Gearing up for March Madness, Danny style

Some of you readers may be interested in the upcoming college basketball March Madness tournament. If you're wondering how to fill out your bracket this year, you may be interested in the little challenge I'm hosting.

The goal is to write a computer program that takes the results from all of the games from this season (and possibly the games and tournament results from last season) and produces a predicted bracket. The march madness data and full details are available here, and if you need an idea of how to get started, I refer you to my work on predicting March Madness scores.

Even if you don't feel like programming up an algorithm of your own, you may be interested in keeping an eye on the contest.

Also, as if the deal were not sweet enough already, Doug has graciously offered a prize to the winner.

Birthday voicemail with Google Voice

So, it's my birthday and I decided to let Google Voice handle my messages today so I could save the memories--and share them, of course. My family has several aspiring singers. Please vote for your favorite rendition in the comments.

The Bella Effect

In the novel Twilight, the protagonist Bella becomes woozy during a blood lab and has to go to the nurse's office. On the way there, she gets scooped up by Edward. It's the first of many times he saves her and their first real physical contact.

The Twilight books and movie have been entrancing teenage girls, and I think it may even have a connection to emergency medicine. A close friend, a high school teacher and an avid Twilight reader, told me that the second ambulance came to her school in a week after a high school girl passed out after donating blood. An even larger number of girls are "fainting left and right" or laying down on the mats that they have set up in the cafeteria. The assistant principal has never seen anything like this before with blood drives. My friend thinks these girls are channeling Bella.

Previously, psychogenic fainting has been reported in the local Lake Oswego Schools when a cluster of elementary school students fainted after they believed they were exposed to harmful gases. It turned out the toxic gases were imagined, and the fainting was a hysterical response to an odd smell in the classroom.

We can quote the bible, too....

I love it when silly arguments are turned on their head. This is smart:

http://digg.com/d31IJQh

Hands-free Cell Phone Requirement is Bad Policy

As of January 1, 2010, Oregon is part of a majority of states in the US that outlaw texting and handheld cell phone use while driving. Today the Oregonian newspaper reported that a "surprising" new study reports that handsfree cell phone devices do not reduce automobile crashes. This new study shouldn't be surprising to anyone because it is consistent with an abundance of evidence studying this issue. Analysis after analysis has shown the same thing: talking on a cell phone is dangerous. And it is made no less dangerous by using a bluetooth headset.

The study published today was interesting because they approached the question with different methodology. They look at car accident data and insurance claims in 4 jurisdictions where these bans went into place. They looked at accident rates before and after the new hands-free laws went into place. And just to make sure that particularly bad weather or something extraneous was confounding the results, they looked at districts that didn't change their laws. Accident rates held steady in these regions as well, regardless of whether they passed "hands-free only" laws. Measuring outcomes in terms of the actual costs of society is meaningful information and this may be a more important study than other held in more controlled situations (i.e. an obstacle course with research subjects).

A handheld cell phone ban could have worked in two different ways: 1) it could have made people less distracted and cause fewer accidents or 2) it could simply be so inconvenient to hook up a bluetooth that people just talked less (an unintended but plausible consequence of the legislation).

Although popular and legislative opinion has correctly concluded that talking on a cell phone while driving is dangerous, the solution has been wrong. Using bluetooth devices does not fix the problem. This ineffective regulation provides only ads to the profits of device/accessory manufacturers--the constituency that would have been most hurt by a decline in cell phone usage. It is alarming example of how public policy is unresponsive to clear scientific evidence. By making a policy based on good intention--not a careful analysis of research--we are becoming a scientifically illiterate society. Simply acting because a problem exists is not enough. The consequence of this is measured in the purchase of unnecessary headsets and the continued cost of unnecessary traffic accidents.

Medical school is inherently stressful

In our second year PCM course, our student-run session focused on medical student mental health and depression. Many mental health issues that begin in medical school continue as chronic conditions into practice. The session included the screening of a movie on physician depression and suicide (http://www.doctorswithdepression.org/) and a review of the high rates of depression among medical students (http://www.ohsu.edu/pcmonline/docs/Out_of_the_Silence__Confronting.13%20(1).pdf).

