White coats, white lies? Or black marks?

In which Dr Aust ponders what one should do about students who are ‘economical with the actualité’.

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One of my scientific internet friends, Steve Caplan, was blogging a week to two back about a student in a lab he worked in who was, shall we say, less than truthful about their actions.

Steve says at one point, recounting what he said to the lab boss about the student:

“Imagine if s/he lied about little things like salt buffers [experimental reagents], what kind of data s/he might have fabricated later on,”

Which caught my attention – partly because research misconduct, and what should be done about it, is in the news at the moment.

But also partly because it deals with a regular part of University life - that problematic character, the student whose habits give cause for concern.

Much of the debate about student conduct recently has tended to focus on plagiarism, but here I am not talking about that, or even what one might call “academic misconduct’. I am talking about the more subtle things to do with how people behave, and how they interact with their colleagues.

Apart from in the lab, another place this turns up  - and perhaps a slightly special setting – is medical school. There is a long-standing debate about how sub-standard conduct should be dealt with, and what behaviours students should be ‘pulled up’ for – especially for students in the pre-clinical years where we have historically tended to take a more relaxed view of how students should behave than our clinical colleagues.

[The main point was that in the past students did not see patients until their third year of medical school. Nowadays in many courses they are around hospitals and GP clinics from the very start of their student career. So they are under the microscope rather more than was formerly the case.]

One argument for what one might call a “Zero tolerance” policy is studies like this one, in the New England Journal of Medicine a few years back.

Of course, the counter-argument, which also has force, is the ‘youthful high jinks’ one – that is, that everyone does daft, or even idiotic, things, and behaves like a plonker, when young, and mostly people grow out of it. For some medical examples you could try many a medical memoir – or for a recent political example you could try Louise Mensch MP’s robust riposte to the Daily Mail a couple of weeks back. There has even been a discussion in the medical literature of whether previous criminal convictions – which one could call an extreme example of idiotic behaviour – should be an absolute bar to entering medical school.

On the whole, when we hear about misbehaviour by students, we tend to try and distinguish between “stupid stuff” (they really don’t know);  and “worrying stuff” (they know, but do it anyway) - of which the most worrying is usually “dishonest stuff”.

A couple of examples of the latter.

In our lab classes for medical students we teach them stuff that they are later tested on, like using peak flow meters and spirometers, and measuring blood pressure. The test they get on this later is in the form of a what is called an OSCE, a kind of practical exam in which students pass through a series of “stations’ where they have typically 5 or 6 minutes to do a task – like measure a volunteer subject’s blood pressure.

As well as teaching students these skills in scheduled classes, we run revision classes a couple of weeks before the OSCE takes place.

Now, the people who teach these revision class are adamant that these classes are for revision – NOT for teaching the skills from scratch to students who couldn’t be arsed to turn up to the regular scheduled sessions earlier in the semester. So the rule for students is that, if you have missed more than 20% of the semester’s scheduled lab classes without explanation, you cannot come into the revision session,

Though this is well publicised, it sometimes seems to come as a shock to less, errm, organised students.

A good few years ago now, a couple of my colleagues were checking the students in at the door on such a revision class when a student appeared who the records showed had exceeded the allowed number of absences. They pointed this out to him and said he would not be allowed in.

“Oh no” said the student “I gave in notes explaining that absence and that absence” (this would get him into the revision class, as ‘excused for something you couldn’t help’, like a doctor’s appointment or illness, or some other stuff, usually doesn’t count as ‘absent without reason’).

Now, one of my colleagues was a touch suspicious, trotted off to the Faculty Office that ‘logs’ such notes, and checked what the student had said.

The student had handed in nothing for the dates in question. No notes. No reasons for the absences.

The student was told to leave the class, and was, I am pretty sure, reported to the Course Director for what in the old days would have been called ‘a right bollocking’.

It was not the being absent from the earlier classes that was the most worrying thing, but rather that the student had flatly and directly fibbed (about the notes for his absences) to a member of the academic teaching staff.

I am curious to know what my readers, especially the medical ones, make of this.

