Kerry Criticizes Turkish Prime Minister Over Zionism Remark

ANKARA, Turkey — Secretary of State John Kerry chastised Turkey’s prime minister on Friday for recently calling Zionism a “crime against humanity,” a comment that could frustrate Mr. Kerry’s desire to see an improvement in estranged Turkish-Israeli relations.

When Mr. Kerry set off on Sunday on a nine-nation trip, his plan was to use his visit in Turkey to consult on trade, the crisis in Syria and other Middle East issues.

But on Wednesday, Prime Minister Recep Tayyip Erdogan told a United Nations forum in Vienna that the international community should consider Islamophobia a crime against humanity “like Zionism or anti-Semitism or fascism.”

The next day, Prime Minister Benjamin Netanyahu of Israel described Mr. Erdogan’s remarks as a “dark and false statement.”

By Friday Mr. Kerry was faced with the task of trying to discourage another outburst from the Turks and salvaging some chance of an improvement in ties between Turkey and Israel — the first a moderate Muslim-majority nation and important NATO ally, and the other the principal United States ally in the Middle East.

The Americans’ sternest message to the Turks was conveyed before Mr. Kerry’s plane even landed by a senior State Department official who spoke under ground rules that he not be identified by name.“This was particularly offensive,” the official said, referring to Mr. Erdogan’s comments. “It complicates our ability to do all of the things that we want to do together.”

Once in Ankara, Mr. Kerry initially approached the issue somewhat indirectly. Noting that he had attended a memorial event earlier in the day for a Turkish security guard who had been killed trying to stop suicide bomber at the American Embassy, Mr. Kerry said that this selflessness should inspire a “spirit of tolerance.”

“And that,” Mr. Kerry added, “includes all of the public statements made by all leaders.”

But in response to a question at a news conference with Foreign Minister Ahmet Davutoglu, Mr. Kerry was more direct.

“Obviously, we not only disagree with it. We found it objectionable,” Mr. Kerry said of Mr. Erdogan’s statement, noting that he planned to raise the matter Friday evening with the prime minister. The comments by Mr. Davutoglu suggested that it might not be an easy discussion.

The foreign minister insisted Turkey was not hostile to Israel and that the downturn in relations was Israel’s fault, referring to a 2010 episode in which eight Turks and an American of Turkish descent were killed when Israeli commandos boarded the lead ship of a pro-Palestinian activist flotilla that was trying to break Israel’s blockade of Gaza.

“If Israel is expected to hear positive comments from Turkey, I believe they need to revise their attitudes not only toward us but also toward the settlements in West Bank and the people of the region,” he added.

During the 1990s, Turkey and Israel enjoyed close cooperation in ties that were nurtured by the secular Turkish military and the Israeli national security establishment, Dan Arbell, a guest scholar at the Brookings Institution’s Saban Center for Middle East Policy, wrote last year.

Relations began to deteriorate after Mr. Erdogan became prime minister in 2003 and Turkey adopted a more assertive regional posture, which often involved sharp criticism of Israel’s policies. Ties between the countries reached a low point with the deadly Gaza flotilla confrontation.

American officials said they would like to find some way to foster an improvement in Turkish-Israeli relations, which the official on Mr. Kerry’s plane described as “frozen.”

“We want to see a normalization, not just for the sake of the two countries but for the sake of the region and, frankly, for the symbolism,” the official said. “Not that long ago you had these two countries demonstrating that a majority Muslim country could have very positive and strong relations with the Jewish state.”

On Friday night, Mr. Kerry dined at Mr. Erdogan’s residence. The session began inauspiciously when Mr. Kerry apologized for being a little late because of his lengthy discussions with Mr. Davutoglu.

Mr. Erdogan, who seemed irritated, said that Mr. Kerry and Mr. Davutoglu “must have spoken about everything, so there is nothing left for us to talk about.”

“There’s a lot to talk about,” Mr. Kerry said. “We actually didn’t talk about everything.”

According to a State Department official, the Turkish prime minister and Mr. Kerry discussed the gamut of Middle East issues, including the recent meeting in Rome on the Syria conflict, the situation in Iraq, Iran and the prospects for reviving the peace process between Israel and the Palestinians.

American officials did not provide details on the exchange regarding Mr. Erdogan’s Zionism comments or whether the Turkish prime minister believed they had in any way been excessive.

The two men, the State Department official said, had a “frank discussion of the prime minister’s speech in Vienna and how to move forward.”

Read More..

Bits Blog: Judge Slashes Jury Award in Apple-Samsung Case

8:45 p.m. | Updated

A federal judge on Friday weakened the blow from Apple’s legal victory in a patent case against Samsung, lopping more than 40 percent off the damages a jury awarded Apple last year.

