Higher education

My organ is bigger than your organ

by reestheskin on 02/07/2020

Comments are disabled

One thing that sticks with me from medical school onwards (both as student and faculty) is the partisan nature of specialties. Most of this is harmless fun: my organ (skin, liver, kidney etc) is bigger than your organ; the brain is more complicated than any other organ and therefore neurologists must be smarter than everybody else (although curiously this doesn’t seem to stretch to neurosurgeons — at least when neurologists are talking). Let’s call it organ imperialism. The humour of little boys judging their vitality by how high they can p*** up the wall. There are more vital things to get angry about.

There are however some darker sides to this professional ethnicity. Doctors indulging in advocacy for particular patient groups can often seem like doctors wishing their own unit or disease of interest receives more resources. A salient example in dermatology is the way that NHS resources for cancer (or children) frequently trump other demands. It is easier to lobby successfully for skin cancer1 than acne or hair loss in the absence of any meaningful attempt to weigh patient suffering (or just to assume it is self-evident)2. The contrast between paediatrics and geriatrics is often informative about underlying values.

One area that does worry me more is the encroachment of politics on medical education. I am thinking in particular on a priori claims about the superiority of certain models of care, or the attempts to subvert student choice of career in the name of what the ‘NHS needs’.

Undergraduate medical education should be both scholarly and intellectually neutral as to how health care is organised. We should of course introduce students to the various systems, and encourage them to criticise them. We should teach them to be analytical, and to understand the various reasons why people have chosen different systems (or how their views are manipulated). But we should be neutral in the sense that judgments need to be based on rational argument rather than slogans, and that students must be able to argue based on evidence.

I would say the same about career choice. Our primary duty in a university is to students. If a university were to demand that their graduates in computing were only to work for a British computing company and confine themselves to topics of ‘national importance’, or that its graduates in economics were only to work for the public rather than the public sector, they would no longer be taken seriously as an educational institution. And rightly so. Medicine should be no different.

  1. And note my clinical interests were focussed on skin cancer.
  2. I am of course neatly sidestepping the existential difficulty of comparing oranges and apples here. Do not tell me that QUALYs are the answer: it is easy to construct a spreadsheet that tells you the area of skin involvement in a patient with psoriasis, but do not confuse this with the human judgment of whether somebody has bad psoriasis.

Graph of the day

by reestheskin on 26/06/2020

Comments are disabled

Another telling figure from Thomas Piketty’s Capital and Ideology. The stiking thing about much of this book is how predicable and widespread so many social trends are.

 

Graph of the day

by reestheskin on 25/06/2020

Comments are disabled

Another revealing figure from Thomas Piketty’s Capital and Ideology. French education is highly stratified but this pattern will be there in the UK too.

Autodidacticism

by reestheskin on 18/06/2020

Comments are disabled

Story 1

I started my dermatological career in Vienna in the mid-1980s as a guest (I am deliberately not using the cognate German term) of Prof Klaus Wolf. Vienna, for close to two hundred years, has been a Mecca for all things dermatological, and Sam Shuster, in Newcastle, thought it wise to go somewhere else for up to a year — before returning to Newcastle. The plan was to learn some clinical dermatology and see how others worked. I had a great time — Vienna is a wonderful European city – and I didn’t work too hard. I learned some clinical basics, enjoyed the music (more ECM than opera) and spent some of my time doing a little lab work, more as a technician than anything else. I knew that when I returned to Newcastle I would spend a year or so as a registrar before applying for a MRC or Wellcome Training Fellowship (and for the medics amongst you, no, I never registered for higher training). In the meantime, as well as learning some clinical dermatology, I needed to learn some cell biology.

I went to medical school in 1976 and qualified in 1982, having taken a year out to study medical statistics (with an emphasis on the medical) and epidemiology, so I hadn’t any lab or cell biological experience. It was now 1986-87 and the preceding decade has seen a revolution in what we now call molecular cell biology — or just biology(?). I needed to teach myself some. Luckily, the best textbook I have ever read — the Molecular Biology of the Cell was published by James Watson and a bunch of other wonderful scientists in 1983 and my memory is that it was this first edition I bought. The book had attitude. The authors clearly loved their subject, and thought science was to do not so much with facts but the activity of designing and implementing experiments that whispered to you how the biological universe worked. They wanted to share that feeling with you, because one day, just perhaps, you might… On the back cover there was a picture of the authors pretending to be real superstars like the ‘fab four’ on that most famous of pedestrian-crossings in the world. (There is more on this here and here)

In the company of a good companion (a book in this case) there is little in biology that is very difficult. If you are motivated, even the absence of a personal teacher is not too serious a drawback. You would be better off with a teacher — if the cost of teacher was zero — but it would be wasteful to imagine that you need a teacher for a significant fraction of the time you need to spend studying. For some areas of biology, say quantitive genetics, the above statements may need tweaking a little, but the general point holds.

