No, not that sort of skin trade, but inking1. This is from an article in the Economist, and sadly, although I cannot show them here, the images are remarkable. But some nice word lines too about the acquisition of high level skills and apprenticeship — vocation, if you will.
In China several prominent tattooists are taking a different approach. They have set up schools. In Wu Shang’s studio four students are hunched over flat pieces of silicon rubber—mimicking skin, just like his model arms—trying to recreate images that they first painted on paper.
That might seem inoffensive, but it goes against a widespread but unwritten code. Masters may take an apprentice or two under their wings, but only if they are truly committed to the craft. The idea that anyone can just show up, pay a tuition fee and after a few months apply ink to skin leaves purists aghast. Even in China some are critical. Mr Shen, the neo-traditionalist, says that he honed his technique over many years by wielding needles by hand. “You need to learn about the relationship between skin and needle. You can’t just get that overnight in school,” he says.
Many university staff would echo these thoughts.
Mr Handy says this gave him the opportunity to learn from his mistakes in private. He argues that “education is an experience understood in tranquillity. You look back and see where you went wrong.”
Looking back over his career, he believes that teaching and writing is all about creating the “Aha!” moment. That occurs when people realise that an idea the teacher or writer has advanced is both useful and something they already knew but had not articulated.
No Excel or TEF here. The plain language belies the depth of the insight.
Charles Handy, Reflections of a business guru – Bartleby
A few months back, I was walking past the entrance of the old Edinburgh Medical School, founded in 1726. A not-so-crazy thought came into my head, one that I could not dismiss: we need to move on from the idea that a Medical School must be situated within a University (and of course, it wasn’t always, anyway). The founding set of ideas that we have struggled with ever since Flexner, we should now recast for a very different world. We need to create something new, something that makes sense in terms of a university and something that puts professional training within a professional context. At present, we fail on both of these accounts. Rather than integrate we should fracture. We need to search out our own new world.
I read Educated by Tara Westover earlier this year (it was published in 2018 and was a best seller). It is both frightening and inspiring. And important. Her story is remarkable, and it says more about real education than all the government-subjugated institutions like schools and universities can cobble together in their mission statements. WikiP provides some background on her.
Westover was the youngest of seven children born in Clifton, Idaho (population 259) to Mormon survivalist parents. She has five older brothers and an older sister. Her parents were suspicious of doctors, hospitals, public schools, and the federal government. Westover was born at home, delivered by a midwife, and was never taken to a doctor or nurse. She was not registered for a birth certificate until she was nine years old. Their father resisted getting formal medical treatment for any of the family. Even when seriously injured, the children were treated only by their mother, who had studied herbalism and other methods of alternative healing.
All the siblings were loosely homeschooled by their mother. Westover has said an older brother taught her to read, and she studied the scriptures of The Church of Jesus Christ of Latter-day Saints to which her family belonged. But she never attended a lecture, wrote an essay, or took an exam. There were few textbooks in their house.
As a teenager, Westover began to want to enter the larger world and attend college.
The last sentence above has it, as The Speaker of the House of Commons might say.
She gained entry to Brigham Young University (BYU), Utah, without a high school diploma and her career there was deeply influenced by a few individuals who saw something in her. She was awarded a Gates scholarship to the University of Cambridge to undertake a Masters and was tutored there by Professor Jonathan Steinberg. Some of their exchanges attest to the qualities of both individuals, and not a little about a genuine education.
‘I am Professor Steinberg,’ he said. ‘What would you like to read?’
‘For two months I had weekly meetings with Professor Steinberg. I was never assigned readings. We read only what I asked to read, whether it was a book or a page. None of my professors at BYU had examined my writing the way Professor Steinberg did. No comma, no period, no adjective or adverb was beneath his interest. He made no distinction between grammar and content, between form and substance. A poorly written sentence, a poorly conceived idea, and in his view the grammatical logic was as much in need of correction.’
‘After I’ve been meeting with Professor Steinberg for a month, he suggested I write an essay comparing Edmund Burke with Publius, the persona under which James Madison, Alexander Hamilton and John Jay had written the Federalist papers.’
‘I finished the essay and sent it to Professor Steinberg. Two days later, when I arrived for our meeting, he was subdued. He peered at me from across the room. I waited for him to say the essay was a disaster, the product of an ignorant mind, that it had overreached, drawn to many conclusions from too little material.’
“I have been teaching in Cambridge for 30 years,” he said. “And this is one of the best essays I’ve read.” I was prepared for insults but not for this.
