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Archive for the ‘education’ Category

The scientific method

Posted in education, from the living room, from the reading room, science on February 9, 2013 | 3 Comments »

This week I sat next to a student on the train. She was revising her notes on “clinical research”. I was struck by her list of keypoints under the heading “the scientific method”

  • Observation
  • Description
  • Explanation
  • Prediction
  • Control

I have a life long interest in science, but for me, science is just one form of enquiry. I’m actually an insatiably curious person. I love learning. I’m constantly reading. I read on the train, I read in cafes, at home, at work, everywhere. Having a kindle reader on my iphone and my ipad has made it even easier to weave reading into my day. I have thousands of books in my own library. I have google searches set up, rss feeds delivered to my MrReader app, Flipboard and Zite apps on my ipad…..I’m a reader!

But I’m also a photographer and a writer, as you can see if you browse through this blog. And I’m a thinker. I love to learn, to reflect, to understand. I love that every work day I get to spend time with people and try to understand them.

I observe, I describe and I explain.

But predict? I’m not so keen on that one. I find life so complex and every human being so unique, that I find it impossible to predict the future. In broad brush terms, or in generalisations, or statistical probabilities I can have a bash, but I know that for this person, right here, right now, I can’t predict how things will go.

And control?

Control?

No thank you. Way too much compliance and control going on in our society for my liking and it doesn’t seem to be improving much. I’m a lot more keen on values than I am on control.

Is science about control? I thought it was about discovery and wonder. I thought it was about learning with every new insight that we have more to learn.

I was very impressed the first time I read Deleuze and Guattari who described three ways of thinking -

Art – which is thinking about percepts and affects

Philosophy – thinking about concepts

Science – thinking about function

I like that. Science for me is about discovering patterns, and getting some insights into how something works. That’s what I loved about my undergraduate medical degree – discovering the anatomy, physiology, biology of how the body works. It’s been years and years of daily medical practice, of reading, of reflecting and of thinking, which has brought me to my present place of understanding how a person works. And I sure haven’t got all THAT figured out!

There’s something that jars with me about science directed towards control. But maybe that’s because I don’t like to be controlled!

 

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There’s no such THING as knowledge

Posted in education, from the reading room on January 28, 2013 | 2 Comments »

Connectivism is an approach to learning based on the idea that knowledge is not an entity, but rather a process within a network.  As described by Stephen Downes,

“At its heart, connectivism is the thesis that knowledge is distributed across a network of connections, and therefore that learning consists of the ability to construct and traverse those networks. Knowledge, therefore, is not acquired, as though it were a thing. It is not transmitted, as though it were some type of communication. What we learn, what we know — these are literally the connections we form between neurons as a result of experience. The brain is composed of 100 billion neurons, and these form some 100 trillion connections and it is these connections that constitute everything we know, everything we believe, everything we imagine. And while it is convenient to talk as though knowledge and beliefs are composed of sentences and concepts that we somehow acquire and store, it is more accurate – and pedagogically more useful — to treat learning as the formation of connections.”

How different is this from the “Grandgrind” view of education?

NOW, what I want is, Facts. Teach these boys and girls nothing but Facts. Facts alone are wanted in life. Plant nothing else, and root out everything else. You can only form the minds of reasoning animals upon Facts: nothing else will ever be of any service to them. This is the principle on which I bring up my own children, and this is the principle on which I bring up these children. Stick to Facts, sir!

(Gradgrind – the teacher in Dickens’ Hard Times)

I was never a fan of the Grandgrind approach, but its becoming ever more clear just how foolish and unrealistic it is.

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Health in healthcare training

Posted in education, from the consulting room, from the reading room, health on November 20, 2012 | 1 Comment »

I’ve long been bemused by the lack of reference to health in healthcare training. The standard clinical textbooks of Medicine not only have no chapters on health, books like Davidson, still a standard medical school text don’t even have an index entry for health.

Then the other day I stumbled on an old document from 1938 entitled “The Wheel of Health”, by G T Wrench MD. The content of the text is not what I want to mention today, but I’d like to share the following paragraphs from the author’s introduction.

Why was it that as students we were always presented with sick or convalescent people for our teaching and never with the ultrahealthy? Why were we only taught disease? Why was it presumed that we knew all about health in its fulness? The teaching was wholly one-sided. Moreover, the basis of our teaching upon disease was pathology, namely, the appearance of that which is dead from disease. We started from our knowledge of the dead, from which we interpreted the manifestations, slight or severe, of threatened death, which is disease. Through these various manifestations, which fattened our text-books, we approached health. By the time, however, we reached real health, like that of the keen times of public school, the studies were dropped. Their human representatives, the patients, were now well, and neither we nor our educators were any longer concerned with them. We made no studies of the healthy–only the sick.

 

1938! He could have written that today!

Does this not surprise you?

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Heroes not zombies

Posted in books, education, from the reading room, health, philosophy, psychology on June 11, 2012 | 1 Comment »

This blog name grows on me with the passage of time. People like it, and they tend to “get it” very quickly. I came up with it because I saw that an awful lot of people seem to live life on autopilot, but when you sit down with them in a consultation, you discover one hero after another. People are truly amazing. And every person is the hero of their own story. It’s wonderful to hear the stories unfold and see the heroes emerge.

In Becker’s “Denial of Death”, he writes

Modern man is drinking and drugging himself out of awareness, or he spends his time shopping, which is the same thing. As awareness calls for types of heroic dedication that his culture no longer provides for him, society contrives to help him forget. Or, alternatively, he buries himself  in psychology in the belief that awareness all by itself will be some kind of magical cure for his problems.

And he refers to Kierkegaard who criticised the tendency to live a “safe” life by living at “a low level of personal intensity” as a form of

Tranquilising itself with the trivial

……..there’s a lot of that about!

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Stop stealing dreams

Posted in books, education, from the reading room on March 29, 2012 | Leave a Comment »

Seth Godin is sharing his thoughts about education and they are very stimulating thoughts! His ebook (which is free) is entitled “Stop Stealing Dreams“.

The basic thesis is that our education system is designed to produce compliant producers and consumers. Compliant producers/workers tend to end up in hourly paid jobs and with the globalisation of large corporations, there’s been a race to the bottom. If you work for an hourly rate, you are disposable. In fact, increasingly it’s likely your employer will seek to replace you with someone who will work for less – either in your country, or in another one.

There’s not much of a future for any of us down that road, so what we need instead are unique, autonomous, creative individuals – artists (he says) and scientists (of the ideal type – the ones who are truly constantly skeptical, not the ones who think they are the new guardians of THE TRUTH!)

Schools need to change to meet the changing times. In particular we need to move from FEAR – which is used to induce compliance – to PASSION – to encourage self-starters, innovators and life-long committed learners.

Part of that process is to encourage our children to dream (hey, we need to encourage our ADULTS to dream too!) – to dream BIG, but to dream REALISTIC. In other words, not to accept the status quo, but not to opt out by dreaming the dreams sold by those in control – dreams of celebrity for example.  No, the kind of dreams we need to encourage are the dreams which motivate people to engage with working towards making them happen.

Here’s a quote or two -

 19. The dreams we need are self-reliant dreams. We need dreams based not on what is but on what might be. We need students who can learn how to learn, who can discover how to push themselves and are generous enough and honest enough to engage with the outside world to make those dreams happen. I think we’re doing a great job of destroying dreams at the very same time the dreams we do hold onto aren’t nearly bold enough

11. School’s industrial, scaled-up, measurable structure means that fear must be used to keep the masses in line. There’s no other way to get hundreds or thousands of kids to comply, to process that many bodies, en masse, without simultaneous coordination. And the flip side of this fear and conformity must be that passion will be destroyed. There’s no room for someone who wants to go faster, or someone who wants to do something else, or someone who cares about a particular issue. Move on. Write it in your notes; there will be a test later. A multiple choice test. Do we need more fear? Less passion?

29. There really are only two tools available to the educator. The easy one is fear. Fear is easy to awake, easy to maintain, but ultimately toxic. The other tool is passion. A kid in love with dinosaurs or baseball or earth science is going to learn it on her own. She’s going to push hard for ever more information, and better still, master the thinking behind it. Passion can overcome fear – the fear of losing, of failing, of being ridiculed.

Seth highlights a problem I see in health care, even though he is focused on education in this ebook. He describes Taylorism and Scientific Management -

“measure often. Figure out which inputs are likely to create testable outputs. If an output isn’t easily testable, ignore it.” It would be a mistake to say that scientific education doesn’t work. It creates what we test.

That really is the trouble with health care – see my recent post about finding the person in the patient,  and the earlier one about people not processes.

