Content matters

by reestheskin on 07/07/2017

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Interesting graphic from Audrey Watters on the bête noire, that is Pearson (especially if you are an investor). But although I think I am in a minority, I think universities are wrong to not understand how the world of content will impact on their business models. What is your content like, and what do you add to it? Content is key. But it doesn’t cost 9K, at least not if you scale it right.

Nosology

by reestheskin on 06/07/2017

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How to select medical students…………..

On the topic of quotations, though, a longer recent discussion about Hanlon’s Razor on the Farnam Street blog includes this rather nice one from the German general Kurt von Hammerstein-Equord:

I divide my officers into four groups. There are clever, diligent, stupid, and lazy officers. Usually two characteristics are combined. Some are clever and diligent – their place is the General Staff. The next lot are stupid and lazy – they make up 90 percent of every army and are suited to routine duties. Anyone who is both clever and lazy is qualified for the highest leadership duties, because he possesses the intellectual clarity and the composure necessary for difficult decisions. One must beware of anyone who is stupid and diligent – he must not be entrusted with any responsibility because he will always cause only mischief.

The Razor Returns | Status-Q

All about shifting units

by reestheskin on 05/07/2017

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Of all the titles submitted to the 2014 research excellence framework, only “around a half in most subjects achieved at least one retail sale in the UK in the years 2008-14”. 

Worst sellers: warning of existential crisis for academic books | THE News

I wish I had said that

by reestheskin on 04/07/2017

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A large part of Kahn’s legend rests on his fame as a pedagogue, and although his parallel teaching career was driven by financial necessity, he became renowned for his ability to inspire students with a more elevated vision of professional practice than the technically advanced but psychically stunted approach characteristic of postwar American architectural education. (emphasis mine)

From a (book) review in the NYRB about the late architect Louis Kahn (Salk institute etc). “Psychically stunted.” Sounds like some other sort of professional education I am more familiar with.

Compatible scholarship

by reestheskin on 03/07/2017

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If I had one criticism of Drezner’s otherwise excellent book, it is that his cure is thin gruel. He urges universities and think-tanks to regain their independence from big philanthropy. That is all very well. But how could they afford it?

Review in the FT of ‘The Ideas Industry’, by Daniel Dresser.

Failing gracefully.

by reestheskin on 30/06/2017

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Optimism is the idea that we can build things that fail gracefully

This was a quote from Cory Doctorow on a Guardian Podcast interview at the Hay Book Festival. I do not see much of this in my professional life, but he calls it right.

No matter. Try again. Fail again. Fail better.

Inverse dermatology

by reestheskin on 29/06/2017

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I guess you could call this inverse dermatology.

 

Inventing the future

by reestheskin on 28/06/2017

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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

 

Cardiac Arrest

by reestheskin on 27/06/2017

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Jed Mecurio was on Desert Island Discs. He of ‘Cardiac Arrest’ fame. (ITU: they used to call it the ICU — intensive care unit — till they realised, nobody did). Something he said chimed with a conversation I had with somebody who knows a lot more about junior doctor training in the modern NHS than I do.

Mercurio, was the son of working class Italian immigrants. And, as is true of many immigrants, a child moving into the stable world of the professions is encouraged. Mercurio pointed out that the popular representation of medicine often does not match the reality. Those with family members already in medicine know this, whereas those without this, have to discover it (at least, I hope they discover it).

When I was trying to get a handle on some of the issues surrounding junior doctor training with my source, the very same point came up. Many junior docs idea of what medicine was like, he / she argued, was based on TV programs — and more Eastenders than West Wing. And this is a problem, he commented.

Cardiac Arrest may be showing its age, but for me it was more accurate than all the sanitised bumph that medical schools and the GMC produce. Fiction is sometimes more real than reality.

Someone once called Vieux Farka Touré the “Hendrix of the Sahara”.

Kinda cool… FT.

