Reflect thoughtfully and intentionally about every encounter. Predict. Check your work. Follow-up. Mismatch between expectation & observation forces an internal adjustment. Surgeons who repeatedly search for those mismatches and then confront the discomfort will likely recalibrate faster.

We validated our remodeling equation and presented at AAOS! Should be good to use for those interested for distal radius. pediatricorthopaedics.unicornplatform.page/testmark/

I find my first lucid interval invariably occupied by a cordial orientation of my attention in your direction, a kind of secular benediction upon the nascent hours.

n=28. Fatigue ↑ across blocks t222=6.95,p=3.94e-11. High effort acceptance ↓ t138=-9.18,p=5.65e-16; reward acceptance ↑ t222=8.96,p=1.36e-16. Fatigue shifted choices to easier reward opts: beta=-0.349,p=3.24e-4; relevance: fatigue may favor default/low effort decisions.

How it feels as a surgeon to pass the liability-transfer module final test after only 3 attempts.

Modules, mandated CME and other formalized programs don’t really act as professional development nor continuing education - instead they cause performative or compliance-driven behavior.

n=27; acc 97.3%; median RT 634ms. Breaks ↓RT 37ms overall, 6.48%. 28s vs 12s: RT gain 7.9% vs 5.1%, post-break RT 639 vs 647ms, but TOT slope steeper after 28s (p=.02). Recovery↔later decline: r=-.86/-.69. Ortho: short frequent breaks may keep output steadier.

N=50; congruent tgt faster vs incongruent 1341 vs 1716 ms, t49=9.23. Gain cue bias > loss cue bias: DeltaRT 483 vs 267 ms, t49=2.76, p=.004, d=.54. Incongruent info -> AI/DACC/PPC/IFG/SMA activation, stronger after optimistic cues. confirming optimistic data is picked over disconfirming pessimistic.

28 studies/2006-2021 from 5010 records; 17/28 RCTs. MMAT: 17/28 scored ≥75, 5/28=100. Exergames 12/28, CVG 9/28. Console 13/28, PC 9/28. Play time 2 min-15 h; mean 6.6 sessions. Stress/anxiety often ↓, but action/sports titles sometimes ↑ stress.

47-study meta-analysis mapped metacog network; meta-d’/d’=1 = perfect self-monitoring, 0.8 = 80% evidence access. High performers > low in metacog ctl. Training data mixed; offline self-reflection looks strongest. plan. doubt it. refine it. then cut.

n=14, age 20.7. 2 fMRI sessions +3 training sessions. Accuracy ≥95%. RT ↓ pre→post: F=11.58 p=.011; seq<pseudo F=17.88 p=.004; dual slower F=13.38 p=.008. Dual task cost 61ms→11ms. Prefrontal+caudate activation ↓ after practice ⇒ rehearsal preserves OR bandwidth.

I am a module warrior.

How bacteria feel when I wash out a hip joint open with a suction tip on the end of the cysto tubing:

If someone can vote for Phoenix Children’s this year in US news rankings for reputation, it would be helpful to give our orthopaedic team resources to take even better care of patients and do more researcher.

The brilliant Keith Baldwin MD @southNJscoli was at #AAOS2026, & asked a seemingly simple question that I think is actually by far the most important question that nobody is asking about AI: “What does AI do with missing data?” www.upoj.org/wp-content/u... pmc.ncbi.nlm.nih.gov/articles/PMC...

Please take a minute and purchase this great book by my partner Random Hall MD www.amazon.com/Performance-...

An actually great talk by AS at AAOS

If you’re free at noon and in New Orleans - Join the Arizona Orthopaedic society today at 12pm CST in lobby of the Courtyard Marriott 300 Julia St New Orleans, LA 70130 maps.apple/p/fzpvw1qcLH... (this is a last minute location change as our reserved venue, Jazz City Cafe was unexpectedly closed).

Me trying to find a conference room

The Phoenix Children’s orthopaedic surgery team at American Academy of Orthopaedic Surgeons (AAOS) annual meeting to present research is! @phxchildrens @friendsofpch @phxchildrensfellowships @phxchildrensspine @phxchildrensorthopedics #aaos26 @aaos_1

Kinsley Wang MS - my rockstar med student presenting her hard work on an equation that predicts fracture remodeling in kids.

Jasmine Lopez MS presenting her hard work on the quality of spanish language scoliosis information. Thank you to my partner Melissa Esparza MD for including me! @meloosi

Being awake at this early hour, I venture a modest yet professional and formal tacit salutation to mark my alertness and to extend, with due reserve, an small civility for the day, offered in plain good faith and with a view to amiable accord.

