A Harvard Medical School study found a correlation between resident physicians' scores on the United States Medical Licensing Examination (USMLE) and patient mortality rates. Higher Step 1 scores were associated with slightly lower mortality rates for patients hospitalized with common medical conditions. While the effect was small for any individual patient, the cumulative impact across a large population suggests that physician knowledge, as measured by these exams, does influence patient outcomes. The study emphasized the importance of standardized testing in assessing physician competence and its potential role in improving health care quality.
The blog post "Explainer: What's R1 and Everything Else?" clarifies the confusing terminology surrounding pre-production hardware, particularly for Apple products. It explains that "R1" is a revision stage, not a specific prototype, and outlines the progression from early prototypes (EVT, DVT) to pre-production models (PVT) nearing mass production. Essentially, an R1 device could be at any stage, though it's likely further along than EVT/DVT. The post emphasizes that focusing on labels like "R1" isn't as informative as understanding the underlying development process. "Everything Else" encompasses variations within each revision, accounting for different configurations, regions, and internal testing purposes.
Hacker News users discuss Tim Kellogg's blog post explaining R1, a new startup accelerator. Several commenters express skepticism about the program's focus on "pre-product" companies, questioning how teams without a clear product vision can be effectively evaluated. Some see the model as potentially favoring founders with pre-existing networks and resources, while others are concerned about the equity split and the emphasis on "blitzscaling" before achieving product-market fit. A few commenters offer alternative perspectives, suggesting that R1 might fill a gap in the current accelerator landscape by providing early-stage support for truly innovative ideas, though these views are in the minority. There's also a discussion about the potential conflict of interest with Kellogg's role at Khosla Ventures, with some wondering if R1 is primarily a deal flow pipeline for the VC firm.
Summary of Comments ( 88 )
https://news.ycombinator.com/item?id=43173808
Hacker News commenters discuss potential confounding factors not accounted for in the study linking resident physician exam scores to patient outcomes. Several suggest that more prestigious residency programs, which likely attract higher-scoring residents, also have better resources and support systems, potentially influencing patient survival rates independent of individual physician skill. Others highlight the limitations of using 30-day mortality as the sole outcome measure, arguing it doesn't capture long-term patient care quality. Some question the causal link, proposing that resident work ethic, rather than test-taking ability, might be the underlying factor affecting both exam scores and patient outcomes. Finally, some express concern about potential bias in exam design and grading, impacting scores and thus unfairly correlating them with patient survival.
The Hacker News post titled "Resident physicians' exam scores tied to patient survival" linking to a Harvard Medical School article has generated a moderate number of comments, mostly focusing on the nuances of the study and its implications.
Several commenters express skepticism about the direct causal link between exam scores and patient outcomes. One points out the potential for confounding factors, suggesting that residents who score higher on exams might also possess other qualities, like conscientiousness or better communication skills, that contribute to improved patient care, rather than the exam knowledge itself being the primary driver. This idea of "unmeasured confounders" is a recurring theme.
Another commenter questions the practical significance of the observed correlation, noting that the absolute difference in mortality rates is relatively small. They suggest that while statistically significant, the effect size might not warrant drastic changes in residency programs. This echoes other comments questioning whether high-stakes testing is the most effective way to evaluate and improve resident performance.
The validity of using standardized tests as a measure of clinical competence is also debated. Some commenters argue that these exams primarily assess theoretical knowledge and may not accurately reflect a physician's ability to apply that knowledge in real-world clinical settings. They propose alternative evaluation methods, such as simulations or direct observation of patient interactions, as potentially more valuable assessments of practical skills and judgment.
There's a discussion regarding the potential for the study's findings to be misinterpreted or misused. One commenter worries about the possibility of hospitals prioritizing exam scores over other important qualities when hiring residents, leading to a potentially detrimental focus on test preparation rather than holistic development.
A few commenters delve into the statistical methodology of the study, questioning the choice of statistical tests and the interpretation of the results. One suggests that a survival analysis might have been a more appropriate approach than the methods used in the study.
Finally, some commenters offer anecdotal observations from their own experiences in healthcare, sharing personal perspectives on the relationship between exam performance and clinical competence. These anecdotes, while not scientifically rigorous, contribute to the overall discussion by providing real-world context for the study's findings.