I’ve been a bit slow on expanding the availability of my two books on student loans, but as of today, Medical Student Loans and Dealing with Student Loans are now available on Apple iTunes/iBooks as well as from Amazon.
Get them here:
Akhilesh Pathipati, writing “Our doctors are too educated” in the Washington Post (emphasis mine):
U.S. physicians average 14 years of higher education (four years of college, four years of medical school and three to eight years to specialize in a residency or fellowship). That’s much longer than in other developed countries, where students typically study for 10 years. It also translates to millions of dollars and hours spent by U.S. medical students listening to lectures on topics they already know, doing clinical electives in fields they will not pursue and publishing papers no one will read.
We’ve done an amazing job in medicine findings way to fill years with reasonable-sounding and potentially useful activities and then pretending they are not only worthwhile but necessary.
Starting in 2003, my secret work/study music has mostly been comprised of hundreds of wonderfully creative arrangements of video game music, largely thanks to a website called OverClocked Remix, which has been steadily curating a massive collection of high-quality pieces for almost 20 years.
Which brings me to this stellar bluegrass rendition of a theme from a Kirby game (that I haven’t played):
My son wants to listen to this song on repeat in the car on the way to school literally every day.
Check out The Hit Points’ complete new album CD for free on their bandcamp. Every piece isn’t a standout, but the overall effort is still just delightful. If you can recognize Guile’s theme from Street Fighter II from your childhood, you’ll immediately agree that it was meant to be played this way.
This is some niche dorky stuff for a Saturday night, but I’m excited: My digital brain, Workflowy, just got a modern redesign.
For those who don’t know, Workflowy is a totally free (with very optional paid options) outliner/todolist/organizer that allows you to have infinitely nested arbitrarily large outlines/lists. If that doesn’t make sense, just try it. It’s ridiculously simple but very powerful. I even wrote the bulk of my last book in it.
The main downside for me has been that Workflowy’s design has been stuck in yesteryear. I’ve been spoiled by a number of elegant writing environments over the past few years, and I actually do think the extra zen makes a difference. This new design is, as expected, super simple, but the clean lines and font crispen up the experience just enough. Well done!
If you’ve already given Workflowy a try, you can activate the new beta design through the options page here. Now they just need to update the iPhone app!
Simon G. Talbot and Wendy Dean, arguing in STAT that burnout is actually a misdiagnosed consequence of unchecked moral injury:
We believe that burnout is itself a symptom of something larger: our broken health care system. The increasingly complex web of providers’ highly conflicted allegiances — to patients, to self, and to employers — and its attendant moral injury may be driving the healthcare ecosystem to a tipping point and causing the collapse of resilience.
The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”
The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care.
Which is why the chorus of hollow wellness outreach efforts for trainees and other physicians are so patronizing and eye-rollingly ineffective:
The simple solution of establishing physician wellness programs or hiring corporate wellness officers won’t solve the problem. Nor will pushing the solution onto providers by switching them to team-based care; creating flexible schedules and float pools for provider emergencies; getting physicians to practice mindfulness, meditation, and relaxation techniques or participate in cognitive-behavior therapy and resilience training. We do not need a Code Lavender team that dispenses “information on preventive and ongoing support and hands out things such as aromatherapy inhalers, healthy snacks, and water” in response to emotional distress crises.
There’s always a tension between giving specific advice (that doesn’t generalize well across different programs) and broad advice (that can sometimes be almost meaningless), but with that caveat, here are some thoughts about starting radiology training:
Last year I published a book about managing student loans for medical students and doctors. Earlier this year I extensively revised that into a new book for a general audience. This week, I updated both books.
And now, I’m giving them away for free (at least until the end of July 2018).
Student loans are now depressingly the largest category of consumer debt outside of mortgages. With another graduating class hitting the workforce, I wanted to make my student loan books available to everyone. These are around 45k words, so they’ll take a few hours to get through, but it’s time well spent.
Amazon doesn’t easily let you give away free books these days, so I’ve discounted them to $9.99 $2.99.
To get a copy for free, you can download one from your inbox by signing up below for my forthcoming very infrequent/sporadic email newsletter. And, if you aren’t interested in ever hearing from me again, then just hit the unsubscribe link in the first paragraph of the download email. I don’t have any interest in cluttering your inbox.
[sorry, promotion is over!]
If you’re a medical student or physician, click the box for Medical Student Loans. If you’re anything else, click the box for Dealing with Student Loans. These are essentially the same book adapted for different audiences. You only need one.
Topics include:
- Borrowing less and minimizing interest accrual during school
- How Federal Loans Work & Federal Repayment Options
- Income-driven repayment (IBR, PAYE, REPAYE, and ICR)
- Federal “Direct” Consolidation
- Forbearance & Deferment
- Public Service Loan Forgiveness
- Maximizing PSLF
- Long-Term (IDR) Loan Forgiveness & Loan Repayment Programs (LRP)
- Private Refinancing
- Taxes & Retirement
Please consider sharing this. There are very few good resources for student loans and a lot of misinformation. I wrote these books because no one else had. I hope you enjoy them.