I see this much more often in congenital scoliosis

Accept this morning message as a sincere testament to a vitality which completely obscures the vast accumulation of years within my physical frame. This aged carapace conceals a disposition sufficiently spirited to manufacture courtesies whose polish contradicts the rust upon my ancient chassis.

Research shows that doctors get worse after formal disciplinary actions (like lawsuits). I have always wondered why that is, so I did a literature review to learn about it.

The unease that attends conjecture about supplanting by rivals, robots, or AI, creates apprehension that abrades the intellect and dissipates the very vigour required for merited regard, while a fixation upon inviolability hastens decline & diverts attention from cultivated distinction.

SysRev surgeon pay (2014-2024): 3268 rec→39 stud. Ortho salary 9%16→14%24; wRVU 19%16→30%24. wRVU pay shift→vol +45% (THA/TKA site). wRVU≈80% effort; MIPS >9800 GS: high dual-elig caseload→↓score/↑neg adj. Ortho take: push hybrid credits for complexity+teach/research/admin. 

We took swift action on the NSA IDR striker (HB2211) last week. The sponsor heard loud and clear from our community and ended up not moving the bill for a vote. This is not the last we'll hear of the issue, but the bill is dead for this session.

A telehealth visit cost 1/5 the total cost of an in person visit. jamanetwork.com/journals/jam...

How the IRB finds me

I am, this morning, animated by a sentiment of professional regard of such refinement that its expression demands the full deployment of my rhetorical capabilities, which deployment you now are permitted to witness 🙂‍↕️

This is completely insane and as president of arizona orthopaedic society we are aggressively opposed to this law.

I set forth my most tacit of morning acknowledgments composed with the professional gravity of formal practice and directed to you with genuine regard.

I bid you good night & leave you with my most formal & professional aknowlegements, like the sublimation of naphthalene from a stored textile impregnating the enclosed atmosphere with the distinctive yet pungent imprint of my most refined regards and silently communicated goodwill.

This solitary nod of the head constitutes the entirety of my commerce with the daylight hours, rendered in the uninflected register of one who maintains scrupulous equipoise between all competing gravities.

Weekly literature review - we do this in addition to journal club and reading for every case and I do a literature review of my own after every clinic.

2023 psych study where video game gets used as 3D intervention for depression. 46 depressed adults got randomized to 3D gaming (n=14) vs CogPack (n=16) vs TAU (n=16), & the BDI-II signal moved in the game arm (BDI-II >=13 at T1 to T2). (small n, still). Evidence here: doi.org/10.3389/fpsy...

The noonday permits, nay demands, a certain candor of address; thus I reach across the temporal divide to place before you an offering of my attentive neutrality, warmed only by the friction of genuine consideration.

Anxiety regarding replacement by rivals, robots or regression models (like AI) operates as a sort of cognitive abrasion, consuming with inefficiency the very energies requisite to even qualify for the distinction of being considered worth replacing.

Pectus or scoliosis first? n=6 (2020-25); PE→AIS 5/6=83%. Mean HI 6.8±1.9 (3.9-9.2); Cobb 67.4°±16.1 (54-97.5); age 14.3y (12-18); VO2max 60.8%pred (55-70). LOS PE 2.5d (1-6); LOS PSF 3d. AIS-first attempt → hemodyn crash in prone; after Nuss → PSF ok. OR: screen PE/CPET if HI≥~5+big thoracic curve.

The innovation we need in addition to this is a “cost of meeting” hard stop that tells the organizer the organizational cost of this meeting as planned by taking minutes of meeting multiplied by salary per minute of attendees.

Worry less about being replaced and focus more about doing something that makes you worthy of replacing.

A candle comprehends its wick's diminishment by kindling another flame, and so I move through my allotment of days with the singular occupation of rendering my continuance obsolete, that something unwearied may inherit the labor when I subside into the sediment that once whispered me awake.

‘I Built This,’ Whispers Social Media Manager Beholding His Empire Of Successful Fuddruckers Tweets https://theonion.com/i-built-this-whispers-social-media-manager-beholding-1839032610/

Grab the 20-year distillation here: thepalindrome.org/p/the-roadm...

The hype is good and everything but you only need 3 things from this list: 1. Linear Algebra 2. Calculus 3. Probability Theory That's it. If you want a more comprehensive list per topic, here you go: