Trained as a physicist, I quickly learned that the world is not as it seems. Space and time not only stretch like elastic, but can also morph one into another, and matter and energy can appear out of nothing, like rabbits from a magician’s hat. But the great shock to me in recent years is not simply that the physical world is an illusion, but that so too is the human world, as portrayed by our mainstream media and politicians.
This is from a review by Marcus Chown of ‘The Joy of Tax‘ by Richard Murphy. I haven’t read the book, but readers of this blog might note that I too am ‘new’ to much of this. John Naughton, Larry Lessig and James Boyle educated me that much of the un-natural world was not as self-evident as I had once imagined. This is the real danger of STEM.
There is a touching video of Marvin Minsky here. Steven Levy’s wonderful book on how some of this revolution took place is compelling reading (as in the Model Railroad club). You have to wonder how and why so much fundamental and successful (‘an important discovery every few days’) work was done in such a short period of time, with so little money. And across the pond, and elsewhere the biological revolution that dominated the second half of the 20th century was being laid out with even less resource. Not so much ‘events, dear boy, events’ but ‘ideas, dear kids, ideas’.
Pharmaceuticals companies used to be research enterprises that discovered and developed drugs. Then they became marketing giants, skilled at selling as many blockbuster pills as possible. Lately, they have turned into mergers and acquisitions machines, buying and selling medicines invented by others. It is hard to view their evolution as progress……
“We would expect Big Pharma’s current level of R&D spending to become a luxury that investors no longer tolerate,” wrote a group of McKinsey consultants in 2011.
I have read a fair bit about Clark Kerr, and skimmed some of his writings, but I had missed this titbit (quoted in Nature by Colin Macilwain). ‘It was Clerk Kerr, a former chancellor of the University of California, Berkeley, who most memorably defined the role of a university administrator: to arrange parking for the staff, sex for the students and sports for the alumni’. I have a definitive opinion on the merits of two of these three issues.
Being able to receive anonymous feedback is good, although sometimes you think otherwise. But these comments from an (anonymous) student who had gone through our unit made me smile and, if I only knew their name, I would drop her or him an email, saying, ‘thank you’. Some students know more than many medical educationalists.
The student wrote:
“Although there is a lot of material to cover, knowing exactly how much detail is required on each disease is much more useful than the unhelpful ‘disease list’ learning outcomes we are often given”.
Well, the student has exposed the kernel of the problem that I have written about before, using some writings on Cartography from Borges.
Most Many lists of learning outcomes in clinical medicine do not work. They are psychologically naive, and represent cargo-cult like thinking. They can work in many domains (e.g. you must be able to solve simple quadratic equations; you must be able to recognise different patterns of Mendelian inheritance based on examination of a kindred), but in many clinical areas, where formalisation of knowledge structures is poor, they are largely a facade. If you want to know ‘why’ go and read Claude Shannon on Information Theory. None of what I say implies that you shouldn’t let students know what you expect from them, indeed, as currently practised many learning outcomes mislead and hinder learning.
Interesting what comes in your mail. ‘A dog at the master’s gate predicts the ruin of the state’
Dear Doctor, Because of certain developments in the NHS, we are aware that there is a fair amount of dissatisfaction especially amongst experienced NHS Consultants.
In light of this, we are able to offer employment opportunities in Australia, New Zealand and Singapore if you would be looking to make a change.
There are many opportunities available and the benefits would include the following…
This story is not just about physical infrastructure but also about expertise and the relation between expertise and ‘practice’. It is tempting to imagine that certification is about a moment in time, but this is not how medicine or many other areas of high level skill work. The example of surgery is perhaps the easiest, but the same holds for specialties such as imaging, dermatology or histopathology, where perceptual skills are important. How may moles or melanomas you report a week is not the only determinant of competence, but it is a key variable once you pass the novice stage. You know more than you can say, but you only know what you know if you keep doing it every day. The concert pianist still practises his scales every day. BTW, at last, in terms of safe health care, people are beginning to focus once again on diagnostic ability — or lack of it. You cannot control costs or think seriously about medical errors without an obsession about diagnosis and the system wide factors that undermine it (The National Academy of Sciences report is here).
“The digital revolution in higher education has already happened. No one noticed.” Clay Shirky. Stephen Downes comments ‘Like the elites, this article is late to the party, looking at it from a skewed perspective, but still willing to take credit for having discovered it first’.
The University of Nowhere: The False Promise of “Disruption.” Review of ‘The end of college’ by Peter Carey.
Lessons from the PC video game industry: The future of media is here — it’s just not evenly distributed. Actually, I think there are lots of lessons here for higher education.
After Paris, something good.
