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.
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
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.
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.
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).
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?
Nice few words about Charles Handy in the Economist who has been recovering from a stroke. He has had to relearn walking, talking and swallowing.
As far as Mr Handy was concerned, the point of his hospital stay was to allow him to recover as fully as possible. That meant he needed to be up and about. In the view of the nurses, that was a potential problem; he might fall and hurt himself. Their priority was to keep him safe. In practice, that required him to stay in bed and keep out of trouble.
He mused on some themes all too familiar, namely how the organisational obsession with efficiency often results in organisations not being effective.
The purpose of education is to prepare children for later life, but all too often the focus is on getting the children to pass exams.
He saves some special words for Human
As it is, there is a temptation to try to turn people into things by calling them “human resources”. Call someone a resource, and it is a small step to assuming that they can be treated like a thing, subject to being controlled and, ultimately, dispensed with when surplus to requirements.
(The most egregious example of the above is how NHS management refer to preregistration doctors as ‘ward resources’ rather than doctors who are apprenticed to other doctors.)
Sadly his knowledge of the type of modern corporation we call ‘universities’ is out of date.
Indeed, Mr Handy argues that most organisations whose principal assets are skilled people, such as universities or law firms, tend not to use the term “manager”. Those in charge of them are called deans, directors or partners. Their real job is best described as leadership rather than management. And one of the primary functions of leadership is setting the right purpose for an organisation.
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I want to share my favourite course evaluation when I used to teach in the classroom. So, I got a 1 from this student, on a scale of 1 to 5 (where 5 is good and 1 is bad)…. a 1 is really demoralising. So, I look at it:
What does the student say? “This course was very unfair. Professor Roberts expected us to apply the material to things we had never seen before.”
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Sydney Brenner has died. Not quite the last of the handful of scientists who made one of the two scientific revolutions of the 20th century. The first half belonged to physics, the second to the biology that he co-created.
A precocious boy—a student at the University of the Witwatersrand by the time he was 15—and bullied for it, reading was his connection to the wider world. Courses, he said, never taught him anything. The way to learn was to get a book that told you how to do things, and then to start doing them, whether it was making dyes or, later in life, programming computers. If he thought more deeply than the other great biologists of his age, which he did, it was surely because he read further, too.
Reading Brenner was a staccato of insights. I hadn’t come across the ‘courses’ quote before, but no surprises there.
[University] teaching awards seemed to have been added like sticking plasters to organisations whose values lay elsewhere.
Graham Gibbs, Item Number 41, 2016, SEDA
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One in 10 people on the planet are unable to read or write. And many of those who can read, don’t. The reason isn’t lack of interest or a preference for smartphones. It’s simpler than that: they just don’t have books.
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This is from an article in the THE. Catherine Heymans is a physicist at the University of Edinburgh, who works on “dark energy”. She is planning to leave the UK to work in Germany (yes, Brexit). But what caught my eye was this quote describing one of those lightbulb moments (pun intended)
Question: As a physics undergraduate, how did you feel when the theory of dark energy first emerged?
Heymans: ‘It was 9am, and I was sat in a lecture theatre waiting for our lecturer to turn up – he was late. Eventually he ran into the room and said: “We’re not going to be studying high-energy astrophysics today, because the most amazing paper has just been published – you have to see this stuff.” It was new data that showed that the expansion of the universe was getting faster and faster, which could only be explained by extra, unseen “dark energy” in the universe.’
It is an interesting test for whether you believe in the ‘research led teaching’ trope. Or is it: will this be in the exam?
In addition to its vulnerability to spoofing, for example, there is its gross inefficiency. “For a child to learn to recognize a cow,” says Hinton, “it’s not like their mother needs to say ‘cow’ 10,000 times”—a number that’s often required for deep-learning systems. Humans generally learn new concepts from just one or two examples.
There is a nice review on Deep Learning in PNAS. The spoofing referred to, is an ‘adversarial patch’ — a patch comprising an image of something else. In the example here, a mini-image of a toaster confuses the AI such that a very large banana is seen as a toaster (the paper is here on arXiv — an image is worth more than a thousand of my words).
