“I have been this close to buying a nursing school.” This is not a sentence you expect to hear from a startup founder. Nursing seems a world away from the high-tech whizziness of Silicon Valley. And, to use a venture-capital cliché, it does not scale easily.
This was from an article in the Economist awhile back. As ever, there is a mixture of craziness and novelty. The gist of the article is about Lambda School, a company that matches ‘fast’ training with labour force shortages (hence the nursing angle). When I first read it, I had thought they had already opened a nursing school, but that is not so. Nonetheless, there are aspects that interest me.
We learn that
- Full-time students attend for nine months, five days a week from 8am to 5pm. Latecomers risk falling behind, but for most classes, 85% of students who began a course finish. Study is online but ‘live’ (rather than pre-recorded videos). These completion rates are a lot higher than for many community colleges in the US.
- Lambda only gets paid after its students have landed a job which pays them more than $50,000 a year. Around 70% of those enrolled do so within six months of graduation. Lambda then receives about a sixth of their income for the next two years, until they have paid about $30,000 (or they could pay £20,000 up front).
- One third of the costs are spent on finding jobs for graduates, another third on recruitment and only one third on the actual teaching. Scary.
The Economist chimes in with the standard “Too often students are treated as cash cows to be milked for research funding.” Too true, but to solve this issue we need to massively increase research costings, have meaningful conversations with charities and government (including the NHS) about the way students are forced to involuntarily subsidise research, and cut out a lot of research in universities that is the D of R&D.
But this is not a sensible model for a university. On the other hand it is increasingly evident to me that universities are not suitable places to learn many vocational skills. The obvious immediate problem for Lambda is finding and funding a suitable clinical environment. That is exactly the problem that medical (or dental) schools face. A better model is a sequential one, one which ironically mimics the implicit English model of old: university study, followed by practical hospital clerkships. Just tweak the funding model to allow it.
Being an emeritus professor has lots of advantages. You have time to follow your thoughts and allow your reading to take you where it goes. Bruce Charlton pointed out to me many years ago that increasingly academics were embarrassed if you caught them just reading in their office (worse than having a sly fag…). It was looked upon as a form of daydreaming. Much better to fire up the excel spreadsheet or scour the web for funding opportunities. Best of all, you should be grant writing or ensuring that the once wonderful idea that only produced some not-so-shiny results can be veneered into a glossy journal.
Of course, being retired means you don’t have to go to management meetings. For most of career I could reasonably avoid meetings simply because if you spend most of your time researching (as I did), all you care about is publishing and getting funded. The university is just a little bit like WeWork — only the finances are were stronger.
One aspect of teaching-related meetings particularly irked me: student representatives, and how people misunderstand what representatives should and shouldn’t contribute. This is not specific to meetings — the same problem exists in the ‘happy sheets’ that pass for feedback — but is what I see as a problem in inference. Humans are very capable of telling you how they feel about something especially if they are asked at the time of, or soon after, a particular event. What is much harder is to imagine what the results will be if a change is made in how a particular event is undertaken, and how this will relate to underlying goals. This is a problem of inference. It needs some theory and data. So, if students say Professor Rees doesn’t turn up for teaching sessions, or doesn’t use a microphone or uses slides with minuscule text in lectures, this is useful knowledge. What is less helpful, is when you wish to appear to be empathetic (‘student centred’) and allow students to demand that you accept their views on pedagogy. This is akin to the patient telling the surgeon how to perform the operation. Contrary to what many believe, a lot is known about learning and expertise acquisition, and much of it is very definitely not common sense. And do not get me started on bloody focus groups.
Having got that bitching out of the way, I will add that one of my jobs over the last few years was to read virtually all the formal feedback that students produced for the medical school. Contrary to what you might think, it was an enjoyable task and I learned a lot. The biggest surprise was how restrained and polite students were (I wished they would get a little more angry about some things), and often how thoughtful they were. There were the occasional gems, too; my favourite being a comment about a clinical attachment: ‘I am sure the teaching would have been of a high standard — if we had had any.’ Still makes me smile (and the latter clause was accurate, but I am not so sure about the rest).
Now, I don’t want to feign any humblebragging but a few weeks back I received this comment from a former (anonymous) student (yes, the university is efficient at stopping your pay-cheque but thankfully is not good at terminating staff and in any case I still do some teaching..).
“Honestly you just need to look through the website he has built (http://reestheskin.me/teaching/). Who else has created an open-access textbook, lord knows how many videos (that are all engaging and detailed enough without being overwhelmingly complex) and entire Soundcloud playlists that I listen to while I’m driving for revision. I bet you could learn to spot-diagnose skin cancers without even being medical, just learn from his websites.”
Now of course this is the sort of feedback I like 😂. But it’s the last sentence that pleases and impresses me most. The student has grasped the ‘meta’ of what I spent about seven years trying to do. There is an old aphorism that medical students turn into good doctors despite the best attempts of their medical school. Like many such aphorisms they are deeper than they seem. One of the foundation myths of medical schools is that undergraduate medicine really is as is was portrayed in Doctor in the House with just a smattering of modern political correctness thrown in. Sadly, no. Even without covid-19 universities and medical schools in particular are weaker than they seem. Demarcating what they can do well from things that others might do better needs to be much higher up the agenda. This particular student wasn’t taught that but learned it herself. Good universities can get that bit right occasionally.
skincancer909 usage
Just saying….
Here are the figures for skincancer909 my online textbook of skin cancer for medical students. The site was rewritten and updated in the final quarter of last year (with videos). Usage is 80% from search, with the rest from direct links. In June about 4,600 sessions. Local usage (Edinburgh) is around 5%. I am pleased, but financially poorer.
Fear of the known
Universities are certainly putting their courses online. The question is “why?” I talked last week with a University President whom I have known for many years and asked him why he was building online courses. His answer, unsurprisingly, was “fear.”
This is an old quote, but still redolent.
Skincancer909
No, still not finished but useable.
Just one T-shirt away
This can be read as typical Silicon Valley hype, but I think it is more right than wrong. Just as government thought computer education in schools was about using MS Office, too many in higher education think it is about copies of dismal Powerpoints online, lecture capture, or online surveillance of students and staff. The computer revolution hasn’t happened yet. Medical education is a good place to start.
What can we do to accelerate the revolution? From our observation, the computer revolution is intertwined with the education revolution(and vice versa). The next steps in both are also highly overlapped: the computer revolution needs a revolution in education, and the education revolution needs a revolution in computing.
We think that, for any topic, a good teacher and good books can provide an above threshold education. For computing, one problem is that there aren’t enough teachers who understand the subject deeply enough to teach effectively and to guide children. Perhaps we can utilize the power of the computer itself to make education better? We don’t hope to be able to replace good teachers, but can the computer be a better teacher than a bad teacher?
When clinicland is not in the clinic
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?
OEB16 musings
I went to the OEB meeting for this first time this year. I was not certain how much I would like it, but found it really enjoyable. Not a meeting I would go to each year but, if you are interested in teaching and learning in the broadest sense, it is well worth a visit. I would go again.
One of the sessions I enjoyed most was a fairly small concurrent session with the title ‘The value and the price: discussing Open Online Courses’, chaired by Brian Mulligan (IoT, Sligo), and with panellists Stephen Downes(NRC, Canada), Nina Huntermann (edX), Diana Laurillard (UCL), and KonstantinScheller (European Commission). It was all wonderfully informal, with not too many people there and plenty of time for questions and discussion. I got involved too, rather than just listening. The discussion ranged widely over MOOCs (c or x), online learning, ‘conventional teaching and learning’ and other topics, but that is to be expected. You cannot discuss online learning without thinking about offline learning; you cannot discuss new tech, without discussing old tech; you cannot discuss scale without discussing one-to-one; you cannot discuss value without talking about money and non-money.
I didn’t take notes but the thoughts going round in my head (prompted no doubt by the panel were):
- You cannot hide from the question of value. You can think about this is terms of money, time, inner wealth or job prospects, but the calculus has to exist somewhere. If the learning takes place in an institution that performs other tasks and has other goals (research, outreach, engagement, certification), this value has to be factored somewhere. Cross subsidies will be under challenge, whether they are they are sensible, or not. Sensible for whom?
- I am, to use somebody else’s phrase, a libertarian paternalist when it comes to higher education. I really do think I can guide people through difficult terrain. But putting glorious autodidacts to one side, to what extent do many students need coaches, and under what conditions. The answer, at least in some of the domains I know about, is far less than we like to think. And, those who require least guidance are, in many senses, those we want most.
- Content. What is the content, how is it presented, how does it hang together, how tested is it, how has it been curated, how personal is it? I will start ranting about this soon, so I will shut up now. Except to say, it is not a rant: this is so important.
- How important is place? Where is the community? How do you maximise the sense of place?
- How do you balance private study with communal learning. What is the right balance, and how does the answer influence costs?
- I can see differences between MOOCs and other forms of non-institutional learning, but only of degree. Penguin books, and BBC OU broadcasts were open to many of us, and used by many of us. But they only allowed local conversations, rather than networked learning. We can — or at least –could do a lot more now.
“Did you know that this is the 30th anniversary of the very first fully online course?” –
The three laws of elearning failure
I like these from Marc Rosenberg (via Stephen Downes)
- Great eLearning technology combined with bad content results in more efficiently delivered bad content.
- eLearning that is compensation for bad documentation, tools, processes, or management will ultimately prove to be a waste of time and money.
- When great eLearning comes up against a lousy learning culture, the culture wins every time.
Stephen Downes comments: ‘Essentially they are restatements of one of the oldest laws of computing: garbage in, garbage out (GIGO)’.