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Old 05-29-2013, 12:37 PM   #51
Kraydak
 
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Kromm View Post
At the current intensity of undergraduate education and work terms/residencies, I'd go with about 2 points/year, total, in associated skills, techniques, and perks. Someone who has a flat four-year MD has 8 points to distribute; someone who does another four years of specialization has 16 points to distribute. Spend them as you like. The contrast between {Diagnosis (H) IQ [4], Physician (H) IQ [4]} and {Diagnosis (Optional Specialty) (A) IQ+2 [8], Physician (Optional Specialty) (A) IQ+2 [8]} is huge, and the latter person may also have access to perks like Cutting-Edge Training, Efficient, and Hyper-Specialization that aren't taught below the specialist level.
A) The above analysis is completely inconsistent with a flat Professional=12. Good.

B) Med school intensity is far, far beyond undergraduate education.

C) Society definitely seems to be seeing a return well above 2 cp/year of undergraduate education. Which is good, because university is expensive (even outside the US, where other people foot the bill).
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Old 05-29-2013, 12:47 PM   #52
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Default Re: What level Physician skill should an MD have?

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A) The above analysis is completely inconsistent with a flat Professional=12. Good.
Well, who knows? I would assert that the average person going into any field is IQ 10 . . . I don't really accept the "the brightest and the best" theory that university candidates would have higher IQ in GURPS terms. It may sound cynical, but I'd go with IQ 10 and Professional Skill (Exam Writing)-12 in most cases. That would make the above numbers 10 vs. 12, so 12 is pretty consistent. If you want to say that IQ 11+ is the norm, then by all means do so.

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B) Med school intensity is far, far beyond undergraduate education.
We'll just have to disagree on this. The culture is one that promotes this view for sure, but I've seen no evidence that the pedagogy is up to higher standards. In fact, that matter has been called into question in Canada more than a few times.

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C) Society definitely seems to be seeing a return well above 2 cp/year of undergraduate education. Which is good, because university is expensive (even outside the US, where other people foot the bill).
Even 2 points/year is impressive. This means 8 points for the typical newbie undergrad and 12-14 points for professional degrees. Getting even IQ+2 in an Average field is a huge return! The average person has an IQ-5 default and some people actually work from this. The crutches that give those people +7 or more and let them function mean that a truly skilled person with a 12 is functioning at 19.

Don't lose sight of the fact that the GURPS skill system is incredibly skewed toward stupidly dangerous tasks. The game outright assumes that nobody at a normal job is rolling at less than +4, if not that +7 I just suggested.

And I should add that I have no disrespect for or dislike of physicians. I am friends with several, and respect their work immensely. I just don't see any proof that they're better at being physicians than most mechanics are at being mechanics or most nannies are at being nannies, or that they're smarter and more talented than the next person. They seem like pretty ordinary people with pretty ordinary degrees of success and failure . . . it's just that 95%+ of their failures allow a do-over, just like other failures. The idea that every failure kills someone or makes someone worse is fiction; most conditions are slow enough to allow retry after retry. Even my cholecystitis took 20 years and dozens of tries to diagnose!
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Old 05-29-2013, 01:27 PM   #53
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Default Re: What level Physician skill should an MD have?

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With due respect to our MDs here, an MD is not a PhD. The two differ significantly, in many ways. In sheer years, a PhD is typically more educated. In Canada, the MD is actually considered an undergraduate degree, awarded 3-4 years after an optional BSc, also earned in 3-4 years; the mean age of graduation is 25-26, depending on region. The PhD is a graduate degree earned after 3-4 years at the bachelor's level and 2-3 years at the master's level, and takes on average 5 years in itself; the mean age of graduation is >30, and 36 in the sciences most closely related to medicine. In sheer hours-to-skill-points terms, a PhD has 10 years on and higher skill levels than a green, unspecialized MD.

I agree re: skill levels. However, the average MD isn't a surgeon, an ER physician, or a medic in a warzone. For the sorts of doctors (or equivalent) likely to be PCs in action-adventure campaigns, I totally agree that skill 12 is far too low and you shouldn't bother asking for the job with less than skill 14.

This is not the same in Canada. Here, a GP is an accredited specialist who has followed up her four-year MD with a two- to three-year residency in a family medicine program and then passed a special examination. She is what the U.S.A. would call an FP. She is still in no way qualified to work an ER, ride in an ambulance, or do anything in an OR. A significant fraction of the training is in the psychology of the job.

See above – I think that 14-16 is justified for many, even most surgeons. My answer was about MDs, who as a baseline are graduates of a four-year undergraduate program. They are as skilled at medicine as the graduates of any four-year entry-level program are at anything. Saying that they get more out of their four years than other people strikes me as hopeful. I had plenty of pre-med and med students visit my office (and attend the same parties . . .) when I was running physics courses, and they were not more impressive or more diligent students than the people majoring in physical education, sociology, chemistry, commerce, etc.; they were just other undergraduates.

My surgeon claimed it was, relative to her normal work, which is breast-cancer surgery and medical research. YMMV.
Interesting. The difference between a Canadian and an American GP is noted.

And, at least I don't feel like a heretic for wanting Surgery-14, now. Thanks. I mean, otherwise how would you differentiate between an ER doc and a surgeon who both have Physician-12, Diagnosis-12, and Surgery-12? (I assure you that you don't want an ER doc removing your gallbladder.)

In the U.S., I got a bachelor's degree in four years, and then spent four more years getting an M.D. There are a very few programs that give combined BS/MDs in six years.

I would propose that those medical students with whom you met in a social situation and with whom you weren't very impressed were not being observed "doing their thing." (Physics is going to be low on the priorities list.) I'm not saying they're all savants, but they certainly ain't stupid and lazy. I saw an analysis of the required reading at a major U.S. medical school once which assumed reasonable reading speeds, allowed 6 hours of sleep a night on average, and that the students double-tasked by (for instance) reading while they were eating or on the toilet... and it was still impossible to complete all of the reading (assuming that they attended all lectures).

So, anyone who survives medical school has proven, at the very least, that they are very good at learning. Probably by prioritizing well, and leaning heavily on the education that they already have. (I certainly leaned on my biochemistry BS.) And they tend to be very motivated, if only due to the Darwinian pressures that are placed upon them.

Next- I would also describe a cholecystectomy as "easy" but, brother, all things are relative! In game terms it's not "easy" in the same way as the example in the basic set, i.e. a driving roll to commute to work. Yes, I can (and damned near have) done them in my sleep, but again, I trained for five years in a residency. Even an inguinal hernia repair might not count as easy in GURPS terms- inguinal anatomy is confusing, and you wouldn't want a non-surgeon doing yours at default.

I now understand why you were modeling a fresh medical-school graduate. Your explanation is noted and, frankly, I'll agree that skills of 10-12 are reasonable for such a fresh graduate. But that's a bad model, unless you're talking about a resident, who by definition are reasonably fresh medical school graduates. Most independently practicing doctors with whom anyone deals will have also done a residency, though granted not all are as long as mine. My medical school plus my residency utterly consumed a decade of my life; I don't remember doing anything but studying and working (where'd that wife come from?)- and that's not including college. And I was not kidding about 100-hour work weeks in my residency (though that has changed). I maintain that this gets me to PhD equivalence. They are both terminal degrees, after all. A typical (American) surgeon graduated college at 22, medical school at 26, and residency at 31 or 32. (It sounds like your average Canadian GS does it a year or two younger.) And then spends the rest of his life reading journals. This jives with your example PhD. If you still disagree we'll have to have an XBox challenge to decide the matter or something.

THAT'S RIGHT- I just called out Kromm! (hey, what's that buzzing sound...?)

Finally- If the BS is "optional" in Canada, well, that's Canada. I won't start that flame-war. ;P But it also might explain your not being very impressed- those medical students lacking a BS haven't really proven themselves yet. (Or did you mean that they had attended college, but just didn't formalize a degree?)

But, really, I'm kind of arguing with myself here, aren't I? You already granted me Surgery-14.

I'll shut up and step back from the ledge, now...

Last edited by acrosome; 05-29-2013 at 01:48 PM.
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Old 05-29-2013, 01:37 PM   #54
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Default Re: What level Physician skill should an MD have?

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Originally Posted by acrosome View Post

(I assure you that you don't want an ER doc removing your gallbladder.)
I very specifically didn't! :)

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Originally Posted by acrosome View Post

Next- I would also describe a cholecystectomy as "easy" but, brother, all things are relative! In game terms it's not "easy" in the same way as the example in the basic set, i.e. a driving roll to commute to work. Yes, I can (and damned near have) done them in my sleep, but again, I trained for five years in a residency.
Do remember that task difficulty modifiers are not absolute across all tasks. They are relative to other tasks for that specific skill. To come up with an illogical test case: If there were a "Disarm Universe-Destroying Device" skill, then it would still have routine tasks that get from +1 to +10. So back to Surgery, if a laparoscopic cholecystectomy is easy relative to an open, and both are easier than a heart transplant, then it may well be that it's at +1 or better.

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Finally- If the BS is "optional" in Canada, well, that's Canada. I won't start that flame-war. ;P
In practice, just about nobody gets admitted without one. But in principle, if you were what GURPS would call some genius with IQ + Healer of 15+, you might just be able to ace the admission exam and stroll in. I know nobody who has done so. I do, however, believe in waiving academic credentials for those who can prove equivalence through exams. Especially in the tax-supported Canadian system, I see no good reason to force capable people to sleepwalk through four years of proving it. There's some evidence that this is destructive, as it deprives people of productive youthful years focused on their terminal profession.
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Old 05-29-2013, 01:55 PM   #55
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Default Re: What level Physician skill should an MD have?

