I have been busy producing and updating some videos. Here is the first in a series on skin biology.

I came across this video produced by Linguistics here in Edinburgh. I liked it for a number of reasons.

First, it is simple and straightforward in design and purpose. Thea Graham (an ex-student) speaks well, and invites interest. It is an example where what a student says, is likely to be more useful than what staff say. (I remain deeply troubled by many peer-based learning and teaching approaches, and have seen groups of students propagate errors. All that we know about teaching — in terms of domain knowledge; expertise in problems students have within that domain; and general knowledge of pedagogy — suggests that they can make learning worse. The problem of course, is that peer-to-peer learning can work brilliantly in some situations. I just remain uncertain how to define those situations. OK, rant over.). Anyway, I think this video was terrific.

The other issue is how good a job we do of preparing students for life after university and what meaningful advice we can give. And I don’t mean visiting the careers office.

Medicine has problems in this regard, although at one time I would have pooh-poohed this statement. At one time, the answer was quite simple:  you either worked in the NHS in hospital, or in the NHS (as a contractor) as a GP. A small proportion would work in universities, and a small proportion would leave medicine or work within pharma, or go overseas (not such a small proportion, perhaps). If you stayed in the UK, you enjoyed great job security, and careers paths were fairly clear, and largely based on what your peers thought. Things have moved on in the UK, and some of what we see has happened overseas is going to apply here, soon.

There are a number of memes to consider

Job security is diminishing. Perhaps most doctors graduating will work for different employers in their careers, and most will not work for the NHS for all of their career. It may be NHS branded, but it is not the same creature the NHS once was. I cannot see the NHS surviving another 20 years — and, in one sense, it hasn’t survived my career ( the current NHS has a different ethos to the NHS when I qualified).

Professionalism. The rule is that once people start talking up something and wishing to formalise it, you know it has disappeared and will continue to be killed off. So, with professionalism, resilience, leadership, ethics, and the like. Those who ran Enron came top of their ethics classes at the Harvard Business school.  Orwell got all of this right a long time back. Bureaucracies and many corporations (including the UK government) detest professionalism, it is why disability assessments, and much of health care, has to be hived off to non-medical widgets, who do not have the cheek to work to a different value set. I learned something about professionalism from the two neonatologists, Ed Hay and Mike Parkin, who ran the Northern region SCBU. This is a world that sadly has gone. One would have used more colourful language than the other, to describe the current state of affairs.

Specialty choice. It think this is really hard, and I wonder if we do a really good job of informing our students. When I was a student, many wanted to be surgeons, but many of those fell off the ladder, quite quickly. Many ‘physicians’ wanted to be consultant physicians in a teaching hospital, but that is now a post that essentially does not exist, and many still doing it wish they had chosen otherwise. Subspecialism, shift work, and the crazy destruction of the Senior Registrar grade, have all made work in many specialties less enjoyable. People will leave, given the choice.

It is very hard to get an idea of whether you will be happy in a specialty based on very limited undergraduate exposure. There also tends to be a feeling that students need ‘pushing’ into areas because the NHS ‘needs’ people in that area. This is putting the cart before the horse. Or perhaps I should say it more forcibly: the job of universities is not to conflate enthusiasm for propaganda, nor to act in anybody else’s interests, except those of our students.

Specialties also change within lifetimes. At one time ’surgeons’ did things with their hands, and non-surgeons, didn’t. This distinction not longer holds, and some non-surgical specialists, work for longer with their hands than many surgeons I know. Take dermatology. When I came into it was very much ‘physician like’ with little surgery. However, in Vienna there was clearly a different tradition, and in Newcastle where I then trained, surgical dermatology was being pioneered (from a UK perspective, along with Cardiff and London). Now there are dermatologists who do no ‘general dermatology’ and who operate for 50% of their time ( I am married to one), having pinched back a lot of work from plastic surgeons (everybody is pinching work from plastic surgeons: ENT, max-fax etc). Anybody looking to train in dermatology now, would be mad not to consider surgery as a key component of the subject.