Now, Mrs Dr Aust, the family’s medical expert, has little (read: “no”) sympathy for the student in this story. She is suspicious as to whether leopards change their spots, for one thing. And she says that people who will lie, or even just bend the truth a bit, to get themselves off the hook are a flat-out liability in medicine, full stop. The standard scenario she tends to give is one like this:

In an urgent diagnostic discussion about patient Mr X, gets-by-on-charm-but-a bit-of-an-idler junior doctor Dr Y is asked by a more senior colleague about the result of test Z that he, Dr Y, was supposed to have ordered yesterday. Dr Y had forgotten to order the test. However, fearing a public kicking, he does not admit this but says instead ‘ Errm… the result’s not back yet’.

Of course, you can argue that that latter scenario is unrealistic. But Mrs Dr Aust says that this happened sufficiently frequently to her over the years that eventually she took to phoning the lab herself when she heard this line – to be told, on more than one occasion: “Nope, there’s no sample”.  She also says that there were junior doctors who, when confronted about this, would respond with anger rather than holding their hands up. She says one even called her ‘A Fascist’.

You can also argue that this kind of behaviour is a long way from the skiving student-in-the-lab-class example that I gave above.  But, and this is the crux of the matter,  there is always a suspicion that people who are prepared to lie about one thing are more likely to be prepared to lie about other stuff too.

And there is also a sense that, the more they get away with it, the more they will carry on doing it.

So where should we draw the line? 

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The day after I wrote the first version of the above, I was reminded by a discussion on Twitter about something else in a similar vein (artery?).

In our practical tests of measuring blood pressure, which is one of the skills we teach to students, the examiner almost always listens to the same Korotkoff sounds that the student hears via a dual stethoscope.

One of the things you regularly experience as an examiner for this is the student who, when no sounds whatsoever have been audible – typically because the stethoscope bell is in the wrong place – announces:

“One twenty over eighty”

(i.e. a blood pressure of 120/80 mm Hg, which is normal and thus a good random guess for an adult – though it is usually a little high for a fit younger adult, like most of our volunteer subjects tend to be. Of course, we take their BP at the start of the day and periodically thereafter, so we know what their BP is really likely to be).

We were talking about this today, and the thought occurred to me: is offering that answer, when you could not possibly have got a reading of blood pressure, actually – or at least arguably – an attempt to deceive?

And – it would be a pretty draconian way to do it, but should we automatically fail anyone who says it?  

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Postscript:

Just to expand on this a bit:

There is always a kind of tension in professional degrees between the need of students repeatedly to pass exams to progress on the course, and the ultimate need for them to learn to do certain things (like measuring blood pressure). One is regularly told (and it is a reasonable axiom) that ‘assessment drives learning’. So if you have a test where there is no downside to guessing (apart from not getting the mark you would get for getting the right answer), students will guess.  [Many University multiple choice exams use what is called 'negative marking' specifically to give students a downside to guessing at random when they don't know the answer].

But in the setting I have described, there are several problems with this.

One is the problem described above – you could say we are allowing the students to assume it is OK to make up an answer, when really it shouldn’t be.

Two is that it is of course important to be able to measure blood pressure accurately; the students should, in turn, be able to see that it is important that they learn to do it properly. If you are being really earnest, you might say they should be able to see that ‘fronting it’ (doing a third rate version but trying to look super-confident) is not really on.

Three is that you could say this represents a lost opportunity – perhaps the students should be pulled up straight away and asked to expand on why they had trotted out a number when there were no sounds.

The point there being to get them to think about why there might be problems with what they had just done that might make it more than just the equivalent of a random guess in a multiple choice exam.

After all, if behaviours that are not acceptable are not identified and challenged, how do the students actually learn…. that the behaviours are not acceptable?

Or – am I just being a hopelessly crusty old git? Highly possible, after all. I am undeniably middle-aged. And famously curmudgeonly.

Anyway – opinions, anyone?  I know it’s a bit cheeky asking for views when it’s been so long since the last post, but I would be interested in what the readers, young and old(er), think.

 

PS - I should also say that, though I’ve been around medical schools a long time, I don’t pretend to claim any great expertise in assessment. Far greater minds than mine etc etc.

Wanted – dedicated or alive

In which we ponder the language of advertisements for University science jobs..

I was amused recently to see a Tweet from one of my friends in the scientific blogosphere, Stephen Curry (do check out his excellent Reciprocal Space blog), saying that he was:

‘arguing’ – I presume with his HR Department – ‘to be allowed to ask for someone ‘enthusiastic’ in a job advert’.