When clinicland is not in the clinic

by reestheskin on 23/06/2017

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One of the important things I learned from reading Herb Simon’s ‘Models of my life’ was his view that seldom did reading the academic literature feed him with new ideas on what to work on. I do not mean to imply that reading the literature is irrelevant, but that in some domains of enquiry the formal literature is often unhelpful when it comes to  not so much thinking outside the the box, but realising the box needs throwing out and you need a chair instead. For instance, in med ed, I find most of the formal literature akin to chewing sawdust. It is dull and often the main motivation seems to be to advance one’s career rather than change the world. All of this came to my mind when I read the following:

It tells the remarkable tale of Athletic Bilbao, one of three clubs never to have been relegated from La Liga, the Spanish top division, despite having a policy of selecting only Basque players. Bilbao’s story emphasises a recurring theme of the book: the importance of development programmes for young players and the lengths that clubs go to in order to nurture footballers. Benfica, a Portuguese club, uses a 360-degree “football room”, walled by LED lights, to train players in over 100 scenarios. Targets appear for the players to hit with the ball; sensors measure the players’ effectiveness.

( a review in the Economist of The European Game: The Secrets of European Football Success. By Daniel Fieldsend. Arena Sport; 255 pages; £14.99.)

Now, readers will know that given the genes, I am more rugby than soccer, although I marvel at the skill modern footballers show. But what interests me and has interested me for a while is the relation between structured unnatural performance and fluency at performance. Now my phrasing may be a little ugly, and I do not think there is anything deep or new about what I am saying. Just take how we know you learn a musical instrument. How breaking up and sequencing of mini skills is necessary before you put it all together. People do not pay to listen to people play scales (although I will ignore, shred guitar aficionados), but rather they like songs or sonatas etc.

I would push this is the following direction. A real danger in undergraduate medicine is that we have become inured to the idea that learning situated in the clinic is the best way to learn medicine. At one time, I might have agreed. But out clinics have changed, but our ideas have not. One of the benefits of coaching and online learning is that we can make the offline — the clinic — work better. But also need it less, because it is not working well.

There are some interesting apparent paradoxes here. We need (pace the above quote) more ‘football rooms’, but as Seymour Papert argued, if you want to learn to speak French go to France and if you want to learn maths go to mathland. But are these real or virtual?

Foundational?

by reestheskin on 22/06/2017

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Despite this, less than half of developers consider their formal education to be “important” or “very important” to their jobs.

Well this is tech, but it is also true of any many fields of endeavour. But not all. We need to understand when and where the rules of the game change. This is not just about certification

Zuboff’s Laws

by reestheskin on 21/06/2017

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In the context of her research about the implications of information technology she stated three laws:

  • Everything that can be automated will be automated.
  • Everything that can be informated will be informated.
  • Every digital application that can be used for surveillance and control will be used for surveillance and control.

Wikipedia. A lot of interesting links to her work. I never knew the origin.

A rich patient bled dry

by reestheskin on 20/06/2017

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Lots of money is spent on medical education in England – but very little of it goes towards teaching.

Says Philip Chan in THE. Yes, he is not the only one writing on this. I assume the sub-editor was having a poetic day.

 

Benign paternalism in teaching. And nappies.

by reestheskin on 19/06/2017

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Thanks to Betsy DeVos & Co., “school choice” has become a hot-button issue in the US. But across the pond in Germany, choice looks a lot less like private school vouchers and a lot more like…democracy. At Dolli-Einstein-Haus elementary school, kindergarteners exercise their voting rights weekly through “kids’ councils,” collectively choosing everything from class activities to what’s served at snack. The one limit on their civil liberties? Teachers reserve the right to decide when a kid needs a diaper change—to which we say, fair enough.

EdSurge.

Then we can call it computer engineering..

by reestheskin on 16/06/2017

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“If we are really going to turn over our homes, our cars, our health and more to private tech companies, on a scale never imagined,” he wrote, “we need much, much stronger standards for security and privacy than now exist. Especially in the US, it’s time to stop dancing around the privacy and security issues and pass real, binding laws.

“And, if ambient technology is to become as integrated into our lives as previous technological revolutions like wood joists, steel beams and engine blocks, we need to subject it to the digital equivalent of enforceable building codes and auto safety standards. Nothing less will do. And health? The current medical device standards will have to be even tougher, while still allowing for innovation.”

Nice piece on Walt Mossberg from John Naughton.

We need a science of philanthropy

by reestheskin on 15/06/2017

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Or so says an article in Nature. No we don’t , is my response

Philanthropists are flying blind because little is known about how to donate money well. Facebook co-founder Mark Zuckerberg’s US$100-million gift to schools in Newark, New Jersey, reportedly achieved nothing. Some grants to academic scientists create so much administration that researchers are better off without them. And some funders’ decisions seem to be no better than if awardees were chosen at random, with the funded work achieving no more than the rejecte

There is no science to philanthropy. You can study it, you can come up with ideas about it, and try to meld systems of rationality about it. But this is just an abuse of the word science, an abuse meant to demarcate this area of activity from things that are non-science and are, by implication, less robust or rigorous. This is one of the ways the science (and STEM) lobby misunderstand the world. But, the quoted paragraph, does of course say something meaningful.

“Certainly, for frontline doctors like us who are used to wrestling with clunky NHS IT systems, the biggest surprise of the malware attack was not that it happened but why it had taken so long. It is an irony lost on no NHS doctor that though we can transplant faces, build bionic limbs, even operate on fetuses still in the womb, a working, functional NHS computer can seem rarer and more precious than gold dust.’

Here.

Learning in higher ed

by reestheskin on 13/06/2017

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There are two models. Sage on the stage. Or building structures than scale. Individual brilliance and interpretation; or Hollywood. There are not not enough sages; but people deny we can build structures that scale.

I see this dialectic everywhere in education. When do we need n=1; and what can do at scale. It is not just education however. All over the creative world we can see this battle play out. As Paul Simon put it:

“I’m sittin’ in the railway station, got a ticket for my destination

On a tour of one-night-stands, my suitcase and guitar at hand

And every stop is neatly planned for a poet and a one-man band”

On the other hand look at this. The song maker (Max Martin) few have heard of.

Woodie Flowers in a devastating critique of MITx said it well.

I believe the “sweet spot” for expensive universities like MIT is:

1) access to highly-produced training systems accompanied by

2) a rich on-campus opportunity to become educated.

MITx seems aimed at neither.

Medicine gets this confused big time. There is training and education. If we did the former better, we could offer a real education. But to do the training better, we need scale. And that means content. We could do things better and cheaper.

Politics is nothing else but medicine on a large scale

by reestheskin on 12/06/2017

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A few years back at an ADA meeting in Napa I got to listen to a dermatologist who understood how to influence government. I had never heard anybody speak live who was so effective, so effortless in his command of his brief, and with such charm. Maybe JFK might have had this effect, too. The there was Obama.

I do not have these skills, but more worryingly I do not think UK medicine does them that well either. I do not mean the ‘honours’ business, but meaningful attempts to balance the power and corruption of the state. We don’t seem to do activism well, either.

Some advice from last week’s NEJM, worth a read: ‘Effective Legislative Advocacy — Lessons from Successful Medical Trainee Campaigns’. Which, if nothing else, forced me to chase up the quote I (and others) have been misquoting for years from Rudolf Virchow.

Speaking on BBC Radio 4’s Midweek programme on 22 February 2006, Jonathon Kaplan quoted Virchow as saying that, “pathology is politics writ large”. He seems to have been misquoting the usual part‐quotation that, “Medicine is a social science and politics is nothing but medicine writ large”. In fact, what Virchow really said was that, “Medicine is a social science and politics is nothing else but medicine on a large scale. Medicine as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution; the politician, the practical anthropologist, must find the means for their actual solution”

Link here to J Epidemiol Community Health. 2006 Aug; 60(8): 671.

