Ben White

The Best Book for the Texas JP Exam

01.22.16 // Medicine

Update 2024:

Yes, it’s still up-to-date, and yes, it remains the go-to resource for the JP Exam.

Update 9/1/2019:

The Exam is now online. It’s 50 questions taken over 60 minutes and costs only $34. You can take it from the comfort of your own home, and my book remains the go-to resource for thousands of physicians.

This book remains the de facto standard prep material for the JP exam. While you can definitely spend more money and use more resources, you absolutely do not need to. The TMB official materials are $99 and ultimately uneccesary.

Update 4/30/2016:

Within the first two months of publication, my book has become the “#1 bestseller” in the jurisprudence category (less impressive than it sounds I assure you) and received a slew of reviews on Amazon, all 5-stars. The consensus via the reviews is that this is indeed the “best book” for the exam (for which I am both grateful and extremely pleased!).

Okay, that post title is biased (see below), but here it is: The Texas Medical Jurisprudence Exam: A Concise Review.

When I applied for my license in 2013, I searched for the best way to study for the Texas Medical Jurisprudence Exam and was pretty surprised at the state of affairs (you can read my study recommendations here). There was an expensive $200 online course (i.e. narrated powerpoint) with terrible voice acting and a painfully juvenile script. There were expensive textbooks that cost $100 or more and were hundreds of pages long. And there was one affordable option: a $20 effort with a $3 Kindle version that amounted to a long list of facts written in legalese without any attempt at emphasis or context. All of this was for a $58 (then $61) pass/fail test primarily based on common sense that takes less than an hour. You could pass the JP exam with any of them, but none really hit the sweet spot. I left the test thinking that there was an unfilled niche for a study guide that was concise, readable, and reasonably priced.

Then, despite its brevity, it took me two years of intermittently hard work and countless hours to actually write it, fact-check it, and publish it.

So, my first “book” is now out and you can buy it right here.

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My goal in writing this book was to make something that you could read in a single sitting that covered the salient points needed to pass the Texas JP exam while also providing you with a basic understanding of practical jurisprudence for a medical career in the Lone Star State. You can read this 1-3 times (over 1-3 hours; first pass will take around an hour) and pass easily and safely (this has been universally corroborated by the reviews on Amazon).

As much as is possible given the subject matter, I hope you enjoy it. Your comments and feedback are both welcome and appreciated. Any book of this nature can always get better.

Nanoism in the Washington Post

01.07.16 // Reading, Writing

Very fun: Nanoism, a few tiny stories, and I made an appearance in the Washington Post yesterday in an article about Twitter’s planned/rumored character-limit change.

For what it’s worth, while the type of fiction I’ve purveyed is only fun within a predominantly constrained system, for people who write Twitter fiction differently, the ability to say more probably wouldn’t be much of an issue (say, those writing in the longitudinal first person like a digital diary of someone surviving a zombie apocalypse).

What I read in 2015

12.30.15 // Reading

Between the birth of our first child in April and by far my busiest call year of residency, 2015 was shaping up to be an abysmal year for pleasure reading. Ultimately, the saving grace was the combination of my much-lengthened daycare-related commute with Audible (the free 30 day trial/two free audiobooks via that link got me completely hooked). Audible is fantastic, and it’s not an exaggeration to say it’s changed our lives. Dead time in traffic or folding the laundry is no longer the dreary waste of time it used to be; it’s a chance to “read” (okay, listen). Even with Audible, I still ended up with fewer books than I read in 2014 (and this year’s list is padded with some pretty short stuff).

