Pedigree is a poor proxy for quality

From “Graduates of Elite Universities Get Paid More. Do They Perform Better?” an article published in the Harvard Business Review about comparing the “performance” of graduates from elite and non-elite universities:

All in all, our results suggest that hiring graduates from higher-ranked universities would lead to a nominal improvement in performance. However, the university rank alone is a poor predictor of individual job performance. Employers can get a much better deal by hiring the “right” students from lower-ranked institutions, than “anyone” from better-ranked institutions. It would also be wise to use additional tests designed to evaluate the technical and interpersonal competencies needed for the job.

Pedigree is a poor proxy for quality.

In real life, a single datapoint like school identity or the acronym of your medical degree doesn’t adequately summarize a whole person. I’ve personally benefitted from this sort of nonsense but I know better: How well you play the game is different from how good of a person you are or doctor you’ll be.

Averages don’t help you evaluate individuals.

Some people think that Step 1 going pass/fail will mean that programs will just start just interviewing people from big-name schools and other groups will be marginalized (forget for a moment the practical reality that there aren’t enough ivy league graduates to magically fill all residency spots or that every ivy league student wants to enter a “competitive” field).

Any program that really wants the best people should know enough not to do that.

And any program that doesn’t is either intellectually lazy or isn’t valuing its residents as individuals.

There are plenty of convenience metrics programs use to filter applications. Step 1. MD vs DO. US vs IMG. With unlimited applications combined with interview hoarding from well-qualified applicants, everyone is wasting a lot of time and money. The 2020-2021 virtual interview season is compounding that by removing the time constraints of physical travel.

This should be a wake-up call that we need to implement changes that allow–no, force–programs to perform holistic reviews and remove the incentive for students to shotgun-apply.

Application caps pave the way to move away from convenience metrics like Step 1, degree-type, or pedigree by giving programs a fighting chance to give applicants their due attention and forcing students to limit their applications to places they’d actually consider.

But in order for that to be fair, programs likewise need to be transparent about what they’re looking for and their interview criteria. Students need better data to know what types of programs are generally feasible so that they aren’t sending their apps to programs that are going to snub them or overutilizing the limited resources of their “safety programs.”

People who are being filtered out by ERAS deserve to know in advance not to waste their money and emotional energy applying.

Pedigree always sounds good on paper. A nice name looks good on a list just like it does on a CV.

But deep down, as scientists, we should know better.

Simple Sabotage

Simple Sabotage: A Modern Field Manual for Detecting and Rooting Out Everyday Behaviors That Undermine Your Workplace is a book inspired by a real World War II CIA field manual called “Simple Sabotage” that was written to help “guide ordinary citizens, who may not have agreed with their country’s wartime policies towards the US, to destabilize their governments by taking disruptive action.” You can read the declassified original document at that link.

It’s short and fascinating and much of it is timeless. Operationally, it functions as a “how-not-to” for creating an efficient organization. The CIA’s top 3 takeaways:

1. Managers and Supervisors: To lower morale and production, be pleasant to inefficient workers; give them undeserved promotions. Discriminate against efficient workers; complain unjustly about their work.

2. Employees: Work slowly. Think of ways to increase the number of movements needed to do your job: use a light hammer instead of a heavy one; try to make a small wrench do instead of a big one.

3. Organizations and Conferences: When possible, refer all matters to committees, for “further study and consideration.” Attempt to make the committees as large and bureaucratic as possible. Hold conferences when there is more critical work to be done.

These points were once felt to be a great way to sabotage Nazi Germany, but they seem to have been voluntarily taken up by most modern American businesses.

A good example from the book is the “obedient saboteur,” someone who–by doing exactly what he’s told to do–is actually making things worse:

This problem can be particularly acute in organizations with a culture of “continuous improvement.” Continuous improvement is a business philosophy created by W. Edwards Deming in the mid-twentieth century. This philosophy thinks of processes as systems and holds that if each component of the system constantly tries to both increase quality and reduce costs, efficiency and success will follow. But taken to an extreme, even continuous improvement can lead to sabotage.

One company we know had a call center manager driving his team to move from an average pickup speed of 1.4 rings to 1.2 rings. The division head asked, “How often do callers abandon us after only 1.4 rings?” “Almost never,” he was told. “Virtually no callers who actually intended to call us hang up before the third ring.” Yet the call center manager persisted in trying to ensure that all calls were answered more quickly each year. Why? Because getting the phones answered quickly was his job—by definition, quicker was better. He never thought to question whether he had crossed the threshold where process had overridden outcome. He had become one of the Obedient Saboteurs. If you asked him why he was trying to lower pickup times, he would tell you that faster pickup means improved customer experience. That’s true—but the threshold is three rings. Once you get below three rings, faster pickup times don’t continue to improve the customer’s experience anymore.

