New private university for Hereford. Good.

The business of paying for undergraduate education. And politics.

Welfare for the corporations. Just remember this when the government tell you how much they spend on science and research.

Nice talk by John Naughton at UCC. Most of what I know about this little device called the Internet, I learned from his blog and his books (here and here). Took me awhile to realise it was the same guy I used to read in the Listener as a TV critic. As Conor Cruse O’Brien said: an academic and a journalist, ‘one foot in either grave’.

MOOCs are closed platforms…and probably doomed, by Daniel Lemire. So, sort of, were our biological ancestors.

Reinventing MIT education.

Incidentolomas, put to music.

So, you receive an email about yet another new author-pays online journal. This one is called Global Dermatology, with the modest abbreviation, GOD. (Not certain how that works). Anyway, you click on the links in the email, to find they are invalid. You open up the email in a browser and, yes, the links don’t work. Just where you might want to place your research for eternity…[A Google search leads you here] [direct link to this post]

Bug me, as in ‘bugging me’. Things that go round and round in my head, and where I do not know whether what I think is correct, but nonetheless I feel compelled to at worst ruminate, or at best to think I might be right. Standard warnings apply: I often do not agree with myself. And what follows is in no particular order, and worse still, I might will list some more another time.

1. The purpose of medical education is not to train people to be FY1 doctors (interns). Good students will be able to function as FY1 doctors, but many countries to not bother with this step. People learn loads as interns, but that is not a good enough justification for them having to be interns (in the UK sense). All too often junior doctor training is about cheap labour, not education or training. The more you look at international comparisons and practice, the less convinced I am about the UK approach. Time is short, and there are lots of paths to the summit.
2. I do not think assessing medical student competence is especially tricky — certainly not in comparison with many other degrees where there are large numbers of students. The core skill of doctoring it taking a story, making sense of it, and being able to tell the patient what is going on, and being able to plan what to do next. I do not think assessment of such skills is problematic, even though it might appear (at first) expensive. We say it is hard because we don’t get up each morning enthused about it.
3. We should concentrate on measures of the abilities described in (2) to decide whether to pass or fail medical students. Measures of process do not work well in education (general point, I learned from the writings of Dylan Wiliam). Most of the measures the GMC talk about or insist upon have little evidential basis. You can always game process (which is not the same as saying process isn’t important). The problem is that process degenerates into audit and rituals of verification (Michael Power). The latter is why most NHS postgraduate education (sic) is more human resources than education. The NHS has never educated doctors, doctors have. The trainees know it, too. Audit and measures of process are like parasites in biology: if you are not careful >90% of the biomass is parasitic.
4. What I have talked about under (2) and (3) is not all we should think about in terms of educating medical students.
5. Certification or signs-offs always come with errors. The more certification you have, the more straightjacketed you are. However, in medicine we have to be stuck with them — to some degree. But much as the class of degree in many subjects would not predict too well how you survive and function in the non-academic world (independent of what ability you brought to university), so we should not expect too much of claims of competence based on undergraduate studies only. If you want to employ somebody,the responsibility is yours, and you are deluded if you think modules on ‘ethics’or’resilience’ at medical school will have lifelong effects on doctors once they graduate. Those nice people at Enron scored well on their ethics models at business school.
6. The main threat to the honesty of doctors comes from the organisations and the incentives these organisation impose, rather than their personal failings.
7. As people climb up the ladder they know less and less about other branches of medicine. This is a big problem. All to often, opinions on medical education are based on what people experienced 30 years earlier. Big mistake. The same goes for junior doctor training.
8. A la Derek Bok, talking about how he only had the time to read extensively about education once he stepped down as president of Harvard, most people responsible for education in medicine, know little about it. Usually they are too busy to learn anything, or they believe there is nothing really to learn. We don’t train to people to teach, nor are their real career paths for such people. We are stuck between educationalists as the ‘bottom feeders of academia’ (as in the incomparable Clark Glymour’s phrase: ‘Almost all advanced degrees held by teachers are in education, which means that they are academically rock bottom.’) and a lot of not so recent work, informing us how people learn.
9. Medical schools are much more conservative than they were in the 1960/1970s. They are more and more scared to step out of line, and appear to control less and less of their finances. Does anybody really want to be better than Stanford? [as an aside, the costs are not that wildly different if my figures are correct]. I cannot go back and read George Pickering’s ‘Quest for Excellence’ without a feeling of sadness that we no longer have faith in our ability to create better ways of doing things.
10. Thinking is so more enticing when you should be doing something else.

US schooling. Includes a view nice lines: The claim speaks volumes about the low status of education, which (along with politics) is the only profession where lack of experience can be a credential instead of a flaw; and, the one-room schoolhouse of the nineteenth century was “the best school we ever had.

Textbook pricing and the naivety of academic economists here. Via Stephen Downes

Here’s What Will Truly Change Higher Education: Online Degrees That Are Seen as Official. I agree, at least re certification— that is where one battle must be fought (just look at the farce of medical degrees across the world, or even within the EU). I haven’t read the book.

In 1958, Walter Reuther, a powerful US union leader was taken on a tour of a newly automated Ford Motor plant. “Aren’t you worried about how you’re going to collect union dues from all these machines?” Response: “The thought that occurred to me,” Mr Reuther replied, “was how are you going to sell cars to these machines?” Steve Johnson.

