can watch without logging in, as well as sample cases for basically every course. You’ll get a history, review the cases in the diagnostic viewer, then answer a multiple choice question about them. The explanations have annotated lesions and a relatively concise readable description.

They also provide a full free 7-day trial, which is a real steal for trainees or for focused test-prep.

Bottom line is that there are plenty of no-risk opportunities to check it out. There’s lots of totally free content and no bait-and-switch in sight. I wish more companies were this transparent.

Conclusion

MRI Online is actually an impressive and pretty expansive product, particularly for MSK, but also with hours of content for neuro and body. In addition to solid review, I’d definitely consider signing up again if I changed practices and needed to expand my toolset.

Review: The Unremarkable reMarkable

Man, I really really wanted to like the reMarkable ($100 off with that link).

The reMarkable, if you haven’t heard of it yet is a large format e-ink device the bills itself as a Paper replacement. It’s billed as a large touchscreen enabled Kindle with a fast refresh rate and a bundled non-battery-powered stylus that supposedly mimics the texture of paper.

And if the software running this thing was anywhere close to the level of polish in a Kindle or your typical smartphone device, then this thing would be pretty awesome.

But it’s not, so it’s pretty much not.

Unboxing

The packaging was slick and got my hopes up a lot.

 

Screen and Hardware

The screen is pretty nice. A big almost notebook size e-ink display, though without the backlight that folks may have gotten used to on recent Kindle generations. The 300 PPI of the high-end Kindles is substantially better than the 226 PPI of the ReMarkable, so it doesn’t even look as crisp as other modern e-readers. As a radiologist, I was hoping the device would be good for reading image-rich books and journal articles, but the images aren’t crisp enough and the contrast is washed out. The refresh rate when drawing is impressive but the delay when redrawing the screen to change pages in a book is sloooow.

The surrounding is less nice. The plastic frame does jive with the lightness of the device but it belies a build quality far below, say, an iPad or even a Kindle. The front buttons, in particular, are flimsy and loose without firmness or a satisfying click. The little-nubbed pen feels like a cheap but works exactly as billed. It has a satisfying paper scratchiness on the screen.

Software

The software is incredibly weak. The design is hobbled to function as a serviceable paper sketching/drawing app with a buggy, slow, underpowered e-reader bolted on than a real e-reading device. Page turns are slow. Documents are barely searchable. Annotations only sorta work. Unlike Kindle, you can’t, say, export your highlights—they’re basically saved an image overlay, so useless for most people’s purposes unless you are editing/marking up a PDF (as if it were actually on paper). They also have a tendency to shift on the page, making them nonsensical. Underlines should not be strikethroughs. Only non-DRM ebooks in epub or pdf formats work, and the reMarkable doesn’t yet support the new epub3 format. It also doesn’t parse epub files properly, mutilating the majority of the formatting. No links, no footnotes.

You can only sync ebooks via the app, and the app is buggy. I found I was routinely unable to add files to the reMarkable via the app normally, but that I was usually able to add via the iOS “open in reMarkable” extension (which means the files are compatible, just the platform sucks). The organization schema are just a few folders, and book covers aren’t even displayed (the last page visualized is), which makes seeing your collection at a glance a homogenous mess.

There is no in-book search. No parsing of the table of contents. No internal linking.

It shows PDFs like a stack of pictures, not complex files combining images and—of course—text.

Conclusion

Someone who wants to sketch digitally but wants a more paper-like feel than an iPad or a Wacom might enjoy this device.

Anyone hoping for large-format super Kindle is going to be extremely disappointed.

Review: WCI’s “Fire Your Financial Advisor” Online Course

In honor of the new graduating class, the course is 15% from June 30 through July 7, 2018 by using the code INDEPENDENCE.

I’ve been reading Jim Dahle’s White Coat Investor blog for years. And by “blog” I mean watching the WCI empire grow from blog to book to advertising magnate to website network to now e-course.

