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So I'm studying for the MRCPsych again, and the standard resource everyone uses for this is called SPMM. SPMM costs money. If you pay extra money, you get mocks. If you feel desperate, you can pay even more money, for a "stats crash course,".
The MRCPsych Paper B is heavy on statistics. Most of my colleagues find this difficult because most of my colleagues went to medical school, where the stats curriculum is approximately "p < 0.05 means good." I find it less difficult, which is not the same thing as enjoyable.
The problem is that SPMM's stats teaching is bad. I read a passage, frown, screenshot it, send it to ChatGPT or Claude, and ChatGPT says "yeah, this is wrong." This has happened enough times that it has stopped being surprising and started being a sort of recurring bit. The remaining percentage of the time, the notes are oversimplified to a degree that would make an actual statistician put their head in their hands, which I'll grudgingly accept as the cost of doing exam prep.
Now, I present the question that broke me today.
There's a study, presumably real, looking at childhood trauma and hallucinations in adulthood. There's a graph. The y-axis is the probability that someone has childhood trauma somewhere in their history. The x-axis is "number of hallucinatory modalities," running from 0 through 5, because apparently the authors decided five was enough senses and shipped it. Sure, I guess we can skip proprioception, vestibular positioning, and the other minor crap.
The question: "The predictor that emerged as the statistically significant variable is most likely to be..."
I pick ratio variable.
Let's examine my reasoning. The variable is a count. Counts have a true zero, where zero modalities is a meaningful and non-arbitrary absence rather than an arbitrary point on some scale. The intervals between values are equal: going from 1 to 2 modalities is the same conceptual distance as going from 3 to 4. And the ratios mean things, in that a patient hallucinating across four modalities is doing so across literally twice as many modalities as someone hallucinating across two. This is the textbook definition of a ratio variable. Stevens 1946. Every introductory stats book ever written.
SPMM informs me that the correct answer is "ordinal." I wanted to die.
I tried to be charitable. Maybe SPMM is operating from some idiosyncratic but defensible framework I'm not seeing. Maybe there's a niche position that count variables with low cardinality should be treated as ordinal because of how they behave in small-sample inference. Maybe somebody, somewhere, has a real argument.
I went to ChatGPT and laid out my case. ChatGPT said my logic was textbook, my answer was correct, and SPMM was wrong, but I should still pick whatever SPMM said in the actual exam because the exam doesn't care about being right, it cares about agreeing with whoever wrote the answer key. This is very sound career advice and also makes me want to lie down on the floor.
I pushed back. I said no, I have standards, I want to know whether there is some technical sense in which SPMM could be right and I am wrong. ChatGPT politely declined to manufacture one. After some pushing, it concedes, and says that I should go with my original answer if this specific question comes up in the actual exam. I screamed internally, because screaming externally would wake my neighbours.
The really insulting part is the upsell.
SPMM, having taught me statistics with the precision and care of a man hammering a nail with a banana, also offers a paid crash course in statistics. I will let you guess how I feel about paying them additional money to clear up confusions they themselves introduced.
There are two hypotheses.
Hypothesis A: SPMM is teaching stats badly on purpose, so that you have to buy the crash course to fix what they broke. This is the version I want to be true, because at least it would mean someone, somewhere, is in charge.
Hypothesis B: at some point, an underpaid registrar was handed a brief that said "write 500 stats questions, here's £500, you have a weekend". They paid peanuts, and the monkey just offered me a banana.
Hypothesis B is overwhelmingly more likely. It is also worse, because at least under Hypothesis A there's a coherent villain. Under Hypothesis B there's just a pipeline of tired people producing slightly wrong content for other tired people, who then sit in their flats at midnight wondering whether they're losing their minds or whether the material is in fact wrong, and there is no one to be angry at, because everyone in the chain was doing their best with too little time and not enough money, and the result is diffuse ambient wrongness that lives in PDFs forever, gaslighting trainees into doubting whether ratios still mean what they used to mean.
Anyway. Number of hallucinatory modalities is a ratio variable. It will continue to be a ratio variable on the day of the exam, and if it doesn't, the number of homicide victims in a future study will remain a ratio variable.
