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May 31Liked by Meghan Daum

I knew Meghan was going to say Sherman’s March. I love this documentary too and have seen it about a dozen times.

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May 31·edited May 31

I want to make a contrarian argument: I don't think that the quality of education in med school matters very much.

Indeed, there was an active discussion among my classmates: if we had the option to pay the same tuition and simply stay home and skip all of our classes but still get an MD and go on to residency and medical practice, would we take it? There were a lot of yeses.

Why?

*The thing that matters for professional advancement is board scores, not med school performance (and not shelf exams). There are paid online resources that are optimized for board prep, that are available to everyone. Many students spent all their time on SketchyMicro and Pathoma and UWorld and other such places, and I hear the same thing wherever I go. Some crusty old professor could never provide such good test prep.

*Most basic science will have been taught better before med school than it is in med school. The competition is so fierce (for us non-BIPOCs) that we already know physiology and pharmacology before we get there. The one day you spend on any given subject in med school does not add much.

*Med school, and board exams do not test practical skills. You can easily become a doctor without knowing how to start an IV or how to splint a broken limb. To the extent that doctors have these skills, they learn them voluntarily on their own time.

*The other stuff, the ethics, the communication skills, legal issues, running a business, etc., are not the focus of med school and most of these things aren't that well taught.

*Med school is general, medical practice is specific. If you are an eye surgeon, knowing the stages of labor is not that important.

*Medical knowledge changes so rapidly now that a lot of specific facts will be obsolete almost immediately after you graduate.

*Because med school slots are so full and prospective students are lined up behind you, there is no real incentive for the schools to do any better. Med schools essentially cannot go out of business unless they lose accreditation.

I suspect a lot of the value of the process (if any) comes from sorting for people with high IQs and strong work ethics and inculcating them in the culture rather than sitting in class in learning medical science. Actually learning medicine comes by osmosis from doctors on the wards or by on the job learning during residency. I felt strongly that a lot of my time was wasted in med school, and I still feel it now. It's one of the reasons I somewhat jokingly say that Sarah wouldn't like being a doctor: you just have to put up with so much BS.

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Interesting. Comports with Bryan Caplan's thesis in The Case Against Education

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It probably does, but I am in a different space.

I also happened to find many parts of my (extensive) college education other than med school to be personally, if not financially rewarding. I do not think that my bachelor's degrees or my first master's were wastes of time in the same way that med school was, and I'm largely trading on knowledge I learned before med school. What med school got me is the legal imprimatur to do what I wanted to do.

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First!!

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Interesting conversation, as always.

Sarah - I would maintain a healthy skepticism of data on the purported success of homeschooling. Their advocacy organization is excellent at cherry-picking statistics to support their movement. They shout to the heavens (pun intended) when some kid gets into Harvard, but what about the thousands of kids about whom we know absolutely nothing?

I'm not a fan of homeschooling in general, but the good libertarian in me calls for tolerance.

As for the UCLA story, we'll really be able to confirm the DEI admissions problem in a couple of years if and when a disproportionate number of those students fail the medical licensing exam. The beauty of medicine is that even if a school goes off the rails with DEI, we still have independent barriers to entry which can weed out the unqualified candidates: the licensing exam, residency and board certifications. There is a similar situation in law, engineering, and architecture: no matter what you did or didn't do in school - you have to pass the standardized licensing examination.

The caveat is that some states have begun contemplating changes to professional licensing exam score thresholds in the name of "equity" - we'll see if the effort comes to fruition.

As for Spurlock, at the time of the documentary, we all knew that he gorged himself. What we just found out in the last few days is that he was a chronic alcoholic. His failure to acknowledge his pre-existing health conditions puts a real dent in his credibility. (I'm not arguing that McDonald's is "healthy", just pointing out that Spurlock's analysis was compromised).

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Correct. The licensing exams are national, and graduating students enter a national process to obtain a residency, and that process is unforgiving. If UCLA really has such poor quality in students, they can't hide it indefinitely. I suspect they would try by having some special residency slots for their minority grads to practice in minority areas, which might work to cover up a small deficiency but not one of the scope that's being alleged.

On the other hand, I think Sarah is correct that the general state of things everywhere is more important than one crazy admissions officer. The ACGME controls essentially all graduate medical education in the U.S. They rate every accredited residency and fellowship program on its diversity initiatives and demographic composition, and they can take away accreditation if they don't like what they see. This should concern you far more than anything happening at UCLA.