At my next supervision, Professor Steinberg said that when I apply for graduate school, he would make sure I was accepted to whatever institution I chose. “Have you visited Harvard?” he said. “Or perhaps you prefer Cambridge?”…
“I can’t go,” I said. “I can’t pay the fees.” “Let me worry about the fees,” Professor Steinbeck said.
You can read her book and feel what is says about the value of education on many levels, but I want to pick out a passage that echoed something else I was reading at the same time. Tara Westover writes of her time as a child teaching herself at home despite the best attempts of most of her family.
In retrospect, I see that this was my education, the one that would matter: the hours I spent sitting at the borrowed desk, struggling to parse narrow strands of Mormon doctrine in mimicry of a brother who’d deserted me. The skill I was learning was a crucial one, the patience to read things I could not yet understand [emphasis added].
At the same time as I was reading Educated I was looking at English Grammar: A Student’s Introduction by Huddleston & Pullum (the latter of the University of Edinburgh). This is a textbook, and early on the authors set out to state a problem that crops up in many areas of learning but which I have not seen described so succinctly and bluntly.
We may give that explanation just before we first used the term, or immediately following it, or you may need to set the term aside for a few paragraphs until we can get to a full explanation of it. This happens fairly often, because the vocabulary of grammar can’t all be explained at once, and the meanings of grammatical terms are very tightly connected to each other; sometimes neither member of a pair of terms can be properly understood unless you also understand the other, which makes it impossible to define every term before it first appears, no matter what order is chosen [emphasis added].
On September 1, I’m scheduled to teach 170 students in a windowless room. After 12 sessions of 3 hours in the sealed room with 170 people, 50 of them will then disperse back to their 20+ native countries for the holidays. If the producers of Contagion decide on a sequel, I have an idea for their opening scene.
Two letters in the LRB on the now settled status of student hygiene.
The first from Otto Saumarez Smith:
Keith Thomas reminisces about his introduction to regular baths when at Oxford in the 1950s (LRB, 16 July). The architectural historian Gavin Stamp once told me that when George Frederick Bodley came to build new student accommodation at King’s College, Cambridge in 1888, he asked the fellows whether he should include a bathroom, but was told not to be ridiculous: as terms were only eight weeks long the undergraduates could bathe after they got home.
The second from Richard J Evans, in conversation with a porter at an Oxford college:
‘What’s the main difference between the old days and now?’ I once asked him. ‘Well, sir,’ he replied, after some thought, ‘in the old days the young gentlemen used to change their shirt every day and take a bath once a week. Nowadays they take a bath every day and change their shirt once a week.’ It was clear from the shaking of his head that he did not regard this as an improvement.
I was delighted to get out of university halls, to the luxury of a toilet and bathroom only shared with five fellow students (and their occasional guests). The downsides included rodents, and ice on the inside of the bathroom windows. My memory is that the rent in 1977 was £1.85 per person for a salubrious🤣 central location on the Westgate road (opposite the Harley-Davidson shop, and a house of dubious repute). I was in hospital for a few weeks (as a patient) during this period and, at discharge, my father picked me up at the hospital, and we drove to the house so that I could collect some more clothes before heading back to my parents home; he knew better than to come in.
From an article in the Atlantic a couple of years back (but the song remains the same).
“I used to joke that I could just take all my papers and statistical programs and globally replace hospitals with schools, doctors with teachers and patients with students,” says Dartmouth College’s Douglas Staiger, one of the few U.S. economists who studies both education and health care.
Both systems are more market driven than in just about any other country, which makes them more innovative—but also less coherent and more exploitive.
State cutbacks did not necessarily make colleges more efficient, which was the hope; they made colleges more entrepreneurial.
You can even get a degree in this sort of behaviour, now: ouroboros studies.
The killer whales (cash cows) of high-tuition prestige universities are international students. We claim we let them in for diversity. This is bullshit. International students are the least diverse cohort on earth. They are all rich kids who pay full tuition, get jobs at multinational corporations, and often return to the family business. At NYU, they constitute 27% of our student body and likely half our cash flow, as they are ineligible for financial aid. We have a pandemic coupled with an administration committed to the demonization of foreigners, including severely limiting the prospects of highly skilled grad students. This means the whales may just not show up this fall, leaving us with otters and penguins — an enormous fiscal hole.
Straight talking from Scott Galloway of Stern, NYU.
