Last week was my 1-year anniversary using MarsEdit, and I feel not an iota of urge to switch to anything else for publishing. Now, if only there were a general-purpose editor that was as fast but that I could use as an nvAlt replacement. When is nvUltra coming out, again?

I just finished attending a 1-hour career panel for UMBC undergrads thinking about medical school, and the one thing anyone interested in practicing medicine in America should know is that you really, really, really need to know how to answer multiple choice questions. It doesn’t matter how smart, knowledgable, or hard-working you are: if you don’t have the skills needed to pick the one correct answer out of the four to six usually given, be ready to take a hit on how, where, and whether at all you can practice medicine in the US.

To be clear, this is a condemnation of the current system! Yes, there are always tradeoffs: oral exams so prevalent in my own medical school in Serbia weight against the socially awkward and those who second-guessed themselves. But the MCQs are so pervasive in every aspect of evaluating doctors-to-be (and practicing physicians!) that you have to wonder about all the ways seen and unseen in which Goodhart’s law is affecting healthcare.

What would the ideal evaluation of medical students look like? It wouldn’t rely on a single method, for one. Or, to be more precise, it wouldn’t make a single method the only one that mattered. Whether it’s the MCAT to get into medical school, USMLE to get into residency and fellowship, or board exams to get and maintain certification, it is always the same method for the majority of (sub)specialties. Different organizations, at different levels of medical education, zeroing in on the same method could indeed mean that the method is really good — see: carcinisation — ⊕ To save you a click: it is “a form of convergent evolution in which non-crab crustaceans evolve a crab-like body plan”, as per Wikipedia. In other words, the crab-like body plan is so good that it evolved at least five different times. but then if it is so great to be shaped like a crab, where are our crab-like overlords?

Being a crab is a great solution for a beach-dwelling predatory crustacean with no great ambitions, and MCQs are a great solution to quickly triage the abysmal from everyone else when you are pressed for resources and time. But, both could also be signs of giving up on life, like how moving to your parents' basement is the convergence point for many different kinds of failed ambition.

Behind the overuse of MCQs is the urge to rank. Which, mind you, is not why tests like USMLE were created. They were, much like the IQ tests, meant to triage the low-performing students from the others. But the tests spits out a number, and since a higher number is by definition, well, higher than the lower ones, the ranking began, and with it the Goodhartization of medical education. The ranking became especially useful as every step of the process became more competitive and the programs started getting drowned in thousands of applications, all with different kinds of transcripts, personal statements, and letters of recommendation. The golden thread tying them all together, the one component to rule them all, was the number they all shared — the USMLE score.

But then the programs started competing for the same limited pool of good test-takers, neglecting the particulars of why a lower-scoring candidate may actually be a better match for their program. Bad experience all around, unlike you are good at taking tests, in which case good for you, but also look up bear favor. On the other hand, there is all this other information — words, not numbers — that gets misused or ignored. If only there was a way for medical schools and residency programs to analyze the applications of students/residents that they found successful by whatever metric and make a tailor-made prediction engine.

Which is kind of like what machine learning is, and it was such a logical thing to do that of course people tried it, several times, with mixed success. It was encouraging to see that two of these three papers were published in Academic Medicine, which is AAMCs own journal. One can only hope that this will lead to a multitude of different methods of analysis, a thousand flowers blooming, etc. The alternative — one algorithm to rule them all — could be as bad as USMLE.

The caveat is that Americans are litigious. Algorithmic hiring has already raised some alarm, so I can readily imagine the first lawsuit from an unmatched but well-moneyed candidate complaining about no human laying their eyes on the application. But if that’s the worst thing that could happen, it’s well-worth trying.

I agree wholeheartedly with Nicolas Magand’s answer to why he liked monospaced fonts. Any time I’d change the editor to a Serif font it ended poorly. I would add the IBM Plex family to the list of favorites: they are clean, readable, and underused despite being widely available via (ick, I know) Google Fonts.

🕹️ The 25th anniversary of Valve’s Half-Life is tomorrow, and they have a one-hour documentary out. The whole game is also available on Steam for free. There goes my weekend! (ᔥwaxy.org)

Booting up an Intel MacBook Pro for the first time in months, and the fans spin up as soon as I enter my password, and they are louder than the AC, and the screen freezes before getting to the desktop, and how on Earth did we ever tolerate this garbage? Isn’t technology grand?

🗃️ Chris Aldrich’s advice on zettelkasten for course work applies to anyone who is just getting introduced to a new field:

A zettelkasten practice like that of Niklas Luhmann is more useful when one already has a strong lay of the land and they’re attempting to do the work of expanding on the boundaries of new areas of knowledge.

…

If you’re attempting to create 30 permanent notes a day and interlink them all, then you’re going to find yourself overworked and overwhelmed within just a few days.

This is why slip boxes get abandoned: not because they’re empty, but because they are full on unintelligible gunk. And doing it digital — looking at you, Obsidian and Roam — just makes it worse for those without discipline.

🏀 You know it’s bad when they have to send the mascot out to the nosebleed seats to animate the crowd. A 13-point differential at the end was too generous to the Wizards.

I am not a fan of legalese, but this case of typographic mischief was right up my alley. Just read the judge’s closing paragraph:

The Court further notes that the last thing any party needs is more words on a page. The length of an argument is no guarantee of its success, and indeed could result in more confusion, not clarity. Moving forward, the Parties are encouraged to spend their valuable time focusing on the merits of this case, and certainly not figuring out how many sometimes-useless words will fit on a page.

Words to live by! (ᔥMatthew Butterick, who was — no suprise there — involved in the case)