Now, this struck me as a little surprising. As I tweeted back:

@Stephen_Curry You're struggling to INCLUDE 'enthusiastic'? Most Univ job ads I read include it… or even 'fanatically committed'—
Dr Aust (@Dr_Aust_PhD) June 09, 2011

For, as anyone who regularly scans the academic job ads in (e.g.) the Times Higher will know, language tending to the hyperbolic has become such a regular feature of advertisements for jobs in British Universities that it no longer seems even slightly remarkable. I remembered that I had once written a short satirical piece on this, so I headed off to my archive (the pile of mouldering papers in the corner of my spare room) to try and find it. Turns out it was a full six – yes, six – years ago. I have reproduced it, with minor amendments, updates and hyperlinks, below.

I leave you, dear reader, to judge if you think anything has changed in academic job-ad-speak in the meantime.

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You used to know where you were with advertisements for academic jobs in science.

‘The Something-logy department of the University of Grumbleton requires a lecturer. Duties will be teaching, supervision of graduate students, and conducting research in something-ology.’

Of course, these adverts often concealed a whole raft of hidden agendas, and more often than not some research areas would be ‘preferred’, but at least the language in the advertisement was to the point.

Not any more.

Nowadays most academic job advertisements in the UK give the impression of having been written by a committee consisting of a Head of Department with messianic delusions, one or more human resources ‘professionals’ (the inverted commas are mine), and a public relations flack in the grip of a Prozac frenzy. And all of them seem to have been on some special course in mangling English.

These adverts now have a language all of their own. The odd thing, though, is that they are all so similar – despite the hyperbole and obscurantist/coded vocabulary – that they could practically have been written by a computer programme.

The simplest change is the proliferation of superfluous adjectives, or, to be more precise, Obligatory Adjectival Qualifiers (OAQs for short). An OAQ is an adjective that must automatically precede a noun every time that particular noun appears. Some examples:

‘world-class’ (institution, or research)

‘outstanding’ (individual) [also ‘exceptional’, ‘pro-active’, ‘committed’, ‘energetic’]

‘exciting’ (opportunity)

‘state-of-the-art’ (facilities, buildings)

‘leading’ (centre) [also ‘world-leading’]

‘proven’ (ability)

Then there are the phrases that have both a literal and a shorthand, or parallel, meaning. Examples:

The institution:

‘An exciting, vibrant, research-led academic community’: Research-intensive ‘old’ University / Russell Group.

‘Progressive and innovative’ (also ‘modern and innovative’): Former polytechnic / ‘post-92′.

‘High-quality student-centred learning environment’: We have a new building and are desperately trying to enrol enough students to fill it.

‘Committed to anticipating and satisfying students’, employers’ and clients’ needs’: Staff will work for food.

‘One of the countries most popular student destinations’: Nothing stands out about our University, but thank heaven the night-life and the cheap booze still brings in the punters.

‘Offering opportunities to work with leading international academics whose visions are shaping tomorrow’s world’: I don’t think they’ve got my antidepressant dose quite right at the moment.

You:

‘A committed and work-focused individual’: Prepared to work 50+ hrs a week for little money on a fixed-term contract.

‘A high-calibre and driven individual’: You should be unashamed, or at least unaware, of your Borderline Personality Disorder.

The job, and department:

‘We are committed to personal development’: We have a widely loathed staff appraisal scheme.

‘An innovative, challenging work environment’: You might get a desk.

‘We have pursued a focused strategy of appointing world-class researchers’: In: Professors with 5-year (Programme) grant funding; Out: Teaching staff over 50.

‘Staff are integrated into cross-cutting, multi-disciplinary themes’: Our senior management believe strongly in putting their oar in.

‘We aim for the highest levels of research excellence’: Five-star in the next Research Assessment, or early retirements all round.

I should say that all the above examples are real: you couldn’t make this stuff up. And this is only a starter pack. Anyone got any more particularly choice examples?

Finally, to end on a positive note (sort of) – the observant among you will have noticed that, should you ever need to, you can now write your own University job advert simply by selecting the appropriate phrases from the lists above. Think of the time you’ll save!

Assuming, of course, that HR will let you.

Enjoy.

Of slime and childish curiosity

In which Dr Aust ponders slime. And scientific tendencies.

