Posts in: science

Education as scaffolding

Adam Mastroianni had another interview with Russ Roberts, and this one didn’t sit with me as well as his previous appearance. They talked about things we learn in school — higher education, for the most part — and what the point of it all was when most of what we cram in is forgotten.

They gave several examples of this, all of which I have quickly forgotten (ha!), but listing things we were made to learn in medical school never to use again was a popular past time on #medtwitter so I will list a few topics that come to mind first:

  • Bernoulli’s equation
  • the Krebs cycle
  • names of all 12 branches of the maxillary artery
  • formula for the independent two-sample t-test
  • recommended step height and depth for elementary school stairwells

Though that last one was clearly a relic of Serbia’s socialist past, the first four weren’t, and are still being taught in pre-med courses and medical schools around the world. If the goal was to have every doctor know all of these throughout their careers, well, mission failed. But why would we even want that to happen?

Well, I have come around a bit since that 6-year-old tweet and came to appreciate the exposure to different concepts as the scaffolding to whatever career we end up in. No one cries out, after a skyscraper is complete, about all the money and time wasted putting up a scaffolding, setting up cranes, temporary elevators, and such. It is not a perfect analogy since most people in higher education don’t have a blueprint — not even medical students since a doctors' job can be anything from an artist (plastic surgery) to woodworking (orthopedics) to glorified administrative asssistant (general practitioners in most countries) — so it is like building a scaffolding to nowhere, parts of which ossify into the building proper, parts of which decay with time, and parts of which you dismantle as soon as it seems safe to do so, since you hate them from the bottom of your being.

“Why ever did I bother learning about the Krebs cycle five different times!?” Twice in high school — biology and chemistry separately, and three times in medical school — chemistry proper, biochemistry, and physiology. I cry out now, as a hematologist/oncologist without a regular practice; but things could have taken a turn towards a career in organic chemistry, or genetics, or one of those specialties where the cycle is more relevant (though really oncology may very well be one of them!)

The poor Krebs cycle is notorious because it is repeated so often without practical use for most of medicine, but there are many more such concepts throughout life that went in one ear and out the other (Are viruses causing hemorrhagic fevers made of DNA or RNA? Well, I knew it for my USMLE Step 1 exam!) RNA, says Wikipedia.

The scaffolding analogy puts a slightly different spin on grades as well, which could be a rather useful signal of where your construction should go and what kind of a building you want to make, and not your worth as a human being that most teachers and some students want it to be. But let’s not bring up grades again.

So I was surprised by Mastroianni’s and Roberts' surprise about us forgetting — because of course we do! And if the intent of the teachers was to instill knowledge that will last forever and ever, well, most of it is a miserable failure, except for that one sliver of insight that each of us carry for life. But the slivers are different for each of us, and to appreciate your unique sliver you may still need background knowledge that you will eventually forget — the more specialized the area, the more background knowledge needed, so good luck trying to untangle that web.

When the “Nobel Prize for Economics” gets announced, and people cry out that well-actually it’s the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel and it’s not part of Alfred Nobel’s original endowment, it is because this joker has won it, so how valuable could it possibly be? On the other hand, the most recent award went to the genuinely brilliant Claudia Goldin — here is a good pre-award interview — and the other Nobel prizes also went to some real ding-dongs. Things are never so clear-cut.

When did medical conference sessions become Apple keynotes?

The last time I attended a large annual meeting of a professional society was in 2019, and either things have taken a strange turn in the last 4 years, or hematology and oncology are so different that attending any other society’s opening session feels uncanny.

I say this because I attended one yesterday — see the other post from today — and if my eyes could have rolled all the way back into my skull, they would have. This is what I am used to: speakers standing behind the podium — usually elevated, sometimes not — looking straight ahead, reading off the teleprompter more or less skillfully — since after all they are doctors and PhDs, not professional salespeople — occasionally averting their gaze in an attempt to connect with the crowd, which is of course impossible because of the glaring stage lights, but all is forgiven because, after all, we are there to learn, not to be entertained.

Well, someone must have come in and told the medicine men they were doing it all wrong, because this session looked like an Apple keynote — the boring parts, where Tim Cook talks about how many stores they opened — crossed with a TED Talk from a dubious but super-enthusiastic liberal arts professor. There is no podium to anchor yourself, so you and your hands are all over the place gesticulating wildly — power-posing, perhaps? — while you gaze into the teleprompter positioned at 45° above the horizon to give you that contemplative look.

This style of presentation is cringy even when most tech companies do it: Apple is Apple; the other big ones don’t even try to compete, and it’s not until you come to the mid to lower-tier This is a link to the Procreate Dreams reveal video. It is an excellent product which I will definitely get for my kidds to play with, and the creators seem rightfully proud of what they accomplished, but copying Apple did it a disservice. that the “person emoting in front of a large professionally-made slide” style re-emerges.

