Learning

BMJ visual summaries and not being wrong

by reestheskin on 23/05/2018

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Maybe it is just me, but I find many of the graphics in the BMJ hard to follow. The image below is from a clinical update on “Depression and anxiety in patients with cancer” (BMJ 28 April 2018, p116-120). It occupies two whole pages. I am not certain what problem the graphic is trying to solve. For me, it just induces a sense of incomprehension. Or nausea.

In dermatology, there was a famous US academic known for producing slides with numerous arrows, many involving feedback. It was professional cargo-cult science (as the BMJ is cargo-cult education). Sam Shuster always cautioned: more than 3 or 4 arrows per slide, usually means bullshit.

That which is simple is wrong; that which is complicated is useless (Paul Valery).

Go where the messes are

by reestheskin on 13/04/2018

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(Isaiah)Berlin had learned that if you studied them with philosophical intent, certain second-rate minds grappling with first-rate problems could teach you more than first-rate minds lost in the shrubbery. (Another reason, perhaps, that he abandoned analytic philosophy.).

Mark Lilla in the NYRB

Which for some reason reminds me of a quote from the Economist:

Professors fixated on crawling alone the frontiers of knowledge with a magnifying glass.

Just one point in your life?

by reestheskin on 09/03/2018

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Training gets a bad rap for a reason – it’s all a bit, well, dull and inflexible. At one point in my life I point blank refused to be in a room with round tables, a flipchart, coloured pens and a bowl of mints for inspiration.

Donald Clark Link. And please no breakout sessions.

I have no idea how I do what I do (spoke the dermatologist)

by reestheskin on 21/02/2018

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This article (‘Humans may not always grasp why AIs act’) in the Economist gets to the right answer, but by way of a silly example involving brain scanning. The issue is that people are alarmed that that it may not be possible to understand how AI might come to a certain decision. The article rightly points out that we have the same problem with humans. This issue looms large in medicine where many clinicians believe they can always explain to students how they come to the correct answer. The following is one of my favourite Geoff Norman quotes:

Furthermore, diagnostic success may be a result of processes that can never be described by the clinician. If the right diagnosis arises from pattern recognition, clinicians are unlikely to be able to tell you why they thought the patient had gout, any more than we can say how we recognize that the person on the street corner is our son. Bowen claims that “strong diagnosticians can generally readily expand on their thinking”; I believe, instead, that strong diagnosticians can tell a credible story about how they might have been thinking, but no one, themselves included, can really be sure that it is an accurate depiction.

We are Strangers to Ourselves, as Timothy Wilson put it.

Flat out on the apprenticeships

by reestheskin on 20/02/2018

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The article is about Germany, but I just wonder how much the rite of passage of moving out of the family home is relevant.

Second, apprentices in less prestigious positions are paid very poorly, she said. A trainee hairdresser might receive just €350-€400 (£311-£356) a month, not enough to allow them to move out of their parents’ house, Professor Solga explained, and sectors with shortages such as hotel work or food processing often involve shift and evening work. “For young people, they are not the best working conditions,” she said. THE

“Debt douses every flame – it’s a great retardant.”

by reestheskin on 19/02/2018

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The result, he says, is not only a meek student population but also “the biggest Ponzi scheme in British history” – a comparison famously made by Theresa May’s former adviser Nick Timothy.

“The great thing about a Ponzi scheme”, Professor Sutherland continued, “is that you can keep expanding it.”

(All the way to jail, some might say).

John Sutherland (‘The war on the old’ and now the ‘War on the young’, quoted in the THE. Not so much kindling a flame, nor even filling the vessel, then.

MAD and Mutually assured instruction

by reestheskin on 12/02/2018

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Young people, both rich and poor, are ill-served by the arms race in academic qualifications, in which each must study longer because that is what all the rest are doing. It is time to disarm.

I guess we need a version of CND fit for out time. Economist.

Statistics

by reestheskin on 08/02/2018

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I love statistics, but I am just not very good at it, and find much of it extremely counter intuitive (which is why it is ‘fun’). The Monty Hall problem floored me, but then Paul Erdos got it wrong too (I am told), so I am in good — and numerate — company. During my intercalated degree in addition to a research methods tutorials (class size, n=2), we had one three hour stats practical each week (class size, n=10). We each used a Texas calculator, and working out a SD demanded concentration. Never mind, that during the rest of the week we were learning how to use FORTRAN and SPSS on a mainframe, ‘slowing’ down the process was useful.

Medicine has big problems with statistics although it is often not so much to do with ‘mathematical’ statistics but evidence in a broader sense. IMHO the biggest abusers are the epidemiologists and the EBM merchants with their clickbait NNT and the like. But I do think this whole field deserves much greater attention in undergraduate education, and cannot help but feel that you need much more small group teaching over a considerable period of time. Otherwise, it just degenerates into ‘What is this test for?’ exam fodder style of learning.

The problems we have within both medicine and medical research have been talked about for a long while. Perhaps things are improving, but it is only more recently that this topic has been acknowledged as a problem amongst practising scientists (rather than medics). This topic certainly resurfaces with increased frequency, and there have been letters on it in Nature recently. I like this one:

Too many practitioners who discuss the misuse of statistics in science propose technical remedies to a problem that is essentially social, cultural and ethical (see J. Leek et al. Nature 551, 557–559; 2017). In our view, technical fixes are doomed. As Steven Goodman writes in the article, there is nothing technically wrong with P values. But even when they are correct and appropriate, they can be misunderstood, misrepresented and misused — often in the haste to serve publication and career. P values should instead serve as a check on the quality of evidence.

I think you could argue with the final sentence of this (selected) quote, but they are right about the big picture: narrow technical solutions are not the problem here. Instead, we are looking at a predictable outcome of the corruption of what being a scientist means.

When lectures work

by reestheskin on 06/02/2018

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“What were your most memorable moments at university?”

 

“There was a man called Walter Ullmann who taught medieval critical philosophy at 10am – and there was standing room only. I went every week, regardless of how wasted I’d got the night before, because he was brilliant.” THE

Reminds me of people queueing to get into to listen to Isaiah Berlin. Some merit as a metric: standing room only. (Until H&S arrive)

PS. And,  for another example, see this from a recent book review of a biography of Enrico Fermi (The Last Man Who Knew Everything: The Life and Times of Enrico Fermi, Father of the Nuclear Age. By David Schwartz).

[the author]..He interviewed many of Fermi’s students and colleagues, shedding light also on Fermi the educator (his lectures were so renowned that even notes taken by his assistants were a bestseller).

TEF that!

Theatres of the mind

by reestheskin on 19/01/2018

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I am not a big fan of lectures. The single best piece of advice I received at medical school was not to attend. I therefore skipped lectures for three years (although I got the handouts). It is not that all lectures are bad, they are not. It is just that often they are used for ‘content delivery’, much as we think about delivery of a takeaway. They are ill suited to this role, now that we can write and distribute text cheaply. Good lectures serve a different purpose, but you don’t need too many of them and, in my experience of medicine, there are very few people who lecture well. Lecturing well means choosing those fragments of a domain that lend themselves to this media type. Lectures are (and should be) theatre, but the theatre of the mind needs more.

By chance, I came across the following thoughts from the preface to the Ascent of Man (the TV series and the book). Bronowski understood many things, and I still marvel at how prescient his ideas were.

If television is not used to make these thoughts concrete, it is wasted. The unravelling of ideas is, in any case, an intimate and personal endeavour, and here we come to the common ground between television and the printed book. Unlike a lecture or a cinema show, television is not directed to crowds. It is addressed to two or three people in a room, as a conversation face to face – a one-sided conversation for the most part, as the book is, but homely and Socratic nevertheless. To me, absorbed in the philosophic undercurrents of knowledge, this is the most attractive gift of television, by which it may yet become as persuasive an intellectual force as the book.

The printed book has one added freedom beyond this: it is not remorselessly bound to the forward direction of time, as any spoken discourse is. The reader can do what the viewer and the listener cannot, which is to pause and reflect, turn the pages back and the argument over, compare one fact with another and, in general, appreciate the detail of evidence without being distracted by it.

Then there was PowerPoint and lecture capture.

Off piste, no more; and wear a helmet.

by reestheskin on 12/01/2018

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The endless concern about stamps of approval and achievement distorts education and can even rob an interesting career of its joys. A professor friend introducing students at an East Coast college to Beethoven was greeted with a dead-eyed question from the back of the class: ‘Excuse me professor, will this be in the test?

FT

Textbooks and smartphones

by reestheskin on 11/01/2018

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A new copy of Glenn Hubbard and Tony O’Brien’s widely used introductory economics textbook costs more than some smartphones. The phone can send you to any part of the web and holds access to the sum of human knowledge. The book is about 800 heavy pages of static text. Yet thousands of college students around the US are shelling out $250 for these books, each semester, wincing at the many hours ahead of trying to make sense of this attempt to distill the global economy into tiny widgets and graphs.

Link

Quote of the day

by reestheskin on 10/01/2018

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The easiest way to predict the future is to prevent it.

Original version is Alan Kay (the easiest way to predict the future is to invent it), and this permutation is his, too. As he says, very appropriate for education.

New playlist from Skincancer909 on YouTube

by reestheskin on 09/01/2018

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Real numbers from the opaque world of cookbook publishing

by reestheskin on 08/01/2018

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In my professional area of medical education there is clear market failure. Publishers are simply unable or choose not to, to develop what we need. And the institutions — universities — despite their origins have simply looked the other way, ignoring the needs (and wants) of their students. And do not get me started on “lecture recording”.

The quote below is a great article on some of the economics of book publishing: it is about a cookbook. And why not?

One of the most opaque industries around is publishing, not here online, but good old-fashioned print-books and their digital and audio spin-offs. Poke around and try to find some hard sales numbers and you’ll quickly find that it’s near impossible to do so. You can find bestseller lists from reputable sources like the NYTimes, Amazon and others but tying those rankings to an actual number of books sold at retail is simply not doable. Publishing costs, deals, and profit lines are even harder to shake loose.

“Why We Are Self Publishing the Aviary Cookbook – Lessons From the Alinea Book”. Real numbers from the opaque world of cookbook publishing. [Link]

And if you want insights into the research publishing business, here is a link to a great article that appeared in 2017 on this topic by Stephen Buranyi. Mind you, I almost have a sneaking admiration for some of the crooks: foxes in the henhouse.

Teaching led research, anybody?

by reestheskin on 03/01/2018

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There is something about teaching that makes you a better researcher. I know this is very countercultural wisdom, but I believed it all along. Luria, Magasanik, and Levinthal all believed it. Levinthal and Luria both had a very strong influence on me in this regard.

An (old) interview with David Botstein, in PloS genetics. Link

At least we are spared the ‘research led teaching’ mission statements.

Allan Holdsworth RIP 16/4/2017

by reestheskin on 31/12/2017

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Legato to kill for

I am a bad (awful) guitarist, but remain fascinated by guitars and the people who wield them. In recent years I have become ever more interested in the pedagogy of the guitar, and what insights it may throw on professional practice and education, and how people learn outwith the academies. And even if I would not have expressed it in these terms at that time, as a teenager the guitar was my intellectual bridge into understanding that there is as much — if not more—  discipline and rigour outside the academy than within it. (If you are interested in the ‘how’ of learning the guitar, check out Gary Marcus’ book).

With many great players, even if I cannot work out exactly how they do it, I have a good idea. You can spot the pentatonic or the classic major and minor scales easily enough: Clapton doesn’t play the same notes as Akkerman. But the first time I heard Allan Holdsworth (playing with Bill Bruford), I was confused. I couldn’t work out the scales and his phrasing was not like that of any guitarist I knew (nor was I any wiser, quite frankly, after seeing him on stage at Newcastle University,  on this tour I suspect).

Bjørn Schille, says it well below 

“As opposed to much of the music I spent time listening to and examining, his music left me with both chills and a feeling of total confusion. I had no idea what he was doing. Both his chord progressions and his phrases defied my sense of tonality and sounded like nothing I had ever heard. At the same time, it all sounded so perfectly unstrained and logical; like a beautiful language I had yet to understand. His choice of notes may have resembled jazz, but the character of the music had a much darker melancholy, as well as an absence of the swing rhythm that to me makes traditional jazz always a little too cheerful.”

(Bjørn Schille, Master Thesis in Musicology – February 2011 Institute of Musicology, University of Oslo [ you can hear the author here])

There was an obituary in the Guardian here, which contains a phrase from the Mahavishnu himself (worthy of Holdsworth’s tombstone, I think):

The guitarist John McLaughlin has wryly admitted he would have been happy to borrow just about anything his fellow Yorkshireman invented, if only he could have figured out how it was done.

There are some YouTube clips below. The sound is not too good, but they give a flavour of his genius. There is also a 12CD boxed set released shortly before he died [link here]. He would have hated the title.

Childhood lost?

by reestheskin on 06/11/2017

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Childhood, which is supposed to be the province of spontaneous play, has become highly administered, with parents and schools priming their human capital investments — children — for a merciless jobs market: “Between 1981 and 1997, elementary schoolers . . . recorded a whopping 146 per cent gain in time spent studying.”

FT link here

Rearranging the deckchairs

by reestheskin on 06/11/2017

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Woodrow Wilson once remarked that it is easier to change the location of a cemetery than it is to change a curriculum.

Via Jon Talbot, commenting on an article on the ?failures of online learning. I would only add the comment made by Henry Miller, in the context of medicine: curriculum reform, a disease of Deans.

Cognitive prostheses

by reestheskin on 03/11/2017

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This is a term I first learned from Clark Glamour and colleagues in Android Epistemology. Dermofit was a failed attempt to try and invent such a prosthesis.

Thinkers and thinking societies build tools that enhance their own thinking. When the speed of the positive feedback increases rapidly, we see a scientific and cultural revolution. When grit is put into the cogs or the base metals diluted, the opposite happens.

Last week I was giving a talk about tech, medicine and medical education, and for the life of me could not remember the following example, showing how key representation is to our intellectual toolbox. Worse, I knew it had an Edinburgh connection. Wikipedia has more.

Foundational knowledge

by reestheskin on 11/10/2017

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You don’t learn to draw by knowing how pencils are made

These sort of aphorisms always make me to want to think harder about what exactly is foundational in medical education. The suspicion is that it is far less than we think. Schooling is full of wasted time spent learning things that are of little use, but easy to test, meaning there is little time for students to learn things that are useful.

The case for anatomy in surgery is robust and self-evident. If you remove tumours in the preauricular area or on the temple, you have to know what structures to avoid or which ones may have become compromised. If you ask any competent surgeon they will of course know what these structures are. But when you move into many areas of clinical medicine, I am always amazed by how much competent physicians have forgotten about all these things that were labelled ‘foundational’, and formed the basis of high-stakes exams. It is of course possible to be aware of schema, that structure your behaviour, and be unable to recall them — schema that experts implicitly know and novices don’t. But I suspect we need some sort of minimalism project, to work out how far we can go.

What Toy Story got wrong. And more.

by reestheskin on 10/10/2017

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If we go back to the traditional kindergarten, kindergarten was first invented about 200 years ago. It was explicitly designed to be different than the traditional school, where it was primarily about delivering instruction, delivering information that students who then dutifully wrote down on paper and recited it back. The early kindergartens recognized that something very different was needed for five-year-olds.

And yet:

There’s a real challenge today because even kindergartens are starting to become more like the rest of school with children filling out phonics worksheets and looking at arithmetic flashcards

Interview with Mitch Resnick

Incarceration as the educational business model. Medium

Staying sharp

by reestheskin on 25/09/2017

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For obvious reasons, it’s difficult for researchers to know just how common the “smart drug” or “neuro-enhancing” lifestyle is. However, a few recent studies suggest cognition hacking is appealing to a growing number of people. A survey conducted in 2016 found that 15% of University of Oxford students were popping pills to stay competitive, a rate that mirrored findings from other national surveys of UK university students. In the US, a 2014 study found that 18% of sophomores, juniors, and seniors at Ivy League colleges had knowingly used a stimulant at least once during their academic career, and among those who had ever used uppers, 24% said they had popped a little helper on eight or more occasions.

