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.
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.
I am generally nervous about doctors or academics working for the government. Not that I think the roles are unnecessary, far from it. But what worries me is when instead of resigning from their academic role, they end up working for more than one master. So, I tire of the use of university titles when the principle employer does not subscribe to the academic ideal. I think if you have been at Stanford and you go to Washington it should be as a regular civil service post. I think the Americans get it right.
But the retiring CMO, Dame Sally Davies, in an interview in the RCP in-house journal ‘Commentary’ speaks some truths (Commentary | October 2019, p10).
I hear non-stop stories from unhappy juniors. In my day, we (consultants) made up the rotas for the juniors, but now administrators do it without understanding all of the issues. I’m told you can’t go back to the ‘firm’ structure because there are so many doctors in the system, but whenever I meet a roomful of young doctors I ask: ‘Does your consultant know your name?’ It’s rare that a hand goes up. We have depersonalised the relationships between doctors and that can’t help the workings of the medial team, or with the patients.
Your mileage may vary, but when I was a junior doctor it was us — not the consultants — who came up with the rotas. But the point she makes is important, and everybody knows this (already). At one time junior doctors didn’t work for the NHS, rather they worked within the NHS for other doctors, for good and bad. I find it hard to imagine that the current system can deliver genuine apprenticeship learning. Training and service may often have resembled a bickering couple, but there was a broader professional context that was shared. I am not certain that this is the case anymore. Whenever people keep pushing words such as ‘reflection’ or ‘professionalism’, you know — pace Orwell — that the opposite is going on. Politics is a dominant-negative mutation.
There is lots of variation, but in general elite institutions have been the biggest growers. Some, including Oxford and Cambridge, have chosen not to expand. But most prestigious universities have sucked up students, grateful for their fees, which subsidise research. The intake of British students at members of the Russell Group of older, research-focused universities has grown by 16% since restrictions were lifted. Some have ballooned. Bristol’s intake has shot up by 62%, Exeter’s by 61% and Newcastle’s by 43%.
Increases in intake do not automatically mean a worsening of what is on offer, but the difference between Oxbridge and the Russell group shout out at you: some are more equal than others.
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An economist may have strong views on the benefits of vaccination, for example, but is still no expert on the subject. And I often cringe when I hear a doctor trying to prove a point by using statistics.
There were some critical comments about this phrase used by Wolfgang Münchau in a FT article. The article is about how ‘experts’ lose their power as they lose their independence. This is rightly a big story, one that is not going away, and one the universities with their love of mammon and ‘impact’ seem to wish was otherwise. But there is a more specific point too.
Various commentators argued that because medicine took advantage of statistical ideas that doctors talked sense about statistics. The literature is fairly decisive on this point: most doctors tend to be lousy at statistics, whereas the medical literature may or (frequently) may not be sound on various statistical issues.
Whenever I hear people talk up the need for better ‘communication skills’ or ‘communication training’ for our medical students, I question what level of advanced statistical training they are referring to. Blank stares, result. Statistics is hard, communicating statistics even harder. Our students tend to be great at communicating or signalling empathy, but those with an empathy for numbers often end up elsewhere in the university.
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Smith was supported by earnings from his professorship at Glasgow, where a university teacher’s earnings depended on fees collected directly from students in the class. This contrasted with Oxford, where Smith had spent six unhappy years, and where, he observed, the dons had mostly given up even the pretence of teaching.
But Smith relinquished his professorship in 1763, and the writing of ‘Wealth…’ and the remainder of his career was financed by the Duke of Buccleuch, who as a young man employed Smith as a tutor.
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[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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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?
June, July are the busiest time of year for. It is when I update all my teaching material, and I always underestimate how long it will take me. Here is a guide to some of it. But still I need to catch up with some more, as the new students have already started.
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.
This article from the Economist is much more nuanced than you might think — especially about all the benefits of attending school that are unrelated to what specifically goes on in the classroom. But if you couple it with a close reading of Bryan Caplan’s ‘The Case Against Education’ then it is hard not to feel that the academy has been guilty of failing to check out their own entrails before passing judgement on everybody else’s.
It sounds like a counsel of despair. If every child went to school, millions more would sit in woeful, boring classrooms. But while this sounds awful, it would probably still be good for them, their families and broader society. For, as Justin Sandefur of CGD points out, there is plenty of evidence that even when children do not learn much at school, they still do better for having gone.
Some benefits are economic. Attending school for longer is associated with earning more in later life, in part because those with additional schooling are more likely to get non-agricultural jobs and move to cities. This may indicate that young people are in fact learning something useful at school that is not being picked up by researchers. But it could also be a signalling effect: a shopkeeper may prefer workers who stayed at school for at least five years.