Here’s his definition of an artist by the way -

“An artist is someone who brings new thinking and generosity to his work, who does human work that changes another for the better.”

He uses the same definition in his We are All Weird.

And, just to finish with here, he highlights the issue of getting people to give a damn -

“Can we teach people to care? Can we teach kids to care enough about their dreams that they’ll care enough to develop the judgement, skill, and attitude to make them come true?”

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The importance of stories – fictional stories

Posted in books, creativity, education, from the living room, from the reading room, life, narrative, psychology, writing on September 11, 2011 | 1 Comment »

I’m a great fan of stories. In fact, I think we understand ourselves and others by using narrative, and the central way in which I work as a doctor is to hear people’s stories, and help them to change them from stories of being stuck or in chaos, to stories of flow, and flourishing and growth.

I’m also a great fan of fiction and the importance of the imagination. I vividly remember Ian McEwan writing this, about this day, ten years ago…

If the hijackers had been able to imagine themselves into the thoughts and feelings of the passengers, they would have been unable to proceed. It is hard to be cruel once you permit yourself to enter the mind of your victim. Imagining what it is like to be someone other than yourself is at the core of our humanity. It is the essence of compassion, and it is the beginning of morality.

So, this recent article in the Guardian caught my eye, “Reading fiction improves empathy, study finds”. There are a number of studies described in this article, and it’s introduced me to something called “the pyschology of fiction”, and, specifically to the work of Keith Oatley. If I wasn’t so insatiably curious I wouldn’t keep finding these amazing new worlds to explore! One of the studies described in the article compared the effects of reading Harry Potter with the effects of reading Twighlight. They used a new measure – “Twilight/Harry Potter Narrative Collective Assimilation Scale”! Don’t you love that? Look at this conclusion from that research -

“The current research suggests that books give readers more than an opportunity to tune out and submerge themselves in fantasy worlds. Books provide the opportunity for social connection and the blissful calm that comes from becoming a part of something larger than oneself for a precious, fleeting moment,” Gabriel and Young write. ”My study definitely points to reading fulfilling a fundamental need – the need for social connection,”

and read this fascinating comment by Keith Oatley

“I think the reason fiction but not non-fiction has the effect of improving empathy is because fiction is primarily about selves interacting with other selves in the social world,” said Oatley. “The subject matter of fiction is constantly about why she did this, or if that’s the case what should he do now, and so on. With fiction we enter into a world in which this way of thinking predominates. We can think about it in terms of the psychological concept of expertise. If I read fiction, this kind of social thinking is what I get better at. If I read genetics or astronomy, I get more expert at genetics or astronomy. In fiction, also, we are able to understand characters’ actions from their interior point of view, by entering into their situations and minds, rather than the more exterior view of them that we usually have. And it turns out that psychologically there is a big difference between these two points of view. We usually take the exterior view of others, but that’s too limited.”

Spot on. He really nails the importance and value of fiction as a tool for building empathy. We reduce the place of the Humanities in our education system at our peril!

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September – time to think about learning

Posted in creativity, education, from the living room, life on September 1, 2011 | 3 Comments »

september learning

I remember taking part in a small group once which opened with asking everyone to say which month was their favourite month, and why. One of my colleagues said September because that was the beginning of the Academic Year. I liked that response and I’ve always remembered it.
I have many criticisms of our educational system and institutions, and what I really believe is that everyone should learn all the time. I am insatiably curious which drives my constant desire to learn.
However, this time of year is the time when the universities and colleges publish their programmes for “adult” or “continuing” education classes, so I think it’s a great time to plan what you’d like to learn in the coming weeks.
My most recent experience was a course in artists photographic book self-publishing. If you’d like see what I produced have a look here.
What would YOU like to learn next?

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Penn Reading Project

Posted in art, education on August 17, 2009 | Leave a Comment »

The University of Pennsylvania usually sets a book for their new students to read over the summer before term begins. It’s a way of introducing their freshmen to academic life. This year, however, they’ve set a painting to be studied instead of a book.

They’ve chosen the local artist, Thomas Eakins and his 1875 painting “The Gross Clinic”. The university has another of Eakins’ paintings in its collection – the 1889 Agnew Clinic.

I think this is a very interesting development, and I’m not aware of any other universities which set a painting for everyone to study and discuss in this way.

Which painting would you choose for all the new students at your local university to study?

I’m pretty sure one of my first choices would “The Anatomy Lesson of Dr Tulp” (which happens to be one of my all time most viewed posts!)