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The spread of DEI mandates by higher ed accrediting agencies is woefully under-reported by the media.

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The degradation of the legal profession is considerably farther along, as I understand it.

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The legal academy leadership much more heavily leans left than medicine, which I bet is largely apolitical. A perfect example is Berkeley Dean Erwin Chemerinsky, who watched students hijack his little backyard garden party. Chemerinsky has been an outspoken advocate of DEI initiatives and is thereby very much in the mainstream among faculty and administrators.

When medical education associations get captured by wokism, we hear brave individual professors like Jeffrey Flier and Stanley Goldfarb publicly pushing back - not so much in law.

There's also a structural curriculum issue. If some woke accreditor proposes to the medical schools - spend X number of hours on DEI crap, the schools can push back by saying: "we have to teach a ton of relevant courses in a limited amount of time - we don't have the capacity for extra BS." By contrast, the core law school curriculum is complete by the second semester - leaving two more years for useless crap.

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Medicine is no longer apolitical. The thing is, we spend more time in residency than we do in med school, so there isn’t really a unified voice of medicine. The specialties vary in their political leanings; psychiatrists and pediatricians tend to be far left while surgeons tend to be center-right.

I’ve met Stanley Goldfarb and I appreciate what he’s doing. But he is basically retired at this point. There is not a lot of pushback from people who are really in academic medicine right now.

I would agree that law school has a lot of fluff, but medicine has a lot more structure. Between four years of med school and 3-10 years of GME, that’s a lot of time where you have basically no leverage and you are learning under a curriculum that is run by a national regulator. A lawyer can sit through three years of law school, and then say “peace out” and go work for FIRE or something. I graduated from med school in 2019 and I’m still a trainee.

What’s striking to me about the legal profession’s meltdown is how meta it is. We’re not the free speech and due process guys, but for lawyers to “go woke” they basically have to reject the law itself.

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Ok. Your analogy with geometry and moving furniture is laughable. That is 3D spatial reasoning and it’s really not tied to geometry at all. I’m a diesel technician, almost all of us are very good at manipulating oddly shaped objects to fit into oddly shaped spaces. Geometry is not part of this skill set. Men are typically better at this than women.

Homeschooling is an interesting one. Homeschooling can be great if your kid is gifted or challenged, but for every benefit, there are drawbacks. That said, places online like Kahn academy are wonderful mathematical teachers and aides. I’m sure there are other places that do similar things for other subjects.

With regard to UCLA. The lack of understanding of what happens when DEI and affirmative action take priority over competence is terrifying. You can get away with it for short stretches but the math wins in the end. If they don’t change the competency standards what ends up happening is one of the more uncovered stories of affirmative action- students who are not equipped academically for high end programs end up failing out and falling behind, accumulating lots of debt in the process. Competency will inevitably fall short of what it could be if you don’t make it the priority at the outset. This concept was clear to me when I was very young. I mean, our high school competition classifications are based on this truth. 1A, 2A, 3A……it’s all based on talent pool sizes. It’s basic math.

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Years ago, when considering a career change, I took a battery of aptitude tests from a company called Johnson O'Connor (https://www.jocrf.org/)

It was a fascinating process. They don't just test the typical SAT stuff. They test for things like fine motor control, strength, pattern memory, pitch recognition, spatial intelligence and lots of other stuff. The whole process took two days.

It was the first time I realized that, though I'm very good with numbers, I'd make a terrible mechanical engineer because my spatial intelligence is below average. The fine motor control test was even worse -- I was in the bottom 30%.

How does this stuff apply to careers? Well, people with good fine motor control tend to excel at dentistry and surgery. People with good pattern memory make good detectives because they notice if something that should be there is not there (they notice clues). People with high strength tend to make good police offices.

Anyway, I really wish I had taken those tests in high school. Honestly I think they should be require of everyone prior to graduation.

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I agree, with your last statement. I did three years of mechanical engineering before I made my peace with the fact that I can’t force myself to sit at a desk for that long.

I read something recently in a trades-related discussion. The mechanical fields, specifically the repair ones require very good spacial reasoning to be good at them. It’s not just what you can see, but also fine motor control in areas that are totally blind, all you have to go off of is a mental picture of where things are. It was an obvious truth to the people in the fields but not one often expressed to people considering a career.