The ruling did not shift the case — one of the most closely watched in the high-tech industry — in Samsung’s favor. While Apple has lost other skirmishes against Samsung in courts around the world, the jury award in this case has been the biggest victory for either side so far.

Even at a reduced level, these would be among the highest damages in a patent dispute.

The judge ordered a new trial to recalculate a portion of those damages, leaving open the possibility that some of them could be restored.

She also indicated that Apple was entitled to additional damages for sales of Samsung products that have occurred since the jury’s decision last summer, which could further swell the amount Apple is owed by Samsung.

Tech companies around the world are waging legal battles over patents as they compete for supremacy in the lucrative smartphone market. Apple and Samsung are the most prominent combatants in that war; the two companies divide most of the profits in the surging mobile phone market.

Samsung has soared to the No. 1 spot in the smartphone business in recent years, but Apple says that it is, in part, because the company has swiped many of Apple’s ideas.

In her review of the jury’s decisions, which originally awarded Apple more than $1 billion for patent violations by Samsung in its mobile products, Judge Lucy H. Koh of the United States District Court in San Jose, Calif., knocked those damages down by $450 million, to $599 million. The new trial will determine how much of the $450 million, if any, should be restored.

“It will be years before the parties exhaust all of their litigation avenues and options,” said Alan M. Fisch, an intellectual property lawyer with Fisch Hoffman Sigler in Washington, who is not involved in the case. “Still, some form of patent cross-license between the two would not be an unsurprising final result.”

None of Judge Koh’s opinion changed the jury’s finding that Samsung violated a series of Apple patents in its smartphone and tablet products. But the judge took issue with how the jury calculated the damages Apple was entitled to from the Samsung devices named in the case, more than two dozen of them in all.

In her 27-page opinion, Judge Koh said that the jury failed to follow her instructions in calculating damages for a certain class of patents, known as utility patents.

She also decided in Samsung’s favor in a dispute between the two parties over when Apple notified Samsung that it was infringing Apple’s intellectual property. Evidence of such notice dates are important because they help determine how hefty the damages are in a court case, once the party being notified is found guilty of infringement.

Judge Koh chided Apple for using an expert in the case who used an “aggressive notice date” — meaning, an early one — to calculate damages.

“The need for a new trial could have been avoided had Apple chosen a more circumspect strategy or provided more evidence to allow the jury or the court to determine the appropriate award for a shorter notice period,” she said in her ruling.

Steve Dowling, a spokesman for Apple, declined to comment.

In a statement, Adam Yates, a Samsung spokesman, said that the company was pleased with the judge’s decision and that it intended to seek further review of the remaining award.

Apple and Samsung, meanwhile, continue to fight ferociously in the smartphone market, where Samsung has steadily worked its way to the No. 1 position over the last few years. In the fourth quarter, Samsung accounted for 29 percent of global smartphone shipments, while Apple accounted for 21.8 percent, according to IDC.

Mark A. Lemley, a professor at Stanford Law School, called the judge’s decision “an extremely careful and thorough opinion on a very difficult and interrelated set of issues.”

Mr. Lemley predicted that Samsung would eventually win some reduction in the original $1 billion award, but “almost certainly” less than the $450 million that Judge Koh reduced it by on Friday.

“We’ll need a new trial to figure that out,” said Mr. Lemley, who has done legal work in the past for Google, maker of the Android operating system involved in the Samsung case and others. “Judge Koh has encouraged both sides to appeal first. That may clarify some questions, but it is unlikely to prevent a new trial, just delay it some.”

Read More..

Well: A Rainbow of Root Vegetables

This week’s Recipes for Health is as much a treat for the eyes as the palate. Colorful root vegetables from bright orange carrots and red scallions to purple and yellow potatoes and pale green leeks will add color and flavor to your table.

Since root vegetables and tubers keep well and can be cooked up into something delicious even after they have begun to go limp in the refrigerator, this week’s Recipes for Health should be useful. Root vegetables, tubers (potatoes and sweet potatoes, which are called yams by most vendors – I mean the ones with dark orange flesh), winter squash and cabbages are the only local vegetables available during the winter months in colder regions, so these recipes will be timely for many readers.

Roasting is a good place to begin with most root vegetables. They sweeten as they caramelize in a hot oven. I roasted baby carrots and thick red scallions (they may have been baby onions; I didn’t get the information from the farmer, I just bought them because they were lush and pretty) together and seasoned them with fresh thyme leaves, then sprinkled them with chopped toasted hazelnuts. I also roasted a medley of potatoes, including sweet potatoes, after tossing them with olive oil and sage, and got a wonderful range of colors, textures and tastes ranging from sweet to savory.

