Medical education in an age of austerity

by reestheskin on 23/09/2019

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There is a collection of articles on health care in the FT today. This caught my mind:

At the same time, there has been a growing “pull” from the UK and other richer nations for doctors and nurses from Africa, as their own health systems have struggled to train and retain sufficient local healthcare workers while demand from ageing populations continues to rise.

I am aware of the issue but keep being pulled back to the claims about how expensive it is to train doctors (in the UK or other similar countries). Yes, I know the oft wheeled out figures, but I am suspicious of them.

Fast and slow

by reestheskin on 18/09/2019

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Chambers Street is closed for the filming of Fast and Furious 9, or so my regular barista at Bobby’s tells me. I was only was there a minute or two before it was shutting up shop time for this scene anyway. But even on this hurried snap you can see all the infrastructure necessary for a second or two of film — or an unused reel.

Last week, on a beach, I read The Pigeon Tunnel, reminisces by John let Carré,  one of my favorite authors. One of the themes is the solitary nature of much of his creation: the silent scribbling outwith this world, looking in. Another is the complexity and interconnectness of film making.

Which all makes my wonder about teaching, learning and education. Where do we belong?

Job of an academic

by reestheskin on 06/09/2019

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Whatever the context(s) of these events, the words are right.

The job of a scientist is to look for the truth, and the job of a teacher is to help people to empower themselves. I failed to do my job on both counts.

It is however not just the job of scientists.

I am writing to apologize to Jeffrey Epstein’s victims

All that glitters in silicon

San Francisco conducted its biennial point-in-time homelessness survey. The numbers are up sharply. Two observations: first, most people are from SF, not (contrary to myth) from elsewhere; and second, there are more people sleeping on the street in San Francisco (population: 870k) than in the whole of the UK (population: 66m). Link

Benedict’s Newsletter: No. 296

Wellbeing

by reestheskin on 29/08/2019

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 Size matters

Pace my earlier post, The Economist writes about the increase in student numbers at many UK universities (and falls at others).

There is lots of variation, but in general elite institutions have been the biggest growers. Some, including Oxford and Cambridge, have chosen not to expand. But most prestigious universities have sucked up students, grateful for their fees, which subsidise research. The intake of British students at members of the Russell Group of older, research-focused universities has grown by 16% since restrictions were lifted. Some have ballooned. Bristol’s intake has shot up by 62%, Exeter’s by 61% and Newcastle’s by 43%.

Increases in intake do not automatically mean a worsening of what is on offer, but the difference between Oxbridge and the Russell group shout out at you: some are more equal than others.

The winners and losers of England’s great university free-for-all – Searching for students

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Education is an experience understood in tranquillity

Nice few words about Charles Handy in the Economist who has been recovering from a stroke. He has had to relearn walking, talking and swallowing.

As far as Mr Handy was concerned, the point of his hospital stay was to allow him to recover as fully as possible. That meant he needed to be up and about. In the view of the nurses, that was a potential problem; he might fall and hurt himself. Their priority was to keep him safe. In practice, that required him to stay in bed and keep out of trouble.

He mused on some themes all too familiar, namely how the organisational obsession with efficiency often results in organisations not being effective.

The purpose of education is to prepare children for later life, but all too often the focus is on getting the children to pass exams.

He saves some special words for Human Remains Resources:

As it is, there is a temptation to try to turn people into things by calling them “human resources”. Call someone a resource, and it is a small step to assuming that they can be treated like a thing, subject to being controlled and, ultimately, dispensed with when surplus to requirements.

(The most egregious example of the above is how NHS management refer to preregistration doctors as ‘ward resources’ rather than doctors who are apprenticed to other doctors.)

Sadly his knowledge of the type of modern corporation we call ‘universities’ is out of date.

Indeed, Mr Handy argues that most organisations whose principal assets are skilled people, such as universities or law firms, tend not to use the term “manager”. Those in charge of them are called deans, directors or partners. Their real job is best described as leadership rather than management. And one of the primary functions of leadership is setting the right purpose for an organisation.

If only.

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“I have wasted a lot of time living”

John Gray on Michael Oakeshott

He would have found the industrial-style intellectual labour that has entrenched itself in much of academic life over the past twenty-odd years impossible to take seriously. He wrote for himself and anyone else who might be interested; it is unlikely that anyone working in a university today could find the freedom or leisure that are needed to produce a volume such as this. Writing in 1967, Oakeshott laments, ‘I have wasted a lot of time living.’ Perhaps so, but as this absorbing selection demonstrates, he still managed to fit in a great deal of thinking.

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Shorting the truth.

by reestheskin on 21/08/2019

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Awhile back I was sat in a cafe close to the university campus. I couldn’t help but listen in on the conversation of a few students who were discussing various aspect of university life, and their own involvement in student politics. I couldn’t warm to them: they were boorish and reminded me of a certain Prime Minister. But I did find myself in agreement on one point: many UK universities are too big and if you are really serious about undergraduate education, you need smaller institutions than is the norm in the Russell group. You can have large institutions and teach well — the Open University is the classic example historically — but Russell group universities are not designed for the same purpose.

A few months back there was an interview in the Guardian with Michael Arthur, the Vice Chancellor of University College, London (UCL). In it he said some extraordinary things. Not extraordinary in the sense that you have might not have heard them before, or that they were difficult to grasp. Just extraordinary in their banality of purpose.

UCL like many universities in the UK has and will continue to rapidly expand undergraduate student numbers. The interviewer asked him whether or not UCL was not already too big. Arthur replied:

“We want to be a global player,” says Arthur. “Round the world, you’re seeing universities of 90,000, 100,000 students. If you have critical mass, you can create outstanding cross-disciplinary research on things like climate change. You can do research that makes a difference.” He mentions a treatment recently developed at UCL that makes HIV, the virus that causes Aids, untransmittable. If UCL didn’t increase student numbers, thus maximising fee revenue, such research would have to be cut back. “To me,” Arthur says, “that is unthinkable.”

The tropes are familiar to those who have given up serious thinking and have short attention spans: ‘global player’, ‘critical mass’, ‘cross disciplinary’, ‘make a difference’, and so on. Then there is the ‘maximising fee revenue’ so that research is not cut back — “that is unthinkable”

Within the sector it is widely recognised that universities lose money on research. In the US in the Ivy League, endowments buffer research and in some institutions, teaching. In the UK, endowments outwith Oxbridge are modest, and student fees fund much research. As research volume and intensity increases, the need for cross subsidy becomes ever greater. This is of course not just within subjects, but across the university and faculties.

That universities lose money on research is a real problem. For instance, in medicine much research is funded by charities who do not pay the full costs of that research. Governments pretend they fill this gap, but I doubt that is now the case. Gaps in research funding are therefore being made up out of the funds that are allocated to educate doctors, or students in other subjects. And anybody who has been around UK universities for a while knows that a lot of the research — especially in medicine — would have at one time being classed as the D of R&D. This sort of work is not what universities are about: it is just that the numbers are so large that they flatter the ‘research figures’ for the REF (research excellence framework).

Pace the students in the cafe, few can mount any argument that once you have grown beyond several thousand students that the student experience and student learning worsen. Phrases such as ‘research-led teaching’ and ‘exposure to cutting edge research’ are common, but the reality is that there is little evidence to support them in the modern university. They are intended as fig leaves to mask some deeper stirrings. Arthur states that it ‘would be unthinkable’ to cut back on research. He may believe that, but I doubt if his self-righteousness is shared by the majority of students who spend much of their lives paying off student debts.