The newest WCI endeavor is a video course on the Teachable platform called “Fire Your Financial Advisor.” Because of the site you’re currently reading, I was invited to review the course a couple months back when it was first released. Which means I got it for free. In this case, it also means if you buy it for yourself after clicking that link that I also get a few bucks.

But lest that dissuade you: I don’t think this course is for everyone. Or even most people?

But before we get to the review, there’s a special deal in honor of Match Day:

Instead of the normal $499 for the course, now through Sunday, March 18 (at midnight), the course is $425 and you get a signed copy of The White Coat Investor book thrown in for free. There’s a no-questions-asked 7-day money-back guarantee, so there’s no risk (though no free book until then either). Just enroll here if you’re interested and enter coupon code MATCHDAY18 at checkout.

The Review

The WCI course is unsurprisingly like a more interactive and version of the WCI book and website with a lot of video (a good chunk of which is reading from a teleprompter with bluegradient background). Though scripted, the delivery is solid but not flawless. There’s also an audio bug (which they are in the process of fixing) that plays the mono audio as single channel stereo (i.e. it comes out of only one of two speakers). The default speed was a bit slow for me but easy to change, either for the whole course or on a per video basis (I’m always a 2x kind of guy).

The big plus side to this particular course, as opposed to most books and finance websites, is that the lessons include a game plan that once completed will result in a real on-paper financial plan for you and your family such as you would get from an actual financial advisor. Actual financial advisors also cost money, often a lot of money (either upfront or in fees), and thus the big-ticket price for admission here is far more reasonable in comparison. A course like this is an investment in yourself.

The thing about financial literacy is that anyone, and especially a high-income professional, should be literate enough to understand and evaluate the work of their financial advisor. It’s the people that blindly trust their advisors and don’t know what they’re paying for that get fleeced. I don’t care if he’s an old buddy from your fraternity days or your best friend’s neighbor’s cousin. So even if you never plan to spend $499 (or even $425) on a course, you should learn enough to know what’s happening in your financial life even if you ultimately decide to outsource it.

So, the theoretical niche for this product or people who want to become financially savvy and are willing to spend a good chunk of change to guilt themselves into becoming so but thus far have not had the motivation required to read very much on the subject. Sound like you? Read on!

Breakdown

Section 1 is the introduction. Section 2 is mostly background and discussion of how financial advisors get paid. Section 3 is about insurance. Section 4 is about housing. All of these are well covered in the White Coat Investor book.

Section 5 is about my favorite topic, student loans, and is substantially enlarged and updated relative to the old book. Since this is my area of greatest focus, I noticed a few minor factual mistakes: one toss away error is that medical residency does not qualify for the graduate fellowship program deferment. It’s really just forbearance as an option for residents who can’t make payments. It’s also not possible to start making PSLF payments during the last few months in school as he mentions (must be working full time, cannot consolidate in-school status loans). The simplified advice to switch from REPAYE to PAYE when you become an attending is often true but not necessarily great blanket advice, as it depends entirely on if your attending income will break you past the 10% payment cap. Plenty of folks in academics will never experience this problem. And switching from REPAYE to PAYE doesn’t require the same decreased vs. full standard payment as switching from IBR does.

Dahle offers a solid overview of the basics, enough to figure out what your options are, but not necessarily always enough to really evaluate those options. He does cover PSLF well. When it comes to student loans, there are a lot of details. Some may say a whole book’s worth. While the course absolutely gets the big picture right, the bottom line is that the student loan component here probably isn’t worth the price of admission.

Section 6 is “living like a resident” and basic personal finance. Important stuff.

The remainder of the course (Sections 7-12) is really where the class differs from most books and gets you to the point where you should feel comfortable handling your own finances. That’s because Dahle walks you through how to set your goals, make your budget, and even use Excel to crunch your own numbers (which he makes much less intimidating than it sounds). He goes over asset allocation and estate planning. All of this is part of writing your detailed financial plan, which he also walks you through as you go. As in, he helps you do the things your financial planner would sit down with you to do for a lot of money.

