Had a lecture the other day which talked about "measurement error" validity and reliability." One of the concepts covered was the measurement error of categorical data, "usually referred to as misclassification." It went on to talk about the analysis of misclassification using a two by two matrix; however, it did it in a way that is extremely confusing and, unfortunately, very standard amongst medical teaching: what I call 'the a/(a+c) and b/(b+d) method'.

there used to be a copy of pred.txt online. there isn't anymore, so here is a replacement. predator, or michael carlton, was an amazing guy who did a lot more than many of us could imagine. this is his story, and some of his writing.

• Pred.txt (pdf - 11MB)

With the semi-collapse of Modernising Medical Careers (MMC), about which I have certainly written elsewhere, if not here, everyone seems to be trying to figure out what to do next. Despite Remedy UK failing in court, they are still the moral voice of UK doctors - and the BMA is rapidly backpedalling to try and regain legitimacy. This is evident in their most recent mail out to doctors, in which they say they are "committed to assisting junior doctors" - although this has hardly been apparent over the past few months, and it is the same signatories at the end of the mail sending us "Best wishes." What is perhaps most ironic is that the BMA consistently claims to be the voice of the profession, representing all doctors, even those not members, yet advice and surveys go only to their members. Oh, but for more choice... roll on Remedy, the union!

And another day. Exam day. Another exam day. For both the proctors (invigilators) and myself - and many of the other
candidates: they all seemed to be foreign. One guy said he'd done 8 different exams since qualifying - requalifications in
various countries. For myself, there will be more to come; and I hope they're not so fake as this one...

USMLE Step 2 CS (Clinical Skills) - "Standardised Patients," abbreviated history and physical, then a short "Patient Note"

Mexico to San Francisco, stopped and changed overnight in Los Angeles: the city of devils. Five hours in the coach station:
dank, sweaty, flourescent illumination and the crusted bodies of a million passers-through; lines winding around each
other, baggage piled high... I didn't ever want to come back.

And here I am. Not through any choice of my own - really. Well, maybe kind of, a little bit, but not the city that enticed
me: a whole other desire. And no, not a woman. I'm here for my exam: Step 2, Clinical Skills, of the USMLEs about which

Presented a talk on "Issues of consent" referencing a number of cases I was involved in, along with a couple that I wasn't. Have put it up here in openoffice format as that's my preference and what I used; there's a brief video that goes along with it (look for the black slide - and imagine that there's only one word to describe the situation). All components are linked in due to failures to attach them properly....

Enjoy!

Have been here now for >48 hours - by two hours, precisely (the train I was on was late, and arrived about 25 minutes later than expected: that's the result of having a single mainline from the capital). Interesting greetings, interesting place. I'm sure I'll figure it out pretty quickly, tho - things will definitely settle down this week.

Ok, said I would come back to this the other day when I wrote about advice for the USMLE. A couple of links that I have remembered since, or that are now reachable.

Here goes for some random notes related to questions that I'm doing for the Step 1 exam.

Leigh disease: mitochondrial disorder also known as subacute necrotising encephalomyelopathy. Specific defect is cytochrome oxidase. Particularly affects muscle and brain, patients present in early adulthood, have progressive intellectual deterioriation, weakness, ataxia and siezures, then die within a few years. I'm not quite sure why they wait so long to present... but I'm not overly bothered either and am too lazy to look it up further!

Wow, mentioned that I was doing USMLEs at the moment on doctors.net and got quite a response with people asking for advice! Not sure how qualified I am to answer all the questions, but I will do my best... for those unaware, my background is a UK trained doctor who is fortunate enough to have dual nationality. I graduated under the "old system" of medical training with 2 years pre-clinical and three years clinical; that was back in 1999. Since then, I've specialised in paediatrics, travelled around the world, and basically seen the postgraduate training system in the UK fall apart... As such, I figured that now was a good time to bail: the new PMETB Article 14 regulations mean that it is not necessary to gain a CCST (certificate of completion of specialist training) in the UK to be admitted onto the specialist register, but instead it is possible to use experience from the preceding 5 years that has been gained anywhere in the world, provided it is considered equivalent to what the UK training would have been.