DCC
Here's the Wikipedia article I just started for DCC, a gene we're supposed to know about, but which I didn't find anything about in Robbins. I got almost everything from the OMIM article.
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Here's the Wikipedia article I just started for DCC, a gene we're supposed to know about, but which I didn't find anything about in Robbins. I got almost everything from the OMIM article.
If you are at all interested in learning, subscribe to the PHYSLRNR listserv. It is mainly Physics educators, and that is the main resource for learning, IMHO: reading what the teachers write for themselves. It is the same thing intelligence agencies do to learn about the enemy: read what they write for each other.
An anecdote from one former student. I graduated with a physics major in 1998. At the time, I wrote horridly, if at all. I can't say I ever learned anything about writing from writing a lab report, or even my capstone project. Several years later I did very well on the MCAT writing sample. What happened? In the intervening years I had four profound influences.
In 2002, I was standing in a very long line at a half-price book sale at a Border's Books in San Diego. After 20 minutes, out of pure boredom, I lifted a slim silver volume off a nearby shelf, thinking, based on the title, that it might have something to do with how to dress. Over the next 45 minutes Strunk and White's Elements of Style changed my life.
From 1998 to 2005 I had three consecutive jobs that required immense amounts of edited writing. Once you have the rule book, that is, Strunk and White, then the humility of being edited, and then the humiliation of further editing on resubmission, is profound. In the Navy, the junior officers write virtually every official document (letters, briefs, memos, instructions, manuals, guides, plans, radio messages, etc), but only senior officers, usually those who have had command, are authorized to release anything for distribution. Thus any given junior officer writes their draft, hand walks it to their department head, who chops the draft, while the JO stands there, then the JO goes back and makes those exact pen-and-ink editorial changes, prints it out, takes that to the executive officer for chop, until, finally, the Captain decides it's good enough. Needless to say, this creates a desperate desire, for the sake of not only efficiency but promotability, to improve one's writing. I probably got even more of this experience than most as my particular trajectory included stints as a ship's legal officer, an executive assistant to a senior officer, and then a staff officer at the Naval Academy. However, these almost daily treks between staterooms afloat and offices ashore did not improve my writing—perhaps I'm incorrigable—until I got my first copy of Strunk & White.
Heeding the advice that only the very brightest are cut out for a career in physics, when I got back to shore in 2003 I started taking med school pre-requisites. I found the biology and chemistry professors were using some strange software called PowerPoint. Perhaps you've heard of it. These biologists can go for years without touching chalk! I had no idea how to learn from this sort of lecture. I had to go learn about learning. Turns out very few people write about learning from a student's perspective. So I did what I'd done in intelligence work: I read what the enemies wrote to each other. I read about teaching. Which led me to Edward Tufte's books. After reading the Visual Display of Quantitative Information for about the third time, I was really starting to think in terms of crafting arguments in paragraphs on pages, and considering paragraphs within the scheme of the entire document, in the context of pages and figures and titles and notes.
Eventually, you find questions Strunk and White left unanswered, and that's what motivated me to find the Chicago Manual of Style. I have grown quite a reference shelf of style manuals, dictionaries, and assorted reference works. In some cases I bought duplicates for home and office. A gem that physicists may appreciate is S Katzoff's internal NASA booklet Clarity in Technical Reporting.
Nevertheless, in my humble opinion, Strunk and White should surely be a required text for any technical writing course, or any course in technical writing. If I were to conduct a writing workshop for undergrads, a daydream I entertain regularly, I would walk to the front and set down on a desk at the front of the room something simple, something that could be seen from the back of the room. A stick. A stone. A brick. I would tell them to write, for the rest of the hour, about that thing. I would take up their work at the end of the period, and work furiously to edit all their work, in red ink, by the next class session. I would return their writing samples and then I would tell a lie. I would tell them their entire grade for the course, A or F, hinged on returning, at the third class period, with a copy of Strunk and White, no matter how worn, and on the publishability of their corrections. I would answer no questions. At the third class period, I would account for their copies of Strunk and White, take up their writing samples, and again, dismiss them. Again I would have to work furiously to edit their writing samples. On the fourth session, I would again return the writing samples. No doubt most would still bear red ink. All Fs.
