How to develop logical thinking ?

[TurbulentWind]

I wrote another post about how our Medical school isn't focusing too much on understanding Biophysics and Biochemistry ( most of my classmates only memorize the whole thing in order to get by and that's it ), and I want to be a psychiatrist, so there were older students and doctors who told me that I don't have to mind that I don't understand Biochemistry and Biophyics, because I won't use them anyway.

My problem is, however, that I feel intrinsically bad about not strengthening my logical thinking in some way.
However, I thought that maybe I don't need Biophysics or Biochemistry to do this, maybe I can use other ways to improve my logical thinking, maybe some critical thinking/reasoning/logic books ? We do not have courses on these subjects !

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[muhali3]

Med school and medicine in general isn't going to test your critical thinking in the same way that other fields do such as math/physics/chemistry/computer science. The most valuable thing would probably be knowing how to properly distinguish good research from bad research and how to not just take the author's conclusion at face value. There are free classes for this online on sites like Coursera. If you want to learn critical thinking just for fun/general life purposes, you should try taking a philosophy/logic class.

 

[Azete]

Med school and medicine in general isn't going to test your critical thinking in the same way that other fields do such as math/physics/chemistry/computer science. The most valuable thing would probably be knowing how to properly distinguish good research from bad research and how to not just take the author's conclusion at face value. There are free classes for this online on sites like Coursera. If you want to learn critical thinking just for fun/general life purposes, you should try taking a philosophy/logic class.

The sad part is, some aspects of the core curriculum at all med schools is based on bad research.

Don't get me wrong, the majority is good, but it's scary to think that some of the stuff we're being fed as "facts" is actually based on flawed research -- in some cases performed decades ago and never repeated.

 

[muhali3]

True, the amount of poorly designed research that populates medical journals (including big names like JAMA) is pretty astounding.

 

[Raryn]

The sad part is, some aspects of the core curriculum at all med schools is based on bad research.

Don't get me wrong, the majority is good, but it's scary to think that some of the stuff we're being fed as "facts" is actually based on flawed research -- in some cases performed decades ago and never repeated.

There's any number of facts we learn and are tested on in medical school that were proven false a decade ago. In almost any field. And it's not the basic science stuff that they just skim over the details or anything. A few clinical examples from things I learned on my clerkships and studied for the shelf exams:

We could all list the organs you shouldn't inject lido c epi into (fingers, toes, genitals, etc). Evidence for this? Poorly controlled concentrations of epinephrine in the 60s. This has been proven safe in every organ afaik.
Every single one of us could regurgitate wind/water/etc for causes of post-operative fever, with wind being atelectasis. This has been proven false. Atelectasis doesn't cause fever.
Metformin causing lactic acidosis. Every time there's been a large study or review article, this has been shown to happen no more often than placebo.

On top of examples like that where it's just dogma handed down, one has to take into account that significant amounts of what we learn in school will be outdated by the time we graduate, much less by the time we retire. New drugs come out, new lab tests, new imaging modalities... Old ones are proven less effective or more effective. Guidelines change. I'm only 4 years out from med school and already seeing significant changes in how some conditions are managed.

 

[IslandStyle808]

I remember from the book ending medical reversal, the author stated around 40% of what is learn in medical school will either be obsolete or proven wrong after graduation. Also, you gotta love those dudes who think having only p values constitutes a strong study.

 

[TurbulentWind]

I remember from the book ending medical reversal, the author stated around 40% of what is learn in medical school will either be obsolete or proven wrong after graduation. Also, you gotta love those dudes who think having only p values constitutes a strong study.

What is a " p value " ?

 

[cbrons]

There's any number of facts we learn and are tested on in medical school that were proven false a decade ago. In almost any field. And it's not the basic science stuff that they just skim over the details or anything. A few clinical examples from things I learned on my clerkships and studied for the shelf exams:

We could all list the organs you shouldn't inject lido c epi into (fingers, toes, genitals, etc). Evidence for this? Poorly controlled concentrations of epinephrine in the 60s. This has been proven safe in every organ afaik.
Every single one of us could regurgitate wind/water/etc for causes of post-operative fever, with wind being atelectasis. This has been proven false. Atelectasis doesn't cause fever.
Metformin causing lactic acidosis. Every time there's been a large study or review article, this has been shown to happen no more often than placebo.