The problem we see, time after time, is that nobody bothers to go back and tell the call center managers of the world to go continuously improve something else.

To keep this kind of sabotage out of your group, step back and conduct a formal review of any continuous improvement programs you have in place. If they aren’t relevant anymore, pull the plug.

Also see: measure what matters.

To fight back, ask yourself:

What is the stupidest rule or process we have around here?

What are the three biggest obstacles you face in doing your job?

If you could rewrite or change one process or procedure, what would it be and why?

A lot of quality improvement isn’t real:

It’s adding clutter. It’s replacing content with process.

We should be just as ruthless when evaluating quality measures and metrics as we are with the fail points that inspire them.

Status Quo Bias

From Machine, Platform, Crowd: Harnessing Our Digital Future by Andrew McAfee and Erik Brynjolfsson:

Research in many different fields points to the same conclusion: it’s exactly because incumbents are so proficient, knowledgeable, and caught up in the status quo that they are unable to see what’s coming, and the unrealized potential and likely evolution of the new technology.

This phenomenon has been described as the “curse of knowledge” and “status quo bias,” and it can affect even successful and well-managed companies.

There are a lot of bad actors in healthcare that I would love to see fall prey to the curse of knowledge.

Anger and Outrage: Features, Not Bugs

From Cal Newport’s Digital Minimalism: Choosing a Focused Life in a Noisy World:

The techno-philosopher Jaron Lanier convincingly argues that the primacy of anger and outrage online is, in some sense, an unavoidable feature of the medium: In an open marketplace for attention, darker emotions attract more eyeballs than positive and constructive thoughts. For heavy internet users, repeated interaction with this darkness can become a source of draining negativity—a steep price that many don’t even realize they’re paying to support their compulsive connectivity.

Encountering this distressing collection of concerns—from the exhausting and addictive overuse of these tools, to their ability to reduce autonomy, decrease happiness, stoke darker instincts, and distract from more valuable activities—opened my eyes to the fraught relationship so many now maintain with the technologies that dominate our culture. It provided me, in other words, a much better understanding of what Andrew Sullivan meant when he lamented: “I used to be a human being.”

Doomscrolling is so insidiously toxic.

I am not a heavy social media user. I mainly use Twitter to make sure I interact with readers who use that medium and to share my newest articles. Since 2009, my main use of Twitter has been to publish other people’s tiny stories in Nanoism, an admittedly bizarre hobby and a largely one-way broadcast (@nanoism). I actively dislike Facebook.

And yet.

Sometimes I find myself scrolling and scrolling, clicking on a shared link to another depressing rantorial and then reading the awful comments from strangers on the internet who didn’t read the actual article acting out their respective caricatures. It all makes me wonder if humans are actually the creatures of morality and reason as argued by some philosophers. For most internet platforms, anger and outrage are features. Yelling at strangers on the internet is gold for companies that serve you targeted ads and profit from your attention. Everything is tailored for engagement.

One app I desperately needed when I was a student is Freedom, a service that allows you to block certain activities either on-demand or on a schedule. It would have saved me from a lot of my old internet demons. I should probably even turn it on more now, but I’m usually in a better place these days. Having young kids to soak up my time and attention has helped me hone my focus.

But Newport takes it a step further, and I think he’s right. It’s not enough to try to limit the damage of new technology or platforms on your life:

I’ve become convinced that what you need instead is a full-fledged philosophy of technology use, rooted in your deep values, that provides clear answers to the questions of what tools you should use and how you should use them and, equally important, enables you to confidently ignore everything else.

Many finance gurus talk about the need for all of us to have “Investor Policy Statements” or a “Written Financial Plan.” The reason being that if you don’t articulate a specific position, you may react inappropriately to the vagaries of life in a way that is counter to your goals. The plan keeps you honest and helps you deal with anxiety.

It makes sense to plot out “use criteria” so that you know if you should be incorporating the newest social media service that comes along and not just reactively picking something up because it’s popular.

Likewise, it makes even more sense to look critically at your use and see where the utility lies. You may not want to delete your Facebook profile or remove Instagram from your phone. Fine, right? But what–specifically–about using those services makes you happy, and what makes you angry, hurt, or jealous? And, knowing that, how can you structure some rules for engagement that can help you get what you want from the platform instead of letting it became just another automatic behavior?