  1. Firefight by Brandon Sanderson (Reckoner’s #2)
  2. The Eye of Minds by James Dashner (Mortality Doctrine #1) (Not as good as The Maze Runner, which while entertaining, wasn’t all that good either)
  3. The Life-Changing Magic of Tidying Up by Marie Kondo (changed how I fold all of my laundry)
  4. Yes Please by Amy Poehler (wife’s choice, meh)
  5. The White Coat Investor by James Dahle (re-read)
  6. Modern Romance by Aziz Ansari (wife’s better choice)
  7. The Martian by Andy Weir
  8. 1984 by George Orwell
  9. Walk the Sky by Robert Swartwood and David B. Silva
  10. Sapiens by Yoval Noah Harari (like Guns, Germs, and Steel, but less rigorous and much broader in scope)
  11. The Pearl by John Steinbeck (so depressing)
  12. A Darker Shade of Magic by V. E. Schwab
  13. America Again by Stephen Colbert (funny, but not as good as I am America)
  14. The Art of Money Getting; or, Golden Rules for Making Money by P. T. Barnum (old, kinda fun, free, my highlights here)
  15. Lean In by Sheryl Sandberg (may be an anthem for working women but perhaps should be read by men just as much. And then one should expand the ensuing mindfulness to include every group and minority you can think of).
  16. The Perks of Being a Wallflower by Stephen Chbosky
  17. This Is Water by David Foster Wallace (the book version of this short essay is pretty much a fluffed out graduation present. The original essay is still available online for free.)
  18. Middlesex by Jeffrey Eugenides (so good)
  19. Hiroshima by John Hersey (the ethics of the atomic bombings in World War II was something we discussed in history class, but this follows the stories of several survivors of the attack. It’s harrowing. I’ve never read anything like it. It’s much more digestible in book form, but the New Yorker released a big chunk of it free online for the 50th anniversary.)
  20. Super Mario by Jeff Ryan
  21. Between the World and Me by Ta-Nehisi Coates
  22. Why We Make Things and Why It Matters by Peter Korn
  23. The Dorito Effect by Mark Schatzker (actually a very fascinating pop-sci discussion of modern food breeding and technology)

A few books make the list from my wife’s Audible choices. There are also a couple of classics that I somehow hadn’t read before, but I’m going to keep trying to do that every year to make up for only pretending to read the assigned books in high school. Here’s to a lively 2016!

Review: ExamGuru Shelf Exam Question Bank

12.16.15 // Medicine, Reviews

Updated 5/16/2016 to reflect new prices, new discount code, and some additional changes. Updated since then to reflect new discount codes. 

ExamGuru is the brand new and currently only question bank geared specifically for the third year NBME shelf exams. While the product itself is new, the company is not: it’s a new brand of the COMQUEST family, one of the two big players in the osteopathic question bank market (for the COMLEX exams, which are analogous to the USMLEs). It was released to the general public this week, but I had early access in order to write this review. I was also able to secure a discount for readers, so if you sign up using the code BWBW2022 , you’ll get 15% off whatever package you get, and I’ll get a few bucks.

Before we get started with the actual review, full disclosure: I wrote a small number of questions for this question bank as a freelancer several years ago. These were sold on a per-question basis; they are no longer my intellectual property, and I have no financial stake in the company or its success outside of the time-limited coupon above.

Size and Cost

The ExamGuru question bank is divided into separate shelf exam products, each with a goodly number of questions (as of the time of this post): family medicine (375), internal medicine (412), ob/gyn (369), pediatrics (406), psychiatry (395), and surgery (399). Each question comes with the detailed explanations we’ve come to expect from medical school question banks: 1) Concept/question explanation 2) Detailed answer choice explanations, including explanations of the incorrect options, and 3) Take home point.

You can buy a subscription for a single shelf product at a time: 1 month for $49 $37 and 3 months for $99 $79. Alternatively, you can buy all six products for a length of time ($129 for 1 month up to $379 for the year). Given that buying a month of each product would add up to almost $300, it would seem that the product is priced to encourage you to either buy a few products for a month each or just shell out for the whole year, which would allow you to the use the bank both as a shelf study resource and as an alternative/secondary Step 2 CK qbank.

Software

The website imitates the FRED software you’re intimately familiar with (and also has an option to change the layout to the one used on Osteopathic examinations for DO students). Everything is accessed via the website itself (no downloads or creepy UW spying/tracking), and the site is responsive: it works appropriately on your computer or your smartphone.

Peer percentage correct for each question is provided a la other competitors. Questions are also rated by difficulty, though I’m not sure how this was calculated; oddly, it seemed like most of questions I did were graded as “hard” in their software. I wasn’t sure if this was simply chance or reflects how they’ve self-graded the difficulty and the relative proportions of each within the qbank. Additionally, EG does provide good actionable data about your performance, including a breakdown by question task (establishing a diagnosis, management, etc), which may be a nice way to pick apart areas of weakness you didn’t know you had. If you’re getting the diagnosis questions but missing the management ones, then presumably it’s time to focus on the “next best step” and drugs of choice.

Question Quality

The question quality is good for its first iteration, but it’s not yet at the UW level of polish. This isn’t surprising: I remember using USMLERx back when it was a newer product, and it was awful and a total waste of time and money. The EG house style in particular a bit spotty and could use more homogenization: Multiple question writers and their particular quirks remain surfaced, and occasional aspects, particularly when it comes to the final stem and answer choices, sometimes stray a bit from what you’d actually see on game day. Buzzwords are over-employed and are even sometimes “in quotation marks” whereas nowadays these terms are more likely to described rather than simply called out. Explanations range from relatively short to long & fluffy, sometimes casual “Don’t forget XYZ on test day” and sometimes stiff.

Topics and narratives are fine overall, but some of the questions slipped through without matching the official question writing guide (which I’ve discussed before). A random example: a question about cirrhosis with blatant over the top SBP contained unbalanced answer choices (1 antibiotic choice versus multiple diuretics). That’s probably too easy and not reflective of the standards. I’d argue the question should have been a bunch of antibiotics asking you to know which type is used to treat SBP, or an even combination of both. One answer choice that stands out from the list is to be avoided. On the flip side, the family medicine section has some really great rash/skin questions, which are high yield and not well represented elsewhere.

EG also still needs a copy editor. Shelf questions are often long but almost never because of fluffy prose (only extraneous details!), and comma errors remain (inappropriate comma use before a coordinating conjunction used in a phrase will always be my pet peeve). Again, not necessarily substantive criticism but certainly one that signifies a lack of polish in its first iteration. The material is there, but these little differences do detract a little from question experience, which otherwise is well designed to approximate the real deal. As above, the software is solid.

Update: The EG CEO informs me that they brought on a copy-editor to deal the issues I raised in this review. He also tells me they’ve updated a lot of questions from user feedback. I haven’t personally taken a look again, but if nothing else, most question-banks generally get better over time, not worse.

On the whole, these are mostly nitpicks. But to me, the level of polish of a product is really important if you’re going to spend a lot of time with it. Errors and inconsistently can detract from the experience and distract from your education. 1 That said, ExamGuru is probably one of the best things to come around for the Shelf exams for a while and breathes some new life into the static review lineup. The mistakes I found during my review were nearly all ones of style, consistency, and grammar. These are the things that are easiest to fix gradually. The core content I saw was just fine.

So my overall impression is that this a supplemental product, not a UWorld replacement. While the important topics are covered and the explanations are generally thorough (sometimes a bit lengthy, I’d argue), the overall quality is not yet up to the consistent quality of UW. The main benefit of EG is that it adds some meat to the UW bones, which are nearly ideal for Step 2 CK but a bit thin for several shelf exams. UW is still I think a critical component of shelf review, but there’s definitely space for another question source. And on the whole, I think ExamGuru is a better question source than the usual alternatives (e.g. PreTest) in terms of depth, ease of use, powers of software, etc. I’d much rather do dedicated shelf questions in a simulated USMLE environment on my computer or phone (yes, EG is mobile-enabled) than thumbing through a book or shelling out for another Step 2 qbank.

Conclusion

So should someone use or buy this product? Depends. If I were a third year again, I would for family (maybe peds and ob/gyn as well). Certainly not internal medicine, UW had plenty of that for me to chug through. Ultimately, as readers of this site are well aware, I believe strongly in doing questions, even as a core study method. UW just doesn’t have a very satisfying number of questions for several of the shelf exams (it’s well-pruned for Step 2 CK). Financially, it either makes sense to buy 1-3 of the shelves for the one-month period to use during a dedicated review push or, if you want more, just get the whole set for the year (ouch). I don’t think the quality or consistency is at the UW level but it’s a tailored source of questions in a friendly NBME style package that you can use on your computer or on your phone. And that’s a great start.

If you do end up using the EG product, shoot me an email or comment and let me know how it holds up to thorough use.

Life Lessons from P. T. Barnum

12.07.15 // Finance, Miscellany, Reading

You may not be familiar with P. T. Barnum, but you’d probably recognize the 19th century showman’s longstanding legacy: the Barnum & Bailey circus. In 1880, he also published the self-help/personal finance book, The Art of Money Getting; Or, Golden Rules for Making Money, which contains essentially everything you’ve ever read in a blog or book about the topic (in old timey English, for bonus points). The book is available for free on Kindle, but here are some of my favorite life lessons:Continue Reading

The Great Filter of Artificial Intelligence

11.20.15 // Miscellany

From Raffi Khatchadourian’s “The Doomsday Invention” in The New Yorker, a profile of philosopher of Nick Bostrom and discussion of the (highly dangerous) future of artificial intelligence:

He stopped and looked ahead. “What I want to avoid is to think from our parochial 2015 view—from my own limited life experience, my own limited brain—and super-confidentially postulate what is the best form for civilization a billion years from now, when you could have brains the size of planets and billion-year life spans. It seems unlikely that we will figure out some detailed blueprint for utopia. What if the great apes had asked whether they should evolve into Homo sapiens—pros and cons—and they had listed, on the pro side, ‘Oh, we could have a lot of bananas if we became human’? Well, we can have unlimited bananas now, but there is more to the human condition than that.”

Long, but well worth the read.

What to do with your old employer-sponsored retirement accounts

11.13.15 // Finance

After you’ve switched employers, it’s time to think about what to do with the old retirement account(s) (401k/403b/457) you previously contributed to. But before you do anything, make sure any company match dollars you’ve earned have vested appropriately. Vesting schedules (i.e. when the money is yours free and clear) vary, and vesting may occur immediately, with some fixed percentage per year employed, completion of a specified residency program or contract period, etc.

As a personal anecdote, my transitional year internship had a 50% match up to 4% of salary with 100% vesting after the completion of a residency program (our TY qualified, as it was considered a complete 1-year program). I noticed that the vested portion of my employee contribution was still zero dollars after finishing two years ago, so I eventually got around to emailing them, they looked into it, realized the error, and contacted the plan: now I have my money. Now, my former employer was very responsive, and I doubt very much that this was done on purpose, but there is no denying that it would be in a company’s best interest to conveniently forget to vest their matching contributions and see who notices. Just saying.

Anyway, once you have all your hard earned money under your name, you have three real choices: cash out the plan, keep it where it is, or transfer/rollover to a new account.

Option 1: Spend it

No. Don’t cash out the plan. You’ll pay both federal and state taxes on it like it’s regular income PLUS an additional 10% early withdrawal penalty (because you’re probably not 59.5 years old). Your tax-sheltered retirement account distributions are limited on an annual basis (i.e. you can only contribute 18k in 2015/16), so why waste the benefits and tax-free growth?

Option 2: Leave it

Leave the money where it is. Nothing wrong with this, but your former employer’s plan may not have the best fund options or the lowest fees. Some employers also won’t let you do this if your balance is low, and others may hike up your fees without giving you a solid heads up once you’re no longer part of the team. Bottom line: if your old plan doesn’t have low management fees with access to low-cost index funds, then it’s not a great place for your money.

Option 3: Move it

For many people, moving it elsewhere is the best plan.