A few years ago, whilst on a flight to Amsterdam, I chatted with a physicist from a Dutch university. We talked about teaching and research. He was keen on the idea of situating institutions that resembled US liberal arts colleges (as in small colleges) within bigger and more devolved institutions. I doubt that would be practical in the UK — the temptation for the centre to steal the funds is something VCs (Vice Chancellors not Venture Capitalists, that is) would not be able to resist. The late Roger Needham, a distinguished Professor of Computing at Cambridge, and former head of Microsoft Research in Cambridge, pointed out that most IP generated by universities was trivial and that the most important IP we produced were educated and smart students. He was perhaps talking about PhDs and within certain domains of knowledge, but I will push beyond that. Educating students matters.

And contrary to what Arthur thinks many of the world’s best universities have far fewer students than UCL even before its recent metastatic spread.

A Study in the History of Civilisation

A remarkable book by a remarkable man. But what ambition!

 

 

 

 

 

 

 

 

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Send in the clown

But what lies ahead for Johnson in those uncharted waters? His best joke was not meant to be one. In November 2016 he claimed that “Brexit means Brexit and we are going to make a titanic success of it.” In this weirdly akratic moment of British history, most of those who support Johnson actually know very well that Brexit is the Titanic and that his evasive actions will be of no avail. But if the ship is going down anyway, why not have some fun with Boris on the upper deck? There is a fatalistic end-of-days pleasure in the idea of Boris doing his Churchill impressions while the iceberg looms ever closer. When things are too serious to be contemplated in sobriety, send in the clown.

The Ham of Fate | by Fintan O’Toole | The New York Review of Books

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NHS founder’s relative died after ‘neglect’.

by reestheskin on 26/07/2019

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A relative of Nye Bevan, the founder of the NHS, died after serious mistakes by two hospital trusts meant his lung cancer went from treatable to incurable… 

Link

(Image courtesy of Alun of Penglas).

Summer flight

by reestheskin on 26/07/2019

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Not so much a jet plane, but I don’t know  exactly when I will be back either.

 

Smombies everywhere

My youngest daughter lived in South Korea for a while and I visited on a couple of occasions. It was a lot of fun in all sorts of ways. The following rings(!) true

The government initially tried to fight the “smombie” (a portmanteau of “smartphone” and “zombie”) epidemic by distributing hundreds of stickers around cities imploring people to “be safe” and look up. This seems to have had little effect even though, in Seoul at least, it recently replaced the stickers with sturdier plastic boards.

Instead of appealing to people’s good sense, the authorities have therefore resorted to trying to save them from being run over. Early last year, they began to trial floor-level traffic lights in smombie hotspots in central Seoul. Since then, the experiment has been extended around and beyond the capital. For the moment, the government is retaining old-fashioned eye-level pedestrian lights as well. But in future, the way to look at a South Korean crossroads may be down.

A dangerous creature is haunting South Korean crossroads – Smombie apocalypse

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Software is eating..

Comparison of the accuracy of human readers versus machine-learning algorithms for pigmented skin lesion classification: an open, web-based, international, diagnostic study.

You can dice the results in various ways, but software is indeed eating the world — and the clinic. The (slow) transition to this new world will be interesting and eventful. A good spectator sport for some of us. (Interesting to note that this study in Lancet Oncology received no specific funding. Hmmm).

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What is science for: dangerous thoughts.

The quote below was from a piece in the Lancet by Richard Horton.

Reading [Bertrand]Russell today is a resonant experience. Existential fears surround us. Yet today seems a long way from the dream of Enlightenment. Modern science is a brutally competitive affair. It is driven by incentives to acquire money (research funding), priority (journal publication), and glory (prizes and honours). Science’s metrics of success embed these motivations deep in transnational scientific cultures. At The Lancet, while we resist the idea that Impact Factors measure our achievements, we are not naive enough to believe that authors do not judge us by those same numbers. It is hard not to capitulate to a narrow range of indicators that has come to define success and failure. Science, once a powerful force to overturn orthodoxy, has created its own orthodoxies that diminish the possibility of creative thought and experiment. At this moment of planetary jeopardy, perhaps it is time to rethink and restate the purpose of science.

