My intercalated degree (1980) was centred around epidemiology, and analysis of what was then a large dataset. So, I had to learn some FORTRAN and file editing on an IBM360 / find my way around a MTS system, all in the days of punchcards, and line printers, with only one ugly green on black monitor to share across a unit. Mostly, I wasted large amounts of print out and got used to retrieving my batch processed requests early morning, with the comment ‘run aborted’ , ‘system error’ etc. I had to wait another 24 hours to find out if I had corrected the errors in my programs. I remember the first time I looked at the GLIM manuals, wondering if I was attempting to read them upside down.

Years later, my interest in statistics resurfaced, mainly as a response to the banality of much of the EBM crowd with their NNT and their apparent lack of understanding of what I disparagingly call ‘probability management’. Most EBM merchants are frustrated chartered accountants. Real science is involved with understanding reality by creating models of how the world works: if you don’t do that, you are not doing science, but rather the the D of R+D, or ‘technology assessment’. The theory of how you should do the latter is a proper academic pursuit, but using these ‘products’ is not a matter for the academy — although it is important for many businesses or professions. Using what others invented is what doctors do in the clinic, but it does not count as research, but as honest professional toil (and very valuable work, at that, compared with say much business).

But statistics is hard, and frequently counterintuitive. We do not teach it well to medical students and for all the mantra about doctors’ communication skills, fluency with statistics is a core medical skill, and in many situations, the key communication skill doctors should possess. If you want your students to communicate well, do not stray far without mentioning binomial, poisson, Bayes etc.

What follows is a comment from Sander Greenland, on Deborah Mayo‘s excellent site, Error Statistics . I do not know Greenland (although we have emailed each other in the distant past), but I think he is somebody who is always worth listening too. There are a couple of points he makes that chime with me, and they relate to both teaching and the ‘crisis’ in much medical (and scientific research). He writes:

“My view is that stats in soft sciences (medicine, health, social sciences among others) has been a massive educational and ergonomic failure, often self-blinded to the limits on time and capabilities of most teachers, students, and users. I suspect the reason may be that modern stats was developed and promulgated by a British elite whose students and colleagues were selected by their system to be the very best and brightest, a tiny fraction of a percent of the population. Furthermore, it was developed for fields where sequences of experiments leading to unambiguous answers could be carried out relatively quickly (over several years at most, not decades) so that the most serious errors could be detected and controlled, not left as part of the uncertainty surrounding the topic.”

First, we have to accept that we have failed. Second, all too often we are ‘self-blinded to the limits on time and capabilities of most teachers, students, and users’. This is a widespread problem in the undergraduate medical curriculum, more generally. Students must be researchers, teachers, scholars etc. All too often this is one giant GMC inspired delusion, fuelled by either the NHS (yes, I know there is no longer one NHS), or speciality groups (my organ is bigger than your organ….). Third, much of higher education has not caught up with its audience (pace, elite higher education).

Finally, the sorts of experimental science he is talking about (final para) is exactly the sort I love. This is the sort of work Brenner and Crick described when they and a handful of others invented molecular biology. Or for an example from another field, look at how David Hubel and Torsten Wiesel described their work. But sadly, most medical research is no longer like this. It is much, much duller, and much less intellectually  secure, because many built in tests of veracity through experimental design and approach, have been replaced by audit of process. Does it have to be this way? A silent bleak voice, tells me yes. As for the teaching, that is a problem we can do something about.

[I like his use of ergonomic, too]

‘Big data is like teenage sex: everyone talks about it, nobody really knows how to do it, everyone thinks everyone else is doing it, so everyone claims they are doing it…’

Dan Ariely, 2013 from a nice talk by Terry Speed on the hype of ‘big data’

[direct link to this aside] 

A well-to-do cancer patient is nearing the end of her treatments. During an office visit, she says to her doctor, “I can’t thank you enough for the care you provided.” Should the doctor simply accept the patient’s gratitude — or gently suggest a way for her to show it: “Perhaps you might consider making a donation?” “We committed our entire estate,” Mr. Hyer said. And Mr. Hyer made a training video for doctors to learn how to effectively ask for donations. NYT

Blendle Is Up To Something Big. This is from the Monday note, and is about micropayments. The thinking is that if adblockers destroy one sort of business model, and keeping subscriptions to high quality journalism for more than a handful of journals per person is too expensive, how can we get traction for micropayments. For medicine and OER, we might think we do not need them at all. On the other hand, the idea of micropayments for individual book chapters is worth pondering. Does a book add value beyond that provided by individual chapters? Sometimes, clearly yet. But on all occasions? iTunes revisited.

Caution: delusions of personalisation (as in personalised medicine). Nice 101 on sources of variation in treatments by Stephen Senn. Variance components for the common man await.

Online university offers refugees chance to study for free. Kiron University, named after the centaur Chiron, known in Greek mythology for nurturing others in times of need, was founded last year by a group of students in Berlin.

“You can see already a changing profile among successful faculty. This is most noticeable in research universities where only a generation ago it was very difficult to get a conversation going about undergraduate education or pedagogy. Now, you’re seeing senior faculty members with sterling research credentials and prestigious careers coming back to the classroom and saying, “How can we do this better? Can we make this more focused on data rather than gut feelings, for example? Is there a better way to use technology?” So, one of the things that will happen is that what it means to be a successful professor will change. It’s going to be increasingly difficult to divorce the successful research professor from the successful classroom educator.”

I agree, but few do. As ever, we will be behind the best in the US. Link.

 [direct link to this aside]

This post is essentially an excuse to share the sight that greeted me when I was visiting family in Rome last weekend. Taken from my bedroom window at around 9:24am (that is metadata for you…) at a small hotel Ilpostiglione in Campagnano just outside Rome.

Rich DeMillo spent some time in Italy, and one section of his first book on Higher Education, dealt with the issue of how the Jesuits disrupted and dealt with the prevailing civic model of university education in Europe in the 16th century (for more on the Jesuits and higher education see, O’Malley JW (1993) The first Jesuits, Cambridge, Mass.: Harvard University Press; and Carlsmith.   DeMillo drew parallels with attitudes around Open CourseWare at MIT in the early 21st century. If the materials you use, are freely available, what value do you add to them in return for fees? Content commoditisation forces you to think sharply about what the value you bring.

The first Jesuit universities realized that they could not possibly produce the quantity of course materials that had been in use for many decades at civic universities. That presented a dilemma to new colleges that wanted to concentrate their meager resources on teaching, not on textbook publishing. “It has been said in town that we do not have a method for teaching,” Father John Paul Nicholas explained in 1558 to the bishop of Perugia, who had asked why Jesuit instructors were reluctant to adopt Latin grammar textbooks. It so happened, said the bishop, that there was an adequate text, written by a professor at the University of Perugia named Christopher Sasso. John Paul replied, “If we use Sasso’s book, they will say what our students have learned, they learned from Sasso, not from us.

When I was a student the only ‘free’ course material were photocopied handouts. Since I didn’t enjoy most undergraduate lectures, I didn’t attend very many(the best bit of advice I received from a lecturer was: ‘perhaps you shouldn’t go to lectures’). I did of course go on the first day, but I remember the apparent disquiet of lecturers who would see me stride in before the lecture, grab the handout, and then walk out. I sympathise with their disquiet, but they needed a reality check. So, in DeMillo’s most recent book this meme is followed up, and it makes me laugh. The scene in not Italy now, but France.

In 1229, the liberal arts faculty members of the University of Paris decided that the lecture was primarily for their own benefit when they enacted the following statute: The masters of philosophy [must] deliver their expositions from their chairs so rapidly that, although the minds of their audience may grasp their meaning, their hands cannot write it down.… Henceforth in any lecture, ordinary or cursory or in any disputation or other manner of teaching, the master is to speak as in delivering a speech, and as if no one were writing in his presence. A lecturer who breaks the new rule is to be suspended for a year. Students had little say in the matter. The statute prescribed a one-year suspension for any student who complained by “shouting, hissing, groaning, or throwing stones.”

So maybe this is the underlying logic of abysmal lecturing (and of Powerpoint)? Of course, it seems to me that we have only moved on a bit. Presently, people claim it is unethical for students to recall — and pass on — exam questions (or in the case of the for profits, possibly illegal). I think this view will soon look as absurd as the views of the ancient French faculty do now.

From a nuanced review of ‘Let me heal: the opportunity to preserve excellence in American medicine’, by Kenneth Ludmerer.

My main site, reestheskin.me, has had a makeover. The design is in place but some of the content I will need to amend over the next few weeks. If your interests include skin cancer, it includes a new skin cancer atlas with close to ~600 high quality images. Works on mobile too.  I will be adding more educational content, including videos soon.

The Future of Work: Navigating the Whitewater

“For my parents, I told the graduates at Arizona State’s commencement this year, the typical career trajectory was like a steamship’s—fire up the engines and full speed ahead. For my generation, the course was more like a sailboat’s—through skillful tacking, we got pretty close to where we thought we would. But today’s graduates need be more like whitewater kayakers, quickly analyzing and responding to an ever-changing flow, knowing and trusting themselves so they won’t panic.” John Seely Brown.

Worth reading in full from the man who led Xerox’s Palo Alto Research Center: he has form. UK medical graduates should read and ponder, and we need to encourage them to do so. [direct link to this aside] 

“Most universities misjudge their own brands, mistaking a longtime monopoly on access to top students for value.”

“Assessing the quality of UK medical schools: what is the validity of student satisfaction ratings as an outcome measure?” I have not read the paper, but you can guess the answer. This is all rather sad, and dangerous. I would just link back to some words from Harvard’s Larry Lessig I quoted earlier: 

The best example of this, I am sure many of you know are familiar with this, is the tyranny of counting in the British educational system for academics, where everything is a function of how many pages you produce that get published by journals. So your whole scholarship is around this metric which is about counting something which is relatively easy to count. All of us have the sense that this can’t be right. That can’t be the way to think about what is contributing to good scholarship.

 Well if you can wreck real research, you can certainly wreck good teaching. 

And if you think I am complacent about the value proposition we offer to students, Rich DeMillo’s long awaited new book its out: ‘Revolution in Higher Education: How a Small Band of Innovators Will Make College Accessible and Affordable’. I have only just started reading it. There is bags to whinge about, but unlike what AJP Taylor said of some academics, ‘He is 90% right, and 100% wrong’, DeMillo is wrong about the little things, and right about the big things that matter. Some quotes:

American Élites had little incentive to change, and change without the active involvement of the top of the academic pyramid was impossible. But then the outsider theory started to crumble. Influential insiders began to say in public what critics had been reporting all along: unequal access was a threat to higher education. Stanford’s president John Hennessy said that the cost of maintaining a large faculty was not sustainable and predicted that in the future, there would be fewer professors but they would be using new technologies to teach more students. He then took a minisabbatical—a rarity for university presidents—to acquire a deep understanding of educational technology.

Universities are generally conceived as vertically integrated entities, but as soon as families realize that they do not have to pay for unadorned content, the natural question is: “Well, exactly what do I have to pay for?” This is the central concern in chapter 2. Affordable quality is a goal of the Revolution, but it is achieved through an unbundling of a university’s value proposition that allows students to pay only for the value they receive. This is an innocent-sounding although in fact dramatic shift in the landscape of higher education.

Most universities misjudge their own brands, mistaking a longtime monopoly on access to top students for value.

Universities ‘decline charity research grants due to fall in public funding’ Not certain about the examples, but you cannot solve the crisis in HigherEd unless you look hard at the money flows, and the various cross subsidies. In medicine — until I have seen hard data to the contrary — I will stick to my view that this is a bigger problem that for other parts of the university. As DeMillo points out (ibid): ‘In fact, the rates paid by research sponsors are kept artificially low by cross-platform subsidies. Who subsidizes low research prices?’ For the Ivy League, the subsidy is from endowments, for many of the rest, it is tuition fees.

Stanford Encyclopedia of Philosophy.This free online encyclopedia has achieved what Wikipedia can only dream of. Not entirely fair, but Wikipedia just isn’t sufficient for all, all of the time. But imagine how much poorer the world would be without it. And yes, Stanford is giving us this encylopedia for nothing, but note the following:

“Our grant application days are over,” says Zalta. “We are practically self-sufficient as long as we don’t try to grow too much or too fast.”

Now this chimed with something I read in Nature about the re-financing of the Scripps Institute. The quote was: 

“Looking forward, I think many scientists realize that NIH funding is a good thing if you have it, but it’s not sustainable,” says organic chemist Phil Baran, who was on the search committee that selected Kay and Schultz. “What is stable are endowments, which you build by having products that give you proceeds, and by philanthropy. You get philanthropy by doing the best science, so that’s why there is such frenzied competition for the brightest minds.”

Many years ago I gave one of the President Council’s Guest lectures at Cold Spring Harbour (I forge the exact title). The audience comprised people who earned more by the day than I did by the lifetime, but I remember how nobody considered funding a PhD here or a project here, instead it was taken as given, that meaningful funding had to be endowed, so as to ensure secure long term funding — funding to play with, in the best sense of the word. Subsistence societies do not produce great artefacts, or produce the sorts of culture that is science (or most types of non-dogmatic learning, for that matter). Money flows matter. And our traditional   funding streams are broken. And my Univeristy Chair is endowed, but I doubt the pot of money has not been used to cross-subsidise something else