I had plenty of oral exams throughout my education and training. It's interesting to see their resurgence, and easy to understand the appeal. If they can be done rigorously and fairly (no easy thing), then they go much further than multiple can in demonstrating understanding of concepts. But, they are inherently more stressful. I agree with the article that the increased pressure is a feature, not a bug. It's much more real-world for many kinds of knowledge.
I tried a number of distros and settled on Omarchy because it has a coherent design and nice aesthetics, but it has some weird quirks about messing with my dotfiles on updates. It's so new I suspect this will be ironed out soon.
The recent direction of MacOS has been a good excuse to try out a few new linux distros. As someone who was away from linux for a while, the degree of UI customization continues to be both amazing and a little overwhelming, but it feels more polished than before. Taking a look at Niri and hyperland, it's hard to feel satisfied with the UI of MacOS.
One popular approach to saving money is to replace physicians with nurse practitioners and physician assistants, who have less education and training. The article does not discuss this element, and I'd be interested to see if that is a factor in patient outcomes. There's less data on this than you might expect.
ETA: From my post lower down, adding for visibility:
[The training gap is] quite a lot more than a year - in primary care, it's more like four additional years of training for physicians, and 15000 supervised clinical hours for physicians (vs 500 to 1500 hours for NPs). The gap can be wider in other physician specialties, because many have longer residencies than the primary care programs. For example, child psychiatry training is four to five years (depending on the route you take), making it longer than the three years of family practice residency.
I unfortunately have had to be in and out of medical offices and hospitals recently - and I feel like compared to 10-15 years ago practically everyone I deal with is a physician assistant. Nothing against them but it's kind of annoying that it's almost impossible to actually talk with a doctor anymore.
I get it they're probably overworked too and their time is valuable but it's not quite as reassuring not actually interacting with doctors very much. The few times I have it was literally for my actual surgeries and surgery pre-appointment. Practically everything else is some assistant.
It’s at the point where we might as well be seen by a CNA who takes blood for the blood test and have the AI assess it (you were too soon my dear Elizabeth Holmes). If we were to just measure the situation, how can we say first-level medical care got better if people are literally no longer seeing doctors?
What does that look like in a more intensive hospital setting? I've seen the shift to midlevels happening in primary care, but I'm not sure how that translates to inpatient settings - I'm vaguely aware that there are rules around when a PA/NP must consult an MD before making a decision, and I feel like they would encounter those situations way more for an inpatient.
Many states now have unsupervised, independent practice for PAs and NPs from the first day they are issued a license. There is variation by state, however, and some still require physician oversight. The amount and quality of that oversight also varies considerably.
Don't worry, MAANG-affiliated startups backed by private equity will work on a way to replace MD/DO/FNP/PAs with AI chatbots so patients can have the full Idiocracy experience while paying zillions for the privilege.
The next step is going to be turning over primary care to AI. Doctors will be mostly reviewing cases or consulting when the AI decides it's sufficiently nececessary.
I mean we are talking what another year in school? Surely those outcome differences are gone once the nurse or pa is in the field for a couple of years.
It's quite a lot more than a year - in primary care, it's more like four additional years of training for physicians, and 15000 supervised clinical hours for physicians (vs 500 to 1500 hours for NPs). The gap can be wider in other physician specialties, because many have longer residencies than the primary care programs. For example, child psychiatry training is four to five years (depending on the route you take), making it longer than the three years of family practice residency.
I have a family member who is an NP and her biggest complaint is 20 years ago, most NPs were RN who had 5+ years of RN experience then returned to school vs current Undergrad -> NP -> licensed cutting out that practical experience. You think NP would be better if licensing required certain amount of RN clinical time?
Or how about - train more physicians. It is one of the most critical and in-demand professions yet the most artificially gatekept. Doctors will endlessly compain about working conditions and patient load but still not agree to this because they know it will devalue their own labor.
Major medical organizations have been advocating for years for more physician residency spots. Unlike NPs or PAs, some residency is required for physicians to be licensed.