Sweet winter vegetables also pair well with spicy seasonings. I like to combine sweet potatoes and chipotle peppers, and this time in a hearty lentil stew that we enjoyed all week.

Here are five colorful and delicious dishes made with root vegetables.

Spicy Lentil and Sweet Potato Stew With Chipotles: The combination of sweet potatoes and spicy chipotles with savory lentils is a winner.

---

Roasted Carrots and Scallions With Thyme and Hazelnuts: Toasted hazelnuts add a crunchy texture and nutty finish to this dish.

---

Carrot Wraps: A vegetarian sandwich that satisfies like a full meal.

---

Rainbow Potato Roast: A multicolored mix that can be vegan, or not.

---

Leek Quiche: A lighter version of a Flemish classic.

---

Read More..

Well: A Rainbow of Root Vegetables

This week’s Recipes for Health is as much a treat for the eyes as the palate. Colorful root vegetables from bright orange carrots and red scallions to purple and yellow potatoes and pale green leeks will add color and flavor to your table.

Since root vegetables and tubers keep well and can be cooked up into something delicious even after they have begun to go limp in the refrigerator, this week’s Recipes for Health should be useful. Root vegetables, tubers (potatoes and sweet potatoes, which are called yams by most vendors – I mean the ones with dark orange flesh), winter squash and cabbages are the only local vegetables available during the winter months in colder regions, so these recipes will be timely for many readers.

Roasting is a good place to begin with most root vegetables. They sweeten as they caramelize in a hot oven. I roasted baby carrots and thick red scallions (they may have been baby onions; I didn’t get the information from the farmer, I just bought them because they were lush and pretty) together and seasoned them with fresh thyme leaves, then sprinkled them with chopped toasted hazelnuts. I also roasted a medley of potatoes, including sweet potatoes, after tossing them with olive oil and sage, and got a wonderful range of colors, textures and tastes ranging from sweet to savory.

Sweet winter vegetables also pair well with spicy seasonings. I like to combine sweet potatoes and chipotle peppers, and this time in a hearty lentil stew that we enjoyed all week.

Here are five colorful and delicious dishes made with root vegetables.

Spicy Lentil and Sweet Potato Stew With Chipotles: The combination of sweet potatoes and spicy chipotles with savory lentils is a winner.

---

Roasted Carrots and Scallions With Thyme and Hazelnuts: Toasted hazelnuts add a crunchy texture and nutty finish to this dish.

---

Carrot Wraps: A vegetarian sandwich that satisfies like a full meal.

---

Rainbow Potato Roast: A multicolored mix that can be vegan, or not.

---

Leek Quiche: A lighter version of a Flemish classic.

---

Read More..

Bits Blog: Judge Slashes Jury Award in Apple-Samsung Case

8:45 p.m. | Updated

A federal judge on Friday weakened the blow from Apple’s legal victory in a patent case against Samsung, lopping more than 40 percent off the damages a jury awarded Apple last year.

The ruling did not shift the case — one of the most closely watched in the high-tech industry — in Samsung’s favor. While Apple has lost other skirmishes against Samsung in courts around the world, the jury award in this case has been the biggest victory for either side so far.

Even at a reduced level, these would be among the highest damages in a patent dispute.

The judge ordered a new trial to recalculate a portion of those damages, leaving open the possibility that some of them could be restored.

She also indicated that Apple was entitled to additional damages for sales of Samsung products that have occurred since the jury’s decision last summer, which could further swell the amount Apple is owed by Samsung.

Tech companies around the world are waging legal battles over patents as they compete for supremacy in the lucrative smartphone market. Apple and Samsung are the most prominent combatants in that war; the two companies divide most of the profits in the surging mobile phone market.

Samsung has soared to the No. 1 spot in the smartphone business in recent years, but Apple says that it is, in part, because the company has swiped many of Apple’s ideas.

In her review of the jury’s decisions, which originally awarded Apple more than $1 billion for patent violations by Samsung in its mobile products, Judge Lucy H. Koh of the United States District Court in San Jose, Calif., knocked those damages down by $450 million, to $599 million. The new trial will determine how much of the $450 million, if any, should be restored.

“It will be years before the parties exhaust all of their litigation avenues and options,” said Alan M. Fisch, an intellectual property lawyer with Fisch Hoffman Sigler in Washington, who is not involved in the case. “Still, some form of patent cross-license between the two would not be an unsurprising final result.”

None of Judge Koh’s opinion changed the jury’s finding that Samsung violated a series of Apple patents in its smartphone and tablet products. But the judge took issue with how the jury calculated the damages Apple was entitled to from the Samsung devices named in the case, more than two dozen of them in all.

In her 27-page opinion, Judge Koh said that the jury failed to follow her instructions in calculating damages for a certain class of patents, known as utility patents.

She also decided in Samsung’s favor in a dispute between the two parties over when Apple notified Samsung that it was infringing Apple’s intellectual property. Evidence of such notice dates are important because they help determine how hefty the damages are in a court case, once the party being notified is found guilty of infringement.

Judge Koh chided Apple for using an expert in the case who used an “aggressive notice date” — meaning, an early one — to calculate damages.

“The need for a new trial could have been avoided had Apple chosen a more circumspect strategy or provided more evidence to allow the jury or the court to determine the appropriate award for a shorter notice period,” she said in her ruling.

Steve Dowling, a spokesman for Apple, declined to comment.

In a statement, Adam Yates, a Samsung spokesman, said that the company was pleased with the judge’s decision and that it intended to seek further review of the remaining award.

Apple and Samsung, meanwhile, continue to fight ferociously in the smartphone market, where Samsung has steadily worked its way to the No. 1 position over the last few years. In the fourth quarter, Samsung accounted for 29 percent of global smartphone shipments, while Apple accounted for 21.8 percent, according to IDC.

Mark A. Lemley, a professor at Stanford Law School, called the judge’s decision “an extremely careful and thorough opinion on a very difficult and interrelated set of issues.”

Mr. Lemley predicted that Samsung would eventually win some reduction in the original $1 billion award, but “almost certainly” less than the $450 million that Judge Koh reduced it by on Friday.

“We’ll need a new trial to figure that out,” said Mr. Lemley, who has done legal work in the past for Google, maker of the Android operating system involved in the Samsung case and others. “Judge Koh has encouraged both sides to appeal first. That may clarify some questions, but it is unlikely to prevent a new trial, just delay it some.”

Read More..

U.S. Aid to Syria Shows Obama’s Cautious Approach to Crisis

ROME — The food rations and medical supplies that Secretary of State John Kerry said Thursday would be provided to the Free Syrian Army mark the first time that the United States has publicly committed itself to sending nonlethal aid to the armed factions that are battling President Bashar al-Assad.

But the nature of the assistance also illustrates the Obama administration’s caution about getting involved in the Syrian crisis.

At each stop of his first foreign trip as secretary of state, Mr. Kerry has emphasized that one of his principal goals was to change Mr. Assad’s calculations about his ability to remain in power.

Mr. Assad is “out of time and must be out of power,” Mr. Kerry asserted after meeting here with Moaz al-Khatib, the leader of the Syrian opposition coalition.

The announcement of the supplies fell well short of the weapons and equipment Syrian rebels have requested and left unclear why Mr. Assad, who has fired Scud missiles at the city of Aleppo, would now conclude that he could no longer stand up to his opponents.

The nonlethal aid was just one element of the American program of assistance that Mr. Kerry unveiled on Thursday.

The United States is also providing $60 million to help the political wing of the Syrian anti-Assad coalition improve the delivery of basic services like sanitation and education in areas it has already wrested from the government’s control.

A covert effort to program to train rebel fighters, which State Department officials here were not prepared to discuss, has also been under way. According to an official in Washington, who asked not to be identified, the Central Intelligence Agency since last year has been training groups of Syrian rebels in Jordan.

The official did not provide details about the training or what difference it may have made on the battlefield, but said that the C.I.A. had not given weapons or ammunition to the rebels. An agency spokesman declined to comment.

Defending the limited program to provide medical supplies and military rations known as Meals Ready to Eat, or M.R.E.’s, to the military wing of the Syrian resistance, Mr. Kerry said that other countries would also provide help. He said that the “totality” of the effort would make an impression on Mr. Assad.

“We’re doing this, but other countries are doing other things,” Mr. Kerry said. But neither he nor any diplomats at a meeting here of the so-called Friends of Syria countries that support the Syrian resistance provided details about that effort.

Britain is planning more substantial nonlethal aid, which could include vehicles, bulletproof vests and night vision equipment, according to an American official. British officials have been consulting with European counterparts about what sort of nonlethal aid might be allowed under the terms of European Union decisions.

There is speculation that the Obama administration might expand its program of support to the Free Syrian Army to include nonlethal equipment if rebel fighters use the initial assistance effectively and do not allow any to fall into the hands of extremists.

“We’re in the Middle East. It’s all about the bargaining,” said Mona Yacoubian, a Middle East expert at the Henry L. Stimson Center in Washington. “It could be this is part of a strategy of deliberately trickling in aid, to sort of see how things are going on the ground. You start with harmless things, like M.R.E.’s. Is this a conversation starter? We might think of it that way.”

But Mr. Kerry provided no indication that the White House was committed to such a phased expansion of nonlethal support.

“I am going back to Washington with a number of thoughts and ideas that were put on the table today, and I’m confident we’re going to have a robust and ongoing conversation,” he said.

Some members of the Syria opposition said they were disappointed by the Rome session.

“It is obvious that the real support is absent,” said Walid al-Bunni, a spokesman for the anti-Assad coalition. He said what the resistance needed most was weapons. “What we want is to stop the Scuds launched on Aleppo, to stop the warplanes that are bombing our towns and villages.”

Mr. Khatib, for his part, delivered an emotional statement in which he urged establishment of a humanitarian corridor to the besieged city of Homs, and complained that many in the West were too quick to judge some members of the opposition as Islamic extremists because of “the length of a beard of a fighter.”

“Bashar Assad, for once in your life, behave as a human being,” Mr. Khatib said. “Bashar Assad, you have to make at least one wise decision in your life for the future of your country.”

One aim of the $60 million in aid is to help the Syrian Opposition Coalition, the umbrella group led by Mr. Khatib that the United States backs and has helped shape, in building credibility within the country and contesting the influence of extremist groups like the Al Nusra Front, an organization affiliated with Al Qaeda.

American officials have become increasingly concerned that the Al Nusra Front is making inroads among the Syrian population by dispersing assistance in the areas it controls.

The American assistance could also help the Syrian coalition develop the governance skills it will need to play a role in any post-Assad political transition.

The funds are to be used in areas controlled by the Syrian opposition coalition to improve education, sanitation and security. Another goal is to strengthen the rule of law in these areas and discourage vigilante justice or revenge killings. To carry out the program, the United States plans to send technical advisers to the headquarters of the Syrian opposition in Cairo. The advisers will be drawn from nongovernmental organizations.

The $60 million is on top of more than $50 million in assistance, including communications equipment, that the United States has already provided to local councils and civil activists. The new funds need to be approved by Congress, which is caught up in politics over how to cut the American budget deficit. But Mr. Kerry said that he expects Congressional approval soon.

Reporting was contributed by Mark Mazzetti from Washington, Anne Barnard and Hwaida Saad from Beirut, Lebanon, and Christine Hauser from New York.

Read More..

Bits Blog: Senator John D. Rockefeller IV Introduces 'Do Not Track' Bill

Before his planned retirement from Congress at the end of next year, Senator John D. Rockefeller IV, the West Virginia Democrat, intends to give American consumers more meaningful control over personal data collected about them online.

To that end, Mr. Rockefeller on Thursday introduced a bill called the “Do-Not-Track Online Act of 2013.”

The bill would require the Federal Trade Commission to establish standardized mechanisms for people to use their Internet browsers to tell Web sites, advertising networks, data brokers and other online entities whether or not they were willing to submit to data-mining.

The bill would also require the F.T.C. to develop rules to prohibit online services from amassing personal details about users who had opted out of such tracking.

Mr. Rockefeller proposed the same bill two years ago. But he did not push it in the Senate at the time because industry groups had pledged to voluntarily develop systems to honor the browser-based don’t-track-me flags. Last year, however, negotiations between industry groups and consumer advocates over how to execute these mechanisms essentially broke down and have since made little progress.

The new Rockefeller bill indicates that the senator believes the industry has not acted in good faith.

“The privacy of Americans is increasingly under assault as more and more of their daily lives are conducted online,” Mr. Rockefeller, the chairman of the Senate Committee on Commerce, Science and Transportation, wrote on Thursday in an e-mail sent to a reporter. “Industry made a public pledge to develop do-not-track standards that will truly protect consumer privacy — and it has failed to live up to that commitment. They have dragged their feet long enough.”

Industry representatives said that legislation was unnecessary because advertising networks and data brokers several years ago voluntarily introduced their own opt-out program for consumers, called Your AdChoices. Unlike the Do Not Track signals which would allow users to make a one-time decision about all online tracking from their own browsers, the industry program requires people to go to a site and individually select the companies, among several hundred, from whom they prefer not to receive marketing offers based on data-mining.

Stuart Ingis, a lawyer for the Digital Advertising Alliance, an industry consortium, said the program, which involves consumers installing individual cookies on their browsers, demonstrates that users already have choices about data collection.