An obsession with safe spaces is not just bad for education: it also diminishes worthwhile campus protests. The closing off of debate on university campuses.
The misery of some PhDs. Too often, all too lonely, and a system that is out of kilter with what is needed.
Why I’ve Stopped Doing Interviews for Yale. from mathwithbaddrawings.
Hackers vs. Academics: who is responsible for progress? Answer: it depends.
Med students are marginalized in the hospital. It’s time for that to stop.. Solutions, please.
I came across an acronym, new to me at least, in the GP magazine, Pulse. RLE (retire, locum or emigrate).
Gee, now there is a magazine named after that gene I spent so much of my life studying (MC1R). I am not on commission.
A magazine for redheads and their appreciators, MC1R is proof that independents can grow fast by tapping into a clear niche.
Launched last year in German, the magazine switched to English for issue two when founder Tristan Rodgers realised he’d stumbled across an editorial concept with truly global potential, and this third issue is his biggest and best yet. Smart and sexy (and tastefully NSFW in places) it’s a brilliantly focused read.
I have just been browsing on the new FT beta site. Coupled with Medium, quartz and the Intercept as examples, we have eventually rediscovered what the typographers learned hundreds of years ago [even look at my homepage!] Text, benefits from space; and narrow text blocks work even better. Rich DeMillo doesn’t follow, but the content more than makes up. He is blogging again now that his new book has been published. Recommended.
Howard Green has died. I only met him once, although interacted with Jim Rheinwald a little more a long time back when I was the cancer section editor for the J. Invest Dermatol. I am never certain whether the technology ever delivered as much as people wanted, but Green always struck me as a scientist of the old school (and I say that with fondness).
Great video from Bruce Schneier (in the Economist’s words, ‘the security guru’). A number of reasons for posting. First, re his comments on 23andme, we will see an attempt to link individual medical records with state security. Whereas once, society would demarcate safe-havens (journalist enquiry, legal representation, medical care), this may no longer hold in the future. In the UK, I doubt any online medical records are private in the sense that we once understood that term. The second reason, is of course that although Schneier’s background was in cryptography, it is his breadth of knowledge as a public intellectual that makes listening to him so compelling, and at the same time shines a not so flattering light on too much of UK academia. Third, his views on social change are nuanced — but still he is an optimist. A great summary of one of the key issues of our time.
‘What specialty do you have your eyes on?’ ‘Australia’
To a student from mainland Europe. ‘What do you think is better — or at least different — here from home?’ ‘We wouldn’t be having this conversation at home: students aren’t allowed to talk to professors, that is what the assistants are for.’
In a discussion about overcrowding in the library, and the ‘towels on the sun lounger’ syndrome. ‘If you don’t need to use the library books, why study in the library.’ ‘We don’t have to pay for keeping warm in the library’
“Money spent that makes a population more economically productive by getting people off sick leave and back to work is an investment. Money spent that gives people illnesses they were not complaining off, puts them on treatments that make them less economically competent, treatments that cause more death and disability than they alleviate, comes close to being a tax on us and our jobs but paid to corporations rather than government.”
“Germany justifiably takes pride in its long tradition, and high standards, in science. So what is going so badly wrong in its medical faculties? In most countries, medical students receive their medical degree — and ‘Dr’ title — after successfully completing both preclinical undergraduate studies and clinical training, and then passing a state examination. Not so in Germany, where the degree gives them only the right to practise medicine — not to title themselves Dr. To acquire that honour, an extra step is required: a research project leading to a thesis, done, written up and published in the student’s spare time…..
But it makes no sense to maintain the requirement for a quick-and-dirty thesis, which adds stress to medical students who are already under immense pressure, while teaching them little beyond the dangerous lesson that it is acceptable for medical science to be sloppy.”
A new welcome video for our Edinburgh Medical School dermatology module. Judging by the gesticulation, I must have some Italian blood in me (or so somebody tells me).
I feel a sense of guilt that some of our medical students spend money on additional tuition (beyond what they pay my employer). Some sign up for online courses, others pay for cramming sessions for finals. I do not know how effective some of these courses or resources are (different students give me different answers). It reminds me of paying for private schooling, then hiring tutors in the evenings. I am not sure my guilt is entirely rational: failing finals for instance is traumatic, and will result in a loss of income. It may be quite rational to reduce that risk,if you can afford it. And of course, I do not object or think it unreasonable that students buy books, so why complain about other resources such as online lectures. I am however interested in the money back guarantees on some sites and, out with medicine how some universities say they well reimburse half your fees if you are not in relevant employment (University of Law). Giving the issues about FY jobs for our medical students, the latter deserves some consideration.