Teaching with a vision

 Teaching with a vision

I mentioned in a recent post that I haven’t yet detected any great vision or philosophy behind the medical teaching in Cambridge. Today, I’d like to write about a place where I have actually experienced teaching with a vision: at the university where I did my undergraduate degree.

Ok, admittedly I did not go to a large state-funded university, but the small private University Fresenius (where I did a chemistry degree), but I don’t think it’s necessarily the source of funding that makes a difference here.

In Germany, the name Fresenius (for an article on the Chemist Carl Remigius Fresenius, see here) is associated with excellence in analytical chemistry. One strong point of studying at Fresenius Uni is still a strong background in analytical chemistry to this day. However, being named after the great founder of analytical chemistry does not mean that the university is resting on its laurels. A quick visit of the website reveals that the chemistry course has undergone several transformations since my graduation year, proof of ongoing improvements and adaptations in times of change. Already when I was a student, the curriculum had been refined over the years by constant feedback from industry, ensuring that it was up to date, but also that the graduates would be happily recruited and employed. Furthermore, I found the content of the course very well constructed, both in terms of what was taught and what content was omitted (that's also important!), as well as in terms of organisation. (To be completely honest, I sometimes wished at the time to learn particular topics in a bit more detail, such as quantum chemistry, but that still has not changed even today as a student in Cambridge. So it’s obviously more to do with my personal ideas than anything else). 

It seemed as if someone had sat down initially to really think about what knowledge makes a good chemist and then built up the curriculum from first principle, open to constant improvement. The key 

philosophy seemed to be the communication of what is the most comprehensive "working knowledge" of a chemist, and to really bring across these principles. One way in which this was achieved was the high amount of practical lab teaching, more than 50% of the time if I remember correctly. Apart from the obvious different disciplines of chemistry, the overall masterplan also includes the possibility to integrate minor studies in other subjects such as economics and languages, in order to develop a well rounded set of skills.
I think this overall strategy really brings home the content and still does not prevent anyone from indulging in more detailed studies, now able to fall on the fertile ground of a sound foundation of knowledge.

Germany is different to the UK in that there aren't (m)any elite universities with longstanding traditions (although there is a discussion if this should be changed), and there is a much more common-sense attitude towards the significance of school grades. As one example, there is no restriction on the A-level average of a student wanting to study Chemistry at Fresenius or anywhere else (apart from the fact that they don't fail, of course). However, I am convinced that every student going through the Fresenius system, no matter how academic or not, won't be able to help him/herself but to emerge with a sound knowledge of chemistry in the end. I think this steady output of good graduates is quite an achievement in the light of the generous admission policy and is certainly tribute to the educational philosophy. In Cambridge and Oxford on the other hand, where only the best A-level students of the country are admitted, I don't think it's as surprising that the graduates are excellent, because they were already excellent in the first place. Sometimes I even think they are excellent despite the teaching they have encountered, not because of it.

To sum up, as a result of an overall vision, I think that the people produced at Fresenius enter the professional world with a great foundation and working knowledge of Chemistry, perhaps not excessively familiar with the academic intricacies of the most advanced chemical topics, but well rounded and ready to be placed in any lab and start working. I don’t think this is the result of chance, but of a well thought through approach to produce exactly the type of person needed in the world of chemistry.

I definitely think that every university course on offer in an institution should at least aim to stand out in some way and give their students something special along the way, and Fresenius definitely shows that this can be done, even on a smaller budget and without relying exclusively on the best students in the country.

Some aspects of studying (Medicine) in Cambridge

After two years of studying in Cambridge, I’ve made some observations about the learning experience here. I can’t help that it will be a rather negative post, but I am sure you can find plenty of articles praising Cambridge for its amazing education elsewhere.

In fact, I think the many purely positive reviews can set students up for disappointment once they identify an aspect of Cambridge education that isn’t ideal, and I’ve seen a few of the more critical students doubt themselves and feel isolated in an environment where criticism is not welcome (They ask themselves: If Cambridge is one of the best institutions in the country, how can it be that I am unhappy?).

