Apparently it was first said about theories in Psychology, but it applies as well in learning sciences: “Theories are like toothbrushes. Everyone has their own and no one wants to use anyone else’s”.

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Whenever I hear or read the phrase ‘learning outcomes’ I think of the story ‘On Exactitude in Science’ by Jorge Luis Borges. It is a short story, very short in fact, coming in at fewer than 150 words. So the danger in attempting to describe what it is about, is that you use more words than Borges himself. The hazards of summary or précis is of course part of its subject. So here it is:

…In that Empire, the Art of Cartography attained such Perfection that the map of a single Province occupied the entirety of a City, and the map of the Empire, the entirety of a Province. In time, those Unconscionable Maps no longer satisfied, and the Cartographers Guilds struck a Map of the Empire whose size was that of the Empire, and which coincided point for point with it. The following Generations, who were not so fond of the Study of Cartography as their Forebears had been, saw that that vast Map was Useless, and not without some Pitilessness was it, that they delivered it up to the Inclemencies of Sun and Winters. In the Deserts of the West, still today, there are Tattered Ruins of that Map, inhabited by Animals and Beggars; in all the Land there is no other Relic of the Disciplines of Geography.

—Suarez Miranda,Viajes de varones prudentes, Libro IV,Cap. XLV, Lerida, 1658

By learning outcomes I simply mean stating what you expect students to know or be able to do. I suspect there are lots of exegeses in the academic literature, but I assume this definition will suffice. In the context of medicine it seems especially important to be able to tell students what you expect them to know (for the record I do not believe that this is a sensible strategy in all contexts, just most).
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“A full 14 minutes into the 20-minute appointment, I realized that the patient sitting in front of me in the exam room was softly crying, her hands cradling the box of tissues that she had searched out herself. I had spent the majority of the appointment engaged in a frantic search through her extensive electronic medical record, and I cursed myself for being so buried in the computer screen that I had hardly glanced in her direction. Mrs. S had end-stage cancer, and my misguided chart review had revealed countless studies, medical therapies, and procedures that had done little to change her very poor prognosis. I turned the computer monitor off, wheeled my chair over, and gently took her hand. With five minutes left in the appointment, I discovered the real reason she had come to see me.”

William Bynum in Academic Medicine [Issue: Volume 89(2), February 2014, p 212–214]

Scary concept of the day:  “Global Governance”.

Former PM Gordon Brown hammered this home. The last thing we need is a European-style bureaucracy to act as a gate-keeper for higher education. Rich DeMillo at the World Economic Forum

The situation was a familiar one. Some time back, I was gossiping to a medical student, and he began to to talk about some research he had done, supervised by another faculty member of staff. I asked what he had found out: what did his data show? What followed, I have seen if not hundreds of times, then at least on several score occasions. A look of trouble and consternation, a shrug of embarrassment, and the predictable word-salad of ‘significance’, t values, p values, statistics and ‘dunno’. Such is the norm. There are exceptions, but even amongst postgraduates who have undertaken research, the picture is not wildly different. Rarely, without directed questioning, can I get the student to tell me about averages, or proportions, using simple arithmetic. A reasonable starting point surely. ‘What does it look like if you draw it?’ is met with a puzzled look. And yet, if I ask the same student, how they would manage psoriasis, or why skin cancers are more common in some people than others, I get —to varying degrees—a reasoned response. I asked the student how much tuition in statistics they had received. A few lectures was the response, followed by a silence, and then, “They told us to buy a book”. More silence. So this is what you pay >30K a year for? The student just smiled in agreement. This was a good student.

Statistics is difficult. Much statistics is counter-intuitive and, like certain other domains of expertise, learning the correct basics often results in a temporary —or in some cases a permanent —drop in objective performance.**  That is, you can make people’s ability to interpret numerical data worse after trying to teach them statistics. On the other hand, statistics is beautiful, hard, and full of wonderful insights that debunk the often sloppy thinking that passes for everyday ‘common sense’. I am a big fan, but have always found the subject anything but easy. But, like a lot of formal disciplines, the pleasure comes from the struggle to achieve mastery. I also think the subject important, and for the medical ecosystem at least, it is critical that there is high level expertise within the community. On the other hand, in my experience many of the very best clinicians are (relatively) statistically illiterate. The converse is also seen.

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Sometimes we try to make ourselves smarter. We call that research. Sometimes we try to make our peers smarter. We call that publishing. Sometimes we try to make our students smarter. We call that teaching. And that’s it. That’s all there is. These are important jobs for sure, and they are hard jobs at times, but they’re not magic. And neither are we.

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It is hard to find anything in the Scotsman worth writing about. Newspapers and good journalism are victims of the medium I am writing in. But here is something.  Sir Harry Burns, is stepping down from his role as Chief Medical Officer for Scotland, and taking up a position in Global Public Health at the University of Strathclyde. I am a little bit cynical about the academic bandwagon of ‘Global Public Health’. Much of it seems to miss the point that Sydney Brenner with characteristic insight made many years ago: the most common disease on this planet is MDD. Otherwise known as money-deficiency-disease. Correcting this is not straightforward— and medicine has an important, but limited role— but, as Bruce Charlton pointed out, industrialisation and capitalism has lifted more people out of poverty in the last quarter century (and hence cured more people with MDD) than public health research funding. Too often I am suspicious academics are trying to mine away at a newly exposed seam of research funding, rather that solve problems. Exceptions all around; Paul Farmer and the like, I accept. What however is worthy of mededed.me, is that Burns takes a broadside at the way we train doctors.

Looking back on his time as CMO, Sir Harry said there were still issues needing addressed. “I am not happy with the way we train young doctors now,” he said. “As I look at young people training in medicine now, I think their opportunity to do the kind of things that I have done, which has been a very varied career, I think those opportunities are harder to deliver now. “How they are trained now is very rigid. What I did in moving from surgery to public health would be really difficult now. “There’s an over-emphasis on ticking boxes, as opposed to encouragement of innovation and new ways of looking at your career.”

Well, I couldn’t agree more. But walk down any hospital corridor in Scotland and many doctors will tell you postgraduate training is a mess, and has been getting worse. Yet, each year, another report will spew forth from one of the various Bunkers in London, and yet more tick-boxing will be enforced, alongside more debasement of the English language. And the position in Scotland, under Burns’ watch, is arguably worse than in other parts of the UK. I used to wonder how people in the former eastern bloc melded official doctrine, with their private thoughts. How did they reconcile their inner beliefs with all the bullshit. I now know— as do a lot of doctors. Too much of medical education is about producing widgets for the NHS, wrapped up in an unwholesome diet of newspeak and doublethink. The problems are that we do not know what sort of widgets we might want, and second, many of us do not think medical education should be in the widget business. There is plenty left to do in the UK.

Citation classics tend to be cited more often than read

Edwin AM Gale

Think of our current institutions as powerful chisels, relentlessly chipping away at our edges until we fit neatly into the tightly defined roles that our institutions have created. (John Hagel)