Any suggestions?

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Two mindsets – fixed and growth

Posted in books, education, from the reading room, life, psychology on August 4, 2008 | 8 Comments »

Stanford university psychologist, Carol Dweck has published a book entitled “Mindset. The New Psychology of Success” (ISBN 978-0-345-47232-8). Guy Kawasaki posted about it, and wrote a commendation which is printed on the front page. And Stanford Magazine did an article about it last year.

She’s identified two “mindsets” in relation to how people approach challenges and effort.

When you enter a mindset, you enter a new world. In one world – the world of fixed traits – success is about proving you’re smart or talented. Validating yourself. In the other – the world of changing qualities – it’s about stretching yourself to learn something new. Developing yourself.

One point she made which struck me as surprising at first was that people with a fixed mindset often have had lots of praise. She makes the point that just telling your child they are clever, or wonderful, or whatever, sets up a belief system in them which can become fixed and she recommends instead praising children for their effort, for what they’ve learned. This is her key point really – that when you have a mindset about loving learning you can grow, but when you have a mindset where you think talents are fixed then you get stuck.

The fixed mindset limits achievement. It fills people’s minds with interfering thoughts, it makes effort disagreeable, and it leads to inferior learning strategies. What’s more, it makes other people into judges instead of allies. Whether we’re talking about Darwin or college students, important achievements require a clear focus, all-out effort, and a bottomless trunk full of strategies. Plus allies in learning. This is what the growth mindset gives people, and that’s why it helps their abilities grow and bear fruit.

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The importance of the person in medicine

Posted in education, from the consulting room, from the reading room, health on February 4, 2008 | 8 Comments »

Sometimes these days, with the dominant biomedical model of health and illness it can seem like people don’t actually matter. The individual stories of patients are dismissed as anecdotes and treatments are divided into one of two categories “proven” or “unproven” on the basis of statistical analyses of clinical trials (experiments on pre-selected groups of volunteers). The implication is that what works in health care is the intervention, be that a drug or a surgical procedure. Who the patient is, and who the doctor is, seems to be of secondary, or, sadly frequently, of no importance at all.

Yet, if you are ever unwell, I bet it matters to you who you consult and how they behave. I think we all want to consult a doctor who, frankly, gives a damn! I know I do. How many of us would seek a health care system based on dispensing machines which dole out drugs after you input your symptoms?

Amazingly, this idea of the importance of the person in medicine is having to be fought for. So, it was with great interest that I read a review of a book in the BMJ this week. The book is “When Doctors become Patients” by Robert Klitzman (ISBN 978 0 19 532767 0). The author is a psychiatrist who became depressed and was so shaken by his experience of becoming a patient that he set about interviewing other doctors who had become patients too.

Time and again Klitzman found that becoming a patient transformed the doctors’ views (and of practice) of medicine.

Non-specific complaints, side effects such as weight gain and fatigue, fear, humiliation, and spirituality acquired new significance. Struggling to adhere to burdensome schedules, they became less draconian about poor adherence to treatment. In presenting medical information, they became aware of the importance of framing the information sensitively.

I guess this is not a surprise. You’d expect experience to change your views. However, you’ll probably find it more than a little shocking that the doctors needed the illness experience to figure this stuff out. We’re clearly missing something in medical education.

The phrase that really hit me between the eyes though was this -

In choosing their own doctor, most interviewees preferred bedside manner over technical skill.

It’s what I’ve always felt personally. I’ve always felt that what’s really important is that you find a person who cares, listens and puts your interests at the heart of the consultation. I take the technical skill bit as kind of a given. ALL doctors should have the technical skills they need to do the job and the processes of continuing education, annual appraisal and the coming revalidation procedures of the General Medical Council are all designed to ensure that. But what about the human bit? What about the importance of the person? We need to make this case more clearly. Too often, the technical skills are attended to, and then we stop.

Finally, the BMJ reviewer concludes -

Klitzman, like Gawande and Groopman, is part of a contemporary group of reflective doctors who, through their writings, contribute to the less palpable but nevertheless crucial moral, social, and experiential dimensions of medicine.

We need more of this. Maybe we are building a body of knowledge and opinion but we’re sadly lacking in the areas of research into the “experiential dimensions of medicine” and in providing medical education which considers this as of equal importance to the knowledge of drugs, trials and the technical skills required to do surgical procedures.

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