There have been a similar set of category errors in play this month over TEF. I can’t find a lot wrong with putting metrics in the mix when making judgements and assessments. But to suggest that the precise collection of metrics with their precise weighting is somehow innately in all students’ interests is preposterous. As is the aggregating of all the metrics relating to different student experiences on different programmes into a single institutional score. That this is then further boiled into one of three medals, well, it’s almost as ridiculous as the UK degree classification system!

Jim Dickinson. The full article is well worth reading — especially about hidden costs and changes to course delivery.

I often have great difficulty understanding the way the legal system works. The way ‘learned’ is usually appended to ‘judge’, and the track record of corruption when legal officers do the dirty work of governments, suggests to me that a great deal of scepticism is warranted. That is before we get to the inability of judges to understand what sort of statements we can make the empirical world. Then there is the problem of the interpretation of statistics. Physicists try to measure the speed of light, and they can only report the answer when they have worked out a way to do it. By contrast, law (like much economics) seems to just make it up — whether it is possible to answer a question or not, instead of remaining silent (“Wovon man nicht sprechen kann, darueber muss man schweigen”).

Anyway the above little rant was provoked by what I thought were some bizarre statements in the BMJ in an article from the ethicist and barrister, Daniel Sokol (BMJ 2017;357:j2949). I am going to take some of the argument out of context, so beware.

This issue was about an adverse medical event, and to what extent the failure of a junior doctor to ask a question led to the event and whether the junior doctor should have asked the question. Sokol summarises an argument underpinning the judgment as follows:

“In short, the law expects history taking to be the same, whether it is by an inexperienced junior doctor or a senior consultant. Lord Justice Jackson Sai that history taking was a basic skill that hospital doctors at all levels should possess”

As I said, I am not debating the particular case, but the generality. So, let me alter some words in the above:

“In short, the law expects surgical skills to be the same, whether it is by an inexperienced junior doctor or a senior consultant.”

Or, how about:

“In short, the law expects diagnostic skills taking to be the same, whether it is by an inexperienced junior doctor or a senior consultant.”

Now, my two statements are patently absurd. If they are not, then we can get rid of all consultants, and save all this money. Indeed I notice when you consult members of the legal profession they show you a scale of fees that reflect different levels of expertise — and you have to choose.

The mistake is to view history taking as a checklist of questions. It is not. Or at least in many situations it is not. Some doctors are much better at it than others and just like you can quickly objectively score surgical ability based on videos of surgeons operating, to me it is obvious that the ability to elicit a history is highly variable. But most doctors get better at it over time.

A long time ago, there were three consultant neurologists in the unit I worked at in Newcastle. They all — reasonably I think — were viewed as excellent clinicians (and BTW they were terrific teachers of medical students and junior doctors). Two of them remarked that the third was not so good at eliciting physical signs but was better at taking a history than either of them.

I believed this at the time and still do. But more importantly the statement underpinning the judgment seems to be to based on a failure to understand what a history is. It is an active process, and reality does not reveal itself without an interaction between doctor and patient, that is dependent on the prior experience of both. It is not a checklist, and there is not a finite list of questions to regurgitate. Just as in science, it is experiment rather than observation, that reveals the true nature of reality. And some are better at it than others — as we should expect. So the idea that doctors of widely different experience will be able to ‘interrogate’ the same way or with the same skill is mistaken.

Rant over.

This can be read as typical Silicon Valley hype, but I think it is more right than wrong. Just as government thought computer education in schools was about using MS Office, too many in higher education think it is about copies of dismal Powerpoints online,  lecture capture, or online surveillance of students and staff. The computer revolution hasn’t happened yet. Medical education is a good place to start.

What can we do to accelerate the revolution? From our observation, the computer revolution is intertwined with the education revolution(and vice versa). The next steps in both are also highly overlapped: the computer revolution needs a revolution in education, and the education revolution needs a revolution in computing.

We think that, for any topic, a good teacher and good books can provide an above threshold education. For computing, one problem is that there aren’t enough teachers who understand the subject deeply enough to teach effectively and to guide children. Perhaps we can utilize the power of the computer itself to make education better? We don’t hope to be able to replace good teachers, but can the computer be a better teacher than a bad teacher?

Tutoring System

One key finding is that because interest rates on student debt are very high — up to 3 per cent above RPI — the average student accrues £5,800 of interest while studying, meaning they borrow £45,000 but have a debt of £50,800 on the day of graduation. By contrast, the average debt burden on students in the US is far lower at $36,000 (£27,900), even though the cost of tuition varies far more at US institutions.

Arguments about university funding are everywhere (and here and here and from the IFS, too). The UK government is indulging in fantasy / PFI like economics again, and much of this story looks like another mis-selling scandal. The universities again, come out of this badly (FT). Whereas many have behaved badly, they are going to end up being treated worse.

My eldest daughter warned me that reading comments will make me sad or angry. But sometime anger is more valuable than sadness. The comment below, in the FT, from Matt_us is germane (The case for reform of UK university finances)

Hang on a minute. Students now graduate with about £50k of student debt (tuition and maintenance loans and interest). Student loans cannot be repaid by the majority of students. That is because the interest rate is higher than the repayment schedule. Despite repaying loans, the student debt continues rising. It is a pyramid scheme. 

In detail: Graduates have to earn over £56k to even repay £1 of their loans, otherwise the loans get bigger, rather than smaller. Graduate starting salaries are between £20k and £30k. And only the best graduates will earn over £45k after five years in the job.  During that time all loans will increase by 6% per year.

Interesting graphic from Audrey Watters on the bête noire, that is Pearson (especially if you are an investor). But although I think I am in a minority, I think universities are wrong to not understand how the world of content will impact on their business models. What is your content like, and what do you add to it? Content is key. But it doesn’t cost 9K, at least not if you scale it right.

How to select medical students…………..

On the topic of quotations, though, a longer recent discussion about Hanlon’s Razor on the Farnam Street blog includes this rather nice one from the German general Kurt von Hammerstein-Equord:

I divide my officers into four groups. There are clever, diligent, stupid, and lazy officers. Usually two characteristics are combined. Some are clever and diligent – their place is the General Staff. The next lot are stupid and lazy – they make up 90 percent of every army and are suited to routine duties. Anyone who is both clever and lazy is qualified for the highest leadership duties, because he possesses the intellectual clarity and the composure necessary for difficult decisions. One must beware of anyone who is stupid and diligent – he must not be entrusted with any responsibility because he will always cause only mischief.

The Razor Returns | Status-Q

Of all the titles submitted to the 2014 research excellence framework, only “around a half in most subjects achieved at least one retail sale in the UK in the years 2008-14”. 

Worst sellers: warning of existential crisis for academic books | THE News

A large part of Kahn’s legend rests on his fame as a pedagogue, and although his parallel teaching career was driven by financial necessity, he became renowned for his ability to inspire students with a more elevated vision of professional practice than the technically advanced but psychically stunted approach characteristic of postwar American architectural education. (emphasis mine)

From a (book) review in the NYRB about the late architect Louis Kahn (Salk institute etc). “Psychically stunted.” Sounds like some other sort of professional education I am more familiar with.

If I had one criticism of Drezner’s otherwise excellent book, it is that his cure is thin gruel. He urges universities and think-tanks to regain their independence from big philanthropy. That is all very well. But how could they afford it?

Review in the FT of ‘The Ideas Industry’, by Daniel Dresser.

Optimism is the idea that we can build things that fail gracefully

This was a quote from Cory Doctorow on a Guardian Podcast interview at the Hay Book Festival. I do not see much of this in my professional life, but he calls it right.

No matter. Try again. Fail again. Fail better.