The NBME recently released an “updated May 2018” official “USMLE Step 2 CK Sample Test Questions,” but these are actually completely unchanged over the past two years since the June 2016 update, which was itself almost unchanged from the 2015 set.
Since it’s been a couple years, I’ve included the explanations below (which are, again, unchanged). You might see the comments on the old post for possible additional questions you may have. The multimedia question explanations are also at the bottom of this page.
Last year, helpful reader Jarrett made a list converting the question order from the online FRED version to the pdf numbers. I didn’t go through in detail to see if the online version order has changed, but the multimedia questions were in the same spots except that the block 3 question had shifted by one, so they may have done a little something.
I’ve given the ABR a lot of flak over the past few years at pretty much every opportunity, from their expensive, non-portable, and occasionally questionably-written examination to their fumbling of a technical mishap during last year‘s June examination in Chicago. Today, I wanted to highlight something I think the ABR does well, which is something that other medical boards should strive to do better: support nursing mothers.
I also wanted to give additional props on customer service, because unlike my experiences in the past, when I emailed the ABR recently to confirm their nursing mother’s policy, they responded within an hour with a detailed and thorough response.
These are the ABR accommodations for nursing mothers:
* Your pump must be kept in your locker until needed.
* A private room is available where you can go to pump.
* If you do not have a battery-operated pump, an electrical outlet will be available.
* You will need to provide your own method to store / refrigerate the milk.
* Your break time clock will be updated to reflect a total of 60 minutes of break time. While on break, your exam time will pause and break timer will count down. Once break time has expired, your exam time will begin counting down.
* Any extra time you need beyond the additional time will cut into your regular exam time.
These accommodations are standard at both Tucson and Chicago locations.
So, the ABR provides a private space with an electrical outlet and a bit of extra time (30 min) to accommodate nursing mothers. They do ask that you submit an official-looking ADA form at least three months in advance, but this is only a mild inconvenience because they clarified that they do not require a signed doctor’s note as would be necessary in the case of actual disability.
In years past, the ABR has told candidates that no electrical outlet was available, forcing several budding radiologists to purchase a new battery-operated or rechargeable breast pump, a special pump battery pack, a more expensive multipurpose plug-enabled battery pack, or a hand pump. As of this year, they now guarantee access to an outlet if needed, which means that no one will need to spend any extra money to pump during the exam assuming they have insulated storage and ice packs etc (which they would need for traveling anyway). At this point, the last thing that they could do to improve would be to provide access to a staff refrigerator for storage during the exam.
There is a dearth of women in radiology, and this type of support—while free and requiring only a nominal effort—is nonetheless rare and very meaningful, and I want to give credit where it’s due and applaud the ABR’s improving efforts for inclusivity. One of the perks of the ABR’s choice to administer all examinations at their own locations is that they completely control the experience and the rules.
So while I and others have criticized the ABR for imposing additional travel costs and inconvenience on examinees to fly to one of two testing locations in order to take a computerized exam that should theoretically be distributable, I don’t want to discount the overall good job the ABR does with the exam experience. It’s undeniably substantially better than that of your typical commercial testing center with their prison-like ambiance, inefficiencies, and unpleasant TSA-style pat downs. Accommodations for nursing mothers at most commercial testing centers like Prometric and PearsonVue are typically permission to pump in a filthy public restroom or perhaps your car.
Now, as a comparison: feel free to read how this story of a pediatrician’s experience a couple years back. Or this ACLU post about how the NBME handles nursing. Long story short, even though Prometric locations are required by federal law to have a private room to pump available for their employees, they would never deign to share it with an examinee. Instead, it was:
It is still up to you to find a place suitable to you to nurse; whether it is your car, a restroom, or any other public space accessible to you as an exam candidate
Additionally, many accommodations from boards like the ABIM still require a doctor’s note:
Documentation from a medical provider demonstrating the need for an accommodation – ordinarily, a physician’s letter stating the candidate’s delivery date and the anticipated frequency/duration of sessions to express breast milk will suffice.
That’s just silly.
We’re physicians. The purpose of a board exam is to ensure that trainees and recent graduates are ready for safe independent practice, not an opportunity to play at being a poorly-organized police state.
It’s trivial to give women a quiet room to pump in and the respect that they deserve. It’s not even an accommodation—it’s just the decent thing to do. And I don’t think it’s acceptable in 2018 for most major medical organizations to cede the responsibility for all testing policy implementations to large testing corporations that clearly do not care about service.
While the federal law for nursing mothers was designed to protect hourly employees and doesn’t apply to customers or salaried employees (like residents, sadly), I think a law that was written to prevent the extortion of employees earning minimum-wage is probably a good starting point for the standards we should also expect for physicians and just about everyone else in the country. Good job, ABR.
May 2019 update:
This super helpful book was revised for 2019-2020, is still totally free, and even has a new cover. Get it in your inbox by signing up below.
Here’s a new book. It’s called Fourth Year & The Match, and you can get your copy by using this form to (at least temporarily) sign up for my new planned very infrequent/sporadic email newsletter:
If you’d like the book but aren’t interested in hearing from me, just click the instant unsubscribe link at the bottom of the download email. I don’t want to pester you.
And if you want to learn more about this project, keep reading: