I am not going to comment on the content (the usual Newspeak), but if you were looking for an example of how not to design informative graphics or communicate, this has to be up there: Edward Tufte will have to kill yet more kittens.

I think sequencing — the order — of how we put teaching together is a big issue in medical education. Not the only big issue, just one of a handful. Historically medical education hid behind the idea of education as a form of apprenticeship. There is a lot to be said for post-graduate medical education as an apprenticeship (despite the attempts by the NHS and HR (aka postgraduate deans) to kill it off). But at the undergraduate level it fails; class sizes are too large; the sense of belonging gone; specialisation has led to lots of small attachments; and nobody has been quite certain how to deliver teaching when the responsible body is a university, but where the patients are physically located in the NHS.

In some mythical far distant past, students would be lectured to, and then appear on a ward where they would be supervised, mentored, and where their progress would be monitored in real time (as in real feedback). And many of those delivering the teaching, would know exactly what standards would be expected of the students. This is not how it works now. No surprises here then. Like much of modern education: it doesn’t work.

Even when I was a student the clinical attachments through year 3 and 4 would be in the mornings, with lectures in the afternoon. The problem was that the two activities were out of sync: the mornings might be spend in paediatrics, but the lectures could have been on geriatrics. The time hallowed linkage between seeing patients and reading about them was rendered problematic. My solution was to not attend lectures. It worked for me :-)

There were attempts to get round this problem. Dermatology teaching in Newcastle in those days was made up of 4 weeks of clinical mornings, but the lectures were delivered on another ‘out-of-phase’ period, and each afternoon, after say a lecture on psoriasis, 10–15 patients with psoriasis would appear, along with 10–15 staff who would demonstrate physical signs and patient stories, to students. You needed a lot of staff, and a lot of seminar rooms, and seminar rooms close to each other (i.e. a medical school). When I was in charge, I kept that system going for a few years, but eventually we had to abandon it due to a lack of resource and central support (‘who is paying the patients’ travel expenses’).

The prompt for for all of this is merely to remark how badly we organise or instruct what we want students to know before they appear on the ‘wards’. Tech allows us to think of ways to do this that were simply impossible 20 or even 10 years ago. But it needs a sea-change in how we view medical education. And much as I fear the expropriation of medical education from the ‘ward’, (simply because bedside teaching is so expensive) we have to think hard about allowing our students to take most advantage of the clinical exposure we can provide.

So, we started a new academic year this morning. The first group of students — there will be another 17 groups this academic year — who will spend two weeks with us throughout the year. And what surprised me, and cheers me up enormously, is how, when medical students are given firm and coherent guides as to what to cover by themselves, they can, with little interaction, achieve so much (connectivists and social constructivists, please note). And when you then interrogate them interactively on these topics, you can feel and see them struggling (successfully) to make sense of so much new material. And with an evident sense of pleasure and achievement.

“It’s no accident that only 11% of the US workforce is passionate about their work. This is a sign of great success. This is exactly what these institutions were designed to do – suppress passion. It starts with our schools that seek to prepare us for all the other institutional environments seeking people who can reliably follow instructions and execute in a predictable manner. Think of our current institutions as powerful chisels, relentlessly chipping away at our edges until we fit neatly into the tightly defined roles that our institutions have create.”

John Hagel

“If we’re really going to save money in health care, it means that somebody’s going to get paid less,”

Of course, this is not always true, but just in the same way that you should never say never in medicine.
Austin Frakt, quoted in the Boston Globe

“No one should use comic sans for lectures in a university.” Student feedback. It wasn’t me!

A comment in Science

A well-stated hypothesis describes a state of nature. It is either true or not true, not subject to probability. The phrase “probability the hypothesis is true” is meaningless. One can only say, “likelihood that the observed data came from a population characterized by the hypothesis.”

I only post, because I seem to spend my life trying to argue that the dismal null hypothesis is a tool for doing one type of statistics, and has a limited role in science. It has little to do with what we mean by a scientific hypothesis. There are not an infinite number of scientific hypotheses: there is a not a probability distribution in the  way we use this term in statistics.

The most important thing in learning is copying how other people think. I don’t think learning by doing really gets one to emulate how other people think. Marvin Minksy

“Classics are written by people, often in their twenties, who take a good look at their field, are deeply dissatisfied with an important aspect of the state of affairs, put in a lot of time and intellectual effort into fixing it, and write their new ideas with self-conscious clarity. I want all Berkeley graduate students to read them.”

Reading the classics by Christos Papadimitriou. [As in maths / computing classics, so includes Euler’s paper on the Konigsberg bridges etc, but also Vannevar Bush’s ‘As we may think’.

This is a quote from a review of Alice Gopnik’s most recent book, ‘The gardener and the carpenter’. I have enjoyed Gopnik’s previous work, and this quote could, with some latitude, be applied to medical school and medical education (where students become competent despite the best intentions of the medical educators…).

It assumes that the ‘right’ parenting techniques or expertise will sculpt your child into a successful adult. But using a scheme to shape material into a product is the modus operandi of a carpenter, whose job it is to make the chair steady or the door true. There is very little empirical evidence, Gopnik says, that “small variations” in what parents do (such as whether they sleep-train) “have reliable and predictable long-term effects on who those children become”. Raising and caring for children is more like tending a garden: it involves “a lot of exhausted digging and wallowing in manure” to create a safe, nurturing space in which innovation, adaptability and resilience can thrive.

We can only grasp reality by metaphor.

‘The Socratic slogan: “If you understand it, you can explain it’, should be reversed: Anyone who thinks he can fully explain his skill, does not have expert understanding’. Hubert Dreyfus.