Scott Alexander examines why skills plateau, proposing decay and interference hypotheses to explain the phenomenon across various fields. Longer summary

Scott Alexander explores why skills plateau despite continued practice, focusing on creative artists, doctors, and formal education. He presents two main hypotheses: the decay hypothesis, where knowledge is forgotten if not regularly reviewed, and the interference hypothesis, where similar information blends together, making it difficult to learn new things in the same domain. The post discusses how these hypotheses explain various learning phenomena, including the ability to learn multiple unrelated skills simultaneously. Scott also considers edge cases and potential applications of these theories, such as mnemonic devices and language learning strategies. Shorter summary

Scott Alexander examines whether psychiatrists should test for lead more often, concluding that while it could be relevant in some cases, there's not enough evidence to justify universal testing. Longer summary

Scott Alexander discusses the question of whether psychiatrists should test for lead more often in patients with mental health issues. He presents a case where lead poisoning was found to be a factor in a patient's psychiatric symptoms, and explores the broader implications of this. Scott then examines the complexities of deciding which potential factors to test for in psychiatric practice, given the numerous possible causes of depression and other mental health issues. He argues that while lead could be a factor in some cases, there's insufficient evidence to justify universal testing. He also discusses the challenges of interpreting and acting on test results, especially when they fall within normal ranges. Scott concludes by reflecting on different approaches to medical practice and the difficulties of balancing evidence-based guidelines with emerging theories and individual clinical judgment. Shorter summary

Scott Alexander explores why medical residency test scores plateau after the first few years, proposing theories related to knowledge retention and individual differences in learning. Longer summary

The post discusses the plateau in standardized test scores for medical residents across different specialties. Scott Alexander analyzes data from internal medicine, psychiatry, and surgery residencies, noting that while scores improve significantly in the first year or two, they tend to level off in later years. He explores various potential explanations for this plateau, including ceiling effects, decreased motivation, and changes in teaching methods, but finds these unsatisfactory. The author proposes that the plateau might be related to how knowledge is reinforced and retained, drawing parallels to spaced repetition learning techniques. He suggests that individual differences in memory, intellectual curiosity, and integration of knowledge may contribute to the differences in scores among residents at the same level. The post concludes by considering the implications of this plateau effect for understanding learning and education more broadly. Shorter summary

Scott Alexander reviews 'House of God', a satirical novel about medical internship that exposed systemic issues in healthcare and influenced real-world changes. Longer summary

Scott Alexander reviews the novel 'House of God' by Samuel Shem, a satirical and magical realist portrayal of medical internship. The book uses dark humor and exaggeration to highlight the absurdities and ethical dilemmas in the medical system, particularly regarding the treatment of elderly patients. Scott discusses how the book inverts common assumptions about healthcare, its historical impact on medical practices, and its emotional resonance with his own experiences as a doctor. Shorter summary

Scott Alexander shares his experiences and reflections as a final-year psychiatric resident, discussing communication techniques, challenges in psychotherapy, and the anxiety of managing patient risks. Longer summary

Scott Alexander reflects on his experiences as a final-year psychiatric resident. He discusses the differences between resident years, the challenges of dealing with patients and attendings, and the techniques he's learned for effective communication. He also shares his struggles with psychotherapy, his frustrations with psychoanalysis, and the constant anxiety of managing suicide risk among patients. The post ends with Scott contemplating the 'reverse lottery' nature of psychiatric practice and how a patient's suicide attempt has affected his approach to patient care. Shorter summary

Scott Alexander discusses the British junior doctors' strike, detailing the harsh working conditions and systemic issues that likely led to it, based on his experience in a similar system. Longer summary

Scott Alexander discusses the recent strike by junior doctors in Britain, drawing on his experience in the Irish medical system. He describes the extremely demanding work conditions faced by junior doctors, including 100-hour work weeks and 36-hour shifts, which lead to burnout, depression, and a mass exodus of doctors to other countries. The British system responds by importing foreign doctors rather than addressing systemic issues. While Scott doesn't know the specifics of the current dispute, his experience leads him to sympathize with the junior doctors' position, believing their complaints are likely legitimate. He concludes by expressing a desire for a more principled system to address labor disputes, while acknowledging that in a socialized healthcare system, strikes may be necessary to address grievances. Shorter summary