Consent for whom?

by reestheskin on 09/06/2017

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Interesting piece in today’s NEJM on data sharing and clinical trials and how meaningfully patients are involved.

Patients also said they wanted trial results to be shared with participants themselves, along with an explanation of what the results mean for them — something that generally doesn’t happen now. In addition, most participants said they had entered a trial not to advance knowledge, but to obtain what their doctor thought was the best treatment option for them. All of which raises some questions about how well patients understand consent forms.

Which reminded me of a powerful paper by the late David Horrobin in the Lancet in which, from the position of being a patient with a terminal illness, he challenged what many say:

The idea that altruism is an important consideration for most patients with cancer is a figment of the ethicist’s and statistician’s imagination. Of course, many people, when confronted with the certainty of their own death, will say that even if they cannot live they would like to contribute to understanding so that others will have a chance of survival. But the idea that this is a really important issue for most patients is nonsense. What they want is to survive, and to do that they want the best treatment.

I have always been suspicious of the ‘equipoise’ argument and terrified when I see participation rates in clinical trials  as a NHS performance measure. It is bad enough that doctors might end up acting as agents of the state. But this is worse than shilling for pharma.

Thew NEJM piece also draws attention to people’s reluctance to share with commercial entities. What this tells you, is that many people view some corporations —pharma — in this instance as pirates. Or worse. This topic is not going away. Nor is the need for (commercial) pharma to finance and develop new drugs.

 

An age of optimisation rather than optimism for a different future

by reestheskin on 08/06/2017

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Institutions with histories matter. It is just that in many instances innovation often comes from the periphery. I think this is often true in many fields: science, music, even medical education. It is not always this way, but often enough to make me suspicious of the ‘centre’. The centre of course gets to write the history books.

An article by Mark Mazower in the NYRB, praising Richard Evans, the historian of the Third Reich, caught my attention. It seems that nobody in the centre was too excited about understanding the event that changed much of the world forever. Mazower writes:

If you wanted to do research on Saint Anselm or Cromwell, there were numerous supervisors to choose from at leading universities; if you wanted to write about Erich Ludendorff or Hitler, there was almost no one. The study of modern Europe was a backwater, dominated by historians with good wartime records and helpful Whitehall connections—old Bletchley Park hands and former intelligence officials, some of whom had broken off university careers to take part in the war and then returned.

Forward-looking, encouraging of the social sciences, open to international scholarship from the moment of its establishment, St. Antony’s is the college famously written off by the snobbish Roddy Martindale in John le Carré’s Tinker, Tailor, Soldier, Spy as “redbrick.” The truth is that it was indeed the redbrick universities, the creations of the 1950s and 1960s, that gave Evans and others their chance and shaped historical consciousness as a result. The Evans generation, if we can call them that, men (and only a very few women) born between 1943 and 1950, came mostly from the English provinces and usually got their first jobs in the provinces, too.

It is interesting how academics who had had career breaks were important. And how you often  will need new institutions to change accepted practice. All those boffins whose careers were interrupted by the war led to the flowering of invention we saw after the second world war. You have to continually recreate new types of ivory towers. But I see little of this today. Instead, we live in an age of optimisation, rather than of optimism that things can be different. The future is being captured by the present ever more than it once was. At least in much of the academy.

Pathological medical students

by reestheskin on 07/06/2017

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Some nice memes in this letter from an MD student in Australia. Please discuss. Pharma might be interested

Considering this, if we thought about the pervasive attitudes that inform our definition of a “good” medical student as a disease, it’s hard to believe that we would not try to treat it.

Academic Medicine.

DOI: 10.1097/ACM.0000000000001700

The day they banned Powerpoint

by reestheskin on 06/06/2017

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Edward Tufte’s ‘The Cognitive Style of Powerpoint’ is funny. The problem is that it is not just funny, but deadly serious. Literally. His argument and case studies concern how humans died because people failed to understand how to communicate. And the title says it all. Powerpoint (at least its templates) degrades communication.