One is simply that if girls are at school they are not having sex at home
Besides, “university league tables are like sausages: the more you know about how they are made, the less you want to [do with] them”.
“Research was structurally unprofitable even if you scored really well in the research excellence framework,” he claims. “It’s being financed by surpluses on taught master’s. I think that’s fine because part of the reason people came on the taught programmes was because the place was very highly ranked in research, and they thought they were going to be sitting at the feet of the best economists around. Academics had to understand the dynamic and deliver the teaching because that was what was paying for the research. Yet because of the history of underfunding [undergraduate] students [before the introduction of £9,000 tuition fees in 2012], a kind of mood gained ground in British universities that [all] students were an unprofitable activity.
“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).
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.
Luis von Ahn, somebody who has changed the world on more than one occasion, has also been awarded a teaching award from his own university. Take his tips seriously 😉
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.
This was a quote from an article by an ex-lawyer who got into tech and writing about tech. Now some of by best friends are lawyers, but this chimed with something I came across by Benedict Evans on ‘why you must pay sales people commissions’. The article is here (the video no longer plays for me).
The opening quote poses a question:
I felt a little odd writing that title [ why you must pay sales people commissions]. It’s a little like asking “Why should you give engineers big monitors?” If you have to ask the question, then you probably won’t understand the answer. The short answer is: don’t, if you don’t want good engineers to work for you; and if they still do, they’ll be less productive. The same is true for sales people and commissions.
The argument is as follows:
Imagine that you are a great sales person who knows you can sell $10M worth of product in a year. Company A pays commissions and, if you do what you know you can do, you will earn $1M/year. Company B refuses to pay commissions for “cultural reasons” and offers $200K/year. Which job would you take? Now imagine that you are a horrible sales person who would be lucky to sell anything and will get fired in a performance-based commission culture, but may survive in a low-pressure, non-commission culture. Which job would you take?
But the key message for me is:
Speaking of culture, why should the sales culture be different from the engineering culture? To understand that, ask yourself the following: Do your engineers like programming? Might they even do a little programming on the side sometimes for fun? Great. I guarantee your sales people never sell enterprise software for fun. [emphasis mine].
Now why does all this matter? Well personally, it still matters a bit, but it matters less and less. I am towards the end of my career, and for the most part I have loved what I have done. Sure, the NHS is increasingly a nightmare place to work, but it has been in decline most of my life: I would not recommend it unreservedly to anybody. But I have loved my work in a university. Research was so much fun for so long, and the ability to think about how we teach and how we should teach still gives me enormous pleasure: it is, to use the cliche, still what I think about in the shower. The very idea of work-life balance was — when I was young and middle-aged at least — anathema. I viewed my job as a creative one, and building things and making things brought great pleasure. This did not mean that you had to work all the hours God made, although I often did. But it did mean that work brought so much pleasure that the boundary between my inner life and what I got paid to do was more apparent to others than to me. And in large part that is still true.
Now in one sense, this whole question matters less and less to me personally. In the clinical area, many if not most clinicians I know now feel that they resemble those on commission more than the engineers. Only they don’t get commission. Most of my med school year who became GPs will have bailed out. And I do not envy the working lives of those who follow me in many other medical specialties in hospital. Similarly, universities were once full of academics who you almost didn’t need to pay, such was their love for the job. But modern universities have become more closed and centrally managed, and less tolerant of independence of mind.
In one sense, this might go with the turf — I was 60 last week. Some introspection, perhaps. But I think there really is more going on. I think we will see more and more people bailing out as early as possible (no personal plans, here), and we will need to think and plan for the fact that many of our students will bail out of the front line of medical practice earlier than we are used to. I think you see the early stirrings of this all over: people want to work less than full-time; people limit their NHS work vis a vis private work; some seek administrative roles in order to minimise their face-to-face practice; and even young medics soon after graduation are looking for portfolio careers. And we need to think about how to educate our graduates for this: our obligations are to our students first and foremost.
I do not think any of these responses are necessarily bad. But working primarily in higher education, has one advantage: there are lost of different institutions, and whilst in the UK there is a large degree of groupthink, there is still some diversity of approach. And if you are smart and you fall outwith the clinical guilds / extortion rackets, there is no reason to stay in the UK. For medics, recent graduates, need to think more strategically. The central dilemma is that depending on your specialty, your only choice might appear to be to work for a monopolist, one which seeks to control not so much the patients cradle-to-grave, but those staff who fall under its spell, cradle-to-grave. But there are those making other choices — just not enough, so far.