“It’s a lot easier to use a system that is already built and works,” Mr. Ingis said.

Over the last few years, the number of companies that collect information about the reading habits, health concerns, financial capacity, search queries, purchasing patterns and other activities of online consumers has skyrocketed. Industry representatives argue that this benefits people because it enables companies to show them relevant ads, and that the ads themselves finance online sites and services that are free to consumers. Moreover, they say, the data collection is “anonymous” because online services typically use numerical customer codes, not real names or e-mail addresses, to track the behavior of individuals.

But consumer advocates warn that such profiling systems, which can collect thousands of details on nearly every adult in the United States, can be used to segment some people for preferential offers while relegating others to inferior treatment. Despite industry claims that online tracking is anonymous, a few computer scientists have reported that sites often leak information that can identify individuals, including names, addresses and other details, to third parties.

“Nowadays, there is an incredible proliferation of tracking,” said Dan Auerbach, a staff technologist at the Electronic Frontier Foundation, a digital rights group in San Francisco. “Data brokers, companies that you never heard of, are collecting massive dossiers about you as you browse around the Web and, right now, there are no limitations on the collection or use of those dossiers.”

To give people greater control over their own surveillance online, the Federal Trade Commission in a report on consumer privacy last March urged industry groups to adopt Do Not Track mechanisms by the end of 2012. In fact, the major browsers — Firefox from Mozilla, Google’s Chrome, and the more recent iterations of Internet Explorer — already offer the don’t-track-me buttons. When these options are turned on, they send out signals to sites, and third parties like ad networks operating on those sites, that certain users do not want to have their information collected.

But industry groups and consumer advocates have been at odds for more than a year over how “Do Not Track” mechanisms should be presented to users and how online services should respond to the signals. In the absence of legislation or industry consensus, companies are free to ignore those user preferences.

Some browsers have responded to this standstill by taking matters into their own hands and blocking third-party tracking cookies, as my colleague Somini Sengupta reported this week.

But Mr. Rockefeller’s bill indicates that legislative action could pre-empt voluntary industry measures.

“This is a signal that Senator Rockefeller is serious about getting Do Not Track done,” said David C. Vladeck, a professor at Georgetown Law. Until last month, Mr. Vladeck served as director of the bureau of consumer protection at the F.T.C. “I think industry writ large – browser companies, advertising networks, data brokers – are going to understand that he is serious about getting across the finish line.”

Read More..

Doctor and Patient: Why Failing Med Students Don’t Get Failing Grades

Tall and dark-haired, the third-year medical student always seemed to be the first to arrive at the hospital and the last to leave, her white coat perpetually weighed down by the books and notes she jammed into the pockets. She appeared totally absorbed by her work, even exhausted at times, and said little to anyone around her.

Except when she got frustrated.

I first noticed her when I overheard her quarreling with a nurse. A few months later I heard her accuse another student of sabotaging her work. And then one morning, I saw her storm off the wards after a senior doctor corrected a presentation she had just given. “The patient never told me that!” she cried. The nurses and I stood agape as we watched her stamp her foot and walk away.

“Why don’t you just fail her?” one of the nurses asked the doctor.

“I can’t,” she sighed, explaining that the student did extremely well on all her tests and worked harder than almost anyone in her class. “The problem,” she said, “is that we have no multiple choice exams when it comes to things like clinical intuition, communication skills and bedside manner.”

Medical educators have long understood that good doctoring, like ducks, elephants and obscenity, is easy to recognize but difficult to quantify. And nowhere is the need to catalog those qualities more explicit, and charged, than in the third year of medical school, when students leave the lecture halls and begin to work with patients and other clinicians in specialty-based courses referred to as “clerkships.” In these clerkships, students are evaluated by senior doctors and ranked on their nascent doctoring skills, with the highest-ranking students going on to the most competitive training programs and jobs.

A student’s performance at this early stage, the traditional thinking went, would be predictive of how good a doctor she or he would eventually become.

But in the mid-1990s, a group of researchers decided to examine grading criteria and asked directors of internal medicine clerkship courses across the country how accurate and consistent they believed their grading to be. Nearly half of the course directors believed that some form of grade inflation existed, even within their own courses. Many said they had increasing difficulty distinguishing students who could not achieve a “minimum standard,” whatever that might be. And over 40 percent admitted they had passed students who should have failed their course.

The study inspired a series of reforms aimed at improving how medical educators evaluated students at this critical juncture in their education. Some schools began instituting nifty mnemonics like RIME, or Reporter-Interpreter-Manager-Educator, for assessing progressive levels of student performance; others began to call regular meetings to discuss grades; still others compiled detailed evaluation forms that left little to the subjective imagination.