After a pregnant pause, I would say "That sucks, eh? Can't tell you how many times I've had that experience on the job. Turns out, the world really does have high standards. Makes you want to write well and never write again, all the same time, yeah? No worries, just an exercise for you all." Then I'd pass out the real syllabus.
I suppose if it was a physics class I might bring a meter stick to that first class, drop the brick from, oh, 0.73 meters, and tell them they'd get an extra chance at rewriting if they could, on a separate sheet of paper, predict the brick's velocity when it hit the ground and if it had been dropped from the same height on Phobos.
The patent (US5443036) for a novel method of exercising a cat. Trumped in pure audacity only be Dispair Inc's trademark of the frownie emoticon :-(
I was in the middle of applying to medical schools and, coincidentally, I had to go to Bethesda's dermatology department where, as it happened, and a buddy of mine was applying for residency. He had even taken me to their Grand Rounds. But now I was the patient. And I'd been in the exam room nearly an hour.
“I don't need a graph. What's your issue?” Thus spoke the chief dermatology resident at Bethesda. I knew this “chief resident” guy was smart. And I needed his help to heal the skin on my fourth proximal interphalangeal joint. It looked like the skin had little holes in it, like I'd dropped concentrated hydrochloric acid on my finger in Organic Chemistry over a year ago. After months of visits to other providers, this was my second visit to the ivory tower. The inflammation was just a spot, a little bigger than a pencil eraser. Why wouldn't it heal?! I'd been prescribed anti-fungals, anti-bacterials, anti-histamines, steroids. In the mean time, I'd also gone mountain-biking, swimming in the ocean, and changed countless poopy diapers. Maybe the acid had only activated some dormant process that had been waiting for years. In recent years I'd been in the engineering department of a ship. My hands had been soaked in fuel oils, lubricating oils, and, treat of treats, bilge water: the collected putresense of a ship that collects in the bottom of the hull. The next ship I'd been on was nuclear-powered. I didn't know what was the causitive agent was, but I'd had a year to think of possibilities. The medical student who'd taken my history had worked very hard to smile, but I was clearly the nightmare patient—I knew just enough to be really annoying. “Some patients just know so much about their own diseases!” the fourth-year student had said, her smile revealing gritted teeth, as she'd extracted herself from the thirty-minute interview from hell to go brief the chief resident.
Was the chief being rude by not listening? Yes. Did he need to be rude? Probably not. Was it better to be rude? Quite possibily. In retrospect, they were asking about the forest and I was telling them about the trees. It really wasn't a profoundly difficult problem, merely one I didn't understand. And, nice as it may have been, I'm not sure either they or I had the time for a complete course in immunology and inflammation, which is probably what I would've wanted before I understood the issue to my own satisfaction.
So, back to our little dialogue. How did I, the patient, respond?
“I don't need a graph. What's your issue?”
“They...”
“Who? Who's 'they'?”
“At the Naval Academy clinic, the PA gave me Westcor ...”
“Butter. Westcort's butter. Then what?”
“I came here and you gave me Clobeta...”
“Clobetasol. Are you taking it?”
“No, not n...”
“Why not?”
“Goodman and Gilman's says...”
“It's strong shit. The best. Why aren't you taking it?”
“You told me to take it for ten days.”
“So why's it still there?”
“That was month ago.”
“Why'd you stop?”
“'Cause it's steroids. I didn't want my adrenal glands to shriv...”
“Was it getting better?”
“Ye...”
“Take the clobetasol. Here's another scrip, get some more. You'll be fine. You're not taking enough of this to have any systemic effects. If you were smearing this over your entire arm, I'd be concerned. Take the clobetasol till it goes away.”
Exeunt.
At Amy Tenderich's Diabetes Mine. Theme: a series of letters home from a first-year medical student.
A link to Ernesto Illy's Scientific American articleThe Complexity of Coffee
Judge Posner takes on, and Professor Becker responds, to the Professor David Cutler, et al's, article in the New England Journal of Medicine, The Value of Medical Spending in the Unites States, 1960-2000. The context of the whole debate is framed by
Paul Starr's book The
Social Transfomation of American Medicine.
There are a host of issues that people have brought up to me about, in my particular instance, podcasting, and that I have discovered in my research that would merit consideration in any policy document for the school, or the University, and professors. The issues break out roughly along the lines of pedagogy, that is, how teachers believe they do and should influence their students, three legalistic domains -- copyright, libel, and employer-employee relations, and, finally, technical issues.
- "Students with learning disabilities may benefit to benefit greatly by having access to audio outside of a classroom setting." Again, this seems to be obviously good.
- "Professors must impose a schema, a framework for knowledge, on the lecture material." This ties in with the next statement.
- "Students need one schema in which to place the material they learn." The upshot of this is the students can't avoided the lecturer's schema. Many students don't attend class because they find that professors imposing their schema, however temporarily, destabilizes the fragile schema the student is trying to build using other sources. Too many schemas, too many frameworks, make a bush, instead of a building. A bush won't hold the first brick.
- "Even very bright students have a hard time parsing high level visual input (text-and-diagram slides) and audible input of the lecturer's voice, at the same time." This exists in parallel with the issues of schema, and it is almost totally unavoidable, unless one goes to lecture and covers their eyes. This also causes students to not go to class because their information transfer rate that asymptotically approaches 0. This is a matter of information overload. It is simply to much; people shut down.
- "I believe this offers another excuse for students to not go to class." Hopefully, but even still, we haven't seen a dramatic drop in class attendence simply because the audio is recorded. Indeed, popular lecturers get more attendance and more downloads.
- "I believe this will cause the class's USMLE board scores to go down." Maybe it will. Maybe they will go up. We don't know.
- "I believe more students will have consumed the lecture material before practicals and labs." No one but me has stated this, but it seems intuitively obvious.
- "I believe podcasting will lead to students who are less prepared for their clinical years." Again, we don't know one way or another.
- "I believe lecture is one of the more effective methods for learning the material." No one has actually said this. Quite the opposite, as a matter of fact.
- "I believe it is fair and reasonable to only allow the noteservice, a for-profit business to which not all students subscribe, to have exclusive access to recordings of my lectures." This was one professor's defacto position, but I think it was only a consequence of not having had the time to thoroughly think it through.
- "I believe that the presence of a digital recording will inhibit me from providing my students the best possible lecture performance." This has not proven to be the case. Ask me about Dr Jeter's joke.
- "I believe that the presence of a digital recording will challange me to provide my students the best possible lecture performance." I'm not sure this is the case either, but wouldn't it be nice if it were?
- "I don't want students to hear old material." This goes to the technology issues discussed below, but it certainly seems reasonable to dispose of the lectures after each class's preclinical years. That is, the first anatomy lecture should be up until the last student has finished USMLE Step 1.
- "I flat out don't want to be recorded." In so far as it is your performance, then that is your right to reserve.
- "I believe the possibility of a student distributing my lecture once he or she has possession of the digital recording provides unfair access to information to people other than my paying students." This goes to the technical issues below, as well as the legitimate desire to have everyone on the same page. It is not unreasonable, in my opinion, to ask students to sign an agreement acknowledging their responsibilities. It would be better, in my opinion, to have site protected with personally accountable university network passwords, instead of directory-local ht-access passwords.