Hinton, one of the giants of this field, is of course referring to Plato’s problem: how can we know so much given so little (input). From the dermatology perspective, the humans may still be smarter than the current machines in the real world, but pace Hinton our training sets need not be so large. But they do need to be a lot larger than n=2. The great achievement of the 19th century clinician masters was to be able to create concepts that gathered together disparate appearances, under one ‘concept’. Remember the mantra: there is no one-to-one correspondence between diagnosis and appearance. The second problem with humans is that they need continued (and structured) practice: the natural state of clinical skills is to get worse in the absence of continued reinforcement. Entropy rules.
Will things change? Yes, but radiology will fall first, then ‘lesions’ (tumours), and then rashes — the latter I suspect after entropy has had its way with me.
I noted that he seems to be one of the leading thinkers in the push to rebrand STEM as STEAMED (Science, Technology, Engineering, Arts, Math, and Everything Delightful).
Alan Kay: The Computer Revolution Hasn’t Happened Yet, OOPSLA 1997
Of course, children can learn many things without special mentoring just by experimentation, and by sharing knowledge amongst themselves. But we don’t know of any examples where this includes the great inventions of humanity such as deductive mathematics and mathematically based empirical sciences. To use an analogy: what if we were to make an inexpensive piano and put it in every classroom? The children would certainly learn to do something with it by themselves – it could be fun, it could have really expressive elements, it would certainly be a kind of music. But it would quite miss what has been invented in music over centuries by great musicians. This would be a shame with regard to music – but for science and mathematics it would be a disaster. The special processes and outlook in the latter (particularly in science) are so critical and so hidden that it is crippling not to be taught them as “skills which allow the art”. As Ed Wilson has pointed out, our genetic makeup for social interests, motivations, communication, and invention, is essentially what humans were in the Pleistocene. Much of what we call modern civilization is made from inventions such as agriculture, writing and reading, math and science, governance based on equal rights, etc. These were hard to invent, and are best learned via guides.
Any real education is incapable of robust widely accepted psychometric assessment that will satisfy a professional regulator.
There is one of those beautifully written pieces on Medium, written by the ex-editor of Nature, Philip Ball [link]. It speaks of something particular, and also in the round.
My handwriting has been terrible as long as I can remember. I have tried on various occasions to improve it, but these attempts seldom last as long as the end of the day. In truth, it is not just others who find my writing hard to decipher — after a few minutes I seldom can make much sense of it. And much as though I would like to blame being a doctor for my troubles, I suspect this is just wishful thinking.
Ball’s article is about the fixation on cursive versus, rather than manuscript writing. He writes:
Something like modern cursive emerged from Renaissance Italy, perhaps partly because lifting a delicate quill off and on the paper was apt to damage it and spatter ink. By the 19th century cursive handwriting was considered a mark of good education and character.
I just smile when I read titbits like this. One of those fascinating explanations for something I had never considered or thought about. He argues that the usual arguments for cursive writing — that it is faster, or that it helps with spelling, or that it is useful for those with dyslexia are not well founded. So why does it persist?
He fixes (rightly) on the strange set of beliefs that constitute considered thought in education. You know, the sorts of things that are not far away from the “ I went to school, so I understand education” trope. (The medicine version is of course: ‘I know how to treat people, so I know how to teach other people to treat people’).
It suggests that what teachers “know” about how children learn is sometimes more a product of the culture in which they’re immersed than a result of research and data. It seems unlikely, in this regard, that teaching cursive is unique in educational practice. Which forces us to wonder: What happened to evidence?
This must surely lead us to wonder how much else in education is determined by a belief in what is “right,” unsupported by evidence. Education and learning are difficult to pin down by research. Teaching practices vary, it’s often impossible to identify control groups, and socioeconomic factors play a role. But it’s often the case that the very lack of hard, objective evidence about an issue, especially in the social sciences, encourages a reliance on dogma instead. The danger is greater in education, which, like any issue connected to child rearing and development, is prone to emotive views.
This all bothers me. Not that I think he is wrong, but rather, I find it hard to conceptualise what character of enquiry is both robust and useful in this domain. One look at medical education, and you realise, we are nowhere close to being there.
A few words from Melvyn Bragg about his radio programme ‘In our time’
He insisted that the programme should be “never knowingly relevant” and jumped wildly from the gin craze of the 18th century to the Palaeocene-Eocene thermal maximum. He expected to be out of a job in six months
In times like ours, not a bad motto to live by.