So, technical advance, and changes in the pattern of care, have big effects over a lifetime. The catch is that much clinical expertise, is developed on the background of being terminally differentiated. As we know, ‘pluripotency’ and ‘generic skills’ are trendy, and easier to bullshit in, simply because they are so superficial  — just look at managers.

Lifestyle. I get nervous here, because the word vocation was one used. And I have never considered my job and my non-job life to be very far apart. I think many academics feel the same way. But I used to be puzzled by observing that in the US, dermatology was one of the most popular specialties. Now the UK is the same, and the quality of our trainees is terrific. Once again, I think the young see further than their elders: they probably don’t need my advice. Virchow said it best: ‘not the first, nor the last time, youth was right.’

To many diplomates, this appeared like a conflicted money grab rather than the necessary cost of providing the education. [JAMA Dermatology]

Well, I for one, love some of the freshness of US English. The article is about the various motives behind those who demand continuing accreditation of physicians (dermatologists, in this case) and those organisations who appear to benefit from changes in regulation.

Of course, this is not confined to the US, nor professional education. If, in Shaw’s words, professions are conspiracies against the laity, the laity are extracting financial revenge.

And not just because you have it in your pocket. Sean Baker has filmed a whole movie about ‘two miniskirted transgender prostitutes on the hunt for a woman who’s had an affair with one of their pimps’ with ‘just’ an iPhone. Below is an image my daughter Elizabeth Rees took, again, just with an iPhone. The subject matter is not the same, the father would add.

10 text layout FAILS in online learning

10 top INTERFACE rules for online learning

10 similarities between Higher Education and the Catholic Church on the eve of the Reformation?

10 ideas on use of much maligned TALKING HEAD videos in online learning. Including: ‘Do NOT have some small, postage stamp size video embedded in the corner or anywhere else for that matter’.

10 things you really need to know about reading on screen for effective online design

I know, I just couldn’t resist another Catholic church reference. At least those Christian Brothers taught me a thing or two.

Martin Wolf penned a terrific article in the FT, ‘Running a university is not like selling baked beans’. I actually think he was too kind to universities, and I wonder whether he underestimates the change that is necessary in HE.` UK universities are no longer about elite education — their marketing and cacjetis based on their being little room at the top, but their business model is based on the argument that there is plenty of room at the bottom . Some quotes give you a flavour:

The question is partly whether it makes sense to view higher education as a business. The government recognises problems. But it underestimates them.

In its origins and still today, a university is a special institution: a community of teachers and scholars. Its purpose is to generate and impart understanding, from generation to generation. The university is a glory of our civilisation. It is neither a business nor a training school.

An immediate concern, however, is whether the conditions for a competitive market exist. Special institutions have long provided higher education, for good reasons. By definition, students cannot understand what they are buying: that is what makes them students. The value of what they obtain is likely to become evident over many years. They rely on reputation. They must believe, therefore, that the institution cares about its reputation. That is why the longevity of these institutions is so vital.

(The video is also well worth a watch. We are now in a world where even the undead are going to be called upon to subsidise corporate lack of innovation with university ‘laboratories of financial engineering’ (I jest not) suggesting that all of life becomes the substrate for financialisation, and yet more bubbles and misselling (the title is ‘Buying cures versus renting health: Financing health care with consumer loans’). Makes the FT’s caution about buying university bonds seem quite sedate.)

Although I accept the general maxim that reading comments online is akin to masochism, many — if not most of the comments — are well worth reading, and pondering. A selection below:

‘The fact that all universities have shiny marketing departments tells us what is actually going on – students are being conned.’

‘I strongly suggest the government and the British public consider the experience in the U.S. with for-profit universities. It’s been dismal. Students have worthless degrees and tens of thousands of dollars in student loan debt.’