I wish that was all there was to it. Alas, there was a keynote speaker for this openning session of a professional medical society, and the keynote speaker was — it was at this point that I realized the universe was making me pay for coming to Hawaii — a YouTuber! Which is fine, only they decided to set their talk to background music and flashy videos, and pepper it with excerpts from their own content, letting a good personal story of their family and education get drowned in dumb glitz.

Therefore, to be possess’d with double pompe,
To guard a Title, that was rich before;
To gilde refined Gold, to paint the Lilly;
To throw a perfume on the Violet,
To smooth the yce, or adde another hew
Vnto the Raine-bow; or with Taper-light
To seeke the beauteous eye of heauen to garnish,
Is wastefull, and ridiculous excesse.
William Shakespeare, King John, 1623

Four centuries later, we are in full-on gild mode.

Last week I went to Bethesda for the NIH hematology/oncology fellowship’s “career panel”. They didn’t have those back in my day so I can’t attest to their value for the heme/onc fellows, but I learned a lot! One interesting tidbit noted by a panelist: academia emphasizes owning the idea, industry emphasizes owning the execution.

Some wise words from Thomas Basbøll:

It is not whether what you are saying is true, but how you respond when someone tells you that you are wrong, that determines whether you’re an academic (or at least what kind of academic you are.)

He blogs at Inframethodology, which is a wonderful resource for academic writers.

By the way, these were just the lectures that interested me. The entire NIH calendar of lectures and courses is freely available to everyone, and the ones that are videocast and/or provide CME are marked as such, so feel free to make your own autodidact list.

October lectures of note

The first one is tomorrow, and it’s a good one!

Sometimes, the Tartars do show up

The 2023 Nobel Prize in Medicine went to Katalin Karikó and Drew Weissman, and deservedly so. I do not look forward to the re-writing of history that will inevitably come about the role that the NIH, University of Pennsylvania, and academia in general had in their work. As a reminder:

“Every night I was working: grant, grant, grant,” Karikó remembered, referring to her efforts to obtain funding. “And it came back always no, no, no.”

By 1995, after six years on the faculty at the University of Pennsylvania, Karikó got demoted. She had been on the path to full professorship, but with no money coming in to support her work on mRNA, her bosses saw no point in pressing on.

She was back to the lower rungs of the scientific academy.

“Usually, at that point, people just say goodbye and leave because it’s so horrible,” Karikó said.

She didn’t quit. But even when the breakthrough came, the leading journal saw it as “incremental”:

“The breakthrough, as you put it, we first sent to a Nature journal, and within 24 h, they rejected it as an incremental contribution. I started learning English only at university, so I had to look up the meaning of the word incremental! Anyway, we then sent it to Immunity, and they accepted it (3). We literally did all the work ourselves, Drew and I. Even at the age of 58, I didn’t have much help or funding to perform the experiments, so I did them with my own hands. It took us a while to publish the follow-up paper in Molecular Therapy in 2008, where we presented data on the superior translation of the pseudouridine-containing mRNA and the lack of immune activation in mice.”

The story gets more tangled from there: Karikó and Weissman co-founded a company that failed, then joined BioNTech, and in parallel Moderna started working on their own modified RNA platform, and none of it would have mattered an iota if SARS-CoV-2 hadn’t provided the unfortunate opportunity for mRNA vaccines to shine. For all of our (deserved!) ex post glorification of everyone involved, no Covid-19 — no glory.

Which reminds me very much of The Tartare Steppe’s lonely soldier Drogo who wastes away his life guarding a fortress from the barbarian hordes that don’t arrive until it is too late for him to shine in battle. How lucky for us all that humanity has enough Drogos, and how lucky for this particular pair of soldiers that their Tartars showed up on time.

Box-checking and deadlines are important, but are they "Science"?

If there was any doubt whether I’m middle-aged, I am, in fact, past middle age, as I will turn 40 in December. The average life expectancy for a 39-year-old male in the United States is 37.85 years per the Social Security Administration actuary tables. the kids started school last month and it has been one back-in-my-day moment after another ever since.

This is the most recent one: the eldest has started 6th grade, which in the US is considered Middle School, and is apparently a big deal because that is when they start getting actual grades. Now, back in my day and — this is probably the more relevant fact — in Serbia, you started getting properly graded scored The unfortunate characteristic of the American school system is that it uses the term “grade” for too many distinct but adjacent concepts, so I will stick to “grade” for the yearly cohort of kids, and use “score” for the number they get on assignments and at the end of each year. in 1st grade: there was none of this descriptive assessment shenanigans. It was also probably the reason why the teachers were so interested in what your parents did for a living. But this is not a tirade against descriptive scoring; I had that moment 5 years ago at our first encounter with the 1st grade. The 6th grade b-i-m-d moment was that the scoring is performed nearly real-time, is viewable by both parents and children via an online portal, and — this is what got me — includes whether you:

  1. wrote your full name instead of only the first name on a line that says just “Name”;
  2. checked all of the boxes on an end-of-class exit form, regardless of whether you performed the tasks outlined next to those boxes;
  3. turned in your field trip forms on time.