I do not have a coherent overview of many of the traditional professions, but I wonder if people will soon say similar things about doctors.[Link]
“The big issue that concerns me at the moment in the English education system is the supply of high-quality teachers. We’ve seen quality issues in recruitment to teaching and our schools are getting increasingly desperate to find decent teachers. The whole workload issue has come to a big head again in England with teachers having very big workloads and their conditions of service is deteriorating a lot recently. We’re seeing a big exodus in teaching and so of course, we need a bigger inflow to maintain the balance.”
Wiliam is talking about schooling, but it is also true of medical education.[Link].
“For me, I think the issue in the United States in particular is how we improve education at scale. I argue there are two things that have particularly powerful impact. One is a knowledge-based curriculum, recognizing that the purpose of curriculum is to build long-term memory into our students and what distinguishes novices from experts is knowledge not skills. And the second one is creating a culture where every teacher accepts the need to improve, not because they’re not good enough, but because they can be even better.”
I am pleased with the comment about long-term memory: intellect’s ballast. Knowing things matters.
“I have been seriously attempting to raise money to carry out this science education effort ever since the Nobel Prize (in 2001),” Wieman said. “While on sabbatical last year I prepared about 34 proposals for support directed to private individuals and foundations, mostly in Colorado, and to state and federal funding agencies,” he said. None of the proposals were awarded.
The title above and quotes below are from this article by Lincoln Allison. To create teaching machines, you need to make teaching so bad that even the machines can do it. We are almost there.
The most particular annoyance for me was the doubling of seminar size from nine to 18 – allegedly to free up time for research. As if anyone is going to develop the capacity for original thought because they have two or three more hours available in the week! To some of my colleagues, this was merely a technical change, but to me it was the abolition of the real seminar, the thing we should have been most proud of in the English university system.
It was part of a general deprioritising of teaching. I remember a colleague looking at her extremely poor ratings on student “feedback” and remarking gaily: “I’m really not very good at this, am I?” She had just had a book published that was extremely well received, and she couldn’t care less that she was failing in her core duties to communicate her ideas within an academic community. Her remark stiffened my resolve to leave – especially once students picked up the vibe about the level of staff interest in teaching and became less challenging and more instrumental.
Much of what I have seen and heard of UK universities in the 14 years since I retired seems to relate to what I would consider proper university teaching about as much as “value” tinned food relates to fresh food. And I think that just as there are people who have never tasted fresh food, there are people who have not experienced real lectures and seminars.
Education is probably the field in which we deceive ourselves the most, because the damage only appears decades later. We pretend that all children learn at the same rate and in the same way. Every teacher and parent knows this to be untrue, and to deny it is folly. But deny it we do.
Algeria Shut Down the Internet to Prevent Students from Cheating on Exams
Via Bruce Schneier. The solution in New South Wales, Australia was to ban smartphones.
One selling point of MOOCs (massive online open courses) has been that students can access courses from the world’s most famous universities. The assumption—especially in the marketing messages from major providers like Coursera and edX—is that the winners of traditional higher education will also end up the winners in the world of online courses.
But that isn’t always happening.
In fact, three of the 10 most popular courses on Coursera aren’t produced by a college or university at all, but by a company. That company—called Deeplearning.ai—is a unique provider of higher education. It is essentially built on the reputation of its founder, Andrew Ng, who teaches all five of the courses it offers so far. Link
The MOOC story is like so much of tech — or drug discovery for that matter. Finding a use for a drug invented for another reason often offers the biggest payback. This story has barely begun.
This is a tweet from Dylan Wiliam — who knows more about education than…..well I am too polite to go there.
“goes straight to the top of my list of studies that I trust but wish were not true. I think it is the most important book on education I have ever read.”
He is referring to Bryan Caplan’s disturbing and excellent book. (The case against education). One comment of mine: not in all possible worlds.
And no, I wouldn’t have thought the effect was measurable. Wrong again.
From the results presented here it is clear that there has been a slow but steady decline in the frequency of certain variants in the Icelandic gene pool that are associated with educational attainment. It is also clear that education attained does not explain all of the effect. Hence, it seems that the effect is caused by a certain capacity to acquire education that is not always realized.
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).
(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.).
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.
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.
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.