The Haversian Canal

Howard Reich's piece in today's Chicago Tribune, Crisis of culture in New Orleans, has an excellent piece about the cultural challenge New Orleans faces. If you live outside of New Orleans and want your child to learn trumpet, sax, clarinet, trombone, piano, bass, guitar, or any other jazz instrument, check locally, even circulate an ad in the classifieds, for a New Orleans
musician. You may be saving jazz, America's greatest cultural tradition.

My wife got a new laptop because she's finding some need for it at her new job, but we didn't get Microsoft Office. Actually, it was the laptop that Tulane negotiated with Dell to sell to students. It seemed like a great deal, until we got it and realized Microsoft Office wasn't installed. So, with the missus needing to get working ASAP, in desperation I loaded OpenOffice 2.0. After about 30 seconds of using it my wife said, incredulously, "This is free?!" Checking back an hour later, I asked her how it was going and she said she liked it.

Thank youuuuuuuuuuuu, Sun Microsystems and the OpenOffice contributors.

I wish I had come up with Medviews: The Fix. But Dr Stuart Henochowicz did, and bravo to him. In brief, the top five priorities for fixing the American healthcare system:

1. Enacting compulsory health insurance.
2. Promote primary care
3. Fund the National Health Information Network
4. Encourage consumerism
5. Encourage physician involvement and leadership in health care policy.

Is there are journal for the stay-at-home-parent profession? Staying at home with the kids this summer has been an illuminating experience. It's not that it's particularly harder than a day job, although it is more physically demanding. I find it to be most like standing watch on a ship.

Similarities:
1) You're responsible for what happens.
2) It can be mind-numbingly boring
3) You can easily slip behind the schedule if you let the boredom lull you into a sense of 'just passing time'.
4) There is a real chance of people getting hurt, even if you're careful.
5) There may be a greater chance of people getting hurt if you're too careful.
6) Your legal authority is tremendous, but your actual influence is a matter of personal rapport.
7) Decisions have to be made in real time.

Differences:
1) A stay-at-home parent is responsible for fewer people.
2) A stay-at-home parent gets remarkably less respect. I think this may be associated sociologically with the number of people the parent is in charge of. Isn't a parent of 12 held in higher esteem that a parent of 2? There aren't many stay-at-home parents of 100.
3) The equipment is much more mundane: the dryer just isn't as exciting as a missile launcher or turbine engine, although the proper functioning of the dryer is surely a more significant day-to-day concern.
4) I'm not aware of many professional journals of stay-at-home parenting or advanced degrees in stay-at-home parenting.
5) The stay-at-home parent's shift is longer (16-18 hours a day vs 4 to 7 hours for a deck watch), but the sleep schedule is more regular.
6) The typical American stay-at-home parent isn't part of a day-to-day institutional organization, like a ship or a hospital, that brings many practitioners into close contact and facilitates the exchange of ideas. Pockets do exist, notably military base housing, where parents are able to share lessons and stories on the playgrounds, in social contexts, etc, as a part of their daily routine. In retrospect, this a phenomenal advantage of base housing, and community planners should look to it as a model.

Decisions have to be made in real time, but there aren't any professional journals and there aren't a large number of practitioners within a local, physical institution with whom to share stories and lessons. Researchers seem to make a rather nihilistic assumption that people raise their children as they were raised. Well, that's probably true, but it's not the whole story. Stay-at-home parenting, parenting in general, seems to be lacking a lot of the standardized indoctrination that virtually all other fields provide their neophytes.

I use these Moleskine cashiers like they're going out of style. Best notebook I've found to carry in a shirt pocket. You can quickly, anywhere, jot down an idea or paragraph, or several paragraphs if you really want to. I wouldn't recommend them for a treatise, though.

Unsolicited Advice for 2nd Year and Step 1,

I hate to break it to you, but 2nd year is tougher than 1st year, so relax and enjoy what’s left of summer. However, 2nd year is also much more clinically useful, so many people, myself included, did not find it as hard to force ourselves to study. Also, class material is the same stuff that is on the boards, so you’re killing 2 birds with 1 stone.

Immunology—You have to be ready to hit the ground running because you only have 2 exams and about 90 questions total for the class. The first test was about 55 questions, and second was about 35 questions. The remaining 10 points to were from small group sessions. This class was not as strenuous compared to Path, but I don’t know who the new course director is, so I can’t speak to the difficulty. However, if your brain is a few weeks late returning from summer vacation, you might have trouble on the first exam.