Offline: What is science for? – The Lancet

I am just musing on this. We like to think that ‘freedom’ was necessary for a modern wealthy state. We are not so certain, now. We used to think that certain freedoms of expression underpinned the scientific revolution. We are having doubts about this, too. Maybe it is possible to have atom bombs and live in a cesspool of immorality. Oops…

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Living in Scot itchland

Genital scabies was, to the English, “Scotch itch,” and Scotland was “Itch-land.” The pox was the Spanish or Neapolitan Disease to the French; the French Disease to the Spanish, English, and Germans; the Polish Disease to the Russians; the Portuguese Disease to the Japanese. Captain Cook was chagrined to learn that it was called the British Disease in Tahiti as, in so many words, it was in Ireland: in Ulysses the Citizen, a rabid Irish nationalist, mocks Leopold Bloom’s reference to British civilization: “Their syphilisation you mean.”

Vile Bodies | by Fintan O’Toole | The New York Review of Books

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Wigged out!

“There is no urgent need to go discarding something which has been out of date for at least a century.”

The Economist | Wigged out

This quote refers to the wigs judges in the UK wear. But it seems apposite for much of the way we think about medical education.

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Mental Health Services for Medical Students

Medical students have higher rates of depression, suicidal ideation, and burnout than the general population and greater concerns about the stigma of mental illness. The nature of medical education seems to contribute to this disparity, since students entering medical school score better on indicators of mental health than similarly aged college graduates. Roughly half of students experience burnout, and 10% report suicidal ideation during medical school

NEJM

This is from the US, and I do not know the comparable figures for the UK. Nor as I really certain what is going on in a way that sheds light on causation or what has changed. By way of comparison, for early postgraduate training in the UK, I am staggered by how many doctors come through it unscathed. I don’t blame those who want to bail out.

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Statistics and empathy

An economist may have strong views on the benefits of vaccination, for example, but is still no expert on the subject. And I often cringe when I hear a doctor trying to prove a point by using statistics.

Age of the expert as policymaker is coming to an end | Financial Times

There were some critical comments about this phrase used by Wolfgang Münchau in a FT article. The article is about how ‘experts’ lose their power as they lose their independence. This is rightly a big story, one that is not going away, and one the universities with their love of mammon and ‘impact’ seem to wish was otherwise. But there is a more specific point too.

Various commentators argued that because medicine took advantage of statistical ideas that doctors talked sense about statistics. The literature is fairly decisive on this point: most doctors tend to be lousy at statistics, whereas the medical literature may or (frequently) may not be sound on various statistical issues.

Whenever I hear people talk up the need for better ‘communication skills’ or ‘communication training’ for our medical students, I question what level of advanced statistical training they are referring to. Blank stares, result. Statistics is hard, communicating statistics even harder. Our students tend to be great at communicating or signalling empathy, but those with an empathy for numbers often end up elsewhere in the university.

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It’s the economy stupid!

The main story is about an ‘anti-vaxxer’ who had informed the university that he/she was opposed to receiving any vaccinations, but the university had not noticed or acted upon this advice till after the student had started univeristy. Cardiff university were ordered to pay £9K to the anti-vaxxer healthcare student.

Cardiff ordered to pay £9K to anti-vaxxer healthcare student | Times Higher Education (THE)

But this caught my eye even more.

In a separate case summary, also published on 1 July, the OIA said that it had told Wrexham Glyndwr University to compensate eight students who had complained about the quality of a healthcare-related course.

The watchdog said that the students had complained that a key part of the course had not been taught as promised, meaning that they were not given the necessary skills to practise safely. Some teaching hours were cancelled for some modules, and the group also complained about the behaviour of a staff member, who they said was “unapproachable and aggressive”.

The OIA, which ruled that the complaint was partly justified, said that Glyndwr should refund tuition fees of £2,140 to each student, and pay an additional £1,500 compensation to each of them for the inconvenience caused.