Today, I will mention four issues I’ve identified. Some of them came as a bit of a revelation to me. Understanding what it was that bothered me and why I was not enjoying certain aspects of the course definitely helped me do something about it, or just accept the facts and get on with it. Perhaps it will help others as well.

1.     Lack of a grand vision

In terms of the overall medical course, there does not seem to be any grand vision, guiding philosophy or master plan on how to teach medicine in the best possible way. If it does exist, it is definitely not communicated well enough or not obvious in itself.

In general, there should good reasons for why and how every element of the course is taught in order to avoid inefficiency. Strategic thinking and more intense feedback from the medical profession on course structure could yield a more concise syllabus. 

As a particular example for the lack of overall structure, the different pre-clinical subjects are taught alongside each other independently, rather than in a complementary way. There is definitely need for more cross talk between the different faculties ensuring optimal timing of subjects throughout the year and lack of redundancy.

In terms of clinical teaching, there seems to be even more of a piecemeal approach and scope for inefficiency. We are often told that “medicine is an apprenticeship”, but this statement also seems to serve as a convenient catchphrase to hide behind when criticism surfaces. I am convinced that systematic approaches to teach medicine do exist and I am sure they are employed by other leading medical schools in the world. In fact, I am determined to find out more about this and will write about this topic again in due course.

2.     Convolution of information

As I already mentioned in an earlier post, information is often presented in an undigested, incoherent and badly organised format. Unless one wants to pass exams by rote learning random facts, one has to reorganise all the information. This represents an enormous time investment for each cohort of students and I am not sure if it is an important learning experience in itself.

If the building blocks of medicine could be presented in a more logical and concise manner, students could grasp the information much quicker and would have more time to really indulge in in-depth knowledge, leaving them with a firmer grasp of the subject and a better foundation for the future.

This also has practical aspects, some of which are hilarious. We all know that many components of the medical curriculum aren’t rocket science, and sometimes one almost suspects intent behind the fact that access to simple information is made difficult in some way, so that the ultimate challenge is not to know the information for the exam, but to have jumped through hoops in order to get to it.

For example, content of many physiological subjects is displayed on departmental posters during restricted viewing times. These posters are older than most of the students on the course (they have been typed on a typewriter!!) and are not available electronically. Therefore tens of students crowd in front of them at any time, scribbling down the information presented. It is almost farcical.

Another example is the clinical school’s online resource, one of the least intuitive platforms I have ever come across. People joke that once you have found something on this system once, you will never find it again, and sadly this has been true on many occasions. 

It is interesting that very few Cambridge learning materials are available to the public. Some people are convinced that if they were, the differences between Cambridge and other leading universities would become obvious very quickly.

3. Large difference in what is provided and what is expected of the students

On accepting the shortcomings of some of the teaching that is on offer, one is then struck by the great discrepancy between the leniency of the course organisers towards themselves and their teams, and the utter perfection that is expected of the students.

In my opinion, it is a major cause of demotivation, as inspiring a feeling of inadequacy among the students does not foster a desirable environment for learning.

4. Constant assessment leaving no room for learning

This is another point regarding the environment for learning. Learning obviously requires processing and understanding of the information to be memorised. At some point this processing has to take place because learning (at least of the more complicated topics of medicine) is not an instant event.

However, the questions associated with this process of learning aren't generally welcome. Too often, the answer to a question is judgmental rather than explanatory. Even though proper exams only take place at end of the academic year, students are constantly under assessment, even when they encounter facts for the first time and need some time to absorb them.

As a result, there isn’t actually much time for learning in the presence of university teaching staff, both in the departments and the colleges. While some supervisions may present an exception, in general they also take more of an inquisitive format.

What remains is for the student to do the actual learning in their own time. With a full schedule, the time for this is scarce, especially on the graduate course. If nothing else, this is another unnecessary source of inefficiency.

The more I think about it, the more I realise that Cambridge often confuses teaching and learning with assessment. But assessment alone is just not enough....

In my opinion, the atmosphere would greatly improve if there were also some protected times when students can go through and enjoy the process of learning without constant external pressure.

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Anyway, these were some of my impressions over the past two years. I think Cambridge will definitely have to address some of these issues if they want to compete internationally in the long term.

good and bad teaching...

