All elements on this iOS 7 Calendar screen that are in red are tappable. All except one, that is. The month name is in red, but tapping it doesn’t do anything.
This means color doesn’t signify whether an element on the screen is meaningful to tap or not. How do you then know what is tappable and what is not? You could tap everything and see what responds to your tap and what doesn’t.


All elements on this iOS 7 Calendar screen that are in red are tappable. All except one, that is. The month name is in red, but tapping it doesn’t do anything.

This means color doesn’t signify whether an element on the screen is meaningful to tap or not. How do you then know what is tappable and what is not? You could tap everything and see what responds to your tap and what doesn’t.

The Real World Is Not an Exam | Well Blog (NY Times)


Multiple-choice board exams may not be the best assessment modality for doctors in training:

Educators may not actually teach to the test, but students think to the test, in linear multiple choice.

We spend the first few years of medical training imbuing our bright medical students with test-taking expertise focused on obscure and rare but well-characterized diseases. We then expend the remaining years breaking them of these habits to get them thinking of horses instead of zebras.

[See this related post about what med students use to study.]

✚ The Real Problem with Medical Student Debt—Investors, Look Here!


The link above is an annotated Twitter chat between myself, Karan Chhabra, and Allan Joseph about the medical student debt problem. The quoted sections are our actual tweets and clicking the [Twitter logo] at the end of each will take you to the original tweet. I want to thank Karan and Allan for having the foresight to put this together. You can read more of their excellent writing at Project Millennial. Enjoy!

✚ Shorten med school, but not overall training



This past week, the Washington Post published an article detailing some recent efforts to shorten med school to 3 years. The illustrious Dr Cranquis weighed in with his usual acerbic, dead-on commentary.

Pauline Chen MD took on this issue back in October in the NY Times, primarily in…

As usual, @mediiolab brings terrific commentary on an important medical education issue, with FOOTNOTES even.

MnmlRdr — A lightweight & minimal feed reader you’ll want to use every day. [Sponsor]



MnmlRdr is the best RSS Reader/Service I have used to date. Period. And, there is a special deal this week only for Minimal Mac readers to get 50% off the normal rate.

I, like many people, was looking for the perfect replacement once Google Reader was killed. And, despite the huge opportunity this left for others to fill, nothing had come along that seemed an equal replacement — let alone, better. So, I was skeptical when the developer of MnmlRdr reached out to me to let me know about the service. And, to be honest, I kind of put him off for a couple of weeks due to the holidays and all…

Boy was that stupid.

Because, it took no more than signing up for the 7 day trial period and using it for a few minutes to know that I had finally found a true replacement for my RSS needs that was better than what I had been using for years before. It is fast and clean, provides just the features you need, is beautifully designed, and has a responsive web interface so good that one could easily forgo the need for a client. The mobile interface is especially fast and, dare I say, feels native — it supports gestures for cripes sake! That said, the service does support a number of popular clients including:

  • Fiery for iPhone/iPad
  • Reeder (1 & 2) for iPhone/iPad
  • ReadKit for OSX
  • Mr. Reader for iPad
  • Read a Fever for Windows Phone
  • Press for Android

Plus it is chock full of great features like: keyboard shortcuts, tagging, folders, many “read it later” services, fast updates, and more. Plus it is private, secure, and ad free.

Seriously, I have tried just about every RSS service since Google Reader died. This one is the best. Like I said, as a Minimal Mac exclusive for this week only, you can get 6-months of MnmlRdr for free when you sign-up for a yearly plan. Don’t pass up this deal.

Happy New Years! Now, go to Paris.



Remember my post about Medicine X and how it’s quite possibly one of the best conferences you’ll ever attend? Well, now, not only will you go to Medicine X, but you could go to Paris to attend Doctors 2.0 as well! ALL FOR FREE. 

Doctors 2.0 is Medicine X’s sister conference in Europe and they have a similar focus and enthusiasm about bringing progress to medicine. If you apply to Stanford Medicine X’s student leadership track, you could be selected to attend Doctors 2.0 in Paris, France during June 2014. All your travel and lodging will be included in your student scholarship. 

This is as close as it gets to “too good to be true” in academia. If you’re any kind of health professional student - dental, nurse, medical, pharm, PA, and more - do yourself a favor and APPLY. This could be huge for you.

Looks like a fantastic opportunity. I will be applying.

Certification Exams: Are We Testing Recall or Judgment? | Am Board of Pediatrics

Great to see a medical board seriously thinking about and discussing open-book exams. This post from the American Board of Pediatrics does a nice job laying out the pros and cons of such a system. Two important issues they raise:

Previous exams have “ample psychometric data in support of [their] fairness, validity, and reliability”—Although any new testing format would need to undergo a tremendous amount of testing, this should in no way hinder improving an exam. The above statement means that the ABP board exam has good internal validity [1] but has no bearing on its external validity [2]. Board exams, at all levels, need to reflect the real-world practice of medicine. Kevin Pho MD wrote eloquently about this over 3 years ago on his blog.

Cheating—This is a solvable problem by controlling the testing environment. Test-takers could be limited to a select number of commonly used resources, not the full internet [3]. Or, all internet traffic for the examinees could be monitored. The potential for cheating should not be a significant barrier to changing exam formats. Even with the current exam mechanisms, cheating happens.

I previously wrote about why exactly I think we need open-book testing in medical eduction. The practice of medicine is about finding the right answer for your patient, not how you find that answer.

  1. That is, how well the exam tests what it is supposed to test and performs year-to-year between similarly skilled test-takers.  ↩

  2. How well the exam tests someone’s skill at actually practicing medicine.  ↩

  3. Admittedly, such a system would have its own issues, most notably implicit endorsement of certain clinical resources.  ↩

Medical apps needed, and not just for 'hipsters with chronic diseases' | Chicago Tribune

I have moved my writing to ‘mediiolab’; please follow that account now.


John Carpenter:

[Dr. Scott Stern] said the growing wealth of medical knowledge doctors are expected to use and apply “is just mind-boggling and impossible to keep in your head. It’s clear that we have to do this better to deliver the kind of care that patients assume they are getting, and that they probably are often not getting.”

Reference apps for physicians are nice; they compose the largest number of physician-centric apps currently on the market. However, we need productivity apps for doctors. Why is there no great electronic prescribing app? Why don’t EMR vendors have simple apps for order entry?

I’m waiting for the day when I can walk into a patient’s hospital room, talk to them, examine them, discuss treatment options, then pull out my phone (PHONE, not tablet or going to a computer) and hit a few buttons to add new orders for the patient. I won’t have to enter login information and wait for the computer. I won’t have to enter the patient’s name; it will already know which patient’s room I’m in through RFID (and will have the consequent benefit of reducing errors). For the most common orders, it will only require a few taps. And it all of this has to be faster than a Google search.

That is what doctors need in terms of medical apps.

[via Wing of Zock]

A new place for my writing - introducing ‘mediio’

In an attempt to unify where I create content (namely, writing and podcasting) and have a space for some future projects, I will be moving my writing to a new blog called ‘mediio’ (http://medi.io). As I have tried to do in the past, I want to make my writing as widely available as possible. For this new site, this means a new tumblr for the site and all of the outlets listed below. Thank you to all of my followers and I invite you to follow along using whichever means suit you best:

I know it is a pain to switch things around and I do apologize. I’m not undertaking this lightly, but this new site will afford new opportunities and be a permanent home.

Please share with friends (reblog!!!) and I hope to hear everyone’s thoughts and ideas in the coming weeks!

A few notes:

  1. I will still be active on tumblr under the ‘mediiolab’ user name. This new tumblr will be more than just a feed. I love tumblr, especially the medblr community.
  2. For those who also listen to the medicine.io podcast, it too will be moving to the new website. It will have it’s own RSS feed (which is not up yet), but other than that following mediio at any of the outlets above will ensure you get links to the podcast as well.
  3. I will be leaving my old content up from the blog previously known as ‘number needed to treat’. I have changed the tumblr name for this site to my own name, so it can now be found at joshherigon.tumblr.com. This site will not be updated (for now).
  4. I will be changing around website addresses and doing other things that may break links or feeds or bookmarks to this blog. I apologize in advance.

+ Hot spotting as educational tool


The AAMC has a new initiative to teach the next generation of physicians about ‘hot spotting’ and its role in providing high quality care while reducing costs. They have developed a toolkit to assist any medical student, resident, attending, or community physician in conducting their own hot spotting project with a patient from their practice.

I was immediately taken in by hot spotting when I read about in Atul Gawande’s 2011 New Yorker piece [1]. Around the same time, I heard about a research group that was taking a ‘80/20’ approach to prioritizing their initiatives. They were going to look at the 20% of diagnoses that accounted for 80% of their costs. Electronic medical records enable both strategies and are good examples of using ‘big data’ to direct our efforts.

The initiative and toolkit put together by the AAMC is impressive. Their ‘10 Steps to Hot Spotting’ lays out a framework for comprehensively evaluating a patient who frequents the hospital.

A few thoughts:

  • Absolutely fantastic that their steps include going outside the hospital and clinic. Medical training should include more time for trainees in places providing supportive services (i.e.–nursing homes, physical rehab centers, shelters, mental health centers, etc).
  • Step 2 (essentially identifying the patient) seems like a high bar to pass. Their strategy requires (1) an excellent relationship with a specific care provider in an area likely to see candidate patients and (2) that person to recognize a suitable patient and contact the med student.
  • As written, their 10 steps don’t seem to incorporate identification of a mentor. I think–for med students especially–it would be very beneficial to have a mentor, especially if you can find someone with quality improvement experience/interests.
  • The final step should be presenting all of this at Grand Rounds!! If someone spent the time and effort to put together all of the materials described here, it would make for an amazing presentation. And don’t forget to include the patient (if possible).
  • This would make for a great project to include in quality improvement classes, which should be requisite for med school graduation. I wonder if such a project would count as quality improvement for board certifications now requiring a QI project [2].

Very to excited to see what comes out of this initiative. I think this is an excellent tool for introducing trainees to population-based health without the scary (and often boring) aspects of epidemiology and biostatistics.

  1. Of course, part of that was due to Dr Gawande’s great storytelling.  ↩

  2. For example, the American Board of Pediatrics now requires a pediatrician to complete a quality improvement project as one of four parts to their new Maintenance of Certification. I believe (but don’t know for sure) that other specialties are doing similar things.  ↩