More accurately, late night thoughts from 26 years ago. I have no written record of my Edinburgh inaugural, but my Newcastle inaugural given in 1994 was edited and published by Bruce Charlton in the Northern Review. As I continue to sift through the detritus of a lifetime of work, I have just come across it. I haven’t looked at it for over 20 years, and it is interesting to reread it and muse over some of the (for me) familiar themes. There is plenty to criticise. I am not certain all the metaphors should survive, and I fear some examples I quote from out with my field may not be as sound as I imply. But it is a product of its time, a time when there was some unity of purpose in being a clinical academic, when teaching, research and praxis were of a piece. No more. Feinstein was right. It is probably for the best, but I couldn’t see this at the time.
The practice of medicine is made up of two elements. The first is an ability to identify with the patient: a sense of a common humanity, of compassion. The second is intellectual, and is based on an ethic that states you must make a clear judgement of what is at stake before acting. That, without a trace of deception, you must know the result of your actions. In Leo Szilard’s words, you must “recognise the connections of things and the laws and conduct of men so that you may know what you are doing”.
This is the ethic of science. William Gifford, the 19th century mathematician, described scientific thought as “the guide of action”: “that the truth at which it arrives is not that which we can ideally contemplate without error, but that which we may act upon without fear”.
Late last year when I was starting to think what I wanted to say in my inaugural lecture, the BBC Late Show devoted a few programmes to science. One of these concerned itself with medical practice and the opportunities offered by advances in medical science. On the one side. Professor Lewis Wolpert, a developmental biologist, and Dr Markus Pembrey, a clinical geneticist, described how they went about their work. How, they asked, can you decide whether novel treatments are appropriate for a patient except by a judgement based on your assessment of the patient’s wishes, and imperfect knowledge. Science always comes with confidence limits attached.
On the opposing side were two academic ethicists, including the barrister and former Reith Lecturer Professor Ian Kennedy. You may remember it was Kennedy in his Reith lectures who quoting Ivan Illicit described medicine itself as the biggest threat to people’s health. The debate, or at least the lack of it. clearly showed that we haven’t moved on very far from when C P Snow (in the year I was born) gave his Two cultures lecture. What do I mean by two cultures? Is it that people are not aware of the facts of science or new techniques?… It was recently reported in the journal Science that over half the graduates of Harvard University were unable to explain why it is warmer in summer than winter. A third of the British population still believe that the sun goes round the earth.
But, in a really crucial way, this absence of cultural knowledge is not nearly so depressing as the failure to understand the activity rather the artefacts of science. Kennedy in a memorable phrase described knowledge as a ‘tyranny’1. It is as though he wanted us back with Galen and Aristotle, safe in our dogma, our knowledge fossilised and therefore ethically safe and neutered. There is, however, with any practical knowledge always a sense of uncertainly. When you lift your foot off the ground you never quite know where it is going to come down. And, as in Alice in Wonderland, “it takes all the running you can do to stay in the same place”.
It is this relationship, between practice and knowledge and how if affects my subject that I want to talk about. And in turn, I shall talk about clinical teaching and diagnosis, research and the treatment of skin disease.
Whenever I have looked at the CVs of many young doctors or medical students I have often felt saddened at what I take to be the hurdles than many of them have had to jump through to get into medical school. I don’t mean the exams — although there is lots of empty signalling there too — but the enforced attempts to demonstrate you are a caring or committed to the NHS/ charity sector person. I had none of that; nor do I believe it counts for much when you actually become a doctor1. I think it enforces a certain conformity and limits the social breadth of intake to medical school.
However, I did
do things work outside school before going to university, working in a variety of jobs from the age of 14 upwards: a greengrocer’s shop on Saturdays, a chip shop (4-11pm on Sundays), a pub (living in for a while 😃), a few weeks on a pig-farm (awful) and my favourite, working at a couple of petrol stations (7am-10pm). These jobs were a great introduction to the black economy and how wonderfully inventive humanity — criminal humanity— can be. Naturally, I was not tempted😇. Those in the know would even tell you about other types of fraud in different industries, and even that people actually got awarded PhDs by studying and documenting the sociology of these structures (Is that why you are going to uni, I was once asked).
On the theme of that newest of crime genres — cybercrime — there is a wonderful podcast reminding you that if much capitalism is criminal, there is criminal and there is criminal. But many of the iconic structures of modern capitalism — specialisation, outsourcing and the importance of the boundaries between firm and non-firm — are there. Well worth a listen.
