“Improvement in post secondary education will require converting teaching from a solo sport to a community based research activity.”

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I am fascinated with finding the best metaphors to describe what doctors do, and exactly what sorts of activities allow students to learn to ‘think and behave’ like doctors. Doctors as scientists, doctors as scholars etc., I find dull and too PC. Science is important, rationality more so, but the practice of medicine is called ‘practice’ for a reason. The increasing trend to attempt to redefine medicine as ‘medical science’, dermatology as ‘dermatological sciences’, even nursing as ‘nursing science’, is all about kudos and branding. I have even seen ‘hospitality sciences’, although not on a hospital menu. I think there is a rich mine to explore, looking at comparisons with the acquisition of musical expertise, with the traditional crafts and of course with the traditional professions. This quote from the chef Alain Ducasse captures something important (and avoids the ‘hospitality sciencies’ claptrap).

No geniuses have ever come from the kitchen. The world has had Pierre and Marie Curie, and Leonardo da Vinci. The former couple started a revolution against disease, advancing humanity, and the latter was a man whose genius we’re are still trying to understand. Chefs, on the other hand, are just artisans. If nature doesn’t give us vegetables, if the fisherman didn’t supply us with fish and the farmer with meat, we wouldn’t exist. We are simply the bridge between nature and our clients.

We are simply the bridge between nature and our patients. 

I always thought it was disheartening (understated, I know, but polite) that parents pay say 10K per year for private schooling, and then sometimes pay for tutors for their children after school. It is not irrational—if you want to pay 10K , why not pay 12K and spread the cost between two types of coaches. But it somehow seemed to say something about the value of the first 10K.

Now I see that some medical students are effectively doing the same. They pay fees to the University, and then feel the need to pay additional monies to various commercial companies who provide them with either  clinical practice or MCQs. I don’t know how many students pay for this sort of additional tuition, nor how valuable it is. But when medical student education is running at 20K/40K per year, I am, as I say, disheartened. Anybody know more than me in terms of numbers and value?

I haven’t read the full article, as I do not subscribe. The Wellcome Trust newsletter, SPIN, quoted as follows:

The science and universities minister, David Willetts, has expressed concerns over the numbers of students pursuing medical degrees, pointing to the fact that “the number of young people – and it does tend to be more girls than boys – with an aspiration to do medicine way exceeds the number of places that the NHS is likely to have.” With a need for more engineering students, Willetts bemoaned a university application system which saw good candidates unable to switch courses because they had not taken a physics A-level.

The Times article begins:

Bright students, particularly girls, are being encouraged to become engineers rather than doctors because of a “gross excess” of applicants for medical degrees.
Medical schools across the country received more than 11 applications for every place last year compared with fewer than nine applications in 2008, new figures have revealed. David Willetts, the universities minister, said the level of competition to pursue a career in medicine was “one of the most dysfunctional features” of the education system.

It is the first time I have seen the issue raised in the mainstream press of how sensible medicine is as a future career, specifically in relation to the number of jobs that there may be. I am not convinced that the need for doctors, is the same as the needs of the NHS. Nor am I clear whether the article is suggesting that engineering and medicine are ‘close’ to one another in terms of professional activity. People fail to understand that the need for scientific underpinning in various professions, is far less important than the ‘professional activities’ and learned habits needed. How often do we need our quadratic equations, or Newton’s law of motion. Arithmetic and writing, yes. The rest is up for grabs.

I posted a few days back about economics students rebelling against much of what they are taught. I wonder what the equivalent grounds for dissent for medical students would be. Possibly the confusion between being trained to work in the NHS, and being educated to practice medicine. Perhaps.

John Kay, as ever, has an article full of insights about the issue, and he thinks the students have a point (as I do). Part of the issue is that the academy always prefers formal methods over informal or tacit knowledge. This, to me at least, was one of the key insights Herb Simon made in his book the Sciences of the Artificial. Serious engagement with students is difficult because as Kay states:

In no other subject [other than economics] do students express such organised dissatisfaction with their teaching. It seems, however, to little lasting effect. Impermanence is inherent in student life: they don suits, collect their first salary and leave their complaints behind until the same gripes are rediscovered by a new group of 19-year-olds with similar naive hopes of changing the world.