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What happens when those same DEI initiatives are permeated throughout all major companies and government orgs too though? From university admissions, to student success rates, to the corporate hires, retention, and promotions, it seems that every entity in the typical career path is more concerned with appearing to not be racist regarding their participants’ outcomes than they are with promoting competency

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We all know what we get, but it’s ugly. We get declining competency and performance. I recently had an online discussion with a teacher who said she won’t give less than a 50% grade on any homework or test if they turn it in. That sort of grading is fraudulent, especially in STEM fields. Those teachers should be removed and their teaching records should reflect that they are more interested in passing students than ensuring that they know the material.

For some reason people are not understanding that when you keep passing a student through the system like this, you are doing more harm than good. We all know that in education, you have to walk before you can run. We are sending students to run a 5k in college and they spend the first three semesters learning how to walk. They are just far behind where they should be in many, many fields. Money incentives in public schools are a huge part of the problem.

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I disagree with the idea that education needs to change to prepare people for everyday life as it is now. Why should we take current forms of everyday life as a given? To put it polemically, if everyday life for many people today is a split between mind-numbing work and mind-numbing entertainment, should we modify education to prepare young people for that future, thereby solidifying that way of living? Or should we look to education to broaden their intellectual horizons and lay the groundwork for them to live differently?

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I felt that my coursework in critical thinking and a seminar on evaluating claims on "science and pseudoscience" were immensely helpful to my development. As was my coursework in statistics, writing styles, etc. It helps me understand all sorts of new information as it arises.

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My ideal documentary is Chicken Hawk: Men Who Love Boys from 1994. A documentary about pedophiles that doesn't bother to have disclaimer that child abuse is bad.

I remember liking Blood in the Face, which does have Michael Moore involvement but isn't a Moore film.

Born Again: Life in a Fundamentalist Baptist Church by James Ault from the 1980s is interesting, because Ault began the documentary a non-believer and then converted afterwards.

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I'm still a bit bamboozled by Capturing the Friedmans.

The Act of Killing was well known for a documentary, and I thought it hit hard.

In the world of activist documentary, I remember Jesus Camp being influential to me.

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author

Capturing The Friedmans is a tour de force.

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I actually watched it for a class on critical thinking. College was a different beast not so long ago.

Maybe if Sarah watches it she will give up on her pro-family stance.

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I teach children in the first year of formalised schooling in the UK (children who are five at the start of the academic year). There is a strong emphasis on the acquisition of core knowledge and the speed with which that can be retrieved mentally and applied (fluency). There is a national phonics screening at the end of the year. Basic numeracy is less strictly monitored but children are expected to know the pairs of numbers which add to, and within, ten (and then twenty), among other basic facts. Out National Curriculum has many critics but it does, largely, equip most children with foundational skills. (I suspect Sarah would be happy - or satisfied - at least.)

Hadn't heard of either of those documentaries. Thanks.

'Little Dieter Needs to Fly', would be my recommendation.

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Bryan Caplan's The Case Against Education is essential reading

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I’m familiar with the Caplan book. It’s a critique of education that assumes education is a means to ends. He has little to say about education and knowledge as rewards in and of themselves.

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He does address that point in a section of the book. I’ll paraphrase from my imperfect memory.

Knowledge for the sake of knowledge is a good thing. It isn’t valued in the economy at nearly as high a rate as a diploma. The diploma itself is not a fantastic indicator of knowledge or job performance, but it signals that you have knowledge-or at least the ability to read and regurgitate information.

Your critique is accurate though, he approaches the subject from the pov of an economist. The entire book has its foundation in how the subject effects the economy. Viewed through that filter, he makes a lot of logical sense.

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To put my critique in the language of economists, I’d say he doesn’t sufficiently address education as a form of consumption and as a public good. It is a signaling mechanism as well (especially higher education), but it is other things besides.

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But if education is 80% signaling as he suggests, it's mostly a public bad. It's a zero-sum status competition that creates negative externalities, most of all the devaluation of people who don't pursue education. Seems like you didn't read the book.

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I understand his argument, I just disagree. I explained why education creates positive externalities in this comment above: “Don’t forget the public good aspect. I benefit from being able to talk to educated people who know interesting things and have interesting ideas. Substack subscription fees aside, that’s not a benefit I typically pay for. It’s a positive externality I receive from the time and money others put in to their own education. Hence the rationale for my tax dollars going towards education as a public service”

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His argument is much more extensive than you think and he deals with criticisms you lay out. For one, he acknowledges positive externalities, but they pale in comparison to the negative. Educate yourself and read the book!

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I can get behind that thinking. It leaves me in a place where I start to question whether it could be considered a form of consumption without the massive government subsidization. It would likely look far more like the art industries. A playground of the wealthy, far more a signal of wealth than knowledge.

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Don’t forget the public good aspect. I benefit from being able to talk to educated people who know interesting things and have interesting ideas. Substack subscription fees aside, that’s not a benefit I typically pay for. It’s a positive externality I receive from the time and money others put in to their own education. Hence the rationale for my tax dollars going towards education as a public service.

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I’ll not argue with that. Outside of my immediate family, I have to turn to places like Substack to have interesting conversations.

I would find k-12 a much more useful place to put that sort of knowledge though. Our current rubber-stamp k-12 system is breathtakingly wasteful of keen minds, frankly even of average minds.

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Out of curiosity google told me

That the med school dropout rate is somewhere between 15-18 percent. Not insignificant, that number would almost certainly increase substantially. The tax code is already very progressive. Outside of the super wealthy, who are smart enough and have enough resources to hide their wealth no matter what the tax code says, making the tax code more progressive only hurts people trying to climb the ladder. The top 1% income earners in the us sit right at about 400k/yr. Pushing a more progressive code only makes the legal tax evasion more worth it the higher you go. I would advocate for a flax tax. 20% the tax coffers would be pretty much the same because of the increase from lower incomes and the decrease in legal tax evasion. I have seen charts on the effective tax rate charted across capital gains tax increases year over year and they support this conclusion.

Anyway, I would be more in favor of this sort of thing if it were weighted heavily towards stem degrees. It’s still a trade off though.

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It's more about schooling than education, though he does include retention of knowledge data

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If we’re not retaining learning because we’re not engaging with it in everyday life, maybe the issue is that our everyday lives are too narrow, rather than our education too broad?

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When I read it the first time I remember being pleasantly surprised at how well he explained many of my own thoughts on the subject. Aaron Clarey is another author who writes bluntly about things. Clarey can come off as a huge jerk sometimes though. It makes it very entertaining as a result.

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This medical school stuff is not good. Looking forward to listening.

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I think at this point I’m gonna start prioritizing Asian doctors bc I know it was so much harder for them to get there than anyone else o.O

Feels a little icky to do that though

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I was delighted to hear Blossom Dearie's voice in the outro of this episode, who Miles Davis once proclaimed be the only white woman to ever have soul. The first time I heard "I'm Hip," I made it my mission to listen to her entire catalog. https://youtu.be/WfBDlZYaqBw

Is Meghan a fan, or was it Sarah who picked the track?

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I homeschooled my children and one of the reason why they can be academically ahead is NO Busy Work! teachers give their students worksheets etc to keep them busy while they do one-on-one with struggling students. homeschool cuts all that out.

another reason is experiential learning - we were out on field trips weekly (at least!)

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Another book about how mandatory schooling is useless is called Dumbing Us Down By John Gatto-- a longtime teacher. I don't think there is much value in K-12 except for socialization, structure, and learning the basics of math and reading/writing. I had fantasies of homeschooling my firstborn, who is clever but not curious in anything besides baseball and the Guinness Book of World Records. Trying to teach him would have given me an ulcer. He is happy in school, he is motivated to please his teachers and peers, while he has little regard for what I think of his. So that works for him. If we lived in an older age I think he would have been happier working on a farm or something outdoors/athletic. I truly don't know what (I believe to be) the vast majority of kids who are not particularly curious or motivated should be doing with their childhoods besides compulsory schooling. Maybe just playing/entertaining themselves? There is a chain of alternative schools called the Acton Academy that uses the Socratic Method-- no teachers, just guides. Kids have to take turns initiating projects and working on them together. I love the idea but there aren't any near us. Look into it!

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Fifth

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I'm third 🙄🙄🙄

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wow, you guys are on it!

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