‘I’m at Exeter and the way in which our education is being pimped out is very clear to see.’ 

‘Mediocrity can be commoditized but, not world class excellence and brilliance, the hallmarks of British higher education.’ 

‘I think the article reflects the traditional view that universities have a lock on higher education. For the most part this is true, but I think things are changing’

‘As a somebody who has studied at a Russell group public university and a private professional law school, I can honesly say that this article doesn’t fit with my experience. The public university was complacent, we had poor teaching, lectures of 400+ students, often workshops were palmed off on post graduate students, the buildings were old, we never had the right books and couldn’t find a PC to work on. It was awful.’

‘Talk as you will about superior British universities but those rankings are based upon the past reputation.’ 

‘the UK government, if it were a bank, would be laying itself open to a mis-selling charge. It’s imposing loans on people who are buying a pig in a poke, in the form of a degree whose value is highly uncertain but, given the ineluctable laws of supply and demand, is likely to diminish with every increase in the number of graduates not matched by an increase in graduate jobs.’

‘Please consider Dutch universities. Free, high quality, and english language tuition… and perhaps even closer to your home than unis in the North.’

‘Student loans strike me as the next sub-prime mortgages.’

Now I know; I think.

Kurt Vonnegut said it best: “Do not use semicolons. They are transvestite hermaphrodites representing absolutely nothing. All they do is show you’ve been to college.”

Quoted by John O’Callaghan in the Economist.

Some dark thoughts from Geoff Norman in one of his iconic editorials:

In some of my darker moments, I can persuade myself that all assertions in education (a) derive from no evidence whatsoever (adult learning theory), (b) proceed despite contrary evidence (learning styles, self-assessment skills), or (c) go far beyond what evidence exists. I suspect most readers of AHSE are aware of the first two kinds of assertion, but in this editorial I want to elaborate on the third, the challenge of arriving at general conclusions about the way the world works based on the empirical evidence derived from limited studies.

The link between a particular study, and generalisability is of course what science is all about: this is why much science is about theory, rather than A/B testing. It is why RCTs are not usually about science, but about product comparisons. Some Much medical education research is hurtling into the abyss of studies that have little interest beyond the fact that they got published, and that somebody has a copy of SPSS.

At this stage I always muse over out Clark Glamour’s statements about departments of education:

‘We leave training to schools of education, the bottom feeders of academe’,

‘Almost all advanced degrees held by teachers are in education, which means that they are academically rock bottom’

I could feel guilty for sharing such thoughts, if it were not for the fact that Glymour is a leading figure in statistics, learning and philosophy; and one who has made major contributions to how we can envision learning (see for instance his wok on Bayes Nets and Causal thinking), or his work on statistics teaching and learning, described in Galileo in Pittsburgh).

A long time ago I enjoyed a book called ‘What is this thing called science‘. The one on medical education has yet to be written. Norman’s voice is the closest we have to it. Somehow we have to carve out a space between the sorts of biology that explain human psychology and culture that the Premacks describe (see for instance, Original Intelligence: The Architecture of the Human Mind); George Steiner’s, Lessons of the Masters; and the knowledge of the bazaar that reminds us that we have understood certain aspects of apprenticeship and craft learning for at least a thousand years. And finally, the sorts of deep insights based on experiments that often appear deceptively simple, that  some  areas of experimental psychology are well known for.

Fei-Fei Li, a Stanford University professor who is an expert in computer vision, said one of her Ph.D. candidates had an offer for a job paying more than $1 million a year, and that was only one of four from big and small companies. On the candidate’s list, one of the biggest technology companies was ranked lowest, in terms of both money and excitement, she noted dryly.

NYT. Time will tell.

Like many other medical students in XXXXXX, during my first year of medical school I aspired to become a neurosurgeon to enjoy a lucrative lifestyle and high social status.

Nice piece by a young medical student in ‘Science’. A real hunger. Or perhaps he read Henry Marsh’s, ‘Do no Harm.’