He is right. But his most important point is the broader one:

One cause of the problem is not specific to economics. Modern universities prize research above teaching, to a degree that would astonish people outside the system, who imagine its primary purpose is to educate the young. In reality, teaching ability plays a negligible role in university hiring, tenure and promotion decisions. Many academic staff regard teaching as a nuisance that gets in the way of their “own” work. If most students were not having such a good time outside the classroom, they would be angrier than they are. They should be.

So, if they have a duller social life, we might yet see some barricades to education overturned.

Referring to a paper in PNAS:

To weigh the evidence, Freeman and a group of colleagues analyzed 225 studies of undergraduate STEM teaching methods. The meta-analysis, published online today in theProceedings of the National Academy of Sciences, concluded that teaching approaches that turned students into active participants rather than passive listeners reduced failure rates and boosted scores on exams by almost one-half a standard deviation. “The change in the failure rates is whopping,” Freeman says. And the exam improvement—about 6%—could, for example, “bump [a student’s] grades from a B– to a B.”

“This is a really important article—the impression I get is that it’s almost unethical to be lecturing if you have this data,” says Eric Mazur, a physicist at Harvard University who has campaigned against stale lecturing techniques for 27 years and was not involved in the work. “It’s good to see such a cohesive picture emerge from their meta-analysis—an abundance of proof that lecturing is outmoded, outdated, and inefficient.”

We understand the world through metaphor, and the ones we choose have a deep impact on how we manipulate our thoughts and the world. In medicine, many parallels have been drawn between aviation and health care. I am thinking of checklists, protocols and the like. On the other hand regulators talk about doctors as ‘scholars’ and ‘teachers’ and so on.
An article by Ha-Joon Chang and Jonathan Aldred, caught my eye. The topic is what to do about economics teaching, post 2008. As far as I can see, despite students being aware the academy is behind the times, little has changed.

There is no doubt that these models, and related research in “econophysics”, represent a promising new research direction in macroeconomics. But that does not make them, even in simplified form, candidates for a new undergraduate curriculum. Most graduate economists will have no contact with these models in their careers; a few of them may need, at most, to understand their broad insights. A civil servant in the Government Economic Service expressed the requirements for the latter group pithily: government economists need to know how to drive the car, not build it.

I think this goes for medicine too. “Government economists need to know how to drive the car, not build it.” Doctors are not the people who design or build planes: we fly them. Less physics, not even too much applied engineering. More like bus drivers in the sky, or taxi drivers of the ward.

Source: New York Times

Gregory Hays shares some nuanced thoughts on MOOCs, on reviewing a book and MOOC by Gregory Nagy.

Will the MOOC revolutionize education in a few short years, as the Virginia conspirators persuaded themselves? Will it remain a marginal though useful supplement to conventional college, like the Open University or the correspondence courses of the 1920s? Will it be merely a playground for retirees and intellectual hobbyists, the digital successor to “great lectures on tape”? Or will it prove an evolutionary cul-de-sac, like the fifth-grade filmstrip of the 1970s?

None of these questions really seems answerable as yet. In its current version, in fact, Nagy’s MOOC feels a lot like a conventional large lecture class: there’s a textbook, a professor who does most of the talking (sometimes alone, sometimes in obviously staged “dialogues”), a virtual discussion section, and tests in multiple choice and short-answer formats. As one browses the website one is struck by the ordinariness of the whole thing—even the classroom dynamics. Some participants are being lectured about courtesy on the bulletin boards, modern Greek students are insisting that only they can really understand Homer, and still others are—well, perhaps “disconnected” is the right word.3

None of this should surprise. It’s typical for new technologies initially to mimic an existing one; Gutenberg’s forty-two-line Bible is not easy to distinguish from a manuscript copy. It takes time to figure out what a new medium can do besides the same thing bigger, faster, or cheaper, and for its particular strengths and weaknesses to emerge. Fifty years after Gutenberg, printing had shown itself vastly superior for Bibles and legal texts, a cheap substitute for deluxe books of hours, and no replacement at all for wills, inventories, and personal letters.

His final sentence:

It is, after all, a medium, not a message. And as the typographer Alvin Doyle Moore observed, “if you’re really good, you can do it anywhere—even on the ground with a stick.”