Student Loans Virtual Noon Conference

I gave a virtual noon conference today for MRI Online. It requires a free registration, but it’s one of a collection of great radiology lectures available for free. This is week 19 of the series.

My talk is permalinked here. It starts with discussing a brief history of student loans in the US as well as a pretty detailed discussion of PSLF including dispelling some myths including an explanation of the high rejection rate.

If you listen and notice me laughing at the beginning, that’s because my Zoom session crashed when I attempted to share my screen and I had to restart. Audio cuts out here and there but is nearly 100% intact, pretty good for a Zoom call. And if you listen to any of my podcasts or other talks this past year, you can safely assume I’m sleep deprived (babies are cute) compounded today as I ended up covering the early morning 6 am shift, but it definitely has some really some useful nuggets for those who like audio/video. It’s no substitute, however, for sitting down for a few hours and reading my ad-free totally-free book in whatever format you choose.

One participant asked a great question that I incompletely answered during the Q&A at the end. It was, essentially, what happens to student loan debt after a divorce in a community property state like Texas? The answer is that it usually goes back to the individual borrower, but, that’s only because all assets and debts that happen before the marriage remain individual property and revert back to the individual while all things that happen during the marriage are shared equally. Since most people in the US have just undergraduate loans and most people get married after college, most people won’t have to deal with their spouse’s loans after a divorce. But certainly not all, and this is more likely to be an issue for doctors, who may enter school married or get married while in school. Timing is everything.

Panglossian Medical Fallacies

From Dr. Benjamin Mazer’s “Medicine’s dangerous optimism – Lessons from Dr. Pangloss,” published in The Journal of the Royal Society of Medicine.

Consider the story of Dr. Pangloss, the fictional “professor of metaphysico-theologico-cosmolo-nigology” in Voltaire’s satirical eighteenth-century novel Candide. Dr. Pangloss is remembered for declaring that we live in the “best of all possible worlds.” Pangloss could find logical explanations for the pain and turmoil he saw around him. No one suffered without a good reason. In the face of healthcare’s overwhelming complexity, doctors can also inadvertently resort to assuming our current situation is the best we can hope for.

I am defining Panglossian optimism as the unproven assumption that an observed outcome is the necessary outcome.

That’s the delightful set-up. He discusses four such fallacies:

  1. Favorable outcomes are attributable to medical care, unfavorable outcomes to a lack of it
  2. Arduous training and examination are what produce good doctors
  3. Physician outcomes predict patient outcomes
  4. A sufficiently popular intervention cannot be tested

I particularly love #2. It is, in part, the fallacy of hazing as a constructive and formative practice.

If evaluating applicants is currently too challenging without a Step 1 score, then a Step 1 score must be necessary to evaluate applicants. This is not a sound assumption. A tool that does not select for the qualities we desire inserts bias and noise into the process, making it less efficient.

We also encounter faulty Panglossian reasoning in debates over whether residency duty hours should be restricted for patient and trainee wellbeing. Many experienced physicians imagine their skills molded in the cauldron of inhumane work hours. It is true that they worked inhumane hours, and that many possess excellent skills. The Panglossian assumption is that the latter derives from the former.

For those dejected by the state of high-stakes exams, the arduousness of the journey to attendinghood, or the feebleness of so much of our tautological medical science, his conclusion:

We rationalize the irrational in times of perceived helplessness. By creating an environment more hospitable to questioning and change, we may be less drawn to false comforts.

So, when you are done, or, when you have a position of authority: be part of the solution.

Review: Orbit CME

It was always a good idea, but in this new world where conferences and live events are canceled for the foreseeable future, Orbit CME is a great idea.

(I previously got temporary free access to Orbit for the purposes of writing this review over a year ago, and I’ve got the usual reader discount affiliate link combo for you here: $20 off any plan. As there aren’t any ads here, these types of win-win situations for good products are one of the only ways I earn money through my writing. So there’s your COI disclosure.)

Orbit is a web browser plug-in that promises to automatically track and quantify the qualifying educational activities you do every day on your computer and then provide you with effortless legit AMA PRA Category 1 CME (often including the somewhat more challenging “self-assessment” SA-CME that some fields require that you typically get for answering questions during each lecture at a medical conference or other interactive activity).

How does it shape up?

Pretty darn well. In order to deliver the value of your subscription, you need to have the abilities/privileges to install the orbit browser plug-in (which is currently only available for Google Chrome). This plugin monitors your browsing and triggers whenever you visit a website that might come in handy for CME, like PubMed, Radiographics, or Radiopaedia. It measures your time with that active browser window, and generates an entry in your CME log. You can then choose which entries to actually spend a credit on to get the CME for it, in case you need certain types (like medical ethics in Texas or MQSA, Cardiac CT, fluoro, etc).

For example, while the hospital PCs only had internet explorer installed until recently, I had no problem using Chrome with the plugin when I worked at imaging centers or from home. As a radiologist, I earned CME so fast just from my usual day-to-day work that even if only using it on my home PC I would have been able to get the entire year’s worth of credits within a month or so, at which point I just uninstalled the plug-in.

Every once in a while I would have random difficulty logging into the plug-in (which does require logins periodically to make sure you’re still you), but otherwise, the process was completely seamless. CME is provided through Tufts, and you can download detailed CME logs for submission to various bodies that require such things.

You can also post external CME to the Orbit site allowing you to track all of your CME in one place and generate one report containing everything you’ve done. Very handy.

When I first discussed the product with the Orbit founding team back after finishing fellowship, I couldn’t help but feel that the price was too steep and thus not worth it ($360/yr for 25 credits; $600/2yr for 50 credits). But then I saw how truly effortless it was and how much a hassle the documentation burden of CME can be. If you enjoy conferences, it’ll always be possible to get enough CME through the activities you plan on pursuing anyway. If you’re in academics, you may acquire enough through your work activities like tumor boards and grand rounds to not need anything else.

But for those who don’t–and certainly in the current COVID world we live in where nothing is happening except remotely–I would rather pay to have my CME automatically generate itself than to do so via a virtual meeting (or some other laborious educational activity). I’ve got an infant and a preschooler, a busy practice, and a bunch of hobbies that are struggling for a minute of sunshine. I do CME every single day I work, and this gives me credit for that. Even if you get CME from other places like I do, there was something especially nice about not needing to bother tracking it down or keeping personal records because Orbit gives you everything you need anyway. If you have an academic/educational/CME fund, it’s definitely money well spent. It also works for PAs and NPs in addition to physicians.

The product was initially designed by a radiologist for radiologists, and it is absolutely perfectly suited to our workflow. But it also works well for many other specialties, and they have a handy table here telling you what kind of CME plugin can get you relative to the demands of your specialty society.

I’ll be subscribing again.


Explanations for the 2020-2021 Official Step 2 CK Practice Questions

The NBME released a completely new set of questions in March 2020, which is the first major update since basically 2015.

Last year’s set, which is completely different, is available and explained here. Due to the pandemic, the practice materials page has reverted back to the 2019 set for now, but you still have access to and can complete both sets. More free questions!

These are in the order of the PDF linked above.


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Explanations for the 2020 Official Step 1 Practice Questions

Another year, another set of explanations. As always, the order here reflects that of the new PDF released in February 2020. The official practice material page subsequently reverted back to the 2019 version, but as you can see the 2020 link remains live.

Last year’s 2019 set is available here, though it was almost entirely a repeat of the 2018 set explained here.

The asterisks (*) signifies a new question, of which there are 36.

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