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Wellness Wednesday for February 14, 2024

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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It may not be satisfying per se but some of the oddities of medical examinations come from a very well-defined place (well if it’s like the USMLE anyway).

-Specific pieces of data one specialty wants to convey to another. “No ortho you really do need to know this about the ‘beetus.”

-Making things harder in a way that assess actual knowledge and understanding instead of fact recall.

Those are two of the biggest. Also repeat questions are often stemming from the whole “experimental questions” aspect of the exam.

Making things vague, removing buzzwords. This means you have to actually UNDERSTAND the stuff instead of just memorize facts or guidelines. You need to know the why and what of currant jelly stool instead of just recognizing it in a stem and slamming down on the answer.

I swear to you with time and space you’ll find that some of the stuff is more reasonable than your experience of it felt like.

Except the SJT, fuck that toxic horseshit.

Put another away:

Ideally at some point you’ll be doing a boards question or some other assessment and you’ll have this experience of “I don’t know the answer to this question but my knowledge is sufficient to understand what the answer should be based off of other things I do know.” I’m not quite sure I made that come across the way I wanted to but hopefully you’ll have the ah-hah moment at some point.

Thing is, it's not like the USMLE, I attribute the oddities of this exam to incompetence rather than malice attempts at making questions that get at in depth understanding of medical matters. The SJT alone should be sufficient evidence to back up that claim.

The questions were easy, at least in terms of diagnosis, and I understand scenarios where one has to use limited information to make a snap judgement come up regularly, and vagueness is not necessarily inaccurate to real life, it was the fact that they designed questions that ranged from "why did I even study for this" to "choose between two plausible options with insufficient information to decide between them". Admit? Admit and do what? Refer? Urgently or not? That's critical, and without it the question becomes a matter of guessing, especially when a lot of it hinges on the particulars of where you see the presentation. It matters a great deal whether your nominal location is in a GP practise, or they're showing up at the ER, and in some cases that information was both relevant and absent.

I can't say I know much about the USMLE (given that it would be an entirely academic curiosity for me, right now), but the PLAB exam was significantly better in that regard. Clear curriculum, an understanding of core competencies to cover, better written questions. I can't even say the MSRA by itself was harder, both had the typical pattern matching red currant stuff too, but this exam made me feel like I went to get a driving test and then ended up forklift certified. The difficulty comes solely from the fact it's competitive for limited seats, whereas that's far less of a factor for the PLAB. I'd rather have a hard exam where I know how to prepare than an "easy" one where I'm at just as much at a loss as anyone else.

Ideally at some point you’ll be doing a boards question or some other assessment and you’ll have this experience of “I don’t know the answer to this question but my knowledge is sufficient to understand what the answer should be based off of other things I do know.” I’m not quite sure I made that come across the way I wanted to but hopefully you’ll have the ah-hah moment at some point.

The missile doctor knows what the right answer is by knowing what it isn't eh?

PS: Tarkov cheaters. You learn to live with them. And don't go Labs, if you can help it. I play on Singapore and occasionally Chinese servers, so I'd imagine I have the worst of it, but avoiding Labs and Lighthouse (except for quests) will keep you mostly safe. And eventually you'll be rich enough that dying to a cheater every dozen raids or so is the cost of doing business.

Given the general state of the U.K. I am entirely amenable to the idea that the exam is just absolutely fucking retarded, but I do want emphasize that it's probably just a tinge more likely that they are doing something on purpose, potentially with a heaping dose of "I don't like this."

Sometimes it's straight up "this seems like a stupid question but it seems to correlate with exam performance so..."

I don't know if this exercise is viable for India, but one exercise I have students do towards the tail end of clinical is look back at their first year exams, you'll see clinical correlate questions mixed in with basic sciences questions and at the time they are enormously frustrating "why the fuck did they ask about that" is a common refrain, but if you come back at the end of clinical you'll see that it's common, or a necessary concept to reinforce and so on.

The SJT for instance is stupid, but it's placed there with quite a degree of deliberation, just the two of us hate it.