Monthly Archives: March 2016

Half a colon is worth..

by reestheskin on 27/03/2016

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Now I know; I think.

Kurt Vonnegut said it best: “Do not use semicolons. They are transvestite hermaphrodites representing absolutely nothing. All they do is show you’ve been to college.”

Quoted by John O’Callaghan in the Economist.

What is this thing called medical education?

by reestheskin on 26/03/2016

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Some dark thoughts from Geoff Norman in one of his iconic editorials:

In some of my darker moments, I can persuade myself that all assertions in education (a) derive from no evidence whatsoever (adult learning theory), (b) proceed despite contrary evidence (learning styles, self-assessment skills), or (c) go far beyond what evidence exists. I suspect most readers of AHSE are aware of the first two kinds of assertion, but in this editorial I want to elaborate on the third, the challenge of arriving at general conclusions about the way the world works based on the empirical evidence derived from limited studies.

The link between a particular study, and generalisability is of course what science is all about: this is why much science is about theory, rather than A/B testing. It is why RCTs are not usually about science, but about product comparisons. Some Much medical education research is hurtling into the abyss of studies that have little interest beyond the fact that they got published, and that somebody has a copy of SPSS.

At this stage I always muse over out Clark Glamour’s statements about departments of education:

‘We leave training to schools of education, the bottom feeders of academe’,

‘Almost all advanced degrees held by teachers are in education, which means that they are academically rock bottom’

I could feel guilty for sharing such thoughts, if it were not for the fact that Glymour is a leading figure in statistics, learning and philosophy; and one who has made major contributions to how we can envision learning (see for instance his wok on Bayes Nets and Causal thinking), or his work on statistics teaching and learning, described in Galileo in Pittsburgh).

A long time ago I enjoyed a book called ‘What is this thing called science‘. The one on medical education has yet to be written. Norman’s voice is the closest we have to it. Somehow we have to carve out a space between the sorts of biology that explain human psychology and culture that the Premacks describe (see for instance, Original Intelligence: The Architecture of the Human Mind); George Steiner’s, Lessons of the Masters; and the knowledge of the bazaar that reminds us that we have understood certain aspects of apprenticeship and craft learning for at least a thousand years. And finally, the sorts of deep insights based on experiments that often appear deceptively simple, that  some  areas of experimental psychology are well known for.

Her Ph.D. candidate had an offer for a job paying more than $1 million a year

by reestheskin on 26/03/2016

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Fei-Fei Li, a Stanford University professor who is an expert in computer vision, said one of her Ph.D. candidates had an offer for a job paying more than $1 million a year, and that was only one of four from big and small companies. On the candidate’s list, one of the biggest technology companies was ranked lowest, in terms of both money and excitement, she noted dryly.

NYT. Time will tell.

Become a neurosurgeon for a lucrative lifestyle and high social status

by reestheskin on 18/03/2016

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Like many other medical students in XXXXXX, during my first year of medical school I aspired to become a neurosurgeon to enjoy a lucrative lifestyle and high social status.

Nice piece by a young medical student in ‘Science’. A real hunger. Or perhaps he read Henry Marsh’s, ‘Do no Harm.’

Observational epidemiology simply reflects a power-weighted count of opinion

by reestheskin on 17/03/2016

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This quote is from the ever quotable John Ioannidis, in a commentary of the disagreements about how to interpret the evidence linking salt intake and health.

“Sometimes I wonder whether published observational epidemiology is simply reflecting a power-weighted vote count of the opinions of epidemiologists. What does a risk ratio of 1.3 mean? Perhaps it means that those who believe in the risk factor have 1.3-fold more powerful opinions than those who don’t believe in the risk factor. In this (hypothetical) nightmare situation, risk ratios are accurate measures of epidemiologists’ net bias.

Systematic reviews cannot settle this conundrum after the fact. Even systematic reviews of randomized trials can reach almost any conclusion the reviewers believe in. “

Gary Taubes, talking about our understanding of obesity:

“Here’s another possibility: The 600,000 articles — along with several tens of thousands of diet books — are the noise generated by a dysfunctional research establishment.”

I think it was James Le Fanu who suggested that closing most UK departments of epidemiology and public health might result in a net gain to human health. So much research work is zombie science: you can’t kill it , because it is already dead ( I owe this formulation to Bruce Charlton). But the problem is not just with observational research. Ironically, it may have been the fact that Doll and Hill were right, that may have been, in the long term, a harmful influence on discovery.

No time for Neanderthals

by reestheskin on 17/03/2016

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Some Neanderthals would — based on MC1R sequence — be expected to have red hair. What has always caused me confusion is the way that dates for everything to do with human paleohistory, and the various representations of our evolution, are revised based on n of 1 publications. No doubt the story will get easier, but I think silence for a while on the ‘greatest story every told’ would be in order. At least from me.

Note added: And then…..

‘not to generate lots of data, but instead, lots of understanding’

by reestheskin on 16/03/2016

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Venki Ramakrishnan was on the radio the other day. I cannot remember his exact words but they were something to the effect that he wanted ‘not to generate lots of data, but instead, lots of understanding’. Says it all.

Data is a toxic asset, that needs to be culled.

by reestheskin on 16/03/2016

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I had previously posted Alan Kay’s nice slide to the effect that ‘we need big meaning rather than big data’, but here is a nice article by the ‘security guru’ Bruce Schneider on the dangers of collecting and storing data:

Data is a toxic asset. We need to start thinking about it as such, and treat it as we would any other source of toxicity. To do anything else is to risk our security and privacy.

In health and in education, expect major data breeches.


Quite open, and of the air.

by reestheskin on 14/03/2016

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“Yet somehow the OU quickly put itself on the map. When it opened its virtual doors, 25,000 students soon enrolled, at a time when the combined student population of all other British universities was around 130,000.”

Nice article about the OU. These figures shock me.


How to mess up on invention

by reestheskin on 14/03/2016

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People always want to mess up on invention. This about the birth of email and the death of Ray Tomlinson.

“It wasn’t an assignment at all, he was just fooling around; he was looking for something to do with ARPANET,” Raytheon spokeswoman Joyce Kuzman said in a statement about Tomlinson’s death.

When Tomlinson showed his early work on email to his coworker at Bolt Beranek and Newman (BBN), Jerry Burchfiel, he was initially warned that he shouldn’t show anyone what he was doing. “Don’t tell anyone!” Burchfiel reportedly said. “This isn’t what we’re supposed to be working on.”

Tomlinson’s death gives us a chance to look at how various innovations come to pass. They are rarely, if ever, the work of one person. And in the case of email, Tomlinson contributed greatly, along with people like Bob Clements of BBN, Dick Watson of SRI International, and Stephen Lukasik of ARPA (now known as Darpa). And they all managed to anger the Department of Defense for quite literally being too ahead of their time.

We owe the word ‘revolution’ — in the meaning of changing the world — to Galileo and the motion of the planets. You can almost define invention as that which disturbs: it is why Freeman Dyson, titled one of  his book’s about science, ‘Disturbing the Universe’. But each generation wants to forget this, ours perhaps more than others. One of the great things about computing over the last half century is that sometimes the barriers to entry have been so low: biology and medicine are much harder. The other lesson: do not be too far ahead of your time.

The investor’s timescale: 8 years is just too long (for a university).

by reestheskin on 10/03/2016

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Article in the FT presaging  government announcements about making it easier for new private players in the HE market. I don’t necessarily disagree about new entrants, as there are lots of things HE does, that is does not do well; and conversely it does other things amazingly well, and they are in real danger. But this stuck in my throat:

A green paper Jo Johnson, universities minister, last November proposed a clearer and faster trajectory for providers to award their own degrees and to secure the university title. Existing rules force new institutions to be operating for at least eight years before they can apply to become a university. That is often too long for investors to back a project. [my emphasis]

Just contrast this with the FT’s own Martin Wolf’s comments in an article he wrote a few weeks back.

An immediate concern, however, is whether the conditions for a competitive market exist. Special institutions have long provided higher education, for good reasons. By definition, students cannot understand what they are buying: that is what makes them students. The value of what they obtain is likely to become evident over many years. They rely on reputation. They must believe, therefore, that the institution cares about its reputation. That is why the longevity of these institutions is so vital.

We have a society that is now being reshaped around a short term financialisation model, the only purpose of which appears to be, to subjugate societal advance to capital — while missing out on the goals of invention,  utility or advance. This activity is essentially what biologists call parasitism: and in some systems, the burden of parasites may occupy most of the biomass. The worm ouroboros, continues to devour itself.

The future of medical practice

by reestheskin on 09/03/2016

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This article from Health Affairs is from over the pond, but it chimes with much of the conversations you hear in hospital corridors here (if you want to know what is going on in institution don’t go to meetings or read minutes — listen to what those outside the meeting rooms say).

The strain that third-party payers and other practice intrusions have put on physicians is obvious to those who know physicians or work with them, and it is evident from the 2014 Physicians Foundation survey.3 Fifty-six percent of respondents described their feelings about the medical profession as negative, and 51 percent said that they were pessimistic about the future of the profession. Fifty percent would not recommend medicine as a career to their children, and 29 percent would not choose to be a physician if they had their careers to do over.

