Friday, May 26, 2017

A disturbing truth about medical school--and America’s future doctors

Hat Tip Michael Bruno

The following article appeared on on May 8.

You may be surprised to learn that medical students at many of the best schools in the country aren’t given grades during the first two years of their medical education. They either pass their coursework or they fail. And then, they take one high-stakes test that affects their medical future.

While the effort to allow medical students to take two years of course work on a pass-fail basis was driven by an effort to make the notoriously difficult life of medical students easier, the high-stakes testing consequence creates problems of its own.

In this post, Brenda Sirovich, a physician and professor at Dartmouth College’s medical school, writes about how this approach threatens to compromise both the community of medicine and the quality of patients’ care. She is a 2017 Public Voices Fellow with the OpEd Project, a social venture with both a nonprofit and for-profit arm that is aimed at increasing the range of voices and quality of ideas contributing to national and international debate.

News that a federal educational experiment failed to supply evidence in favor of  Education Secretary Betsy DeVos’s school choice agenda has undoubtedly elicited schadenfreude in some Democratic circles. Somewhat lost in the story, however, is scrutiny of how students’ educational success or failure is measured.

The trend toward near-exclusive reliance on standardized testing to measure educational achievement now extends all the way to medical school. Many may not realize that the readiness of aspiring doctors to enter the world of clinical medicine is now based overwhelmingly on a single, standardized, closed-book, multiple choice test.

Scores on the test — the U.S. Medical Licensing Step 1 Exam (a.k.a. the Boards) — taken after two intense years of classroom education, will overwhelmingly determine where students do their residency training. And their professional futures.

But a decade or so ago, residency programs suddenly started caring, a lot, about Board scores — an unintended consequence of a well-intentioned move by medical schools to grade the first two years pass-fail, to foster student wellness.

Residency programs abruptly found themselves in desperate need of a yardstick by which to measure and compare student applicants. Board scores were suddenly paramount.

Behold the mismatch: We aim to prepare students for a career characterized by collaboration, complexity, nuance and uncertainty; yet, we evaluate them on their ability to select — autonomously and without research — among radio buttons representing a discrete range of right-or-wrong responses.

After 20-odd years in practice, I have yet to see a patient come in with a list of four or five possible diagnoses, and ask that I select the most appropriate response.  

Nor have I, while searching online for current evidence or recommendations, heard a patient cry out, “Stop!  This is a closed book appointment!”

Here’s the thing: Students understand how they’re assessed — they’re all quite brilliant in this way, whether they’re in medical school or high school or third grade. They figure out with lightning speed what they need to do to maximize their performance on the assessment that matters.

As a result, here is my students’ To Do list:
1.       Do not attend class, unless attendance is specifically required.
2.       Complain about the (modest) number of class hours requiring attendance.
3.       Resist discretionary learning opportunities, no matter how interesting.

Their logic is impeccable. Each student’s sweet spot for MCQ mastery involves some combination of lecture videos at double speed, late nights, ear buds, coffee and little human interaction.

It works beautifully in achieving the desired outcome of a good Board score.

But what is the desired outcome?

My students — and others like them — are the doctors of tomorrow. They’ll care for me — and you — as we age. For our parents facing life threatening illness and difficult decisions at the end of life. For the children we haven’t yet contemplated.

The desired outcome should not be about test scores.

We should hope students will have learned how to find, evaluate and apply knowledge; how to work collaboratively; how to tolerate and manage uncertainty; how to reason; how to walk in someone else’s shoes; how to relentlessly pursue what’s best for each patient; how to debate, be wrong, fail — and embrace and learn from it, each time; how to become who they want to be.

Thursday, May 25, 2017

“Manic” DA prosecutes law-abiding citizen who acted in self-defense

The following article appeared on on May 17. The Performance Oil company surveillance video captures the entire event and is available here.