Story 2

Almost a quarter century ago, I read a paper in PNAS on statistics by Peter Donnelly and David Balding on how to interpret DNA forensic evidence. I had studied a little statistics in my intercalated degree but a sentence from this paper made me sit up

We argue that the mode of statistical inference which seems to underlie the arguments of some authors, based on a hypothesis testing framework, is not appropriate for forensic identification.

The paper itself was remarkably clear even to somebody with little mathematics, and unpicking it signalled that I knew even less than I thought I knew. Several years later, it prompted me to go back and try and re-learn what little mathematics I had grasped at school, so that I might appreciate some modern genetics (and medical statistics) a little better.

Learning mathematics is different form learning biology. The absence of a teacher is more of an issue, but there are lots of historical examples showing that a good ‘primer’ with questions and answers allows many children to develop, if not high level skills, a facility with numbers. (I am talking here about using mathematics as a toolbox to follow how one can solve well defined problems — not push back the frontiers). A key aspect of this is the nature of mathematical proof, and how well you can obtain feedback on your abilities by submitting to the discipline of simple exercises with unambiguous answers. I don’t think there is a direct equivalent to this in most of biology but in the process of writing this today I see there are workbooks for the Molecular Biology of the Cell textbook. No doubt they help, but the uniqueness of the correct answer in maths is a wonderful guide and fillip.

Story 3

I retired earlier this year (yes, thanks for asking, it’s wonderful), and one of the projects I had lined up was to learn a little more about a domain of human knowledge in which my ignorance had been bugging me for years. I had made some attempts in this area before — bought some books as an excuse for lack of effort — but had failed. I had found an excellent primer (in fact I bought it ten or so years ago), but speaking of the present, I have to say that I find the task hard, very hard. For me, its tougher than intermediate mathematics, and although there are questions at the end of each chapters there are no given answers. This is not a criticism of the book, but rather reflects the nature of the subject. A teacher or even a bunch of fellow masochists students would help greatly. I make progress, but some more pedagogical infrastructure would, I feel, push me around the winding path a little faster. So, for several months I have been plodding away, mostly being disciplined, but because I have other things to do, occasionally falling off the wagon (indeed I note that I can multitask by falling off several wagons simultaneously).

All three stories are germane to how I think about undergraduate medical education and how it is far too wasteful and expensive. As for the how, that I must leave for another day very soon. Even without an exam in sight, I have to get some studying done. Spaced recall and immersion is the student’s friend.

Teach yourself medicine

by reestheskin on 10/06/2020

Comments are disabled

Being an emeritus professor has lots of advantages. You have time to follow your thoughts and allow your reading to take you where it goes. Bruce Charlton pointed out to me many years ago that increasingly academics were embarrassed if you caught them just reading in their office (worse than having a sly fag…). It was looked upon as a form of daydreaming. Much better to fire up the excel spreadsheet or scour the web for funding opportunities. Best of all, you should be grant writing or ensuring that the once wonderful idea that only produced some not-so-shiny results can be veneered into a glossy journal.

Of course, being retired means you don’t have to go to management meetings. For most of career I could reasonably avoid meetings simply because if you spend most of your time researching (as I did), all you care about is publishing and getting funded. The university is just a little bit like WeWork — only the finances are were stronger.

One aspect of teaching-related meetings particularly irked me: student representatives, and how people misunderstand what representatives should and shouldn’t contribute. This is not specific to meetings — the same problem exists in the ‘happy sheets’ that pass for feedback — but is what I see as a problem in inference. Humans are very capable of telling you how they feel about something especially if they are asked at the time of, or soon after, a particular event. What is much harder is to imagine what the results will be if a change is made in how a particular event is undertaken, and how this will relate to underlying goals. This is a problem of inference. It needs some theory and data. So, if students say Professor Rees doesn’t turn up for teaching sessions, or doesn’t use a microphone or uses slides with minuscule text in lectures, this is useful knowledge. What is less helpful, is when you wish to appear to be empathetic (‘student centred’) and allow students to demand that you accept their views on pedagogy. This is akin to the patient telling the surgeon how to perform the operation. Contrary to what many believe, a lot is known about learning and expertise acquisition, and much of it is very definitely not common sense. And do not get me started on bloody focus groups.

Having got that bitching out of the way, I will add that one of my jobs over the last few years was to read virtually all the formal feedback that students produced for the medical school. Contrary to what you might think, it was an enjoyable task and I learned a lot. The biggest surprise was how restrained and polite students were (I wished they would get a little more angry about some things), and often how thoughtful they were. There were the occasional gems, too; my favourite being a comment about a clinical attachment: ‘I am sure the teaching would have been of a high standard — if we had had any.’ Still makes me smile (and the latter clause was accurate, but I am not so sure about the rest).

Now, I don’t want to feign any humblebragging but a few weeks back I received this comment from a former (anonymous) student (yes, the university is efficient at stopping your pay-cheque but thankfully is not good at terminating staff and in any case I still do some teaching..).