The article points out the move to employee status (rather than independent practice), and the resulting loss of the patient voice: ‘ “ownership” of the patient in this model may no longer be personal but institutional’

Despite these changes, the medical profession will doubtless continue to exist, as there is no lack of young people vying to get into it (applications to medical school were at an all-time high in 2015).14 The question is, Will medicine remain a calling with patient care at its heart or become a mere occupation, characterized by bureaucracy and a focus on the bottom line? The former is to be hoped for, but given current trends, the latter should be anticipated.

I wonder if we will start to see a broadening of post med school career choices. As in some parts of Europe, many graduates will not go into traditional medical practice. Do I find this all depressing? No, quite the opposite in fact, but we need to ensure that we educate our students about the possibilities.

NICE: A terrible beauty.

by reestheskin on 08/03/2016

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blog post about NICE and the publication of  a history of NICE (‘A terrible beauty) contains this nice(!) quote.

‘The interests of clinicians who generally welcome guidance but detest instruction’

As for the ‘Terrible Beauty’ bit, can we leave Yeats out of this. NICE is poetry free, which has always been part of its problem.

The moral imperative of being unreasonable

by reestheskin on 07/03/2016

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Anybody who works in large organisations that want to be corporations (such as universities) knows that they are increasingly plagued by people who persist in being reasonable. This is a very dangerous habit, inimical to the true purpose of so much scholarly enquiry. As Shaw said:

The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.

Universities’ key task is changing the world : this is what the culture of learning and discovery is all about, and  what unpins any chance of survival for a neotenous creature. I am delighted  that there is now more robust empirical enquiry to support what many of us have known for a long time (PNAS here).

Sheen Levine, in a neat letter to the Economist spells out what might seem unexpected. Commenting on an earlier piece showing that ethnic diversity might undermine trust, Levine points out this is one of the advantages of diversity (an hence trust is not always a virtue).

But this may be its [diversity] greatest gift. When ethnically different others are present, people tend to remain cautious, scrutinise information and reach better decisions…..In homogenous markets, we reason, trust in other people’s reasonableness can cause erroneous beliefs to spread more readily. Diversity makes you better precisely because it makes you less trusting.

The more slightly odd people you can find poking around in your dusty library collections, the more likely you are to be in a place that presages an improved world.

Causes of death

by reestheskin on 06/03/2016

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Nice graphic over at Lots of other great graphics, too.

Imitation is the highest form of flattery, but is not always welcome

by reestheskin on 05/03/2016

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Somebody once remarked that two of the most powerful educational forces of the 20th century in the UK were Penguin books (I can still remember the money burning a whole in my pocket as I went into Lears in Cardiff and bought my copy of ‘Introducing Biology’), and the OU. As somebody who occasionally stumbled on these odd looking people (who didn’t look like my parents) early on a Sunday morning, the sense of evident pleasure in learning was obvious even at some ungodly hour. ‘Video’ as we  now call it, worked. And for some of us the fire was lit.

From the THE

The institution’s latest accounts, which were published recently, show that it ran up a £7.2 million deficit in 2014–15, on the back of a £16.9 million shortfall the year before.

This came as the total number of students signed up for OU courses fell by 13,449 (7.2 per cent) year-on-year, to 173,889. From a high of 260,119 learners in 2009–10, the OU has now shed a third of its enrolment in the space of six years.

Mike Boxall, a higher education specialist at PA Consulting Group, said that the OU had been squeezed by a “double whammy” of the “catastrophe” in the part-time and postgraduate sectors, and the entry of other universities into the online learning marketplace.

“They have been hit by a market shift and competition for their core base,” Mr Boxall said. “It is quite challenging for them to stand back and say ‘how do we reposition ourselves against these trends’.”

Mr Boxall said that the gradual erosion of the three-year residential degree as the dominant model of higher education could “play to [the OU’s] strengths”, but warned that the university’s progress in this area was “not very visible yet”.

Future doctors and ‘has beens’

by reestheskin on 03/03/2016

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Maybe I have reading Pulse too much, but it is always hard to attach meaning to the first tremors, before the ground visibly shakes. Lots of interesting memes: whether a medical degree is now a signal not of medical competence but of general skills (hard work, group work, perseverance, ambition); and whether we are seeing a widening of expectation gap between different groups of our own students. What seems clear, and has been for some while, is that an undergraduate medical degree needs to be dissociated from a career in the NHS: this can no longer be its prime educational purpose. Rash talk, perhaps. But please don’t think making medical apps will pay the bills.