- "I believe the possibility of a student distributing my lecture once he or she has possession of the digital recording provides people other than my paying students unfair access to my performance." This is, in theory, the copyrightable issue, the performance. The factual knowledge is not copyrightable. However, if anything, one would expect professors to endorse the widest scope of fair use possible as they and their students are the historical victims of copyright exclusivity. Nevertheless, it does seem reasonable to personalize the students' responsibility.
- "I believe the possibility of a student distributing my lecture once he or she has possession of the digital recording creates a risk of disclosing trade secrets that I share in my lectures, and that such action would jeopordize a business." This is an entirely different subject, and the professors are the ones assuming responsibility if they are disclosing trade secrets without pre-existing confidentiality agreements.
- "I would consent to podcasting of my lectures over a secure university .edu server if and only if the school of medicine or the university had a published policy on the matter." I suppose that's what this is about.
- "I would consent to podcasting of my lectures over a secure university .edu server if and only if the school of medicine or the university required all students to sign a statement of understanding that clearly defined their obligation to protect the digital recording of my lectures." As above, I suppose this is reasonable, though it seems to me there are other ways to raise the stakes without making people sign vaguely worded statements, and all such statements become vague in the end.
- "A supervisor told me I was to not allow podcasting of my lectures." Ditto.
- "I believe my usefulness to the organization will be jeapordized if my lectures are recorded even once, thus making them available to future classes." It seems fair and reasonable that the content should be taken down at the end of that year's pre-clinical years.
- "I find the technical aspects of recording the lectures, as handled by the students, to be cumbersome." This is what is addressed by having 'student-helpers' who deal with the wires and buttons.
For more, here's the Creative Commons Podcasting Legal Guide and Stanford's Copyright and Fair Use site.
PowerPoint is antithetical to the one thing students need from professors: schema. PowerPoint shatters the professor's schema that they are trying to present to the students. It causes students to tear down large amounts of knowledge and attempt to rebuild the information because the information is fragmented and it becomes exceedingly inefficient to try to rebuild whole from the pieces. This destruction of schema is very bad for education, but very good for advertizing.
PowerPoint breaks up the framework for knowledge. Diagrams, outlines, paragraphs, these are the shapes of knowledge and they rarely take the form a computer screen, and those subject-oriented shapes are usually too dense, require to much real estate to fit on a single PowerPoint slide that is readable from the back of the room. Indeed, there's a running recommendation that presenters and lecturers should plan about one slide every two minutes, or about 25 slides for a fifty minute lecture, and this is about what we see, at least at my school, but also in my past jobs, and other schools where I have sat in on classes. These frameworks for knowledge are called schemas. The physical representation of our knowledge is the architecture of the synapses between neurons, and the location of neurons, in the brain. So too, learning is the the formation of new synapses, and nueral pruning.
Not only does PowerPoint fragment the shema spatially and temporally, it can actually tear down the student's partially built schema, by undermining the confidence the student has in their sources. Loss of confidence is a terrible thing. To illustrate this, think about what the phrase 'loss of confidence' means to a military commander in the field. If a commander looses confidence in a subordinate commander, they have to relieve that subordinate of their duties! The commander will decapitate on of their own units to remove that one person who lost their confidence! Similarly, a student who looses confidence in an element of material may feel the need to tear down a whole wall of knowledge and rebuild it if they loose confidence in it. This becomes a wildly inefficient use of time. Its, its, disefficient.
How can PowerPoint cause loss of confidence? If the material is there, surely the student should understand it, right? It's coming in the ears and eyes at the same time, right? Saturation bombing the brain, right? That works. Right? Name a war where saturation bombing worked and I'll show you a war in which there was no fundamental misunderstanding to begin with.
Can the destruction of schema be useful? Perhaps in advertizing, in which the marketer wants to remove any barriers to the consumer's decision to buy. The marketer can make room for their own framework, their reasons for buying the product, by selectively destroying, or at least temporarily weakening, the consumer's schema, which is likely the product of a lifetime of hard knocks.