This is all incorporated into your Science class score. Science. Class. Score.

Now, if the main goal in your life as a scientist is to apply to as many NIH grants as possible and perhaps even win some of them, then yes, science is mostly about box-checking and meeting deadlines. But if you want to call these endeavors “science”, I encourage you to scroll through Adam Mastroianni’s newsletter Experimental History and check your beliefs against some persuasive evidence that science is, in fact, the complete opposite of checking boxes and worrying about the next deadline, and that part of the reason it is stagnating (well, some sciences more than others) and that younger generations are more interested in becoming influencers, content creators, crypto millionaires or whatnot is that they have this misshapen idea about what science actually is from the backwards way it is being presented to them.

With good intent, I should add! There absolutely should be a way to encourage tweens, teens, and adolescents to be more responsible and contentious and middle school is as good of an age to start as any. Heck, there is even a ready-made textbook for it. But call it “life skills”, call it “civics”, call it “behavior” if you will, as we did back in my day. Just please don’t call it Science.

Update: if you thought my quip about box-checking skills being important for NIH grants was facetious, here is the winner of the 2021 Nobel Prize for Medicine describing a recent desk rejection from the NIH for failing to properly format his references on a grant application. Quo vadis, scientia?

Things I got wrong: in-person versus online

We are three weeks into our clinical trials course for the UMBC graduate program. This remark will surprise absolutely no one, but: it was refreshing to see a classroom full of attentive, engaged students, interrupting, asking questions, having a dialogue, others jumping in, etc. Alas, I cannot take any credit for the interactions, as we have guest lecturers on for most weeks.

Regardless, the course has reminded me about how absolutely wrong I was back in December 2019, when during a post-conference The link is for the 2019 ASH Annual Meeting abstract book, ASH being the American Society of Hematology, and I am only now realizing that — in what could be described as our profession’s version of burning man, which is actually quite fitting for an organization called ASH — they tear down the conference website each year to make a new one. So, the 2019 version is no more, but here is one for the 65th annual meeting in December 2023 although if you go to the website after December 2023 I am sure it will point you to the 66th and beyond. I could have linked to the Internet Archive version of the website from 2019 instead — in fact, here you go — but why relinquish myself of the opportunity for that burning man’s ash pun? dinner I stood on my soapbox and wondered in amazing why we were still wasting our time meeting in person once per year like barbarians, when we could in fact be having continuous virtual conversations on Zoom. Timely spread of scientific information and all that.

Well, I have apologized — in person! — to everyone who had to suffer through my Orlando diatribe, because the last 3 years have shown that while video conferencing may rightfully replace most business calls and other transactional meetings, it is absolutely abysmal for education for all parties involved. And it’s not just that any kind of non-verbal communication is lost, it is that even spoken language is stilted, muted, suppressed. With the slide-up-front, speaker-in-the-corner layout that is so common for lectures, you may as well be pre-recording it. It makes absolutely no difference.

And, attending a few online lectures every month myself, it is hard to decide what is worse: having it be completely online and trading off the quality of the lecture for more opportunity for interaction, or watching a live/hybrid lecture and being completely shut out from the discussion (because the in-person attendees take priority when it comes time to ask questions, and rightfully so).

Even at the most basic practical level: technology failure with an online lecture means no lecture; technology failure in-person means, at worst, using the whiteboard and interacting more, which actually makes me wish for more technology to fail. And if you absolutely need to have the slides to make your points, just print them out for your own reference, and share them beforehand for the students to view on their own screens, of which they will have many.

Craig Mod had similar thoughts this week about work in general:

After the last couple of weeks of in-person work, I have to say: Some things simply can’t be done as efficiently — or at all — unless done in person. The bandwidth of, and fidelity of, being in the same room — even, maybe especially, during breaks and downtime, but during work periods, too, of course — of being able to pass objects back and forth, to have zero latency in conversation between multiple people. To not fuss with connections or broken software (Zoom, a scourge of computing, abjectly terrible software (I prefer … Google Meet (!) by a mile)) or cameras that don’t allow for true eye contact — where everyone’s gaze is broken and off and distracted. To dispatch with all of those jittery half-measures of remote collaboration and swim in the warm waters of in-person mind-melding is a privilege for sure, and a gift.

Education is one of those types of work that can not easily be replicated online. AR/VR being a big and obvious caveat here, but that will take a while. For evidence, look no further than the persistence of the physical university campus despite the plethora of free and paid online options. Were it not for the in-person factor, the higher education equivalent of The New York Times would have gobbled up the market by now. I’ll know the tide has turned once Harvard and Yale — which would be my first proxies for the NYT and WaPo of higher ed — start investing more in their online offerings to the detriment of in-person experience.