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.
A new study combining ancient DNA analysis with linguistic and archaeological data suggests the Indo-European language family originated with the Yamnaya pastoralists who migrated from the Pontic-Caspian steppe into Europe around 5,000 years ago. These migrations, associated with the spread of wheeled vehicles and early horse domestication, brought the Yamnaya into contact with European hunter-gatherers, resulting in a genetic admixture that ultimately led to the Corded Ware culture. This Corded Ware population is identified as the source of later migrations eastward, spreading Indo-European languages across Europe and Asia.
Hacker News users discussed the methodology and implications of the study. Several commenters questioned the reliability of inferring large-scale migrations and cultural shifts solely from genetic data, emphasizing the complexity of language evolution and its potential disconnect from genetic lineages. Some pointed to known instances of language replacement without significant population change, highlighting the limitations of using genetics as the sole indicator. Others debated the specific migration routes proposed in the study and alternative theories regarding the spread of Indo-European languages. The discussion also touched on the sensitivity surrounding research into ancient populations and the importance of respectful and accurate interpretation of findings. Some users expressed concern about potential misuse of such research to support nationalist narratives.
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.