David ASCH: We came upon the idea that we should evaluate medical training by its ability to produce doctors who deliver good care or good outcomes to patients. And we were pretty enthusiastic about that idea. It seems pretty logical, but I will say that at the time a lot of people had not been thinking along those lines. In most cases, I would say that people were evaluating residency programs by reputation, something I’d probably have to put into air quotes because I’m not really sure how reputation is created or whether it has any meaning compared to what we fundamentally care about, which is good clinical care. +++ That might sound kind of crazy, but at the time, about 15 years ago, it wasn’t. You see, there wasn’t any good data on the outcomes of physicians who’d trained in quote unquote prestigious residency programs. Sure, their teachers may have been world-class scientists and doctors, or authors of leading medical textbooks. And maybe the residents themselves had studied at prestigious colleges or medical schools or had great test scores. But all of that was really about “reputation,” or our perception of quality, and not about hard outcomes on whether the doctors who were training in the most prestigious programs ended up being any better doctors. So, the big question is: is that reputation valid? When it comes to finding the best doctor, should we care about where they trained? It turns out it’s really hard to dig under the surface here, for lots of reasons Read the full transcript or listen in on Freakonomics MD.