Monthly Archives: July 2014

Our nation’s lack of research in medical education contrasts starkly with the large and essential commitment to biomedical research funded by industry, philanthropic organizations, and the public.

In a NEJM article, ‘ Innovation in Medical Education, by Asch and Weinstein.

“When I was asked to give the keynote to graduates of the class of ’14, it was an honour that nevertheless filled me with terror and a bit of wistfulness.”…”The wistfulness comes from wondering whether I would want to be a member of the class of ’14 if I had the opportunity. These are trying times for young doctors.”

Brian Goldman

It’s tough agreeing with Bill Gates

by reestheskin on 30/07/2014

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“We have to deliver value, and we’ve got to measure that value, and really adjusting the resources so we’re doing that well is a mission for you, the business officers of the colleges and universities. You’re the ones charged with fiscal management, and that has huge impact on every aspect of the student’s experience. On the quality of instruction, the availability of financial aid, the physical plant, the support systems. All of those are trade-offs that the financial model drives. My key message today is that that model will be under challenge. And so, instead of tuning it to find 3 percent here or 4 percent there, which has been the story in the past, there will be dramatic changes. … The role of the business officer won’t be just finding that last little tuning, or getting the reports done. It will be to get in the center of the strategy, working with the educational leaders, the effectiveness measures, and figuring out how those goals and the financial numbers come together.”

It’s tough agreeing with Bill Gates.

Do lectures work? Do drugs work?

by reestheskin on 30/07/2014

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A short while back PNAS published a meta-analysis of studies by Freeman et al comparing traditional lectures with those that include more ‘active’ activities. In an accompanying news and views, Carl Wieman defined those active methods as follows: ‘In active learning methods, students are spending a significant fraction of the class time on activities that require them to be actively processing and applying information in a variety of ways, such as answering questions using electronic clickers, completing worksheet exercises, and discussing and solving problems with fellow students.‘ The magnitude of the effect was large, with some measures showing an effect size of 0.47. In a letter just published, Hora argues that it is hard to define exactly what traditional lectures are, and that there may be much heterogeneity in this group. In his words ‘the jury is still out on lecturing (his argument is more nuanced that this, so read his words).
I have sympathies on all sides. Lectures are not a natural kind, and the delivery, format and style will, I suspect, interact with content and the target group. To some extent, the question, ‘ Do lectures work?’ is a bit like asking ‘Do drugs work?’ Having said all of the that, the weight of evidence seems  clearly be in favour of more active methods. There are however other things to think about.
Changing how you do things in a traditional course is not like swapping one pill for another. Nor are studies based on single courses necessarily a good guide to what happens when you implement widespread change. Most importantly, much as though I think you can improve learning using more active methods in lectures, we need to look hard at why we rely on lectures to such an extent, and how we can phase many or most of them out (at least in medicine). We also need to work out when we should use them. Drugs have both benefits and side effects too (or at least unintended actions); some of the latter are occasionally useful. The art, is in matching the type of drug, to the type of patient, at the right time.

Universities and GDP

by reestheskin on 29/07/2014

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‘If there is more truth in the hallways than in meetings, you have a problem’


Ed Catmull,  Creativity Inc

Downtime? Or the dermatologist’s Cretan paradox

by reestheskin on 14/07/2014

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The dermatologist's Cretan paradox

The Reverend Bayes needs a new prosthesis

by reestheskin on 10/07/2014

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I like Gerd Gigerenzer’s writings (see for instance The Empire of Chance and Simple Heuristics that make us smart) and I am sure it is not his fault that the same stories keep coming round again and again. This story on the BBC web site treads over old ground but of course the lessons remain the same (even if the book is different). Doctors don’t like working using Bayes’ theorem in clinic — at least not if we have to use algebra, rather than real numbers (as Gigerenzer makes clear). And I still think we do a poor job of teaching medical students statistics. But something niggles me about his line of argument, and in part it it is not a million miles away from some of Gigerenzer’s other work on heuristics and ‘quick and dirty’ computation.
One view of expertise is that doctors somehow work from ‘basic principles’ and then work out what to do. This used to be the dominant view of medical expertise: we had to understand the physiology, so that we had a live model in our brain of what was happening to the patient. This may well be true in some instances, but more often it seems to me that the burden of knowledge to do this is so great, that we just follow simple shortcuts or heuristics— or we read it off look-up charts. I actually think this is sensible. We don’t need to fret about the molecules, just as I don’t need to worry about machine code or C+ when I write this blog. What Gigerenzer is drawing attention to is the absence of the relevant cognitive prostheses that takes care of the number crunching for us. Of course if the prosthesis existed, we would play with it, and actually become more at ease with the algebra.

Universities have become Wal-Mart. “We put our courses on line”


Roger Schank.

He spied the current final exam on the professor’s desk and exclaimed: “But the questions are exactly the same as on our exam 20 years ago!” “Of course,” said the professor, “but the answers are different!”

From a letter in the FT, about economics degrees. And for medicine?

The worst-functioning part of the US educational market at the tertiary level is the private for-profit system,” he said. ”It is a disaster. It excels in one area, exploiting poor children.”


Joseph Stiglitz telling it to the Australians

The business of medicine

by reestheskin on 07/07/2014

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Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors. Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.

The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that Health Management Associates, a for-profit hospital chain based in Naples, Fla., kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital.

— Its business. In the UK the incentives would be the other way around.

What ties universities to the modern LMS’s is this link to the bureaucracy, first, and pedagogy last.

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Textbook prices

by reestheskin on 01/07/2014

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There are some tremendous textbooks, Molecular Biology of the Cell, to quote an example, but many are dull. I understand a little about the business of textbook production, and change seems long overdue. My own efforts are of course very humble, but I am working on improving things. This graph does not attest to much innovation: more Eroom’s law than Moore’s law.