Reproduced from the wonderful xkcd.com, the comic strip that regularly captures the spirit and the reality of science

Last weekend the Aust entourage, including Junior Aust (aged six-and-a bit-well-nearly-seven-in-a-few-months) visited this event at one of the nearby museums, run by the people from Manchester University’s Life Sciences Faculty.

In the event you could, as it says, “Come on a tour of the human body” and learn “how the heart works and how your lungs help you breathe”, among other things.

Junior Aust was fairly unimpressed by the nice chaps with their two-electrode ECG trace, even when I told her it was one of the things dad gets his students to measure on each other. I think the ECG wasn’t participatory enough for her, as they weren’t allowed to wire up members of the public (a shame, really, but understandable).

I DID manage to persuade her to blow into the spirometer and have her Forced Vital Capacity measured – another of those things you can find me getting students to do in their lab classes. I also measured myself for comparison, though I’d already done my annual Hypochondrial Full-service Multi-parameter Respiratory Function Self-assessment while I was running the student classes earlier this Semester.

She was a bit more impressed with the video of the view of the inside of your airways during a bronchoscopy (not done live, before you ask!), which I was able to tell her was the kind of thing mummy used to do to patients.

But the thing that REALLY made a deep and lasting impression on Junior Aust was the “make your own mucus-alike slime” stand. Kitted out in disposable plastic pathologist-style apron and dashing purple nitrile gloves, she was helped to concoct some truly disgusting-looking greeny-yellow slime out of acrylic glue, water and food colouring. I reassured her that the yellow colour was just enough to made it look properly yellow phlegm-like and grungey, and she was given some of her confection (tied up in another nitrile glove, no plastic bags left) to take home.

Now, we assumed she would lose interest in the stuff quickly enough, but this turned out not to be the case. For the rest of the day we were repeatedly called into action to stop her turning the slime out over the table, or the chairs, or the floor. Despite our best efforts, small chunks of it made their way onto her and her brother’s clothes, and onto the furniture. Yum.

But then we made a truly catastrophic error.

** Warning – you may find the next bit slightly disgusting. **

In a moment of attempting to out-gross Jurior Aust, The Boss (Mrs Dr Aust) remarked “That slime” (which was now semi-congealed) “looks exactly like what was in Junior Two’s nappies when he was ill the other week*”

Oh dear.

Big mistake.

Big, biiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiig Mistake.

Huge.

For, thoughout the week since this conversation, we have been regaled daily (or indeed several times each day), by one or both children, with the useful information, faithfully and exactly repeated, of just exactly what Jr Aust’s slime resembles. Typically combined with a display of THE GLOVE, turned inside out so we can have a good look at the congealed yellow stuff.

Nice.

Note to self:

Take care what information thou doth impart to those under seven.

For verily, thou canst not take it back.

Anyway, we are trying to look on the optimistic side. You certainly have to applaud Junior Aust, and her younger sibling, for their impressive curiosity. Even curiosity into slightly gross stuff.

Which explains why I found the cartoon at the top of the post, from the brilliant xkcd.com, so funny when I saw it earlier this evening.

Now, Mrs Dr Aust and I have sworn an oath, in blood and in at least two languages, that the Aust-Sprogs are to be discouraged at all costs from going into any career related to science, or into medicine.

But there is, I fear, the chance that genes, or conditioning, will out.

Time, I guess, will tell.

 

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* It was almost certainly a rotavirus infection, BTW. Most unpleasant, and not a week we are keen to remember.

Getting the bird

In which Dr Aust ponders language and its obscurities.

You lookin' at my bird?

One of Dr Aust’s current nightly rituals is reading a bedtime story to one, or both, children.

This evening we were reading a story – one of this charming series – which contained the word:

“budgerigar”

This reminded Dr Aust of an event, over a dozen years ago now, which exemplifies the problems with language (and perhaps also cultural differences) that can turn up unexpectedly in Universities.

The story concerns an exam sat by our undergraduate medical students some time in the mid to late 1990s. Back in those days we academics used to, as they say, “invigilate” all the exams ourselves. Nowadays we have special people – often retired academics – who do this, and the word “Invigilate!” instead tends to conjure up for me a vision of someone casting a spell in a Harry Potter book. But in those days, we would be there ourselves to hand out the exam papers and terrify the students with dire announcements about the consequences of cheating, or inadvertently having any notes about your person. Then we would spend a few hours patrolling the exam room trying to look grim and/or spot students with suspect programmable calculators.