OA and academic publishing. I still think the real issue is that publication is increasingly no longer about sharing discovery, but an accounting mechanism — and a way to make money or at least employ people.

Medicine’s dysfunctional research system here and here. ‘What do readers think? Do these constant reversals on everyday questions make consumers wary of science in general? ’Yes, is the only sane answer.

“Computer science is not that difficult, but wanting to learn it is.” Just replace CS with whatever you like.

Here via here. [direct link to this page]

Interesting aside in Science. To which I would add: arrogance before men, humility before your subject.

At the time, peer review by anonymous outside experts was beginning to take hold among journals in the United States. Einstein, however, wasn’t used to it: Until he left Germany 3 years earlier, he had regularly published in German journals without external peer review. He was indignant when he learned that his paper had received a critical review, and he withdrew it in a huff. “We (Mr. Rosen and I) … had not authorized you to show it to specialists before it is printed,” he wrote to the editor. “I see no reason to address the—in any case erroneous—comments of your anonymous expert.” He and Rosen submitted the paper to another journal, the Journal of the Franklin Institute, without change.

Yet before it was printed, Einstein revised the manuscript, retitling it “On Gravitational Waves.” It now came to the opposite conclusion: that gravitational waves were possible. The unidentified referee had pointed out a legitimate flaw in the original paper. Historians have recently confirmed that the referee was Howard Percy Robertson of Princeton University. After his anonymous criticisms were ignored, Robertson had delicately approached Einstein and convinced him of his error.

Even though peer review had helped Einstein save face, he stuck to his guns and never published another scientific paper in the Physical Review.

Francis Peabody, another Boston Brahmin physician, may have given us a way to think about this question when he famously said that the secret of the care of the patient is in caring for the patient — an old saw, but also a basic truth of doctoring

quoted in NEJM  [direct link to this post]

There is a spirited article in THE (Save field biology skills from extinction risk). It is a demolition of the tyranny of Bloom’s taxonomy in relation to skill acquisition and education. The context is field biology and the acquisition of those skills needed to identify and understand living organisms and their habitats. Not so far from much clinical medicine and dermatology, I suggest: diagnosis and categorisation is the cardinal skill of a physician. It is a familiar trope that dermatologists are butterfly collectors, or bird spotters. Some are, although I have no skills in these domains. But to quote from the article:

“Educationalists have been guilty of formalising a gross undervaluing of the complexities involved in field biology. This has occurred through a naive adherence to an incredibly damaging dogma that has influenced so much of modern educational practice. Ironically, the dogma that has been so detrimental to field taxonomy is known as Bloom’s taxonomy….”

For ‘field biology’, read ‘medicine’

The authors go on:

“In 1956, a committee of educationalists chaired by Benjamin Bloom proposed a classification system for learning outcomes. The objective of the group was to clarify the language used in the design of curricula and exams. They produced a theoretical framework that subsequently has been widely used to classify educational goals. There are now literally hundreds of textbooks, web pages and training courses that provide guidance on writing exam questions based around Bloom’s taxonomy. These documents frequently include lists of approved verbs that are deemed appropriate when writing questions for different levels or years of study. Bloom’s creed tells us that the lowest levels of cognitive skills involve recognising, identifying, naming and memorising. These abilities are considered inferior to the higher levels such as critically analysing, evaluating, criticising and reviewing. This sort of simplistic analysis resulted in field biology skills being excluded from university degrees time and time again as being too “simplistic”. However, ask those responsible for dropping these courses to distinguish Galium saxatile from Galium sterneri and they might just start to appreciate that identification skills are not so simple after all.”

Well, indeed, I do not know my Galium saxatile from my Galium sterneri but the point is well made. Bloom’s taxonomy makes little sense for clinical medicine. Yet again, we see another example of simplistic educational theorising (fads), getting in the way of teaching and learning. (Remember: it is indeed possible for teaching to get worse over time.) The phrase ‘Educationalists have been guilty of formalising..’ is key. Formalisation is attractive, it is what leads to status in fields like physics and mathematics. It is however ‘tricky’, and for many areas of expertise the result is cargo-cult science. All to often people mortgage their honesty in order to purchase that which their colleagues mistake for rigour. Understanding understanding is hard. Understanding competence, less so. [rant over]

Ugly word, but true: massification and higher education. “India, China, Brazil, Nigeria, Russia, Pakistan, Indonesia, the United States and the United Kingdom together enrol more than half of the world’s higher education students.” Follow the money, if you want to know what will happen.

The Compleat lecturer, by the Baron of Jesmond, an article on how to lecture, and a defence of lecturing. I agree with much of it, but the issue is few have the intellectual skills — or integrity — of the Baron. For much of medicine, lectures are a shambles. Another article that talks sense about lecturing, from Patrick Henry Winston.But then if you read the MIT view of teaching, you will realise how shallow much of the higher education world is. And while we are at it, can we reconsider the ppt handouts.

Basic stats or research methods: beware of ratios. An article suggesting that people are being blinded by sex ratios and an apparent higher participation by women in some domains, when what is happening is that men are withdrawing. Seems about right.

““Universities are autonomous. Just because the government is paying doesn’t give them the right to override the autonomy of universities and run them according to their whims.” This is the case in Britain.” This is a quote from Nobelist Amartya Sen,  following his resignation as head of a new elite  university, Nalanda Univeristy in India. I find the final sentence ambiguous. The problem in the UK is that universities are increasingly not independent of the whims of government. [direct link to this page]