Your new employer
You can usually transfer funds into your new employer’s fund (assuming they accept rollovers), which is a good idea if your employer’s plan is better. But if the fees or fund options aren’t better, then the main advantage to a transfer in this setting is having fewer accounts to keep track of.

Roth IRA
If your income is within the Roth limits (which it almost certainly is as a resident or fellow), you can roll over a regular 401k/403b to a Roth IRA (you’ll pay taxes on the conversion, but then it’ll be tax-free on withdrawal). This may be the best option as a resident (if you have the money on hand to pay the taxes on it) and a good in general, particularly if your current income is lower than you expect during retirement. You can also always convert a Roth 401k/403b to Roth IRA with no penalty (Roth to Roth conversions are always Kosher), so if you have a Roth 401k/403b, just do this.

Individual (Solo) 401k
If you moonlight or have any self-employment 1099 income, then you could transfer your old money into a solo 401k that you set up for your side business’ income.2 Individual 401ks are pretty awesome. While you can still only contribute up 18k per year as an individual, your business can also offer up 20% of its (your) profits up to the 51k limit (which is a per business limit, not a per person limit).2 Vanguard, one of the best solo 401k options, doesn’t allow for 401k rollovers, but low-cost competitor Fidelity does. An individual 401k of your choosing should have lower fees and good fund options compared with most employer plans.

Traditional IRA
Lastly, you could roll it over into a traditional IRA. But putting pre-tax money into a tIRA means that if you attempt the “backdoor Roth” in the future (which you should/will), you’ll eventually have pay tax on the conversion. So probably not the best unless you then roll over the IRA into an employer’s 401k (that takes rollovers) in the future. There’s no reason to do this really unless both your old and current employer’s options have high fees and you don’t have any 1099 income at the moment to set up your own 401k.

The internet has a gazillion pages dedicated to this question. Here is some good further discussion of the options and their relative merits.

Should I start saving for retirement during residency?

11.06.15 // Finance

If your employer offers matching contributions to a tax-advantaged retirement account, then yes. You should be contributing to the match limit. That’s free money. Obviously, if you’re training in a high cost of living area and surviving on ramen you steal from a roommate you found on Craigslist, then nevermind.

From there, if you have more money, what to do next depends on the status of your loans.Continue Reading

Best Books Methodology

11.03.15 // Miscellany

I sporadically post “best books” recommendations for medical topics, which if you’re reading this you’ve likely also noticed sometimes cover topics that I’m not in expert in and discuss books I haven’t actually read. This is my general methodology, for those curious:

  • For specialties and niches, I typically get a first-round of book recommendations from people I trust in the specialty in question.
  • I simultaneously scour the Internet for all relevant recs including reading through every thread I can find on various forums as well as the remainder the Internet.
  • I then search through Amazon to find additional potential books and read all of the reviews for literally everything.
  • I then read through at least a sample of each book on Amazon to get a feel for the organization, quality, depth, style, and other such factors. This also helps me corroborate other people’s opinions that I’ve been exposed to. You might be surprised how good that quick gestalt can be (I highly recommend it before you buy anything).

The potential downside to this method is that I am not necessarily a subject matter expert on every topic or every book that I recommend. I also definitely have not read each (or sometimes any) book cover to cover.

The positive side is that I’m not just one guy telling you my personal opinion about what I personally like; I’m instead building a cohesive viewpoint based on a foundation of broader public opinion, somewhat similar to the old-school Wirecutter or US News cars reviews. I’d like to think it’s refreshing to see a reasonable grouping of book recommendations that can be attributed to a single person. I am not an expert in or even a trainee in every field, but I know from the continued popularity of my medical school posts and initial forays that people find these types of recommendations helpful and a one-stop shop anxiolytic.

I could call the series “good books that will likely serve you well,” but that doesn’t have much of a ring to it. These “best books” of course aren’t necessarily really the best books. Or sometimes they are, but they still might not be the best books for you. Nonetheless, the goal of these posts is to provide you with a simple straightforward reasonable selection of books that you can read or “read” without remorse.