Path—This is by far the biggest course you have all year and also the most board relevant. I bought Baby Robbins and Big Robbins. I read all of Baby Robbins as we covered the material, and only used Big Robbins for reference and to look at pictures/figures. There is also a medium-sized Robbins that many of my classmates liked. Also, I used BRS Physiology(skimmed the relevant chapters at the start of each block to brush up on normal processes) and BRS Pathology throughout the year. The last book is the Robbins Review question book. Do these questions a few days before the exam. Some of the questions will find their way on the exams, and the others are good for distinguishing between features of similar diseases. You shouldn’t need any of the Atlas/Picture books…I don’t know anyone that used them, and they give you a CD representatives of all the pictures that are used on exams. Exam questions can be very frustrating because many of them are 2 jump questions (they describe a disease but don’t tell you what it is, and then the question asks you about another feature of the disease, so you have to be able to know what disease it is, and then pick out another aspect of it). The questions are good though in that they closely resemble what board questions are like. Doing practice questions is VERY important for success on both class exams and boards.

Pharm—The first test is one of the biggest so do well. Unlike Immuno this is a year-long class, so it is possible to come back from a less than stellar performance, but who likes playing catch up. They give you a great drug list, so study that primarily. Many people bought either Katzung or Katzung’s Board Review Book and used them mostly for reference. Seriously, the drug list is key.

Micro—This course was very inconsistent for us. Most people used Clinical Microbiology Made Ridiculously Simple as their main text and class handouts for professor specific details. I would recommend also reviewing what’s in First Aid before exams.

Behavioral Science—Read a board review book before the exam and you should do fine.

Boards—Most people that I know started studying somewhere between the end of Christmas break and mid- March. It all just depends on how competitive of a specialty you want to enter. The 2 main resources that most people used were First Aid and Q Bank. First Aid is more along the lines of bullet points than paragraphs of info. I spent a few months reading board review books and annotating First Aid with info that I thought was testable and missing in First Aid. I would recommend using the board review books along with the class schedule because this increases efficiency and lowers cramming in April/May/June. Then I just read First Aid multiple times, trying to extract new info each time. This was supplemented with Q bank questions. Q Bank can also be used as practice questions for class exams, but I would advise to set up most of your tests with all the possible subjects checked because the computer will create tests with a similar breakdown to the actual exam. A few important tips:
1. You’ve done well in school/exams thus far, don’t reinvent the wheel for this exam. Do what you know helps YOU learn.
2. It is a marathon, not a sprint. Don’t start studying too late, and don’t burn out early. Make a schedule with goals of what you want accomplished by when, and discipline yourself to stick to it.
3. It’s not how much you study or how many books you read, it’s what you remember from what you study that will help you on the exam. Pick a limited number of books to study from, and learn those well. Be realistic about how much info your brain can hold on test day, and know that info well.
4. Good luck.

Just a reminder: the internet really is a physical thing:

This evening (July 14th) from about 5:25pm-6:55pm many of our servers were offline causing significant downtime for many of our users. The outage was due to a severe power outage in the north end of Orem, Utah where our servers are located. We do have UPS backup as well as diesel generators, but at about 5:30 they finally gave out. The power outage was for much longer than that period of time, but the reserve power was eventually consumed in its entirety.

you all should be eligible for a Dell laptop at good discount as a medical student starting a new track. Go through their education store. You'll need to e-mail Dell Education an image (.pdf or .doc) of your acceptance letter (a web-based e-mail embedded in the ordering process). The authorization to order will take a few days to clear as a human has to look at your acceptance letter and the computer doesn't come with Microsoft Office, but who cares when OpenOffice 2.0 is free and better? I just got mine, loaded OpenOffice 2.0, gave it to my wife, who is very techno-phobic, and she uses it every day. Her MS Word documents opened just fine and her response after an hour with OpenOffice was "This is free?!" It's $1800 out the door and handles Windows XP .doc format just fine. The equivalent Dell on the open market is $2400 and has less storage (Tulane package has a 120GB hard drive; Dell's mass market max hard drive is 100GB). If you have a hunormous iTunes library, I recommend keeping it on an external hard drive.

I believe Apple offers a similar deal. If someone knows the scoop on that, please share. Update, here's a review of recent Apple notebooks from Zed Shaw. When I read it, it ranked number 12 on reddit (ie: good advice *and* a good read).

Another option, recommended by Wallace Wang of "Steal This Computer Book" fame, is to order a refurbished computer from a big seller, like Dell, Apple, Toshiba, whoever. Besides the discount these machines have a fairly quick turn-around, and often get better inspections before going out again because the company doesn't want to loose more money on them.