On top of examples like that where it's just dogma handed down, one has to take into account that significant amounts of what we learn in school will be outdated by the time we graduate, much less by the time we retire. New drugs come out, new lab tests, new imaging modalities... Old ones are proven less effective or more effective. Guidelines change. I'm only 4 years out from med school and already seeing significant changes in how some conditions are managed.

The erroneous things being taught in the basic sciences have led stepwise to the development of worthless or even harmful interventions. I.e. Starling's model of the microcirculation and liberalized IVF therapy, hetastarch, etc.

One of my favorite deeply flawed concepts is "lactic acidosis," which has almost nothing to do with anaerobic metabolism/tissue hypoperfusion.





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[Moose A Moose]

Eh. I don't know about "developing" logical thinking. Doesn't it align more with intelligence and genetic predisposition?

 

[MrChance2]

Guidelines change. I'm only 4 years out from med school and already seeing significant changes in how some conditions are managed.

What's crazy is that doesn't stop some of the professors at least from my school from teaching medicine like it's 1970. You would think sometime in the last 40 years they would update their slides but nope.

 

[muhali3]

Eh. I don't know about "developing" logical thinking. Doesn't it align more with intelligence and genetic predisposition?

not necessarily. even highly intelligent people are subject to the same logical fallacies/cognitive biases that all humans are.

 

[Moose A Moose]

not necessarily. even highly intelligent people are subject to the same logical fallacies/cognitive biases that all humans are.

Agreed. Being "book smart" doesn't imply "street smarts". I'm just saying that unlike analytical ability- which can be honed- I feel like logic is apart of the 'package of heredity'... for better or for worse.

 

[muhali3]

I guess it depends on the context. Mathematical logic I definitely feel is mostly innate, whereas philosophical logic/making logical arguments I think can be taught.

 

[sloop]

What is a " p value " ?

It tells you how long the author's penis is.

 

[Raryn]

The erroneous things being taught in the basic sciences have led stepwise to the development of worthless or even harmful interventions. I.e. Starling's model of the microcirculation and liberalized IVF therapy, hetastarch, etc.

One of my favorite deeply flawed concepts is "lactic acidosis," which has almost nothing to do with anaerobic metabolism/tissue hypoperfusion.

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Marik certainly has some great points, but the rest of critical care isn't completely wrong in their management. There's a lot of people that disagree with his statements regarding iatrogenic salt water drowning and the uselessness of all the measures that we keep track of (including lactate clearance). I think it's a lot more complicated than he makes it sound (even if he is a phenomenal writer).

That said, I don't have to take care of ICU patients anymore outside of the occasional moonlighting shift, so it doesn't particularly matter to me.

 

[I'm No Superman]

It tells you how long the author's penis is.

<.05 🙁

 

[sloop]

<.05 🙁

Always a bad sign when you ask someone how big it is and they respond with "it's significant."

 

[dempty]

What is a " p value " ?

The easy way: it tells you how much the data disagree with the null hypothesis in a given test (smaller p-value means more disagreement).
The less easy way: assuming the null hypothesis is true, the p-value is the probability of obtaining a test statistic that's at least as extreme as the current one.

I remember from the book ending medical reversal, the author stated around 40% of what is learn in medical school will either be obsolete or proven wrong after graduation. Also, you gotta love those dudes who think having only p values constitutes a strong study.

It's even worse that (probably) upwards of 75% of people in research can't actually tell you what a p-value means (or doesn't). More to your comment: only reporting p-values doesn't make a study weak, necessarily. It would depend on what the study aims were, but you'd certainly have a hard time assessing the practical implications that come from estimating effect sizes with confidence intervals.

I guess it depends on the context. Mathematical logic I definitely feel is mostly innate, whereas philosophical logic/making logical arguments I think can be taught.

These "different" kinds of logic are often overlapping.

 

[medicinewoman101]

you need to chill. The only thing that matters is that you develop strong clinical logic. Forget the biochem and all that other BS. Get into the clinic from first year and start learning critical clinical thinking. Its the number one thing that is lacking right now in interns/residents/many attendings.