Avoid PowerPoint. If you lecturers use it, ask your teachers to not use it. If that doesn't work, avoid class. If you lecture, don't use it. If you are at a business meeting, decide before the first slide is shown whether you really want to allow this person to tear down your knowledge of the business you're in. This dichotomy of PowerPoint and good schema is realized implicitly by anyone who appreciates the irony of drug company education programs for doctors. We need to tell teach others about this. Schema, unfortunately, is Latin, which is very useful academically, because it's easily adopted by a mind interested in studying it and brings with it little to nothing in the way of background, but it's not a metaphor, which makes it ill-suited to widespread acceptance. We need a better word. Not just a word, a metaphor. Perhaps PowerPoint itself is the best metaphor available, but to appreciate it, we still need to introduce the concept that schema is the framework.
I recently got an e-mail that included this: "some students are questioning if and what is being addressed and how".
This is an issue of schema, and I empathize, to a point. The students with this concern want to know how this stuff should fit in the framework of knowledge, even as they are trying to build their own framework for the knowledge, their own schema. I recommend every first year medical student go get First Aid for USMLE Step 1 and start annotating their own copy with anything that isn't covered in class. Second year students who don't have this are likely behind the curve, or fall into the enviable group of people who don't have to study.
With an N of 1, a sample size of 1, the variance is infinite. You never get more variance reduction than when you go to N = 2. So maybe others had better think a bit about the audience, at least in some regards." - Edward Tufte, Technical Communication Quarterly, 13(4), 447–462
First Aid is written and edited by students and former students who have taken the test. So it's kind of like Wikipedia, in that it is a constantly improving resource, indeed, the kind of resource it is is a schema, which is improved by community feedback. A new edition is published every year, and I can attest to the fact that the current edition has new content every year. It the best possible ready-made schema simply because so many minds over so many years have worked on it. Perhaps you can develop a better schema all on your own, but First Aid has 400,000 customers, so the odds are against any given individual doing better. Peer-review from some subset of 400,000 recent test-takers, or one PhD, who never took the test. What do you think? A professor can certainly be relied on to get the solution right to the first approximation, and that's a big first step, huge, but First Aid has gone through new iterations of peer review every year and it is sensitized *to the test*, not to what one person or one school's department may have learned over the last year. It's not sensitized to what I think. First Aid is sensitized to the test.
Another interesting point about First Aid is who is investing their effort into it: all of the contributing authors for this year are from Yale. What, I thought the authors were from California? Well, Yale doesn't require their students to take tests, let alone go to class. You want to talk about some people who *need* to find their own schema, it's the Yale kids. Schema, schema, schema. See my blog's archives of medical education for copious detail on schema.
If you're a second year medical student, you've probably heard of Katzung's pharmacology books, but did you know he is one of First Aid's five faculty reviewers? Perhaps the most appropriate thing to do would be for medical school classes to buy their course coordinators their own personal copies of First Aid. At least then the maximum number of people would be singing from the same sheet of music.
I've thought about writing about this before, and I wish I had, because Pin-Chieh Chiang did and now her comments section has become a world-wide confessional for medical students. 85, count-em, 85 comments, each with an illuminating story. From almost every continent. The value is fairly obvious; the side effects I've heard of are post-medication psychoses (716 hits in PubMed — once on Ritalin, always on Ritalin), loss of appetite, and cardiovascular risk (because Ritalin, speed, meth, etc, are sympathomimetics: they make your heart race). What do you think?
Would a shift of lectures away from PowerPoint factoids toward a focus on schema help?
Here's the (in)famous score estimator. Reading around the site, I'm not sure how good it is. I'm just not sure. Using real-time regression modeling to determine the 'most appropriate' coefficients for the estimate is probably a good idea, but weighting of recency is an arbitrary weighting and it makes me wonder what the weighting factor is and why they added that. The other variables should not change much over time. And what, exactly, is 'recent'?
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