From the Obit of Derek Walcott.

He would cup a breast as he fondled a white stone from the beach. These propensities, noted when he was teaching in America in the 1980s and 1990s, cost him the chance to be, in 1999, Britain’s poet laureate and, ten years later, professor of poetry at Oxford. He was not concerned, for he did not want to drop his anchor long on any northern shore.

Economist

‘I think we’re seeing the benefits of a good funding environment, and – to be frank – no research excellence framework’

Brexit and the Emerald Isle. Your mileage may vary. Here.

It is odd to live in a country whose very name—the United Kingdom—sounds increasingly sarcastic.

FT. Obvious, but puzzled as I haven’t see it everywhere.

last month (, for example, when) the University of Copenhagen fired seismologist Hans Thybo, president of the European Geosciences Union. The official explanation for Thybo’s dismissal — his alleged use of private e-mail for work, and telling a postdoc that it is legitimate to openly criticize university management — seems petty in the extreme.

Nature December 2016. Little hygge on show here, then.

A little awhile back after a teaching session, I asked — as I often do — a googly: ‘What is the worst thing about being a medical student?’ The response: ‘Feeling like a spare part’.

My quick and facetious response was to argue that at least spare parts were useful, whereas students were (usually) not. The humour was appreciated :-)

But if you think this through, it is possible to argue that students are indeed less useful than they once were. At one time, final year students were a key component of clinical service. They clerked people, they could insert iv lines, write up drugs, and they were around long enough in one environment for people to make meaningful judgments of their abilities and remember them. And to be able to trust them. They could do paid locums, and even when they were not being paid, they could not be absent, nor did you need to formalise start and finish times. One of my colleagues  reported that he used to be able to ‘prescribe anything apart from diamorphine’ as a final year student.

This all raises some interesting questions

1. Medical education may be getting worse. This is not to attach blame, merely a speculation based on what I see. There are indeed more educationalists, but making things explicit is easily confused with competence that is implicit.  It is even conceivable that those who ran medical schools were once more thoughtful, possibly because they were  not juggling so many roles, and because the environment was less cluttered by regulators.
2. Engagement with clinical service helps learning, but the opportunities for this may be diminishing. Again, this is in part a change in the environment. The inpatient service is not where most medicine occurs: the office is (whether in the OPD or in primary care)
3. I wonder if we are sequencing medical education incorrectly. The pressure is for more and more training and less and less education, but the facilities for training are diminishing all the time and are largely outwith the control of the universities. In a health service that is falling to bits, medical students are not a priority (and expect things to get worse). The NHS has never taught doctors: doctors have taught doctors. If culture eats strategy — as the saying goes —the toxic nature of much NHS provision, will negate all those lectures on ethics, fairness and sense of vocation. And don’t mention resilience.
4. Never promise ‘engagement’ when you cannot deliver it, otherwise disenchantment grows. We overpromise, and universities increasingly advertise with exaggerated claims. Scholarship, and advertising are opposing world belief systems.
5. Comparisons with some other EU countries makes me wonder if we should revisit the boundary between ‘student’ and ‘practice’.
6. Our ideas of medical education owe much to a time when most people did not go to university. 

Medical education is indeed always advancing: but many of us think it is increasingly out of phase with the world we live in. Magnitudes matter.

We deal with children as individuals when we “teach” them as children. What is wrong with MOOCs is the “massive” part. Education cannot be both massive and actual education. Learning starts with a goal followed by questions when you have trouble reaching your goal. We each have our own questions and our own goals.

……

Clark is wrong about MOOCs because the very concept of massive education is oxymoronic. Education is only massive because we have created a world of schools that include classrooms and not enough teachers to do one on one education. MOOCs are an extension of a vary bad educational idea called lecturing. We have come to accept lecturing because it is everywhere and we all had to endure it.

Roger Schank. Worth reading in full.

“We have a policy to help each ward—not just the acute admissions wards, but each ward in the hospital—decide who is the ‘least bad’ patient to approach to ask to sleep on a bed in the corridor. We have a plan for which nurse takes responsibility for taking observations—they are recorded in ‘the corridor folder.’”

Other realistic medicine comments on the same BMJ page here collated from a RCP report.

For a flavour:

Now if I had to pick, I would overcome my suckerproneness and take the butcher any minute.

Incerto here. Deadly serious.

Their conclusion was that there are 25m tonnes of spiders around the world and that, collectively, these arachnids consume between 400m and 800m tonnes of animal prey every year. This puts spiders in the same predatory league as humans as a species, and whales as a group. Each of these consumes, on an annual basis, in the region of 400m tonnes of other animals.

Martin Nyffeler of the University of Basel and Klaus Birkhofer of Lund University, quoted in the Economist.

“An estimated 400–800 million tons of prey are annually killed by the global spider community” Link

“When an older person dies, it’s harder to know that they died because of poor care,” but he added that the “families know”.

This is an article about the entirely predictable crisis in care for vulnerable people. We used to do it better, but decided cheating was more profitable. “Most local authorities buy care piecemeal via an auction system where contractors bid to provide a care package for each elderly or disabled person.” You cannot run a service on this basis; you might or might not make money. I remember being told as a young medical student: the local authority homes are the best, they have professional standards their staff have pensions, and unions etc . Avoid private providers.

FT

The lyrics are about a cognate issue but on this topic I am always reminded of Peter Gabriel’s words  and sense of disgust.