For months I have been pondering about what it takes to teach (science) well, inspired by many far-from-ideal lectures I had to endure. At the beginning of this academic year, we had three great lectures within first week only (exceeding the number of great lectures of the whole last academic year), so I decided to put this blog entry on hold. Now it's 6th week and there definitely haven't been any great lectures since, so I am back to thinking... the writing is still in progress, but I thought I put up these two pictures in the meantime. In my opinion, they summarise the bottom line of ideal versus reality....

Number one is how I would imagine one would go about teaching. Start with the basics (the foundations, but it seemed too hard to draw a basement) and then build on them.

Number two is a summary of how I often feel in lectures. Imagine the paper shredded... It was too hard to draw that, too!! ;-)

1 year into medschool...

one year ago, i put my scientific career on hold to start an adventure... med school in cambridge.
i took this leap in order to work more closely with people rather than proteins, to do something more applicable that may perhaps lead me to a new direction of (potentially more fundable) research in the future. even though i loved my job, the science and academic life, i wanted to do something more tangible and be able to approach science with a much broader perspective.

so i moved from oxford to cambridge in september 2010, ultra-keen and excited about what was to come. so now, after my first year in medschool, what are the conclusions i can draw?

it has definitely been a year of adjustments... it started off with my initial expectations meeting reality (see this previous post), and then getting on with things and studying for the exams. now that i've passed the 1st year exams and gained some more experience, i can look back and evaluate:

would i choose cambridge again?

* cambridge's special focus on science
the cambridge graduate course is one of the few in the country that does NOT compress two years of pre-clinical teaching into one year, but keeps two full years of pre-clinical science on the curriculum. these two years are accompanied by an accelerated version of the first clinical year of the standard course, taught during the term "holidays". after these initial two years, one enters straight into the 2nd clinical year of the standard course, i.e. the penultimate year of medical school, making it a 4-year course in total.
since obtaining a broad and in-depth foundation of the science involved in medicine was one of my reasons for starting medschool in the first place, i have definitely enjoyed this aspect of the course.
working through the material my own way, i definitely got a lot out of it and am full of ideas for the future. in that way i can only recommend it to anyone interested in science.
but contrasting the amount of cambridge's scientific teaching with the required working knowledge of a physician, one can perhaps understand why other medical schools choose to define their focus differently. given that this is a graduate course and there is also a lot of medicine to learn, the two years of intense science are perhaps a bit of an indulgence. that's why i recommend choosing any particular medical course carefully based on one's preferences of how much science one wishes to encounter... :-)

* tailoring of the course to graduate students
the course organisation i described in the previous paragraph means that the graduate students work alongside the undergrads during termtime of years one and two, and have their own separate clinical teaching during the term "holidays". after pre-clinical finals in the 2nd year, the graduates join a more advanced cohort of undergrads for the full-time clinical training for another 2 years.
so apart from the few weeks of clinical teaching in the first two years, very little course content has actually been specifically designed for graduates. the grads do almost everything the undergrads do, only in less time and with much less time off.
in my opinion, the course hardly takes into consideration or even exploits the different starting points and skill sets of graduates and professionals compared to younger undergrads. while this is a pity, it would be much less of a shortcoming if it wasn't for the relatively ineffective timetabling and execution of the course. the time constraints of the graduate course (and without wanting to sound snobbish: perhaps also the higher degree of university and life-experience??) definitely highlight any redundancy or inefficiency of teaching. while it was definitely painful to sit through practicals teaching you how to hold a pipette, no matter how many times you have done it before, it was worse to suffer through full schedules of compulsory attendance, leaving you little freedom to organise your time in a way that makes learning most efficient for you, something that a mature student could definitely be entrusted with.
finally, with only very few weeks off during the year (in total ~5, of which at least 2 have to be used for studying), there just isn't much flexibility for any unforeseen events that life throws at you (such as parents falling ill etc... sadly more likely to happen as you get older), or to simply coordinate your life with that of your family or partner.
i wonder if other medical schools offering accelerated courses have incorporated more obvious strategies for teaching older students. at least the titles of some other courses (e.g. "graduate/professional entry" at king's college london) suggests some awareness in that direction.

considering these aspects, the course has definitely been quite disappointing. but then again, there is no guarantee that it will be better anywhere else... ;-)

* to sum up...
given that cambridge is a beautiful and convenient place to study, i'd probably still choose cambridge again. but if i could start over, i would equip myself with thick skin and various coping mechanisms right away:
- keep your expectations low and your humor high
- keep up as much of an outside life as you can
- keep some aspect of your previous career going to give you some affirmation
- never loose sight of the big picture.

