“What we have right now is a reputational model for universities rather than an outcome model,” Romer says. “The presidents at the elite institutions know that if the competition were to be based on some credible measure of output or value added, they would lose.”

Paul Romer

Well I am glad I am not the only one who thought this graphic was awful.  It is absolutely dreadful. Migraine inducing.

There is an ‘interesting’ exchange in Academic Medicine over a paper published by Geoff Norman and colleagues. Some daggers drawn methinks. Norman and colleagues state:

‘Errors in diagnosis are more likely to be rectified by conscientious acquisition of relevant knowledge (i.e., clinical experience) than by any attempt to extinguish general cognitive biases and thinking failures.’ I agree.

Croskerry (from the ‘Critical Thinking Program, Division of Medical Education’) and colleagues seem to disagree with this formulation of the issue. I will stick my head above the parapet. The attempt to formalise self-examination of error outwith of multiple contextual examples will fail. It is an academic growth area, but it assumes we not only understand error, but that we have a formal mechanical model of thinking: I suggest we don’t have any such meaningful computational model. Yes, yes, I know the Kahneman and Tversky work, and have feasted on the Simple Heuristics School. Time will tell. But if I see an address like ‘Critical Thinking Program’, I am reminded of the quote attributed to that great physicist: “Whoever undertakes to set himself up as judge in the field of truth and knowledge is shipwrecked by the laughter of the Gods.”

 Final point: there needs to be a tax raised every time the word ‘reflection’ is used in the context of medical education. Just think of all the dermatological misery mirrors have caused mankind.

Dartmouth, along with the other Ivies, ends up with most of its students crammed into three majors – pre-med, pre-law and pre-wealth

 

David Blanchflower on Dartmouth students

This figure is from the MIT Task Force report on Education. What I find surprising is the lack of change. Yes, the post doc numbers have gone up, but what I am struck by is the attention to being a certain size and not growing for the sake of it. I would love to see comparable figures for the Russell group Universities. 

The university bubble is also beginning to burst. Democratising universities has proved an expensive and inefficient way of providing mass higher education. Americans, who led the way, have taken on more than $1 trillion in student debt. But a growing number think that they got poor value for money—taught by PhD students not professors, forced to subsidise expensive research programmes and administrative cadres, and provided, at the end of it all, with a college diploma that no longer automatically brings a desirable job.

Schumpeter in the Economist

I cannot help but wonder if we really have forgotten things,  or are just choosing to ignore what we know to be true.

“The teacher was to begin each lesson with a praelectio (a “pre-reading”) in which he offered an overview of the content, explained difficult words, and raised some of the important issues to be discussed. The students were enjoined to “be regular in going to the lectures, diligent in preparing for them beforehand, in repeating them afterwards, in asking about points they do not understand, and in noting down what may be useful to assist the memory later on.” At the end of each day’s lesson an exercitatio was held, in which the students were examined on the material they had learned that day; this served as a review and an opportunity for the students to practice using the knowledge they had just gained.”

Struggling toward Success: Jesuit Education in Italy, 1540-1600. Christopher Carlsmith, History of Education Quarterly, Vol. 42, No. 2 (Summer, 2002), pp. 215-246

Profserious of ‘profserious: serious engineering’ agrees. People always seem to feign surprise when I say this. I then follow up with the line that unless you are using endowments, then it is likely that teaching budgets are subsidising research. If, as in medicine, most research is charity funded, the problem is even more acute than in engineering. Of course there is supposed to be money in the system to pay for underfunded charity research, but I am not convinced the gap is filled. Medical students attract large amounts of money, most of which is coming from the tax payer. The problem is that much of this money—whether it comes via the university or the NHS—is not used for teaching, but instead underpins research or supports NHS service. The VCs (as in Principals rather than Venture Capitalists, although I should think more about the differences sometime) will of course want bigger student fees, so that they can fund even more research. There is a lot to be said for cross-charging within an institution; there are also lots of arguments that caution against it as a long term institutional strategy. Finally, this is not a UK only phenomenon (nor, dare I mention it, a Scotland only phenomenon): have a read of Rich DeMillo’s ‘From Abelard to Apple: The Fate of American Colleges and Universities’.

out of 12,000 doctors surveyed in 2008, Jauhar notes, just 6% reported positive morale in their colleagues

 

Quoted from a brief review of Sandheep Jauhar’s ‘Doctored: the disillusionment of an American physician’ in Nature. If that doesn’t depress you enough, or you think it is a US phenomenon only, take  a look at Henry Marsh’s ‘Do no Harm‘, the best book I have read about the collapse of physician professionalism in the NHS.

From an article in the Economist.