An aside. Of course, even those who have achieved the most in research do not alway want to work for nothing, post retirement. I heard the following account first hand from one of Fred Sanger’s previous post-docs. The onetime post-doc was now a senior Professor, charged with opening and celebrating a new research institution. Sanger — a double Laureate — would be a great catch as a speaker. All seemed will until the man who personally created much of modern biology realised the date chosen was a couple of days after he was due to retire from the LMB. He could not oblige: the [garden] roses need me more!
Incarceration as the educational business model. Medium
This year the University of Edinburgh plans to become one of the first big European universities to launch a blockchain course. Aggelos Kiayias, chair in cyber security and privacy and director of the blockchain technology laboratory at the university, says: “Blockchain technology is a recent development and there is always a bit of a lag as academia catches up.”
What interests me is how we think about all the things that universities do first. And why and how we lose that advantage for our students.
Terrific interview with Alan Kay. Familiar memes, but I do not tire of them.
The business of a university is to help students learn contexts that they were unaware of when they were in high school.
His use of the word context encompasses intellectual creations such as reading, writing, printing etc. His oft quoted quip: a change in context is worth 80 IQ points
Nice piece in ‘Science’ with the title: ‘No easy answers: What does it mean to ask whether a prekindergarten math program “works”?’ Geoff Norman, many years ago, used the term RCT in the context of medical education to stand for Randomised, Confounded and Trivial. Research into what works and what does not work in education is hard, and most studies (IMHO) fail to inform. Education isn’t a product like a drugs is, and gee it is hard to demonstrate when and where most drugs will work if you do not have an understanding of the biology and large effects to play with and outcomes that need to be measured over the long term.
I think about this a lot, but have no easy rules to guide action. Which is, of course, exactly the problem.
At the risk of raising the ire of many researchers, I should note that I am not basing my assessment on the rapid growth in educational neuroscience. You know, the kind of study where a subject is slid into an fMRI machine and asked to solve math puzzles. Those studies are valuable, but at the present stage, at best they provide at most tentative clues about how people learn, and little specific in terms of how to help people learn. (A good analogy would be trying to diagnose an engine fault in a car by moving a thermometer over the hood.) One day, educational neuroscience may provide a solid basis for education the way, say, the modern theory of genetics advanced medical practice. But not yet.
Keith Devlin, talking sense — again. I want to believe the the rest of the article but, worry it may not be so. But it contains some gems:
Classroom studies invariably end up as studies of the teacher as much as of the students, and often measure the effect of the students’ home environment rather than what goes on in the classroom.
This just adds to the problem that Geoff Norman (DOI 10.1007/s10459-016-9705-6) and others have talked about in course evaluations, namely that many studies — even accepting of the limitations outlines above — are riddled with pseudoreplication.
What is missing is any insight into what is actually going on in the student’s mind—something that can be very different from what the evidence shows, as was dramatically illustrated for mathematics learning several decades ago
But, like many outwith medicine, I think he puts too much store by the robustness of the RCT approach — even with digital tools to allow large scale measurement. RCT: ‘randomised, confounded and trivial’, as has been said before (Norman).
I have been busy updating some teaching stuff. It is never finished but there is time for a little pause. I have completed all the SoundCloud audio answers to the questions in ed.derm.101 (Part C) and there is a ‘completed’ version of ed.derm.101 Part C half way down the linked page. Not all the links have been checked, and a lot had to be redone because the superb New Zealand Dermnet site changed their design (the best source of dermatology images, IMHO). An example of the sort of audio material is below.
Interesting post from Tony Bates on the history of distance learning, and the University of London External Programme, which started in 1828.
Unfortunately I have no knowledge of the individuals who originally created the University of London External Programme back in 1828. It’s a worthy research project for anyone interested in the history of distance education.
I was once (mid-1960s) a correspondence tutor for students taking undergraduate psychology courses in the External Programme. In those days, the university would publish a curriculum (a list of topics) and provide a reading list. Students could sit an exam when they felt they were ready. Students paid tutors such as myself to help them with their studies. I would find old exam papers for the course, and set questions for individual students, and they would send me their answers and I would mark them. Many students were in British Commonwealth countries and it could take weeks after students sent in their essays before my feedback eventually got back to them. Not surprisingly, in those days completion rates in the programme were very low…
But I am fascinated by (and was ignorant of) the following:
Note though that teaching and examining in the original External Programme were disaggregated (those teaching it were different from those examining it), contract tutors were separate from the main faculty were used, and students studied individually and took exams when ready. So many of the ‘new’ developments in distance education such as disaggregation, self-directed learning, and many of the elements of competency-based learning are in fact over 150 years old.
I have added some more SoundCloud answers and added and sorted the links in Part C Chapters 5,6,7. Getting there.
I have posted some new audio SoundCloud answers to questions from the first three chapters of ed.derm.101 Part C.