“Honestly you just need to look through the website he has built (http://reestheskin.me/teaching/). Who else has created an open-access textbook, lord knows how many videos (that are all engaging and detailed enough without being overwhelmingly complex) and entire Soundcloud playlists that I listen to while I’m driving for revision. I bet you could learn to spot-diagnose skin cancers without even being medical, just learn from his websites.”

Now of course this is the sort of feedback I like 😂. But it’s the last sentence that pleases and impresses me most. The student has grasped the ‘meta’ of what I spent about seven years trying to do. There is an old aphorism that medical students turn into good doctors despite the best attempts of their medical school. Like many such aphorisms they are deeper than they seem. One of the foundation myths of medical schools is that undergraduate medicine really is as is was portrayed in Doctor in the House with just a smattering of modern political correctness thrown in. Sadly, no. Even without covid-19 universities and medical schools in particular are weaker than they seem. Demarcating what they can do well from things that others might do better needs to be much higher up the agenda. This particular student wasn’t taught that but learned it herself. Good universities can get that bit right occasionally.

Graph of the day.

by reestheskin on 08/06/2020

Comments are disabled

From Capital and Ideology, by Thomas Piketty. Discuss…

Online link

On sleeping through the lecture

by reestheskin on 27/04/2020

Comments are disabled

The papers — at least the FT and Guardian — are full of woes about COVID-19 and Higher Education in the UK (and to a lesser degree, elsewhere). My old VC (Tim O’Shea) pointing out that few UK universities are capable of delivering reasonable online teaching in the near future. As Warren Buffet is reported to have said, when the tide goes out you can see who has been swimming without a costume. Answer: lots of people. It is just that many universities preferred the bums on (lecture) seats’ fees, since the only people who were embarrassed by them were the students.

Below is a quote from Steven Downes from last week

But it doesn’t matter. I think any genuine futurist in the field of online learning could and should have seen this coming. As I’ve repeated through the years, “educational providers will one day face an overnight crisis that was 20 years in the making.” Now it’s here.

After all, it is nearly a full quarter of a century after Eli Noam published his paper in Science with the title Electronics and the Dim Future of the University. We (?or they) were warned.

Would a medal do?

by reestheskin on 22/04/2020

Comments are disabled

Interesting article from a final-year PhD student in Bristol. She writes:

Around one week before lockdown, Public Health England sent a message to UK universities; it needed their help to find PhD students, postdocs and other researchers to carry out diagnostic testing in London.

Despite the urgency of the call, the email didn’t mention pay or whether researchers should have permission from their grant funders to up and leave lab projects. It also omitted any details on accommodation or travel support for those of us living outside the capital…Then, on 2 April, we received another email, apparently from Public Health England (PHE), which was circulated to everyone in our faculty calling on us to join a “scientific reserve to support regional Covid-19 testing operations”.

The email cautioned that the work would be hard, and would require ‘five or seven day on/off shift patterns with long shifts’. No mention again of whether funders approved. Are the companies that provide testing or the reagents for testing getting paid, I wonder? She speculates as to  whether the government will be generous to her and others like her in the coming economic crisis.

My assumption is probably not: it will ask us to get ourselves in debt to the tune of tens of thousands of pounds to get the skills the country needs, but not pay us to work once we have them.

Well said.

Twenty year of schooling…day shift

by reestheskin on 14/04/2020

Comments are disabled

The millennial generation — the first to have lived entirely inside the mature meritocracy — appreciates these burdens most keenly. Elite millennials can be precious and fragile, but not in the manner of the special snowflakes that derisive polemics describe. They do not melt or wilt at every challenge to their privilege, so much as shatter under the intense competitive pressures to achieve that dominate their lives. They are neither dissolute not decadent, but rather tense and exhausted.

The Meritocracy Trap, Daniel Markovits.

(“Twenty years of schooling and they put you on the day shift – look out out kid, they keep it all hid”, Bob Dylan)

Following your interest ‘du jour’

by reestheskin on 10/04/2020

Comments are disabled

Many years ago I acted as the host of a visiting US dermatologist. He was due to give lectures in Edinburgh and elsewhere in the UK. I knew of him and, as I remember things, had spoken with him previously on a few occasions at US meetings. However, I did know of his research and, although it was in an area of skin research that was a long way from my professional interests, I admired it. He has taken a group of skin diseases (blistering aka bullous diseases) and explained at the molecular level what they all had in common. He had pulled back the veil, and shown the underlying unity of things that up until then had appeared different. I consider his work a beautiful example of clinical science.

I spent the day with him showing him around Edinburgh. We talked science and, as is often the case, the ‘meta’ of science: how is it done, how is it funded, what is good, and of course how the proposed work has been turned down for funding (’no track’ record’) etc.

At that time he was at NIH in the US. He stated that the great advantage of NIH — as he saw it then — was that if something bugged you at 9am you could spend the rest of the day (or week) thinking and reading about it. He wasn’t seeing patients, he wasn’t doing any formal teaching and admin was minimal. But he was insistent that blisters were ‘his problem’. If nobody would fund his interest in blisters he would do something else. Move to a university or a full time clinical role, but he wasn’t going to work on any other problem.

