5 ms·

> I mean, that's why we trust doctors, because the bar is that high. Two thoughts: 1. The old joke, "What do you call the person who graduated from medical sc

by rosser 10y ago

> I mean, that's why we trust doctors, because the bar is that high. Two thoughts: 1. The old joke, "What do you call the person who graduated from medical school at the bottom of their class?" "Doctor." 2. The ordeal of residency isn't about setting the bar "high", nearly so much as it's about, "well, I went through this shit, so you have to, too". (Source: I have several doctor friends. All of them think it's bullshit. All of them have been explicitly told that, in some form or fashion, by their colleagues, superiors, teachers, or otherwise.)

kbenson 10y ago
1. What do you call the the person who graduated from SEAL training at the bottom of their class? A SEAL. I get the joke, but part of the point is that top and bottom of the class are only relevant for those who actually graduate, and who is capable of graduating can be entirely different based on the goals of the institution. From "everyone can, with work" as in High School, to "only those who are good enough" as (hopefully) in medical school. 2. Humanity, where we've institutionalized pettiness, and not just once, but throughout history. :/
- rosser 10y ago
  There's a pretty staggering breadth of admissions requirements for the various accredited medical schools in the US, and plenty of offshore schools that effectively will take anyone — basically MD mills. The Dominican Republic, in particular, is well-known for this. (Yes, many of the offshore medical schools are LCME-accredited and legit, and have trained some fantastic physicians, but broadly speaking, they're taking people who couldn't get into an on-shore school.)
  - kbenson 10y ago
    Sure, I'm not really arguing that all medical schools have sterling reputations or high standards, just that the joke, as a way to illustrate the problem, unfortunately obscures the real problem. It's pithy and punchy, which makes it good joke and easy to repeat. It's sort of a peeve of mine when I see well intentioned but slightly misleading memes propagate. They're hard to fight for the same reason they are memes.
- gaius 10y ago
  I see you've read DH Xavier too
theseatoms 10y ago
Regarding the second point, this is room for improvement for reducing healthcare costs by increasing the supply of doctors.
Lordarminius 10y ago
> Two thoughts... "What do you call the person who graduated from medical school at the bottom of their class?" What do you call an engineer who graduated from the bottom of their class? The ordeal of residency isn't about setting the bar "high", nearly so much as it's about, "well, I went through this shit, so you have to, too". (Source: I have several doctor friends. Medical doctors are trained to exhibit a level of competence. The 'bootcamp' approach is what we know at the present time to work best. Is it easy? No. Is it pretty? No. Do you have a better suggestion? ___ All of them think it's bullshit All of them is still a small percentage of doctors. (Frankly this argument is old and stale. Anyone who has a better plan for training doctors should speak up instead of rehashing it)
- rosser 10y ago
  > The 'bootcamp' approach is what we know at the present time to work best. What other approaches have even been tried? I don't think, in the absence of meaningfully tried alternatives that have been shown to be lacking, that a proclamation of "best-ness" is particularly warranted. ("It's the best!" "Oh? What else have you tried?" "It's the best." cycles aren't responsive.) I note you're a physician, as well. How much of your perspective on the matter is a result of your having been through a similar process? I'm not. But I take the word of my physician friends — one of whom, a perinatologist, recently accepted a position at a prestigious teaching university — very seriously. They aren't just speaking from their experience. They're, if their explicit statements are to be believed, relating the experience of nearly every other physician they know. Sure, that's still a vanishingly small fraction of the total physician population. At what point, then, does this chorus of, "This is not the best way to do this" become worth listening to, and not merely writing off as griping by the uninformed, or a minority of slackers with sour grapes?

by rosser 10y ago

kbenson 10y ago

1. What do you call the the person who graduated from SEAL training at the bottom of their class? A SEAL. I get the joke, but part of the point is that top and bottom of the class are only relevant for those who actually graduate, and who is capable of graduating can be entirely different based on the goals of the institution. From "everyone can, with work" as in High School, to "only those who are good enough" as (hopefully) in medical school. 2. Humanity, where we've institutionalized pettiness, and not just once, but throughout history. :/

rosser 10y ago
There's a pretty staggering breadth of admissions requirements for the various accredited medical schools in the US, and plenty of offshore schools that effectively will take anyone — basically MD mills. The Dominican Republic, in particular, is well-known for this. (Yes, many of the offshore medical schools are LCME-accredited and legit, and have trained some fantastic physicians, but broadly speaking, they're taking people who couldn't get into an on-shore school.)
- kbenson 10y ago
  Sure, I'm not really arguing that all medical schools have sterling reputations or high standards, just that the joke, as a way to illustrate the problem, unfortunately obscures the real problem. It's pithy and punchy, which makes it good joke and easy to repeat. It's sort of a peeve of mine when I see well intentioned but slightly misleading memes propagate. They're hard to fight for the same reason they are memes.
gaius 10y ago
I see you've read DH Xavier too

theseatoms 10y ago

Regarding the second point, this is room for improvement for reducing healthcare costs by increasing the supply of doctors.

Lordarminius 10y ago

> Two thoughts... "What do you call the person who graduated from medical school at the bottom of their class?" What do you call an engineer who graduated from the bottom of their class? The ordeal of residency isn't about setting the bar "high", nearly so much as it's about, "well, I went through this shit, so you have to, too". (Source: I have several doctor friends. Medical doctors are trained to exhibit a level of competence. The 'bootcamp' approach is what we know at the present time to work best. Is it easy? No. Is it pretty? No. Do you have a better suggestion? ___ All of them think it's bullshit All of them is still a small percentage of doctors. (Frankly this argument is old and stale. Anyone who has a better plan for training doctors should speak up instead of rehashing it)

rosser 10y ago
> The 'bootcamp' approach is what we know at the present time to work best. What other approaches have even been tried? I don't think, in the absence of meaningfully tried alternatives that have been shown to be lacking, that a proclamation of "best-ness" is particularly warranted. ("It's the best!" "Oh? What else have you tried?" "It's the best." cycles aren't responsive.) I note you're a physician, as well. How much of your perspective on the matter is a result of your having been through a similar process? I'm not. But I take the word of my physician friends — one of whom, a perinatologist, recently accepted a position at a prestigious teaching university — very seriously. They aren't just speaking from their experience. They're, if their explicit statements are to be believed, relating the experience of nearly every other physician they know. Sure, that's still a vanishingly small fraction of the total physician population. At what point, then, does this chorus of, "This is not the best way to do this" become worth listening to, and not merely writing off as griping by the uninformed, or a minority of slackers with sour grapes?