July 21, 2016 began as any other day for Wayne Parish. The Crystal Springs resident woke up, bid his family farewell and went to work at Performance Oil on McDowell Road in Jackson Mississippi. But the transformative events of that fateful day changed Parish’s life forever. On that day, the hard-working, law-abiding family man crossed paths with a 17-year-old delinquent named Charles McDonald.

Despite his youth, McDonald was already an aspiring criminal and a recidivist offender. On July 21, his mother, Yvette Mason-Sherman, tried to take him to the Henley-Young Youth Detention facility, which is located next to Performance Oil where Parish worked. McDonald had already been to the youth detention facility eight times in the past two years. During the ride, he jumped out of his mother’s car and ran off.

McDonald then entered the Performance Oil parking lot where a Lexus ES-350 caught his eye. It should be noted that at the time McDonald trespassed on to the lot, he had two outstanding warrants, one of which involved a police chase. McDonald then picked up a large rock and proceeded to smash the car’s driver’s side window in an effort to break in. His actions that day constituted a felony under Mississippi’s penal code.

The police were called and dispatched but Parish exited the store with a .38 Smith & Wesson and ordered McDonald, who was still trying to break into the car, to leave the premises. Instead of leaving, McDonald lunged at Parish in an effort to grab his gun. The two struggled for control of the revolver for less than 30 seconds but it likely seemed like an eternity for Parish. Toward the end of the life and death struggle, which was captured on surveillance video, McDonald, who is still seen grabbing at Parish, falls to the ground from gunshot wounds to the upper torso. He was later pronounced dead at University of Mississippi Medical Center.  
Wayne Parish and Family

After reviewing the evidence and speaking to witnesses, Jackson police determined that Parish was legally justified in using deadly force under the circumstances.   Under Mississippi’s penal code, a person has the right to protect his or her home, business, vehicle or other legally occupied space with reasonable force, including deadly force. This legislation is commonly referred to as the Castle Law. 

All states have some variation of the Castle Law. The concept is derived from the fact that a person’s home is their castle. In the instant case, McDonald was committing felony burglary when Parish confronted him, and then lunged for Parish’s gun when instructed to leave the business premises. Given McDonald’s past, it is a virtual certainty that he would have shot Parish had he succeeded in wresting control of the revolver. If any case cries out for self-defense, it is this one and legal experts who have reviewed the matter concur.

But the Hinds County District Attorney’s office, led by its shady and mercurial DA, Robert Shuler Smith, disagreed. On October 28, 2016 Smith’s DA’s office filed an indictment against Parish for first degree murder (the shoddy indictment filed by Smith’s office erroneously states that the incident occurred on June 21, 2016). He was arrested on December 29, over five months after the police determined that Parish was justified in the use of deadly force and committed no crime. 

Parish was held without bond for at least 12 days. On January 10, 2017 a judge set bond at $50,000, a rather low amount for someone charged with first degree murder. That gives one some insight as to what the judicial system thinks of this case. A trial date has been set for May 30.

During the course of the bond hearing, DA smith made an unexpected appearance and issued no objection to the bond amount but made a startling admission. He told the court that he learned of "the existence of a video of the incident three days ago" and had not had time to review it.

That admission represents sheer incompetence and legal malfeasance. The surveillance video clearly shows the entire sequence of events which serve to exculpate Parish. How could Smith have presented a first degree murder case before a grand jury without first watching the video? Moreover, even if Smith is to be believed, why had he not taken the time, during the three days in which he had possession of the tape, to view the video?  
District Attorney Smith

Smith’s actions in this sordid legal affair are beyond inexplicable. They border on the bizarre. Indeed, there is something perversely amiss in Jackson Mississippi and it centers on the Hinds County District Attorney’s office and its corrupt chief.

You see, Smith himself is under felony indictment and his license to practice law is currently under review. You read that correctly. The Hinds County’s chief law enforcement official has himself come under a cloud of criminal suspicion and corruption.