I know he did move several years later (to become Chair at an Ivy Laguen school) although I do not know the exact reasons why. I wouldn’t be surprised if kids going to college made him review his finances.

But the idea of spending you day in ‘your thoughts’ reading and asking questions appeals to some lifelong academics. Retirement has its pleasures (it is just the pay cheque that is missing).

Education will be fun.

by reestheskin on 06/04/2020

Comments are disabled

35 years ago, Isaac Asimov was asked by the Star to predict the world of 2019. Here is what he wrote | The Star

Schools will undoubtedly still exist, but a good schoolteacher can do no better than to inspire curiosity which an interested student can then satisfy at home at the console of his computer outlet. There will be an opportunity finally for every youngster, and indeed, every person, to learn what he or she wants to learn in his or her own time, at his or her own speed, in his or her own way. Education will become fun because it will bubble up from within and not be forced in from without.

Not in this world, I would add, or at last not yet. Many — possibly most — medical students view university as akin to clearing airport security: a painful necessit if you want to go somehwere. They are no more generous about their schooling.

Original link Via Stephen Downes

On being normal

by reestheskin on 26/03/2020

Comments are disabled

A majority of people in Britain now in their seventies spent some of their childhood growing up in social housing — almost entirely in council houses. When someone of that generation tells you that they grew up in a council house, they are telling you that they were normal. (Danny Dorling, Times Higher Education, 13-2-2020, p46)

And please don’t get me started on the ‘first in my family to go to uni’ trope so beloved of many in academia.

TIJABP

No ‘Room at the Top’

by reestheskin on 25/03/2020

Comments are disabled

In one of Paul Graham’s essays, he writes about the relation between a thriving society and how parents behave (he does not use these terms). He argues that whilst it is natural for parents to seek advantage for their (own) children, in the interests of efficiency, society should try to to limit this tendency. I agree but the details matter.

In the LRB there is a review written by Adam Swift of a few books that deal with this topic. And for those who like to sell higher educationhigher education, the review makes uncomfortable reading.

Education, which promised to be the solvent that would lessen the class structure, has become an effective means of preserving it.

That used not to be obvious to me. Swift however pulls out a lovely quote that illuminates much of the smug complacency shown by some of the ‘educated classes’ and how they see the world. Many of our current political troubles have cognate origins.

Robin Cook’s memoir repeats a story told by a journalist to Roy Hattersley. Tony Blair, asked why he had sent his son Euan to the Oratory, despite the inevitable political flak, said: ‘Look at Harold Wilson’s children.’ The journalist demurred: one of Wilson’s sons had become a headmaster, the other a university professor. Blair replied that he certainly hoped his children would do better than that.

Adam Swift · What’s fair about that? Social Mobilities · LRB 13 January 2020

I wish I had said that

In discussing some aspects of Higher Education, Dennis Tourish writes:

On all sides, it seems that long-term loyalty is an idea without a long-term future.

Tidying up

by reestheskin on 04/03/2020

Comments are disabled

I have spend a lot of time recently sifting through the detritus of a career. Finally — well, I hope, finally — I have managed to sort out my books. All neatly indexed in Delicious Library, and now for once the virtual location mirrors the physical location. For how long I do not know. Since I often buy books based on reviews, I used to put a copy of the review in with the book (a habit I have dropped but need to restart). I rediscovered this one by David Colquhoun (DC) reviewing ‘The Diet Delusion’ by Gary Taubes in the BMJ (with the unexpurgated text on his own web site).

I am a big fan of DC as he has lived though the rise and decline of much higher education in the UK. And he remains fearless and honest, qualities that are not always at the forefront of the modern university. Quoting the great Robert Merton he writes:

“The organization of science operates as a system of institutionalized vigilance, involving competitive cooperation. In such a system, scientists are at the ready to pick apart and assess each new claim to knowledge. This unending exchange of critical appraisal, of praise and punishment, is developed in science to a degree that makes the monitoring of children’s behavior by their parents seem little more than child’s play”.

He adds:

“The institutionalized vigilance, “this unending exchange of critical judgment”, is nowhere to be found in the study of nutrition, chronic disease, and obesity, and it hasn’t been for decades.”

On Taubes and his (excellent book):

It took Taubes five years to write this book, and he has nothing to sell apart from his ideas. No wonder it is so much better than a scientist can produce. Such is the corruption of science by the cult of managerialism that no university would allow you to spend five years on a book

(as would be expected the BMJ omitted the punch line — they would, wouldn’t they?)

There is also a neat quote from Taubes in one of the comments on DC’s page from Beth@IDblog, one that I will try hard not to forget:

Taubes makes a point at the end of the Dartmouth medical grand rounds video that I think is important: “I’m not trying to convince you that it’s true, I’m trying to convince you that it should be taken seriously.”