My small group talked about the structural elements in medical school training that contribute unnecessarily to student stress and depression. With that in mind, an article in May's Journal of Academic Medicine caught my eye. The article title, "A Change to Pass/Fail Grading in the First Two Years at One Medical School Results in Improved Psychological Well-Being" (Academic Medicine, Vol. 84, No. 5 / May 2009). The article followed performance and measures of student well-being at University of Virginia following a shift to a pass-fail grading system. The authors concluded that a change in grading from letter grades to pass/fail in the first two years of medical school conferred distinct advantages to medical students, in terms of improved psychological well-being and satisfaction, without any reduction in performance in courses or clerkships, USMLE test scores, success in residency placement, or level of attendance.



OHSU's adherence to a five interval grading system (eg A, B, C, D, F) has been repeatedly questioned by students. Over 40 medical schools in the US have moved to a two-interval grading system as of 2009, including many of the most competitive schools. One of the primary rationales for maintaining the five-interval system relates to a influential paper co-authored by OHSU faculty members in 2000. The article, title "Early Identification of Students at Risk for Poor Academic Performance in Clinical Clerkships", sought a method for early identification of medical students who are at academic risk in order to provide a basis for intervention with individualized remedial programs. The conclusion of the study was subjective grades in the PCM class provided the best indicator for students at risk of poor clinical performance. The findings in this paper have been extrapolated to indicate that the grading system is generally useful in predicting performance during third year clinical clerkships.

Unfortunately, this conclusion that this data supports a five-interval grading system is flawed. First, the authors indicate that the subjective grading from the small group course is a better predictor of success than the basic science courses. The data show largely overlapping confidence intervals of low PCM grades (4.71, 18.98) and low basic science grades (2.96, 13.80). PCM grades are clearly useful predictors of later performance, but the small sample size of 304 students is insufficient to argue that this metric is superior to other measures of performance.

Second, the grading scales in the two courses are not directly comparable due to the different nominal scales and different distributions. As a result, the wider distribution of point-based scoring in PCM creates a larger dynamic range for identifying trends in the data. The different methods for analyzing the two groups inherently favors the identification of trends in the PCM group. It would be interesting to know if these trends would hold if the percentage and nominal grade scores were converted to class ranks and then compared.


Third, this analysis shows that grades in the first two years are useful for identifying poor performers. The authors arbitrarily chose the bottom 20% of performers. The strength of the association among higher performing students is less strong and not directly addressed by the authors. US medical schools are universally support the idea of failing (offering remediation opportunities) to poor performers. This is not an argument against pass-fail. Surprisingly, the authors do not address the fact that "at risk" students could still be identified in a two-interval grading system.

Future evaluation of the grading system and grading policies should more closely examine performance in the top two quintiles. Equal attention should be given maintaining a minimum standard as an emphasis on training excellent physicians who will be leaders in their field.

As we look to the example of University of Virginia, OHSU has an opportunity to change policies with the confidence that students will benefit in many ways. A two-interval system is associated with improved "satisfaction with the quality of my medical education" and "current satisfaction with my personal life during the last month." Beneficial effects were found on students' deep motives, deep strategies, and their intrinsic motivation for studying. Students identified themselves as feeling more like doctors after the change to standards-based (i.e., pass/fail) assessments. Future studies should focus on whether an early focus on two-interval assessment structure improves measures of personal responsibility and professionalism--that the medical education system works so hard to instill.

Ross Island Grocery closed--to reopen soon

The Ross Island Grocery in the Lair Hill neighborhood--and the cafe below my former apartment--had their store seized by the landlord in early January. I walked by to see the place boarded up 3 new deadbolt locks in the front door of the establishment, the windows papered over, and a nasty note from the landlord claiming the building had been "reclaimed by the rightful owner" of the property.

It's further evidence the J. Matt Sherman, the building owner, is not easy to do business with. The neighbors say that he took over the building when he found they were starting to move out. He even locked some of their merchandise in, before they could get out, according to a source.

Ross Island Grocery will be reopening soon. They are moving down the street to 3502 SW Corbett Ave according to their liquor license application. We look forward to their reopening and their continued presence in the Lair Hill Neighborhood.