Now a new study published last month in the journal Teaching and Learning in Medicine looks at the effects of these many efforts on the grading process. And while the good news is that the rate of grade inflation in medical schools is slower than in colleges and universities, the not-so-good news is that little has changed. A majority of clerkship directors still believe that grade inflation is an issue even within their own courses; and over a third believe that students have passed their course who probably should have failed.

“Grades don’t have a lot of meaning,” said Dr. Sara B. Fazio, lead author of the paper and an associate professor of medicine at Harvard Medical School who leads the internal medicine clerkship at the Beth Israel Deaconess Medical Center in Boston. “‘Satisfactory’ is like the kiss of death.”

About a quarter of the course directors surveyed believed that grade inflation occurred because senior doctors were loath to deal with students who could become angry, upset or even turn litigious over grades. Some confessed to feeling pressure to help students get into more selective internships and training programs.

But for many of these educators, the real issue was not flunking the flagrantly unprofessional student, but rather evaluating and helping the student who only needed a little extra help in transitioning from classroom problem sets to real world patients. Most faculty received little or no training or support in evaluating students, few came from institutions that had remediation programs to which they could direct students, and all worked under grading systems that were subjective and not standardized.

Despite the disheartening findings, Dr. Fazio and her co-investigators believe that several continuing initiatives may address the evaluation issues. For example, residency training programs across the country will soon be assessing all doctors-in-training with a national standards list, a series of defined skills, or “competencies,” in areas like interpersonal communication, professional behavior and specialty-specific procedures. Over the next few years, medical schools will likely be adopting a similar system for medical students, creating a national standard for all institutions.

“There have to be unified, transparent and objective criteria,” Dr. Fazio said. “Everyone should know what it means when we talk about educating and training ‘good doctors.’”

“We will all be patients one day,” she added. “We have to think about what kind of doctors we want to have now and in the future.”

Read More..

Doctor and Patient: Why Failing Med Students Don’t Get Failing Grades

Tall and dark-haired, the third-year medical student always seemed to be the first to arrive at the hospital and the last to leave, her white coat perpetually weighed down by the books and notes she jammed into the pockets. She appeared totally absorbed by her work, even exhausted at times, and said little to anyone around her.

Except when she got frustrated.

I first noticed her when I overheard her quarreling with a nurse. A few months later I heard her accuse another student of sabotaging her work. And then one morning, I saw her storm off the wards after a senior doctor corrected a presentation she had just given. “The patient never told me that!” she cried. The nurses and I stood agape as we watched her stamp her foot and walk away.

“Why don’t you just fail her?” one of the nurses asked the doctor.

“I can’t,” she sighed, explaining that the student did extremely well on all her tests and worked harder than almost anyone in her class. “The problem,” she said, “is that we have no multiple choice exams when it comes to things like clinical intuition, communication skills and bedside manner.”

Medical educators have long understood that good doctoring, like ducks, elephants and obscenity, is easy to recognize but difficult to quantify. And nowhere is the need to catalog those qualities more explicit, and charged, than in the third year of medical school, when students leave the lecture halls and begin to work with patients and other clinicians in specialty-based courses referred to as “clerkships.” In these clerkships, students are evaluated by senior doctors and ranked on their nascent doctoring skills, with the highest-ranking students going on to the most competitive training programs and jobs.

A student’s performance at this early stage, the traditional thinking went, would be predictive of how good a doctor she or he would eventually become.

But in the mid-1990s, a group of researchers decided to examine grading criteria and asked directors of internal medicine clerkship courses across the country how accurate and consistent they believed their grading to be. Nearly half of the course directors believed that some form of grade inflation existed, even within their own courses. Many said they had increasing difficulty distinguishing students who could not achieve a “minimum standard,” whatever that might be. And over 40 percent admitted they had passed students who should have failed their course.

The study inspired a series of reforms aimed at improving how medical educators evaluated students at this critical juncture in their education. Some schools began instituting nifty mnemonics like RIME, or Reporter-Interpreter-Manager-Educator, for assessing progressive levels of student performance; others began to call regular meetings to discuss grades; still others compiled detailed evaluation forms that left little to the subjective imagination.

Now a new study published last month in the journal Teaching and Learning in Medicine looks at the effects of these many efforts on the grading process. And while the good news is that the rate of grade inflation in medical schools is slower than in colleges and universities, the not-so-good news is that little has changed. A majority of clerkship directors still believe that grade inflation is an issue even within their own courses; and over a third believe that students have passed their course who probably should have failed.