The 15 most common smart drugs, and the science behind them — Quartz

The Pen Is Mightier Than the Keyboard

by reestheskin on 31/08/2017

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“Taking notes on laptops rather than in longhand is increasingly common. Many researchers have suggested that laptop note taking is less effective than longhand note taking for learning. Prior studies have primarily focused on students’ capacity for multitasking and distraction when using laptops. The present research suggests that even when laptops are used solely to take notes, they may still be impairing learning because their use results in shallower processing. In three studies, we found that students who took notes on laptops performed worse on conceptual questions than students who took notes longhand. We show that whereas taking more notes can be beneficial, laptop note takers’ tendency to transcribe lectures verbatim rather than processing information and reframing it in their own words is detrimental to learning.”

Psychological Science – Pam A. Mueller, Daniel M. Oppenheimer.

Oh dear….

Profit over prophet

by reestheskin on 24/08/2017

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I actually found this quite witty. But it is more than that. It playfully raises some of those issues about education, assessment, and certification. I would love to say medical education has got this right, but I do not believe that. It is easy to list the problems, but hard to solve them. Numbers and formal systems will always be used by those who understand them least, to exile judgement.

  1. Foundational knowledge does exist, it is just not as common as many believe. Teachers, accreditors and other institutions always want to exaggerate the importance of foundational learning because they rent seek on it: the more there is, the more money they make. They will create a world which suits them. It is not just the world some of use live in.
  2. Assessment may drive learning, but assessment frequently wrecks the learning that is education. I post this on the day that the ‘O’ level results come out: education as a proxy war for  politicians seeking reelection.
  3. Demands for better ‘metrics’ will often come at the cost of what many consider most important. Defending exam procedures, may lead to a quasi- legalistic obsession with reliability at the expense of education. This is not a new problem, and is far broader than psychometrics and indeed permeates much science (see Cornfield, J., & Tukey, J. W. (1956). Average values of mean squares in factorials. The Annals of Mathematical Statistics, 27, 907–949). The danger is people think that metrics are ‘theory free’ and forget that in education (and many other domains) metrics causally alter subject behaviour.
  4. Education is about the future. Any designer or educator has to live in the future. And since most of have enough difficulty understanding the present, we can only see it using metaphor. Blake said it well: every honest man is a prophet. Universities increasingly like to spell that sound with different letters.

Conspicuous education

by reestheskin on 11/08/2017

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Veblen’s conspicuous consumption rides on:

Rather than filling garages with flashy cars, the data show, today’s rich devote their budgets to less visible but more valuable ends. Chief among them is education for their children: the top 10% now allocate almost four times as much of their spending to school and university as they did in 1996, whereas for other groups the figure has hardly budged.

Book review in the Economist: The Sum of Small Things: A Theory of the Aspirational Class. By Elizabeth Currid-Halkett

Turbotic teaching awards

by reestheskin on 07/08/2017

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“I’ve written extensively on the now famous Georgia Tech example of a tutorbot teaching assistant, where they swapped out one of their teaching assistants with a chatbot and none of the students noticed. In fact they though it was worthy of a teaching award”

I keep reading this as ‘turbot’, and wondered what the fish things was. I guess the tutorbot would have corrected me soon enough.

Chips, chips, chips. And more chips, please.

by reestheskin on 04/08/2017

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“Children say they prefer IT in their lessons and courses? Do schools listen when kids say they prefer chips for lunch every day?”

An understatement follows:

Education policy is particularly vulnerable to political whims, fads and untested assumptions. From swapping evolution for creationism to the idea that multiple types of intelligence demand multiple approaches, generations of children are schooled according to dogma, not evidence.

Amen to all that. And not just school children, but university students. The Nature article is referring to: original paper here (The myths of the digital native and the multitasker. Paul A. Kirschnera, Pedro De Bruyckerec. DOI)

The end of an age of optimism

by reestheskin on 28/07/2017

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This is from CP Snow’s ’Two Cultures’. I have never read the book, always warming to critiques of it from others. But I like this snippet quoted by John Naughton, recently.

“I can’t help thinking of the Venetian republic in their last half-century. Like us, they had once been fabulously lucky. They had become rich, as we did, by accident. They had acquired immense political skill, just as we have. A good many of them were tough-minded, realistic, patriotic men. They knew, just as clearly as we know, that the current of history had begun to flow against them. many of them gave their minds to working out ways to keep going. It would have meant breaking the pattern into which they had been crystallised. They were fond of the pattern, just as we are fond of ours. They never found the will to break it.”

Maybe I should go back and look at it. CP Snow, Two Cultures