That said, it's not at all clear that using a computer in or out of class improves test performance or learning. I also came to medical school in the "I type faster than I write" crowd, and, if you peruse my blog's medical education category, you'll find I field-tested the available software options intensively. I don't recommend it. I personally recommend keeping your laptop tucked up on a bookshelf (out of sight, out of mind) and don't ever set it on the desk you study at. If you do use it, and you will have to check e-mail and download assignments, I recommend sitting on the couch with the laptop on your lap (it's comfortable until it gets really uncomfortable); not plugged into the wall (that's right, use the battery to rate-limit your usage). And that's coming from somebody who does web design and analytic design on the side and owns way more computers than necessary. If you want more on computers in medical school, and my personal thoughts on medical education in general, visit the medical education category.

I have a friend, about 50, who manages international financial IT projects. He carries a $15,000 fountain pen but doesn't wear a watch and doesn't employ a personal assistant. He carries a laptop on travel but I've never seen him use it. I asked him how he manages his schedule. He said it's actually quite interesting, it's an entirely different way of organizing one's life.

I think there's a tendency to overrate the value of computers in a formal educational setting. I could go into the tremendous value of the tactile and proprioceptive input of writing, and the synthetic learning value of having to choose which words to write instead of just typing them all, but I digress...

The Bryan—College Station Eagle is doing a great job covering the the tragic deaths of 27 horses in less than 24 hours. The horses belonged to Brad Raphel, simply Mr Brad to our daughter and the other children who learned to ride from him. He provided therapeutic riding for developmentally delayed kids in addition to regular lessons. He still has eighteen of his Peruvians, but their vet bills are in the hundreds of thousands of dollars, and the replacement costs are expected to be astronomical. Two remain at the Texas A&M Vet School, the same facilities that housed Houston's Shriner burn unit during Hurricane Rita. While a refugee-student in Houston my wife and kids lived with my parents in Bryan and I often studied on the weekends at the Health Sciences Library, which the medical and veterinary schools used.

Here's Google News for all the stories.

Our daughter is in love with horses. Of all the activities we've offered her—swimming, gymnastics, soccer, ballet—horseback riding lessons with Mr Brad were her favorite by a mile. We haven't told her that a pesticide Mr Brad used on his feed silo to kill weevils likely killed her favorite riding horses, Red and Navarro.

The deep issue is that PDF is never the editable source file for any document. Portable Document Format is a portable *output* format. It is a core part of Adobe's business to make sure PDFs can be viewed in any operating system and printed on any printer. That PDF is an output format is also why PDF is so popular for distributing documents over the Internet when authors want to preserve their content: the odds of a PDF being compromised without intent are nil.

You can "mark-up" PDFs up and flatten them so they look like clean edits to the casual observer, but you need a full version of Adobe Acrobat (not just the reader), Creative Suite (CS2 is available on education discount for $350, less than any one component retail), Photoshop, or Illustrator. There are some free Linux programs that you can hack together to edit PDFs, but I'm not familiar with them. Google show's a promising PDF editor that actually allows you to edit the PDF's code.

As for converting PDF to DOC, google knows about lots of companies selling software to do that. There may be some free ones.

Short answer: yes, an online database repository of questions and answers is worthwhile for the students. There are four basic flavors, in personal order of preference: OpenACS for the school, a forum for the class, a blog for the course, and, finally, Blackboard (which is like walking on nails, IMHO).

Whatever you decide to do, I'm strongly in favor of telling people in advance that their comments will be subject to moderation and placing heavy weight in your moderation decisions on whether commentors use their real names. Here's one of the best threads on the internet about comment moderation (full disclosure: I participate in aforementioned forum). I also recommend a soft, warm-to-neutral, near-white color palette and minimal use of lines in the design. Swaths of very mild color are better.

Long answer: Is a blog 'worth it'? For the students it would be better than Blackboard (the forum in Blackboard is the most horrid learning interface I have ever seen). A post-per-lecture is probably the best organization for a blog. If all the profs agreed on a forum, that would be even better for the students. The way most schools keep the students distributed among several different, exculsive feedback systems (their own little internet fiefdoms) is . . . less than ideal. Blog or forum, you could link to the audio and the slides in the post (blog) or first post of each thread (forum) and monitor comments by e-mail. Long answer: I think the OpenACS system is the best learning community system going, but it still requires a bright programmer. To the point, I taught myself photography and analytic design and web design on photo.net and Ask ET well enough to get paid, get repeat customers, and turn away work. I tried to get an OpenACS community for Tulane Med set up last year through Philip Greenspun's course at MIT (he developed ACS in the 90s, starting with Hurst Publishing's intranet and then photo.net), and he pushed his students to it take on after the storm (h), but they balked. Maybe I'll try again. The social bookmark site del.icio.us is also based on some ACS modules.