The thrill is gone

by reestheskin on 31/01/2020

Comments are disabled

Today is my last day of (paid) work, and of course a day that will be infamous for many more people for other more important reasons. Europe and my professional life have been intertwined for near on 40 years. In the mid 1980s I went to start my dermatological career in Vienna. I had been a student at Newcastle and done junior jobs there, as well as some research on skin physiology with Sam Shuster as an undergraduate student. Sam rightly thought I should now move somewhere else — see how others did things before returning — and he suggested Paris, or Vienna under Klaus Wolff. Vienna was, and perhaps still is, the centre of the dermatological universe, and has been since the mid 19th century. Now, even if I haven’t got very far into this post — it is a day for nostalgia — so allow me an aside: The German literature Problem.

The German Literature

As I have hinted at above, in many ways there have only been two schools of dermatology: the French school, and the German school. The latter has been dominant. Throughout the second half of the 19th century dermatology was a ‘German speaking’ subject. To follow it you would be wise to know German, and better still to have visited the big centres in Germany, Switzerland or Austria. And like most of the modern research university, German medicine and science was the blueprint for the US and then belatedly — and with typos— for England (Scotland, reasonably, had taken a slightly different path).

All of the above I knew, but when I returned to Newcastle after my first sojourn away (a later one was to Strasbourg), I naturally picked up on all these allusions to the German literature, but they were accompanied by sniggering by those who had been around longer than me. Indeed there seemed to be a ‘German Literature Problem’. Unbeknown to me, Sam had written “das problem ” up in ‘World Medicine’, but World Medicine had been killed off by those from Mordor, so here is a synopsis.

The German literature seemed so vast that whenever somebody described a patient with what they were convinced must be a ‘new syndrome’, some bright spark would say that it had already been described, and that it was to be found in the German literature. Now the synoptic Handbuch der Hautkrankheiten on our shelves in the library in Newcastle ran to over 10 weighty volumes. And that was just the start. But of course only German speaking dermatologists (and we had one) could meaningfully engage in this conversation. Dermatology is enough of a a nightmare even in your own mother tongue. Up to the middle of the 20th century however, there were indeed separate literatures in German, French and English (in the 1960’s the newly formed ESDR had to sort out what language was going to be used for its presentations).

Sam’s sense of play now took over (with apologies to Shaw: nothing succeeds like excess). It appeared that all of dermatology had already been previously described, but more worryingly for the researchers, the same might be true of skin science. In his article in World Medicine he set out to describe his meta-science investigation into this strange phenomenon. Sam has an unrivalled ability to take simple abstract objects — a few straight lines, a circle, a square — and meld them into an argument in the form of an Escher print. A print that you know is both real, unreal and illegal. Imagine a dastardly difficult 5 x 5 Rubik’s cube (such as the one my colleagues recently bought me for my retirement). You move and move and move the individual facets, then check each whole face in turn. All aligned, problem solved. But then you look in the mirror: whilst the faces are all perfect in your own hands, that is not what is apparent in the mirror. This is my metaphor for Sam’s explanation. Make it anymore explicit, and the German literature problem rears its head. It’s real — of a sort. Anyway, this was all in the future (which didn’t exist at that time), so lets get back to Vienna.

Night train to Wien

Having left general medical jobs behind in Newcastle, armed with my BBC language tapes and guides, I spent a month travelling through Germany from north to south. I stayed with a handful of German medical students who I had taught in Newcastle when I was a medical registrar (a small number of such students used to spend a year with us in Newcastle). Our roles were now reversed: they were now my teachers. At the end of the month I caught the night train in Ulm, arriving in Vienna early one morning.

Vienna was majestic — stiff collared, yes — but you felt in the heart of Europe. A bit of Paris, some of Berlin and the feel of what lay further east: “Wien ist die erste Balkanstadt”.  For me, it was unmistakably and wonderfully foreign.

It was of course great for music, too. No, I couldn’t afford the New Year’s Day Concerts, but there were cheap seats at the Staatsoper, more modest prices at the Volksoper, and more to my taste, some European jazz and rock music. I saw Ultravox sing — yes, what else— “Vienna” in Vienna. I saw some people from the ECM label (eg Eberhard Weber), a style of European jazz music that has stayed with me since my mid teens. And then there was the man (for me) behind ‘The Thrill is Gone’.

The Thrill

I saw BB King on a double bill with Miles Davies at the Stadthalle. Two very different styles of musician. I was more into Miles Davies then, but he was not then at his best (as medics in Vienna found out). I was, however, very familiar with the ‘Kings’ (BB, Freddie, Albert etc) after being introduced to them via their English interpreters. Clapton’s blue’s tone on ‘All Your Love’ with John Mayall’s Bluesbreakers still makes the hairs on my neck stand up (fraternal thanks to ‘Big Al’ for the introduction).

The YouTube video at the top of the page is wonderful (Montreux 1993), but there is a later one below, taken from Crossroads in 2010 which moves me even more. He is older, playing with a bunch of craftsmen, but all still pupils before the master.

But — I am getting there — germane to my melancholia on this day is a video featuring BB King and John Mayer. Now there is a trope that there are two groups of people who like John Mayer: girlfriends; and guitarists who understand just how bloody good he is. As EC pointed out, the problem with John Mayer is that he realises just how good he is. True.