In July 2016, The Mississippi Bar’s general counsel asked the state Supreme Court to institute disciplinary measures against Smith. The request came after two judges filed complaints against Smith for behaving unethically and irrationally during the performance of his official duties. 

In his complaint to the Mississippi Bar, Judge Melvin Priester described Smith as “irrational, manic, and virtually out of control.” Judge Tomie Green complained that Smith engaged in, among other things, “retaliatory and improperly coercive” conduct. 

But being disbarred is the least of Smith’s problems. He is currently facing the prospect of a stiff jail sentence for allegedly hindering prosecution and obstruction of justice. His first criminal trial ended in a mistrial because a juror knew Smith and failed to reveal this fact during jury selection. A new trial date has been set for June 12, 2017. Smith’s criminal prosecution is being handled by the state’s attorney general.

The very fact that Smith is still able to retain office while under this cloud of criminal suspicion and maleficence is disturbing to say the least. It nonetheless provides some explanation as to why he would be prosecuting an innocent man who plainly acted in self-defense and most certainly would have been shot had he not acted in the manner that he did. Smith, by both word and deed has proven that at best, he lacks common sense and judgement.

This case has not garnered much national attention (my emphasis) but it makes the injustice inflicted on Wayne Parish no less egregious. For the sake of justice, let’s hope that when the legal dust settles, Parish gets to go home to his family and Smith ends up wearing striped pajamas, courtesy of the state of Mississippi.  

“This case has not garnered much national attention.”    OK.  And how ‘bout if the punk kid had been white, Parish black and sword of justice waving D.A. Smith, white? Wanna bet national attention would have been all over that set of circumstances?  Ed.

Wednesday, May 24, 2017

CNN Analyst Says Manchester Attack Could Be “Right Wing False Flag”

The following article appeared on on May 23. The pics below help to support CNN terror analyst Paul Cruickshank's suggestion that the Manchester bombing "could have been part of a right wing extremist plot." A Coach's Team photographer has courageously revealed the identity of the true culprits.  Ed.

BBC analyst says people need to 'get used to' attacks

By Steve Watson

Less than 24 hours removed from the latest horrific ISIS inspired terrorist attack in the UK, a talking head on CNN programming has suggested that the bombing could actually be a ‘right wing false flag’ in order to ‘frame Islamists’.
Tea Party Members

CNN analyst said Manchester was likely an Islamist attack, but floated the idea it could have been “false flag” by “right wing extremists.”

While admitting that the attack was most likely an Islamist plot, the analyst claimed that there have been multiple instances in Europe of “right wing extremists” plotting to carry out attacks to make it appear that Muslims were to blame. 

The comments appear to have been made on CNN in the first couple of hours of coverage of the attack.
Islamic Jihadists

Meanwhile, BBC anchor Katty Kay told viewers that Europeans must “get used to terror attacks because we are never going to be able to totally wipe this out.”

Kay made the comments on MSNBC’s Morning Joe:

“As ISIS gets squeezed in Syria and Iraq, we’re going to see more of these kinds of attacks taking place in Europe and Europe is starting to get used to that.” Kay added, with the caveat that no one is “used to having children targeted.” 

Kay’s comments echo those of London Mayor Sadiq Khan, who before the Westminster attack in March said that terrorist attacks are ‘part and parcel’ of living in a major city.

Police have now arrested a suspect, and named the suicide attacker as 23-year-old Salman Abedi, who was known to British authorities prior to the attack.
Tea Party Member "Framing Islamists"

British Prime Minister Theresa May said that there is an ongoing investigation to determine if the attacker “was acting alone, or was part of a wider group.”

“This attack stands out for it’s appalling, sickening cowardice, deliberately targeting innocent, defenseless children and young people who should have been enjoying one of the most memorable nights of their lives.” May said. 

“This was among the worst terrorist incidents we have ever experienced in the United Kingdom.” The Prime Minster added.