Nice graph, via John Naughton.  Well, indeed correlation is not proof of causation, but a la Judea Pearl and others, correlation may tell you a bit about causal structures.

Via a great article on the canons of computer software by Paul Ford

‘What a superb medical education we received. It enthused us about every branch of medicine’ …..Now that would be a learning outcome to shout about.

 

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It is not a real crisis, but perhaps not far from it. People have looked upon science as producing ‘reliable knowledge’, and now it seems as though much science is not very reliable at all. If it isn’t about truth, why should we consider it special? Well, a good questions for an interested medical student to think about. But hard to do so. Part of the answer lies with statistical paradigms (or at least the way we like to play within those paradigms), part with the sociology and economics of careers in science, and part with the means by which modern societies seek to control and fund ‘legitimate’ science. Let me start with a few quotes to illustrate some of the issues.

A series of simple experiments were published in June 1947 in the Proceedings of the Royal Society by Lord Rayleigh–a distinguished Fellow of the Society–purporting to show that hydrogen atoms striking a metal wire transmit to it energies up to a hundred electron volts. This, if true, would have been far more revolutionary than the discovery of atomic fission by Otto Hahn. Yet, when I asked physicists what they thought about it, they only shrugged their shoulders. They could not find fault with the experiment yet not one believed in its results, nor thought it worth while to repeat it. They just ignored it. [and they were right to do so]
The Republic of Science, Michael Polanyi

[talking about our understanding of obesity] Here’s another possibility: The 600,000 articles — along with several tens of thousands of diet books — are the noise generated by a dysfunctional research establishment. Gary Taubes.

 

“We could hardly get excited about an effect so feeble as to require statistics for its demonstration.” David Hubel, Nobel Laureate (quoted in Brain and Visual Perception)

The value of academics’ work is now judged on publication rates, “indicators of esteem,” “impact,” and other allegedly quantitative measures. Every few years in the UK, hundreds of thousands of pieces of academic work, stored in an unused aircraft hangar, are sifted and scored by panels of “experts.” The flow of government funds to academic departments depends on their degree of success in meeting the prescribed KPIs [key performance indicators]. Robert Skidelsky

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Shiv M. Gaglani, BA, and M. Ryan Haynes  in an article in Annals of Internal Medicine.

The title may raise hackles, but they are more right than wrong. One of the problems with the one-to-many lecture dominated undergraduate model, with minimal repeated contact between staff and students, is that feedback both for students and staff is scarce. The importance of feedback to staff  (and I do not mean the silly popularity charts) is often forgotten in the usually justified critiques of lack of (student) feedback.

Many students, in some cases as many as 80% (3), choose re- corded lectures over live ones because they can be paused, rewound, and played at various speeds. This generates data that may be used to create heat maps of individual lectures. Suppose 50 students watch a recorded lecture and 30 of them pause and rewind the video at time point 28:30. It would be statistically possible to infer that the concept being discussed at this point was unclear, and the professor involved could be notified with actionable insights…..

For example, if a student spends more time on average viewing documents in the neurology versus the cardiology block, it can be inferred that she is either more interested in or confused by the former’s subject material.

They also have some useful things to say about the limitations of learning management systems (sic)

universities care about undergraduates just enough to require a thousand of them to fill a lecture hall, now they are doing it online so the numbers can get much bigger. It’s all about money.

 

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One of my favourite papers about medical education was an article Geoff Norman wrote called ‘Medical expertise and mashed Potatoes’. In it he recounts a meeting with the famous chef Albert Roux. Norman uses the encounter to point out the similarities between expertise in what seems like very different domains. Since I have recently  almost lost the will to live  having tried to gorge on an ultimately inedible diet of pseudo-competency based descriptions of what doctors ‘are’ (really, the Danish devote pages to an exegesis of the  CanMEDS, and tweaking of where to put ‘professionalism’ in a schema of what doctors ‘are’!) They all need to get a dose of Wittgenstein to see the folly of their ways..) Anyway I digress.

Medicine was historically an apprenticeship, but our problem (well, actually the students problem) is that in large part this is not mirrored in the way we organise it at the undergraduate level. As Alice Gopnik, the psychologist once remarked, at university we tend to think the way to teach people how to cook, is to lecture then for three years and then, and only then, allow them to crack an egg. Here is a nice video from the NYT of people who understand education much better than we do. The video, and Norman’s article, say more than the ever enlarging girth of the working groups.

I have never taught in a school, just been a pupil. I do remember the sparring that goes on between pupils and teacher. The kids push ‘to the limit’. They then improvise just under this limit, causing trouble. My thought was that teachers could either define limits carefully or, to be slightly evil, just behave in an inconsistent manner. For the latter, think: random acts of terror! In this scenario, the kids can never quite work out any rules of engagement, and will sit there terrified in silence. Evil, I know.

I wonder whether this approach might be useful for learning outcomes. Rather than taking part in an evolutionary war between the students on one hand who want ever more explicit statements of what they should know, and on the other, the inevitable ignoring of all aspects of knowledge that cannot be explicitly stated, we should aim for a little more disorganisation. We shouldn’t tell the students what they need to know, and we certainly shouldn’t tell them the format of the exam, or even when it is. What do they need to know? Lots. Pay attention. Evil, I know.

Talking the familiar text book as an example,  American researcher David Wiley compares the cost of renting 75,000 movies  ($9.00 a month  fromNetFlicks) or renting  any of 20 million songs from Spotify  ($9.99/month) with the cost of renting a college text book . A single biology text book rents for $12.99 a month from BookRenter.  This cost imbalance is especially vexing in that consumers choose to rent movies or songs, while professors (often in collusion with publisher representatives) choose the textbooks that others (the students) pay for.

 

Terry Anderson writes

Around 20 years ago my father was admitted to a major teaching hospital in Wales. He was in his early 70’s and had heart failure. He was under the care of the ‘general medics’, on a general medical ward. He became mildly confused after admission, and within a couple of days had fallen in the bathroom, and was developing red areas on pressure points, a harbinger of pressure sores. I remember talking to one of the nurses, who was apologetic that there was no possibility of getting a suitable bed (‘there isn’t the money’), and that he had fallen when he should have been supervised. The poor nurse was literally run off her feet, a couple of nurses trying to cope with a score or more of patients. I was probably fairly cross, and not concealing it well—but so was she, reasonably so. She and I both knew how things could be made better. Both of us found it uncomfortable, because both knew that key decisions about care are usually made by people who don’t see patients, or have first hand knowledge of the ‘front-line’ (remember the Ballad of Reading Jail: prisons have walls, not so that convicts can’t escape, but so that God cannot see what goes on inside).
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