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The digital skin web

On some Swedish trains, passengers carry their e-tickets in their hands—literally. About 3,000 Swedes have opted to insert grain-of-rice-sized microchips beneath the skin between their thumbs and index fingers. The chips, which cost around $150, can hold personal details, credit-card numbers and medical records. They rely on Radio Frequency ID (RFID), a technology already used in payment cards, tickets and passports.

Why Swedes are inserting microchips into their bodies – Bjorn Cyborg

One of these is going to end up being sectioned as some time….waiting for the first case-report. Not often I can get two puns in a three word title.

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Sunday in Lisbon

“Catholicism imbued a spirit of rebellion and the ghost of faith.”

Well, I get that, too. In a review of Bruce Springsteen’s biography in the Economist.

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Did you enjoy Uni?

“The job prospects outweigh three years of misery.”

The Economist | The glum ones

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On  ratio scales and the spirits of invention

It is said that much of the foundations of 20th century physics was done in coffee houses (or in the case of Richard Feynman in strip bars), but things were once done differently in the UK

With neither institutional nor government masters to answer to, the British cyberneticians were free to concentrate on what interested them. In 1949, in an attempt to develop a broader intellectual base, many of them formed an informal dining society called the Ratio Club. Pickering documents that the money spent on alcohol at the first meeting dwarfed that spent on food by nearly six to one — another indication of the cultural differences between the UK and US cyberneticians.

The work of the British pioneers was forgotten until the late 1980s when it was rediscovered by a new generation of researchers… A company that I cofounded has now sold more than five million domestic floor-cleaning robots, whose workings were inspired by Walter’s tortoises. It is a good example of how unsupported research, carried out by unconventional characters in spite of their institutions, can have a huge impact.

A review from 2010 by Rodney Brooks of MIT of “The Cybernetic Brain: Sketches of Another Future” in Nature (For more on Donald Michie and “in spite of their institutions” see here).

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Chadgrind lives on

I have had of all people a historian tell me that science is a collection of facts, and his voice had not even the ironic rasp of one filing-cabinet reproving another.

Jacob Bronowski | Science and Human Values

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Precision medicine and a den of robbers

I have removed the name of the institution only because so many queue to sell their vapourware in this manner

Precision Medicine is a revolution in healthcare. Our world-leading biomedical researchers are at the forefront of this revolution, developing new early diagnostics and treatments for chronic diseases including cancer, cardiovascular disease, diabetes, arthritis and stroke. Partnering with XXXXX, the University of XXXX has driven … vision in Precision Medicine, including the development of a shitload of infrastructure to support imaging, molecular pathology and precision medicine clinical trials……  XXXXXX is now one of the foremost locations in a three mile radius to pursue advances in Precision Medicine.

And He declared to them, “It is written: ‘My house will be called a house of prayer. But you are making it ‘a den of robbers.'” Matthew 21:13

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The pleasures of tenure

Mr Sammallahti is not a recluse, nor lacking in ambition. He travels the world taking photographs; a book, “Here Far Away”, was published in 2012; another, of bird pictures, comes out later this year. But he shuns the art scene, believing that commercial pressures undermine quality. He does not lecture and rarely gives interviews. In 1991 he received an unprecedented 20-year grant from the Finnish government. Its sole condition was that he should concentrate on photography, so he gave up teaching. “I want to work in peace,” he explains, “to be free to fail.”

Economist

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TEF or REF?

Smith was supported by earnings from his professorship at Glasgow, where a university teacher’s earnings depended on fees collected directly from students in the class. This contrasted with Oxford, where Smith had spent six unhappy years, and where, he observed, the dons had mostly given up even the pretence of teaching.

But Smith relinquished his professorship in 1763, and the writing of ‘Wealth…’ and the remainder of his career was financed by the Duke of Buccleuch, who as a young man employed Smith as a tutor.

Is there more to Adam Smith than free markets? | Financial Times

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On statistics

Statistics — to paraphrase Homer Simpson’s thoughts on alcohol — is the cause of, and solution to, all of science’s problems.

Andrew Gelman

Of chaos, storms and forking paths: the principles of uncertainty

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