Edit:
The study is "Association between childhood trauma and multimodal early-onset hallucinations" in the BJPsych. The authors ran a hierarchical binomial logistic regression with childhood trauma as the binary outcome and number of hallucinatory modalities as a numeric predictor, reporting OR = 2.24 (95% CI 1.16 to 4.33) per additional modality. You can't meaningfully report a per-unit OR for an ordinal predictor. Reporting that OR is exactly what you do for a count variable on a ratio scale. The original authors treated it as ratio. SPMM has marked me wrong for agreeing with the people who wrote the study.
My usual recommendation for this kind of thing is to look for stuff you can pirate that US grads are using. Most US speciality boards have at least on killer app or test prep book. Easy to nab on Libgen or whatever.
Obviously might end up with different areas of focus but overall should get the job done?
LibGen has been down for awhile now, and Anna’s Archive got taken down by the powers to be.
Anna's Archive is still up at the .gl domain.
Welib.org is another good alternative but last time I looked it required registration before you can download.
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When using LG make sure you are using the latest TLD - it's still up as of this posting.
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Hmm. Not bad advice in a vacuum, but I'd say it's somewhat impractical. The reason I'm using SPMM is because I don't have the time to go through the official reading list cover to cover, or even to skim it properly. American psychiatry textbooks might be of a higher quality, as might be the case for PG-exam oriented material, but the MRCPsych is very UK specific, in terms of knowledge about systems as well as our psychiatric guidance and patient-pool.
Just the stats? Sure. But I have 10 days and no time to do more than cry, or more productively, cry while doing mocks. Maybe if I fail this go, which I really hope won't happen.
Don't they give you dx and med questions???
Of course. But that's only like half the nominal weighting on the test. Maybe 2/3rds. I imagine there's enormous overlap there, but that's one area where the SPMM notes haven't failed me nearly as badly. It's harder to bungle copy-pasting NICE/BAP guidelines.
Not that I would really have the time either way.
godspeed my guy
Thanks! I'm comparing myself to the other trainees when it comes to test scores and I think I'm slightly ahead on net. Not by the margin where I can take my foot off the gas, but I think I have an honest shot. If not, I'll be mad about breaking a lifelong streak of never failing any exam (of actual importance), but that's not the end of the world.
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How much does it matter? I mean, obviously it matters for passing the exam, but how much a practicing psychiatrist encounters a situation where they need to know statistics on this level and properly set up variables, unless they do academic research? Or, putting it in another way, if I learned psychiatrists are being taught and examined on wrong statistics, how scared should I be?
Not at all. You can spend your entire career as a psychiatrist without ever having to worry about whether you need to use ANOVA instead of MANOVA. I dare say most psychiatrists don't need to know any of this, I've never seen a senior of mine sit down and calculate PPVs or positive LRs while working with a real clinical case. If they ever knew, they've probably forgotten, and it doesn't seem to hurt them.
In theory, this information might come in handy if we need to do critical appraisals of a new paper or engage in research. That's the theory anyway, the practical aspects of it were already iffy, and these days? Everyone is going to check ChatGPT. There are zero clinical scenarios involving a real patient where this specific question matters.
Don't lose sleep over it. That's my job. I'd rather be unemployed.
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When ChatGPT says the SPMM is wrong, does it provide sources or a mathematical proof?
Yes. It's even something I order it to do in my user prompt, though it's pretty good about doing it my default.
I tell people to always ask for citations or double check the work when doing anything mission-critical with LLMs, and my professional trajectory counts. I usually ask both ChatGPT and Claude at the same time, to reduce the risk of error/hallucination being correlated, and if they disagree, I dig into it (assuming I haven't reviewed their sources and confirmed things to my own satisfaction). Of course, for less important topics, I don't go that far.
Here, SPMM is remarkably wrong. They're so wrong that they disagree with the original authors of the paper they've used for the question. In fact, every single fucking time I've asked, it's SPMM that's wrong and the LLMs correct (when they do disagree, my bullshit detector isn't perfect either).
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