Scott reflects on his psychiatry residency experiences, discussing the realities of psychiatric hospitals, patient care challenges, and his transition to outpatient work. Longer summary

Scott reflects on his experiences halfway through his four-year psychiatry residency. He discusses the unexpected orderliness of psychiatric hospitals, the limitations of short-term psychiatric care, and the challenges of dealing with patients' requests and complaints. He contrasts the security theater aspect of inpatient care with the actual therapeutic benefits, noting that many patients don't find their hospital stay helpful. Scott expresses his exhaustion from constant moral self-questioning and looks forward to transitioning to outpatient work. He concludes by sharing his concerns about outpatient psychiatry, wondering if he might be useless or if the job is more difficult than it seems, given the mistakes he's observed in other outpatient psychiatrists. Shorter summary

The post criticizes unnecessary college degree requirements in various professions and proposes an alternative to Bernie Sanders' free college tuition plan. Longer summary

This post critiques the current higher education system, particularly in the United States, by drawing parallels with a fictional tulip subsidy scenario. The author argues that requiring college degrees for many jobs is unnecessary, expensive, and harmful to society. He uses examples from medicine, teaching, and other professions to illustrate how degree requirements often don't correlate with job performance or outcomes. The post then criticizes Bernie Sanders' proposal for free college tuition, suggesting it would perpetuate a broken system. Instead, the author proposes making 'college degree' a protected characteristic in hiring practices to combat degree inflation. Shorter summary

Scott Alexander reflects on his first year of medical residency, contrasting reality with TV dramas and describing the complexities of hospital care. Longer summary

Scott Alexander reflects on his first year of medical residency, contrasting his experiences with the expectations set by medical TV dramas and his medical school education. He describes the reality of hospital work as less about solving diagnostic mysteries and more about managing chronic conditions and dealing with an 'avalanche of disasters' that occur when patients enter hospitals. Scott uses analogies like Searle's Chinese Room to illustrate how hospital care often feels like a system where no individual fully understands the whole process. He concludes by noting his transition to psychiatry and expressing appreciation for the wider world of medicine. Shorter summary

Scott explores the fascinating etymology of 'placebo' from medieval funerals to medicine, then discusses the controversial placebo effect in depression treatment. Longer summary

This post explores the etymology of the word 'placebo' and its journey from funeral rites to medical terminology. Scott starts by debunking the common medical school explanation and delves into its medieval origins as part of funeral rites. He then discusses various theories on how it became an insult and eventually a medical term. The post then shifts to discussing the placebo effect in depression treatment, highlighting the controversy surrounding its effectiveness and the importance of understanding its true nature for patient care. Shorter summary

Scott Alexander discusses a study suggesting communication skills training for doctors may be ineffective, and shares personal observations on the nuances of doctor-patient communication. Longer summary

Scott Alexander discusses a study from the Journal of the American Medical Association that suggests intensive communication skills training for doctors may not improve patient outcomes and could even have negative effects. He relates this to his own experiences in medical training, sharing an anecdote about an attending physician with excellent communication skills who used an unconventional approach when delivering a cancer diagnosis. The post critiques the effectiveness of formal communication skills training in medicine and suggests that some aspects of effective doctor-patient communication may be difficult or impossible to teach. Shorter summary

Scott Alexander examines the limitations of empathy training in medical education and shares his experiences learning to express empathy effectively as a doctor. Longer summary

Scott Alexander reflects on the teaching of empathy in medical school and its application in real-world doctor-patient interactions. He describes the awkward role-playing exercises used to teach empathy, which often result in stilted, scripted responses rather than genuine human connection. Scott explains that this approach is driven by the need for standardized, legally defensible assessment methods. He then shares personal experiences as a new doctor, highlighting the challenges of expressing empathy appropriately in emotional situations. The post concludes with insights on how Scott has learned to better navigate these interactions, emphasizing the importance of focusing on the patient's needs rather than demonstrating one's own empathy. Shorter summary

Scott Alexander analyzes a study revealing poor statistical literacy among doctors, critiquing both the study and its implications for medical decision-making. Longer summary

Scott Alexander discusses a study showing poor statistical literacy among doctors, particularly Ob/Gyn residents. The post highlights that only 42% of doctors correctly answered a question about p-values, and only 26% correctly solved a Bayesian probability problem about mammogram results. Scott critiques the study's questions and interpretation, notes the Dunning-Kruger effect in self-reported statistical literacy, and points out gender differences in self-assessment. He concludes by questioning the FDA's decision to restrict individuals' access to their genome information based on doctors' supposed superior statistical understanding. Shorter summary

Scott proposes creating fictional stories isomorphic to complex scientific concepts as a memory aid, inspired by the ease of remembering Game of Thrones details compared to biochemistry facts. Longer summary

Scott Alexander discusses the difficulty of memorizing complex scientific information, like biochemistry, compared to the ease of remembering intricate details from fiction like Game of Thrones. He proposes creating a story isomorphic to molecular biology pathways as a memory aid. The post explores the potential and limitations of this idea, considering how social information from medical school is easier to retain than medical data. Scott suggests that while perfect isomorphism might be challenging, a looser mapping could still be beneficial. He even considers the possibility of a movie adaptation to enhance memory through visual cues. Shorter summary

Scott Alexander provides a satirical account of a hospital orientation, highlighting its various absurdities and contradictions. Longer summary

Scott Alexander humorously recounts his experience at a hospital orientation, highlighting the quirks and ironies of the process. He describes various elements such as the nun's welcome, the mission statement, ethical guidelines rooted in Catholicism, introductions to executives from the auto industry, an educational movie about drunk driving, a work-life balance presentation, and an inspirational speech about Jesus guiding medical practice. Throughout, Scott's sardonic observations and suppressed comments reveal the often absurd and contradictory nature of such orientations in a medical setting. Shorter summary

Scott Alexander announces his acceptance into a psychiatry residency in Michigan, reflecting on the competitive nature of medical residencies and his unexpected positive experiences following a previous rejection. Longer summary

Scott Alexander announces his acceptance of a psychiatry residency position in Michigan, starting in late June. He expresses great joy and relief, given the competitive nature of medical residencies in the US due to a shortage of positions. Scott reflects on his previous year's rejection and how it unexpectedly led to a fulfilling time in Berkeley. He concludes by acknowledging the unpredictability of life outcomes, referencing a Taoist parable, and expressing cautious optimism about his future in Michigan. Shorter summary

Scott Alexander discusses his brain's arbitrary division of sleep into 'sleep mode' and 'nap mode', which interferes with establishing a normal sleep schedule, and asks for others' experiences and solutions. Longer summary

Scott Alexander describes a peculiar sleep pattern he experiences, where his brain distinguishes between 'sleep mode' and 'nap mode' based on the time he tries to fall asleep. Sleep attempts after 1 AM result in longer, groggier sleep periods, while attempts before 1 AM lead to shorter, more refreshing naps. This pattern interferes with his attempts to establish a normal sleep schedule and is incompatible with standard work hours. He shares his experiences with various sleep aids and techniques, noting their limited effectiveness in addressing this specific issue. Scott asks if others have experienced similar patterns and if they've found solutions. Shorter summary

Scott Alexander discusses his anxiety about potentially not getting a US medical residency and explores various backup career options and plans. Longer summary

Scott Alexander discusses his anxiety about potentially not getting a US medical residency for the second year in a row. He explores various backup career options in case he doesn't secure a residency, including working for MetaMed, MIRI, pursuing a Master's in Public Health, law school, an MBA, biostatistics, programming, or teaching. He outlines a tentative plan for the coming year if he doesn't get a residency, involving staying in Berkeley, doing clinical rotations, and applying to various programs. Scott emphasizes his hope to get a residency and his distress at the possibility of not getting one, as it would mean potentially abandoning his medical career. Shorter summary