Bottom Line

This information is not supersecret copyrightable stuff. No one has a monopoly on it, and you can find it in many places in print and online, including on Dr. Dahle’s site and in his book. This course is selling convenience, and most of all, accountability. If you spend $400-$500 on an online course, I imagine you will take it seriously. And that shouldn’t be discounted out of hand. Guilt and shame can be powerful motivators.

That accountability doesn’t come cheap, however, and the kind of person ready to plunk down several hundred dollars for an online video course may also be motivated enough to read some books and fish around online. Of course, with the 7-day guarantee, the unscrupulous learner could take the whole course and then ask for a refund.

Price aside, there’s no denying that the course is well-made and convenient. If you want a doctor-to-doctor one-stop-shop to hold your hand as you go through finally understanding personal finance, then this is it.

While you could go through the videos in few hours, it will take several more to really do the class assignments.

And, if you do, it would be money well spent.

Brevity: A Flash Fiction Handbook

I finally had a chance to sit down and enjoy Brevity: A Flashfiction Handbook by David Galef.

This was particularly fun because:

I’ve published six stories by Mr. Galef in Nanoism, my unusual journal that exclusively features Twitter fiction, the longest running of its kind. Keeping it in the family, I’ve actually published even more (10!) by his son, Daniel Galef.

Nanoism is featured in the chapter discussing microfiction. Galef defines nanofiction in the book basically exactly as I did when I started publishing in 2009: Twitter fiction, stories of 140 characters or less (i.e. teeny teeny teeny tiny stories). As the book includes examples of flash fiction’s many forms and styles, two pieces from Nanoism’s library of almost 800 stories also made it into the book (on page 123).

Aspiring writers of very short stories would do well to check out Brevity in addition to The Rose Metal Press Field Guide to Writing Flash Fiction which came out back in 2009. Good stuff.

Book Review: The Hidden Curriculum & The Doctor’s Basic Business Handbook

David Kashmer’s The Hidden Curriculum: What They Don’t Teach You At Medical School

is up next on the Kindle Unlimited tour of physician books. I really feel like the title should read “in Medical School.”

Kashmer’s hardest sells in the book are on how valuable he thinks his MBA training was and how great locum tenens positions can be for a young physician’s lifestyle (he owns a locums placement company). It starts with the usual “I’ve made a lot of mistakes doing all the amazing things I’ve done” humblebrag and follows it up with a ton of common sense. I do applaud him for the copy editing and book styling, definitely a notch above the usual.

He also really promotes a company called Provider Lifestyle Experts, a service which helps with dealing with credentialing paperwork for $600/month. Yikes! Only in my wildest dreams could I one day make enough money to think spending over $7000 annually for some light paperwork help was a good use of cash.

There are some generally useful things about contract negotiation, but I think these are better and more succinctly covered by the second book in this review. The practical advice on how to deal with the vagaries of clinical practice sort of sound like marathon advice: At first you’ll be nervous. At some point, you’ll get tired. You may even want to quit. If you trip and fall, well that will probably hurt. How much is hard to say. Is that helpful? Not really. It’s obvious. It’s generally pleasant non-advice. Be nice, work hard, don’t do shady things, and if your job really is a terrible fit, get the hell out of dodge.

Overall: Skip unless it’s free and have 1-2 hours to burn and you got terrible clinical evaluations in medical school and residency (i.e. have no common sense).

Brandon Bushnell’s A Doctor’s Basic Business Handbook: Things I Wish I Had Known When I Got Started

is overall stronger, in that out of the 1 hour it takes to read it, 10-15 minutes are pretty interesting. The book is apparently an extended version of a talk he gave to some orthopedics colleagues.

Chapter 1 is “Ten Points You Need to Know About Contracts.” This is interesting and well written. It’s basically an excellent blog post.

Chapter 2 is an almost joke personal finance chapter: don’t act rich, and get a financial planner (ugh).

This is followed by short chapters covering industry and hospital relationships, basics of coding/billing, marketing. All of this is fine and good basics.

Overall: Good if you know nothing, particularly the first chapter. Worth it on Kindle Unlimited/free. Otherwise pass.