But the banter at the beginning of the video speaks some eternal truths about craft, expertise, and the onward march of all culture — including science. Mayer plays a few BB King licks, teasing King that he is ‘stealing’ them. He continues, it was as though he was ‘stealing silverware from somebody’s house right in front of them’. King replies: ”You keep that up and I’m going to get up and go”. Both know it doesn’t work that way. Whatever the provenance of the phrase ‘great artists steal, not copy’, except in the most trivial way you cannot steal or copy culture: people discover it in themselves by stealing what masters show them might be there in their pupils. Teachers just help people find what they suspect or hope is there. The baton gets handed on. The thrill goes on. And on.

A working life

by reestheskin on 17/01/2020

Comments are disabled

I don’t like the work-life balance meme. I know what it means, but I never wanted it. Medicine was once talked of as a vocation, and when I was a medical student I can remember many doctors who clearly believed so as well. Neonatologists who appeared to live on the special care baby unit; surgeons whose idea of Christmas day was to do a ward round and bring their children with them; and ‘be a paediatrician and bring up other people’s children’. The job was not just any job. I remember the wife of one professor who appeared on the ward when I was a houseman very late one night. “Had I seem the professor, her husband?” I had: I saw him there most evenings when I was on call. On this night, for whatever reason, she had accompanied him. Sadly for her, he had forgotten, and gone home without her. Thales and the well.

For me being an academic was a ‘calling’. A grand phrase, I know. But it has for most of my career been a way of life beyond the paycheque. I believe in the academic ideal, but increasingly fear the institutions no longer do. For me, home and office were not distinct. I vaguely remember — and it is quite possible I am mistaken here — that my first Professorial contract at the University of Newcastle stated ‘that by the nature of the work no hours of work are stipulated’. As my children would testify, weekend mornings were spent in the (work) office, and the afternoon in the gym and pool with them.

I retire* in the near future, and I face a practical problem. Much of my ‘work’ is at home — books and papers of course, but also the high spec iMac Pro that I have used to produce videos, alongside video cameras and lights. On the other hand, my office is full of things that strictly speaking are personal, in that I bought them with my own money rather than with a univeristy purchase order. But my work space — measured in square metres if not mental capacity, I hope — is diminishing. A domestic negotiation is required.

*From paid employment, not from my work.

We need more STEM (STEAM etc)

by reestheskin on 08/01/2020

Comments are disabled

Perhaps, perhaps not. But when and where is even more important.

Hailed as a maths prodigy at school, Shields accepted a junior position at Merrill Lynch after studying engineering, economics and management at Oxford University because the trading room floor offered him a thrilling, dynamic environment. He was not alone: of 120 engineers in his year group at university, Shields added, only five went into engineering.

I think we should be much more cautious in attempting to direct young people’s choices beyond providing them with an education. We should feel proud of their independence of mind, remembering that supply side factors will likely win out over central planning. It is the supply side that we need to deal with, not least Putts Law. The same applies to medicine.

This personal story is worth a read for other lessons, too.

‘The men who plundered Europe’: bankers on trial for siphoning €60bn | Business | The Guardian

Finnish lessons

by reestheskin on 19/12/2019

Comments are disabled

No, not Pasi Salberg, but cognate.

But idealists now have another international beacon of social mobility: long live the Finnish dream, in which a 34-year-old woman who once worked in a shop can become prime minister.

“I am extremely proud of Finland. Here a poor family’s child can educate themselves and achieve their goals in life. A cashier can become even a prime minister,” tweeted Sanna Marin

Meanwhile back in the UK as the FT rightly comments:

..egregious examples of rigging the game endure: on being rejected by the voters, Zac Goldsmith is to be elevated to the House of Lords, from where he will carry on as a minister in the government of Boris Johnson, also an Etonian from a high-profile family.

Looking in envy at Finland’s social mobility pin-up PM | Financial Times

Downward mobility for all!

by reestheskin on 02/12/2019

Comments are disabled

Obituaries are a source of much joy and enlightenment. None more so than those in the Economist. Last week’s was devoted to the ’60’s photographer Terry O’Neill (you can see some of his iconic images here.

Stars had been his subject since 1962, when he was sent to photograph a new band at the Abbey Road Studios. The older blokes at the Sketch scorned that kind of work, but the young were clearly on the rise, and he was by far the youngest photographer in Fleet Street at the time. At the studios, to get a better light, he took the group outside to snap them holding their guitars a bit defensively: John, Paul, George and Ringo. Next day’s Sketch was sold out, and he suddenly found himself with the run of London and all the coming bands, free to be as creative as he liked. A working-class kid from Romford whose prospects had been either the priesthood or a job in the Dagenham car plant, like his dad, had the world at his feet. He wouldn’t have had a prayer, he thought, in any other era.

And obviously it couldn’t last. In a couple of years he would find a proper job, as both the Beatles and the Stones told him they were going to. For it was hardly serious work to point your Leica at someone and go snap, snap.

Obituary: Terry O’Neill died on November 16th – Catching the moment

The reason I found this particularly interesting is the way social mobility appeared to work and the way it was tied to genuine innovation and social change. I have always loved the trope that when jobs are plentiful, and your committments minimal, you can literally tell the boss to FO on a Friday and start another job on the Monday. Best of all you can experiment and experiment lifts all. This to me is one of the best 1960’s rock n’ roll stories.

If you lift your head above the parapet in universities you come across various conventional wisdoms. One relates to ‘mental wellbeing’ or ‘mental issues’, and another is the value of education in increasing social mobility. My problem is that in both cases there seem (to me at least) many important questions that remain unanswered. For the former, are we talking about mental illness (as in disease) or something else? How robust is the data — aside from self-reporting? The widely reported comments from the former President of the Royal College of Pyschiatrists receive no answer (at last not in my institution). An example: I have sat in a meeting in which one justification for ‘lecture capture’ (recording of live lectures) was to assist students with ‘mental health issues’. But do they help in this context? Do we trust self-reflection in this area? Under what conditions do we think they help or harm?

Enhancing life chances and social mobility is yet another area that I find difficult. I picked up on a comment from Martin Wolf in the FT

We also believe that changing individual characteristics, principally via education, will increase social mobility. But this is largely untrue. We need to be far more honest.

He was referring to the work of John Goldthorpe in Oxford. Digging just a little beneath the surface made me realise that much of what I had believed may not true. Goldthorpe writes:

However, a significant change has occurred in that while earlier, in what has become known as the golden age of mobility, social ascent predominated over social descent, the experience of upward mobility is now becoming less common and that of downward mobility more common. In this sense, young people today face less favourable mobility prospects than did their parents or their grandparents.

This research indicates that the only recent change of note is that the rising rates of upward, absolute mobility of the middle decades of the last century have levelled out. Relative rates have remained more or less constant back to the interwar years. According to this alternative view, what can be achieved through education, whether in regard to absolute or relative mobility, appears limited.

[Jnl Soc. Pol. (2013), 42, 3, 431–450 Cambridge University Press 2013 doi:10.1017/S004727941300024X]

There is a witty exchange in Propect between the journalist (JD) and Goldthorpe (JG).

JD: Would you say that this is something that politicians, in particular, tend not to grasp?

JG: Yes. Tony Blair, for instance, was totally confused about this distinction [between absolute and relative rates of mobility]. He couldnʼt see that the only way you can have more upward mobility in a relative perspective is if you have more downward mobility at the same time. I remember being in a discussion in the Cabinet Office when Geoff Mulgan was one of Blairʼs leading advisors. It took a long time to get across to Mulgan the distinction between absolute and relative rates, but in the end he got it. His response was: “The Prime Minister canʼt go to the country on the promise of downward mobility!”

On both these topics I am conflicted. And on both these topics there are the tools that characterize scholarly inquiry to help guide action: this is what universities should be about. I am however left with a strong suspicion that few are interested in digging deep, rather we choose sound bites over understanding. Working in a university often feels like the university must be somewhere else. That is the optimistic version.

Out of time

by reestheskin on 13/11/2019

Comments are disabled

The following is from Janan Ganesh of the FT. The title of the article was “The agony of returning to work in September”.

A personal ambition is to reach the end of my career without having managed a single person.

It seems to me a very sensible ambition, one which used to be the lot of many academics — usually the better ones. He goes on:

Friends who have been less lucky, who have whole teams under their watch, report a quirk among their younger charges. It is not laziness or obstreperousness or those other millennial slanders. It is an air of disappointment with the reality of working life. They will be among the people described in Bullshit Jobs by the anthropologist David Graeber….

A generation of in-demand graduates came to expect not just these material incentives but a sort of credal alignment with their employer’s “values”. The next recession will retard this trend but it is unlikely to kill it.

At one time the words ‘manager’, ‘management’, or worst of all, ‘line-manager’ were alien to much of medicine or academia. Things still got done, in many ways more efficiently than now. It is just that our theories of action and praxis have been ransacked by Excel spreadsheet models of human motivation and culture. It is the final line from the quote that those controllers of ‘managers’ should be scared of:

The next recession will retard this trend but it is unlikely to kill it.

Bullshit (of the world-class variety)

by reestheskin on 12/11/2019

Comments are disabled

Andrew Wathey its chairman [of the UK Standing Committee for Quality Assessment] and vice-chancellor of Northumbria University, said: “The UK delivers world-class education to students from all nations. It is therefore right that the sector commits to ensuring that the value of these world-class qualifications is maintained over time in line with the expectations of the UK Quality Code for Higher Education.”

Universities agree more openness on degree marking guidelines | Financial Times

The language betrays all you need to know: spoken by somebody who clearly has no idea what UK higher education once stood for, or who has any sympathy or understanding of the academic ideal. Will the last person who leaves please turn off the ….