“Grades don’t have a lot of meaning,” said Dr. Sara B. Fazio, lead author of the paper and an associate professor of medicine at Harvard Medical School who leads the internal medicine clerkship at the Beth Israel Deaconess Medical Center in Boston. “‘Satisfactory’ is like the kiss of death.”

About a quarter of the course directors surveyed believed that grade inflation occurred because senior doctors were loath to deal with students who could become angry, upset or even turn litigious over grades. Some confessed to feeling pressure to help students get into more selective internships and training programs.

But for many of these educators, the real issue was not flunking the flagrantly unprofessional student, but rather evaluating and helping the student who only needed a little extra help in transitioning from classroom problem sets to real world patients. Most faculty received little or no training or support in evaluating students, few came from institutions that had remediation programs to which they could direct students, and all worked under grading systems that were subjective and not standardized.

Despite the disheartening findings, Dr. Fazio and her co-investigators believe that several continuing initiatives may address the evaluation issues. For example, residency training programs across the country will soon be assessing all doctors-in-training with a national standards list, a series of defined skills, or “competencies,” in areas like interpersonal communication, professional behavior and specialty-specific procedures. Over the next few years, medical schools will likely be adopting a similar system for medical students, creating a national standard for all institutions.

“There have to be unified, transparent and objective criteria,” Dr. Fazio said. “Everyone should know what it means when we talk about educating and training ‘good doctors.’”

“We will all be patients one day,” she added. “We have to think about what kind of doctors we want to have now and in the future.”

Read More..

DealBook: As Losses Mount, R.B.S. Unveils Plan to Sell Assets

LONDON – The Royal Bank of Scotland, hammered by losses, announced plans on Thursday to sell assets and pare back its investment banking business, in an effort to appease regulators and its biggest shareholder, the British government.

R.B.S. said it planned to sell a stake in the Citizens Financial Group, the American lender it bought in 1988, through an initial public offering in two years. The bank will also continue to reduce its investment banking operations, with plans to cut risky assets and eliminate jobs.

The moves are designed to help bolster the bank’s capital levels and refocus its operations, part of a multiyear turnaround effort initiated by its chief executive, Stephen Hester. In the end, R.B.S. will emerge a much smaller bank, largely focused on Britain.

“R.B.S. is four years into its recovery plan,” Mr. Hester said in a statement, “and good progress has been made. We are a much smaller, more focused and stronger bank. Our target is for 2013 to be the last big year of restructuring.”

Like many rivals, R.B.S. is struggling with the legacy of the financial crisis and a spate of legal issues. On Thursday, it reported a bigger-than-expected loss, in part tied to its legal troubles.

The bank, in which the British government holds an 82 percent stake after a bailout in 2008, posted a net loss of £5.97 billion ($9 billion) in 2012, much larger than the £2 billion loss recorded in 2011. Analysts had been expecting a loss of £5.1 billion. For the last quarter of 2012, R.B.S. reported a £2.6 billion loss, up from a £1.8 billion loss in the period a year earlier.

The rising losses reflect the bank’s regulatory and legal problems.

R.B.S. said on Thursday that it had set aside an additional £1.1 billion to compensate clients to which it improperly sold insurance products, bringing the total provision to £2.2 billion. It also estimated it would have to pay £700 million to compensate small businesses to which it improperly sold some interest-rate hedging products.

The bank agreed this year to pay $612 million to British and American authorities to settle accusations of rate-rigging. Since then, Mr. Hester has promised to tighten controls at the bank to limit the risk of future rate manipulation.

The head of R.B.S.’s investment banking division, John Hourican, resigned at the beginning of February as a result of the scandal related to manipulating the London interbank offered rate, or Libor. The bank plans to pay its fine with money clawed back from bonuses.

‘‘Along with the rest of the banking industry we faced significant reputational challenges,’’ Mr. Hester said in the statement. ‘‘We are determined to overcome the cultural and reputational baggage of precrisis times with the same focus we have applied to the financial cleanup from that era.’’

Eager to get back some of the £45.5 billion it invested in R.B.S., the British government recently increased pressure on the bank’s management to speed up the reorganization.

Some analysts said the government could start selling parts of its investment in the bank, even at a loss, before the next general election, which is set for 2015. R.B.S.’s shares are still trading at about half what the government paid for them in 2008. Some lawmakers said they would favor handing out shares to the public instead of a possible sale of the stake on the open market.

Richard Hunter, head of equities at Hargreaves Lansdown Stockbrokers, said there were signs that Mr. Hester’s efforts to turn around the bank had started to pay off, but that “the ongoing absence of a dividend and overhang of the government stake are negatives which need to be resolved.”

Read More..