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...Do remember that task difficulty modifiers are not absolute across all tasks. They are relative to other tasks for that specific skill. To come up with an illogical test case: If there were a "Disarm Universe-Destroying Device" skill, then it would still have routine tasks that get from +1 to +10. So back to Surgery, if a laparoscopic cholecystectomy is easy relative to an open, and both are easier than a heart transplant, then it may well be that it's at +1 or better.
...
The basic line is that (modern western) society won't tolerate people performing (all but the most difficult) high-consequence tasks without an effective final skill less than 15. The failure rate is too high, and we are rich enough to throw more resources into training. "Society" in general tries to avoid having people spend their time performing tasks with effective final skills above 17 because that just represents wasted potential.

What that means is that since we have a good target effective final skill (16), if we have a baseline skill (IQ+skill+talent+bonuses), we can back out a task difficulty. Or the other way around: baseline skills and TDMs are not independent. Of course, this should only be done for the hardest tasks which are expected to be handled routinely (most tasks will be significantly easier). Or, to put it differently, if training people to Skill 16 is affordable, and they get +6 in equipment bonuses, we'll happily set them to performing difficulty -6 jobs routinely (because, well, they can).

If you start to add up the time and training put into our medical corps, it starts to look like that is where we are: skills around 16, good tech bonuses, very, very hard tasks.
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Old 05-29-2013, 02:01 PM   #56
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Default Re: What level Physician skill should an MD have?

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Do remember that task difficulty modifiers are not absolute across all tasks. They are relative to other tasks for that specific skill. To come up with an illogical test case: If there were a "Disarm Universe-Destroying Device" skill, then it would still have routine tasks that get from +1 to +10. So back to Surgery, if a laparoscopic cholecystectomy is easy relative to an open, and both are easier than a heart transplant, then it may well be that it's at +1 or better.
Hmm. Ok, let me think out loud, here...

How about:

Automatic
Removing a splinter, shrapnel, or other superficial foreign body

Trivial
Removing a small lipoma, or a cyst; placing a central line

Very Easy
Removing a pilonidal cyst; hemorrhoidectomy; phlebectomy

Easy
hemorrhoidectomy; external fixation of midshaft long bone fracture

Very Favorable
laparoscopic hernia repairs; segmental small bowel resections

Favorable
laparoscopic cholecystectomy; gastric banding

Average
Nissen fundoplication; partial colectomy; sleeve gastrectomy; most anatomic arterial bypasses; IM nail

Unfavorable
gastric bypass; meningioma excision; repairing a stab wound to the ventricle; carotid endarterectomy; total joint replacement

Very Unfavorable
Total mesorectal excision; coronary bypass; AAA repair; extranatomic arterial bypass; laminectomy

Hard
Whipple, astrocytoma excision; ruptured AAA repair; acetabular repair

Actually I guess this doesn't help much- I could produce any arbitrary list, couldn't I? But on the other hand if you throw things from other specialties in there, like coronary bypass, then it skews most other things down into easier categories... Hmm.

Thinking...

EDIT- Wow, this is hard, since I'm trying to include procedures that are not in my specialty. I have no idea how to rate laminectomies and such, for instance. (A lot of orthopedic procedures have unimpressive outcomes- a hand that barely works, etc., even on a sucess.) And I think I'm inflating the vascular procedures, and I might be conflating difficulty of diagnosis with difficulty of the procedure, or something. I'm giving up... :) If the need ever arises I'm sure I can wing it.

I mean, really, for most adventuring needs we're talking about trauma, right? The GURPS rules for that are pretty good, though they randomize a lot, and the healing rates seem optimistic.

Last edited by acrosome; 05-29-2013 at 02:19 PM. Reason: for thinking
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Old 05-29-2013, 02:07 PM   #57
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Default Re: What level Physician skill should an MD have?

Many skills can be augmented by Techniques, we see this predominantly with combat skills. There is no reason this cannot be extended to specific applications of non combat skills There are some Techniques that specifically reduce predictable penalties, are there any penalties that seem suitable for Medical Techniques.

Example
Chest Surgery, Surgery/A
Default Surgery -3, cannot exceed Surgery
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Old 05-29-2013, 02:16 PM   #58
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Default Re: What level Physician skill should an MD have?

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The basic line is that (modern western) society won't tolerate people performing (all but the most difficult) high-consequence tasks without an effective final skill less than 15.
You can see things that way, but I don't. Few tasks truly don't allow retries that waste only time. Even "high-risk" ones are like that . . . the risk develops if nobody retries, not the instant someone fails at all. I'd use accumulated odds of success for this. At skill 12, say, two tries are like 14, three are like 16. I'd only go with those as baselines for tasks at which failure is tantamount to critical failure, which is a rare set of tasks indeed. I really don't buy into the belief that we have so much intellectual and professional capital that we're expecting holes in one from just about everybody. That doesn't match reality as I've experienced it anywhere I've lived.
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Old 05-29-2013, 02:23 PM   #59
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Default Re: What level Physician skill should an MD have?

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You can see things that way, but I don't.
Agreed. If anything, 12 is sometimes generous ... ;-)
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Old 05-29-2013, 02:23 PM   #60
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Default Re: What level Physician skill should an MD have?

Made me think - whats the penalty to get a hole in one?
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