Communication is a big thing in medical education, and it is not unusual to have to sit through tedious talks on the subject. They usually start with Powerpoint slides, so at least you know that they are not going to say anything worthwhile and you can get your phone out and play.

Below is a memo, from Jeff Bezos, of Amazon.

Perhaps the single most important thing we could do to improve university education to is to remove all copies of Powerpoint. Words matter. Sentences even more.

Edward Tufte Kills a Kitten

 Via Visually. See more  here

We learn more from examples than from principles

by reestheskin on 05/06/2017

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This is from a book review on the ‘birth of cool’, by Robert Eaglestone in the THE.

Despite laying out some principles (“cool is…”), the book focuses on honed case studies of “the saints of cool” (as Hannah Arendt argues, we learn more from examples than from principles).

This little gem was new to me —but not the concept, or the principle…..

Academia tends to love rules, and formal systems, but for some domains of competence, they are grossly overrated. Formal logic is often not what is need, and we may seem more with a metaphor. Alan Kay’s aphorism: a different perspective may be as valuable as 80 IQ points.

Brilliant article from Steven Levy on Backchannel.

by reestheskin on 02/06/2017

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When I covered Kasparov-Deep Blue match, I thought the drama came from a battle between computer and human. But it was really a story of people, with brutal capitalist impulse, teaming up with AI to destroy the confidence and dignity of the greatest champion the world had seen. That leads me to believe it’s not Skynet that should worry us about AI, but rather the homo sapiens who build, implement, and employ those systems.

Well, this is all about one of the great issues of our age. As I wrote in 2008:

Change in medicine is increasingly driven by the twin forces of specialization, and the desire to codify medical practice, i.e. to produce rules that can be followed by those from a range of educational and professional backgrounds. The battle is over the intellectual heartlands of clinical practice and how the knowledge that underpins clinical practice is acquired, distributed and validated.

The mistake is to believe that this process is not mired in political and financial assumptions about what good care means — and who can make money out of it.

It’s not essay mills that are doing the grinding

by reestheskin on 01/06/2017

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Ultimately, students may feel less ripped off by essay mills than by universities.

I like this take on plagiarism and cheating. As has been said before, if somebody can write your essay, and the change in style not be noticed, those claims in the glossy prospectuses are hollow. Canaries in the coal mine.

Medical education and the TARDIS delusion.

by reestheskin on 30/05/2017

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I saw this giant problem in my education, and I actually designed a course called, “Physician Heal Thyself, Evidence-based lifestyle.” I brought in all these doctors who are experts in sleep medicine, sleep, fitness nutrition, food as medicine, functional medicine, integrative medicine, osteopathy and acupuncture. I got them all in a room and said I want you to teach students what we’re missing. We need to make this medical school education and have to implement this into the board certification programs as well as board exams. If it’s not required, it’s not going to be taught.

No, I am not taking this too seriously. Awhile back, I compiled a list of all the things we needed to  inflict on / ask medical  students to know : I had to buy a larger hard drive. And as for this ‘new medicine’ George Bernard Shaw described it a long time ago.

Quartz

What kind of undergraduate were you?

by reestheskin on 29/05/2017

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I began as a university student after two years of military service. My brain was like an empty sponge. University was fantastic, a world full of knowledge and very interesting people. I studied medicine and went to philosophy lectures as much as I could, and then mathematics until my medical exams came up.

Wolfram Schultz in the THE

The exponential (sic) phase

by reestheskin on 26/05/2017

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During the 7-year period between the introduction of tacrolimus in preclinical studies in 1987 and the FDA approval of tacrolimus in 1994, the transplant program at the University of Pittsburgh produced one peer-reviewed article every 2.7 days, while transplanting an organ every 14.2 hours.

Always thought these surgeons needed to spend more time in theatre .

Science. Obituary of Thomas Starzl.