I think there is a danger in exaggerating the role of caring and compassion in medicine. I am not saying you do not need them, but rather that I think they are less important that the technical (or professional) skills that are essential for modern medical practice. I want to be treated by people who know how to assess a situation and who can judge with cold reason the results of administering or withholding an intervention. If doctors were once labelled priests with stethoscopes, I want less of the priest bit. Where I think there are faults is in the idea that you can contribute most to humanity by ‘just caring’. The Economist awhile back reported on an initiative from the Centre for Effective Altruism in Oxford. The project labelled the 80,000 hours initiative advises people on which careers they should choose in order to maximise their impact on the world. Impact should be judged not on how much a particular profession does, but on how much a person can do as an individual. Here is a quote relating to medicine:
Medicine is another obvious profession for do-gooders. It is not one, however, on which 80,000 Hours is very keen. Rich countries have plenty of doctors, and even the best clinicians can see only one patient at a time. So the impact that a single doctor will have is minimal. Gregory Lewis, a public-health researcher, estimates that adding an additional doctor to America’s labour supply would yield health benefits equivalent to only around four lives saved.
The typical medical student, however, should expect to save closer to no lives at all. Entrance to medical school is competitive. So a student who is accepted would not increase a given country’s total stock of doctors. Instead, she would merely be taking the place of someone who is slightly less qualified. Doctors, though, do make good money, especially in America. A plastic surgeon who donates half of her earnings to charity will probably have much bigger social impact on the margin than an emergency-room doctor who donates none.
Yes, the slightly less qualified makes me nervous.
Henry Miller died a few months before I started medical school in Newcastle in 1976. At the time of his death he was VC of the university having been Dean of Medicine and Professor of Neurology. By today’s standards he was a larger than life figure. I like reading what he said about medical education, although with hindsight I think he was wrong about many if not most things. But there was a freshness and sense of spirited independence of mind in his writing that we not longer see in those who run our universities (with some notable exceptions such as Louise Richardson). In the time of COVID we should remember the costs of conformity and patronage.
It would be naive to express surprise at the equanimity with which successive governments have regarded the deteriorating hospital service, since it is in the nature of governments to ignore inconvenient situations until they become scandalous enough to excite powerful public pressure. Nor, perhaps, should one expect patients to be more demanding: their uncomplaining stoicism springs from ignorance and fear rather than fortitude; they are mostly grateful for what they receive and do not know how far it falls short of what is possible. It is less easy to forgive ourselves…..Indeed election as president of a college, a vice chancellor, or a member of the University Grants committee usually spells an inevitable preoccupation with the politically practicable, and insidious identification with central authority, and a change of role from informed critic to uncomfortable apologist.
Originally published in the Lancet, 1966,2, 647-54. (This version from ‘Remembering Henry’, edited by Stephen Lock and Heather Windle).
“I hope the lesson will really be that we can’t afford as a society to create the fire brigade once the house is on fire. We need that fire brigade ready all the time hoping that it never has to be deployed.”
Peter Piot 1
No just in time here. It’s in the statistical tails that dragons lurk and reputations are shattered. Chimes with a quote from Stewart Brand that I posted a short while back.
Education is intellectual infrastructure. So is science. They have very high yield, but delayed payback. Hasty societies that can’t span those delays will lose out over time to societies that can. On the other hand, cultures too hidebound to allow education to advance at infrastructural pace also lose out.
Britain’s universities increasingly look like the late Soviet economy, running down their social capital behind a glitzy screen of Potemkin imagery and glasnost-era statistics. Bits of it are locking up, alternately insulted and goaded by the gap between central government diktat and the reality on the ground. The result will be the same: a very long slide into mediocrity and mendacity.
I don’t have any wise prescriptions to dispense. Stephen Downes gets it right when he says “educational providers will one day face an overnight crisis that was 20 years in the making”. But a clue is surely in his choice of words: ‘educational providers’.
In 1947, Hobsbawm had excused his acceptance of the Birkbeck post by explaining that teaching preparations never took him more than two hours a week, and while he was an inspiring classroom presence, he always adroitly ducked administrative jobs. Evans tells a story of Hobsbawm backing the young Roderick Floud for a professorial chair mostly, Floud later realised, so he wouldn’t have to be head of department himself. It will be hard for today’s young academics, groaning under research assessments and short-term contracts at below the living wage, to read these passages.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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)
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).
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
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.
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.
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.
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”.
“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.”