Right now, there are not enough residency spots for every US med school graduate.
The AMA very successfuly lobbied to reduce the number of medical schools, cap federal funding for residency and cut the number of residency slots 20-30 years ago, and we are now dealing with the fallout of that. It has softened its stance in recent years, sure, but even if we fix all of this today (doubtful because of the usual political gridlock) it will be another couple of decades before the situation will actually improve.
Now that 20225 has become “The Year of the Terminal”(R), I have been looking at how managing my dot files in a more coherent way. I was thinking straight up git vs stow, but I should would be very interested in comparisons from those who have used this tool.
I haven't looked at this one yet, but until someone compares it to Chezmoi and points out where it's better I'm not even looking attention I fear. Chezmoi is just that good.
For the sake of answering the parent question with regard to Chezmoi specifically: Chezmoi is a very comprehensive dotfiles manager. It can do a lot of things. More than any other I'm aware of.
More does not necessarily equal better, though. I think that's a matter of personal preference. I tried Chezmoi for a while and ultimately decided it was just a lot more levers at my disposal than I really wanted to even think about.
Dotter, by contrast, is a lot more minimal. Dotter is little more than a symlink manager plus templating engine plus config files to declare what machines need what config.
Chezmoi is all that, and does a lot more: encryption/decryption (even has password manager integrations), automatic push/pull. It's also designed so that you can add or manage files regardless of what your current working directory is (via commands like `chezmoi edit/add`).
In my case, after deciding I wanted to go for the minimal end of things, I almost went for GNU Stow however, I wanted templating functionality and I liked dotter's "packages" system for defining what files a given computer needs.
And very much a personal bias here: I found the learning curve of Chezmoi templates not great. I'm also not a big fan of the fact that Chezmoi relies on you naming your source files in particular ways in order to determine what the target file permissions should be.
Chezmoi manages stuff that's in my /home - configurations, scripts in ~/bin/ etc. It also installs a bunch of applications with a runonce_ -script both on Linux and MacOS.
Ansible makes sure the correct system-level packages are installed, things in /etc/ are set up the way I like etc. There's a bunch of overlap with the packages installed by ansible and Chezmoi - but I run `chezmoi update` multiple times a week an I can run it on any computer I'm on. Ansible is for Big Things.
Then I have an opentofu setup that manages a bunch of docker containers, keeping them as stateful as possible.
For daily simple things, I can just edit any config file, add it to chezmoi and push it to git. Then on any machine I can `chezmoi update` and everything is synced.
For example in my dotfiles repo I'll have `etc/pacman.d/01-options.conf` and the dotfiles install script will symlink that to `/etc/pacman.d/01-options.conf`. This way the source of truth is always in a single dotfiles repo.
This strategy has worked well for dotfiles I use on Arch, Debian, Ubuntu and macOS. It includes support for WSL 2 too. The install script has been working with this set up for years to run 1 single command and have everything work where work in this case is installing and configuring a bunch of tools I use. An example is here https://github.com/nickjj/dotfiles.
I found it quite useful. My main use case for it is managing the same dotfiles for Windows and Linux. Specifically that neovim uses different folders and I can set that per OS in dotter.
It also allows for including our not including a config based on an executable being available which can be useful.
It requires some configuration, depending on how many of its features you use but I think it's worth it.
If all you want is GNU Stow with a bit nicer UX, I wrote and have been using https://github.com/bbkane/fling for a few years now. See the demo gif in the README for the UX
I was using "just git" until I realized I've started writing a whole bunch of scripts of various types to recreate ("ad-hoc, informally specified and bug-ridden...") functionality that chezmoi offers out of the box and has already tested in the field.
Maskwise and LLM Guard serve different stages of the AI pipeline. llm-guard basically filters prompts and responses to prevent prompt injection attacks. Maskwise is for preparing datasets before LLM training/fine-tuning. It processes large document collections (PDFs, Office docs, images) to detect & anonymize PII.
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