Seeing the world with the eyes of....

I don't know about you, but when I study a particular subject in depth, my view of the world changes... literally!!! It has happened to me before, but now that I am studying medicine, it is happening again.

During my first degree in chemistry, I spent four years looking at chemical formulas learning about the molecular make-up of the world. Since then, without intending to, my brain has tried to identify chemistry everywhere, most commonly on car license plates:

During my PhD in Biochemistry, I spent day and night analysing NMR data, i.e. looking at spectra with different constellations of dots, in order to identify amino acids and their close neighbours in a protein sequence (for more detail on how this works, see here). After doing this for a while, my brain automatically tried finding protein sequences everywhere. I could no longer look at the night-sky without seeing amino acid side-chains:

 

This year I have been studying anatomy. My colleagues and I have spent more than 50 hours in the dissection room, cutting into cadavers to explore the human body. I have seen a lot of organs, nerves, muscles and tendons. The other day I was in a place where they did some building works, and my brain identified the cables hanging out of the wall as the flexor compartment of the forearm:

 

With this little presentation, I acknowledge the presence of this development, but hope it won't extend too far. Some things are better appreciated as they are... ;-)

Where are you Benjamin?

In the very last episode of Star Trek Deep Space Nine, Benjamin Sisko threw himself into the Fire Cages on Bajor along with Gul Dukat. This put an end to his corporeal existence and since then, he's been living with the prophets in the Celestial Temple (the wormhole). He said, however, that he will return one day.

Well, Benjamin, it's been 12 years - where are you?

I am waiting!

SCHI again, and my behaviour of secondary deviance

Tomorrow is our SCHI exam (social context of health and illness, see an older post), and so I've spent some time reading about medical sociology. It's really interesting to get to know the different way of thinking in this field (perhaps something to blog about another time), as well as to see how medicine and science are perceived from an external point of view.

I've been reading quite a bit about "deviance", the sociological term for behaviour outside society's norms. Deviance describes any type of criminal act, but also includes generally strange/morally flawed behaviour - anything that sets you apart from "normality".
Once deviance has occurred, let's say a person's lie has been discovered, society has certain preconceptions about what the deviant person is like... in this case the "liar". A "liar" will then be treated in a particular way, for example he/she will no longer be trusted. There are many such stereotypes, even for people with red hair (like me)... ;-)

Sociologists further distinguish between two types of deviance: primary and secondary.
Primary deviance is the initial instance of deviance, i.e. lying, stealing, looking different, being ill, etc... Secondary deviance describes additional deviant acts that are a result of the first. For example, someone who lied once may eventually become a a liar, act like a liar, because he/she knows that others think of him/her as such now. Secondary deviance is to behave according to the stereotype associated with the deviant act. It's a self-fulfilling prophecy.

Having this stuff in my head, I've noticed over the past few days that I display behaviour of secondary deviance, too!

Many have heard me whinge in the past few months about how I'm annoyed about how the students are treated around here (see previous post). On many occasions here in Cambridge, students are not taken seriously, not treated professionally, easily patronised or talked down to. According to the SCHI teachings, being a student is the primary deviance.
Now onto the secondary deviance: When I arrived here fresh from the real world, I treated the people I encountered in my new student life just as professionally as I was used to deal with people in my previous job. This week I noticed that this has changed.... I found myself acting like a stubborn teenager! I arrived late, refused to cooperate and was intentionally unprepared, so that I could be "as dumb as they want me to be"... really, why bother?
Then it dawned on me: this is definitely secondary deviance - I was treated like a child, so why act like an adult?

Of course, I put a stop to my secondary deviance at once. After all, I should try to keep up the standards.
But nevertheless, I acknowledge the sociologists for giving me this insight - thank you SCHI!!!