Medicine is just one technology

by reestheskin on 08/11/2019

Comments are disabled

From Wikipedia.

Putt’s Law: “Technology is dominated by two types of people, those who understand what they do not manage and those who manage what they do not understand.”

 

Putt’s Corollary: “Every technical hierarchy, in time, develops a competence inversion.” with incompetence being “flushed out of the lower levels” of a technocratic hierarchy, ensuring that technically competent people remain directly in charge of the actual technology while those without technical competence move into management.

Putt’s Law and the Successful Technocrat – Wikipedia

Just not a business anymore….

by reestheskin on 06/11/2019

Comments are disabled

From the Economist

Dean Whiteboard writes…

Going forward, we need three priorities. First, to get costs under control. The soup-to-nuts cost for an MBA at Stanford is $232,000—out of our ballpark. The five-star accommodation, gourmet cuisine and other perks on our campus are way over the top. So are some of our packages, even if we haven’t got quite as carried away as Columbia Business School, which, it was recently revealed, paid over $420,000 a year to a professor teaching three classes a year and $330,000 to untenured junior faculty.

The future of management education – The MBA disrupted

Strangers to ourselves (and student learning).

by reestheskin on 04/11/2019

Comments are disabled

The quote below is from a paper in PNAS on how students misjudge their learning and what strategies maximise learning. The findings are not surprising (IMHO) but will, I guess, continue to be overlooked (NSS anybody?). As I mention below, it is the general point that concerns me.

Measuring actual learning versus feeling of learning in response to being actively engaged in the classroom.

In this report, we identify an inherent student bias against active learning that can limit its effectiveness and may hinder the wide adoption of these methods. Compared with students in traditional lectures, students in active classes perceived that they learned less, while in reality they learned more. Students rated the quality of instruction in passive lectures more highly, and they expressed a preference to have “all of their physics classes taught this way,” even though their scores on independent tests of learning were lower than those in actively taught classrooms. These findings are consistent with the observations that novices in a subject are poor judges of their own competence (27⇓–29), and the cognitive fluency of lectures can be misleading (30, 31). Our findings also suggest that novice students may not accurately assess the changes in their own learning that follow from their experience in a class.

Measuring actual learning versus feeling of learning in response to being actively engaged in the classroom | PNAS

The authors go on:

These results also suggest that student evaluations of teaching should be used with caution as they rely on students’ perceptions of learning and could inadvertently favor inferior passive teaching methods over research-based active pedagogical approaches….

As I say above, it is the general rather than the particular that concerns me. Experience and feeling are often poor guides to action. We are, after all, creatures that represent biology’s attempt to see whether contemplation can triumph over reflex. There remains a fundamental asymmetry between expert and novice, and if there isn’t, there is little worth learning (or indeed worth paying for).

  • The title is from Timothy Wilson’s book, Strangers to Ourselves, a good place to start on this topic. However, this whole topic is of much more importance than just how we teach students. Lessons for medicine too.

The art of the insoluble

by reestheskin on 30/10/2019

Comments are disabled

The following is from an advert for a clinical academic in a surgical specialty, one with significant on call responsibilities. (It is not from Edinburgh).

‘you will be able to define, develop, and establish a high quality patient-centred research programme’

‘in addition to the above, you will be expected to raise substantial research income and deliver excellent research outputs’

Leaving aside the debasement of language, I simply cannot believe such jobs are viable long term. Many years ago, I was looked after by a surgical academic. A few years later he/she moved to another centre, and I was puzzled as to why he/she had made this career move. I queried a NHS surgeon in the same hospital about this career path. “Bad outcomes”, was the response. She/He needed a clean start somewhere else…

Traditional non-clinical academic careers include research, teaching and administration. Increasingly it is recognised that it is rarely possible to all three well. For clinical academics the situation is worse, as 50% of your time is supposed to be devoted to providing patient care. Over time the NHS workload has become more onerous in that consultants enjoy less support from junior doctors and NHS hospitals have become much less efficient.

All sorts of legitimate questions can be asked about the relation between expertise and how much of your time is devoted to that particular role. For craft specialities — and I would include dermatology, pathology, radiology in this category — there may be ways to stay competent. Subspecialisation is one approach (my choice) but even this may be inadequate. In many areas of medicine I simply do not believe it is possible to maintain acceptable clinical skills and be active in meaningful research.

Sam Shuster always drilled in to me that there were only two reasons academics should see patients: to teach on them, and to foster their research. Academics are not there to provide ‘service’. Some juniors recognise this issue but are reticent about speaking openly about it. But chase the footfall, or lack of it, into clinical academic careers.

That was then

by reestheskin on 22/10/2019

Comments are disabled

The world has problems, as the old saying puts it, but universities have departments.

Well not any more, I would add.

The Puzzle of Economic Progress by Diane Coyle – Project Syndicate

Fast and slow

by reestheskin on 18/09/2019

Comments are disabled

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?

Wellbeing

by reestheskin on 29/08/2019

Comments are disabled


 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

Direct URL for this post.