Next, you need to know what sort of exam it was. This was what we called a “Case paper”, in which the students were presented with a short medical case history. The idea was that they should try and figure out what was going on, first trying to recognise so-called “cues”, and symptoms, in the history, and then suggest what kinds of tests or investigations they would order.

The particular case in this exam paper involved a man called “Mr Polly” (sic) who kept budgerigars. The birds actually appeared in the first line, which went something like:

“Mr Polly was devoted to his budgerigars, and kept several dozen in a shed at the back of his house. They were his pride and joy.”

Now, you need to know that the word “bird” appeared nowhere in the exam paper, though “budgerigar” was in there several times.

Perhaps you can guess what happened next.

A student stuck their hand up.

Dr Aust hurried over. Students sticking their hands up in exams are not unusual, since requests for extra paper, or to be allowed to visit the toilet facilities, were a regular part of invigilating then and doubtless still are. Of course, a minute or two after the exam started was a little bit early.

Dr Aust asked the student what s/he wanted.

The student replied nervously “I don’t understand this word”.

…And pointed to the word “budgerigar”.

This put Dr Aust in a bit of a quandary. He was a fairly junior academic at the time, and was not one of the people who had actually set the exam paper, so he didn’t really feel he had the authority to just tell the student that a budgerigar was a small bird. Scanning the paper, Dr Aust hunted for something else that might offer a clue. His eye fell on a passage more or less like this:

“One day, Mr Polly felt short of breath and a bit faint – walking up the stairs was an effort. Nonetheless, he was determined to attend to his budgerigars. Whilst cleaning out his aviary, he became dizzy and breathless and collapsed. His wife found him and called an ambulance”

Dr Aust pointed at this last sentence and whispered to the student:

“This sentence should help you. Look at this word.“ he said, underlining the word aviary.

The student, who judging by appearance and accent was clearly from outside the UK, looked panic-stricken.

“I don’t know what that word means either” s/he said.

Which is an object lesson, I guess, in being careful what words to use. And in what settings. Especially settings where it is difficult for people to ask clarifying questions.

The story does have a happy ending. After a few words with the Senior Examiner who had set the paper, we decided to make an announcement to all those in the exam hall to tell them that a budgerigar was a small parrot.

It turned out afterwards that several other students had been equally flummoxed by “budgerigar” and “aviary”, though most had not put their hands up.

Over the years I have sometimes wondered if any of those flummoxed students, now doubtless many years qualified in medicine and quite possibly GPs and consultants in the NHS, have ever again encountered the words “budgerigar” or “aviary”.

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PS Mr Polly’s complaint, which I dare say all my medical readers will have guessed, goes by the common name of “Bird Fancier’s Lung”, and is a form of extrinsic allergic alveolitis or hypersensitivity pneumonitis (more here).

PPS Language and comprehension is, of course, an issue in many settings in academia, and more so in medicine. Dr Aust has always (he hopes) been reasonably good at spotting – mostly from the non-verbal cues – when people working in his lab did not understand what he was saying, and adjusting his language accordingly. Not everyone does, though. One eminent Professor I knew was famous in the Department for fixing non-English-native-speaking research assistants with his most gimlet gaze and then saying, in his slowest and loudest voice:

“Do. You. Understand?”

The joke was that he often did this to people who came from cultures where to admit that you hadn’t understood the Great Man’s pearls of wisdom would be a terrible source of shame, and also a grave slight to the Eminent Professor. Thus the unfortunate subordinate would nod meekly, and the Great Man would depart satisfied that he had got his meaning across. Whereupon Dr Aust and the other more junior lab people would explain to the quivering research assistant what the Prof had been saying.

A slightly different problem arises for doctors who work in countries where the language is not their native one. Apart from just the language, they have to cope with regional accents and dialects. In the UK they also have to cope with the British talent for slang and euphemisms.

When Mrs Dr Aust first arrived in the UK to work as a junior doctor in a North West England-shire hospital, she was presented with a glossary of “local terms that your patients may use”. The list ran to a fair few printed pages. I suspect it may have had some similarities to the Yorkshire one here, which was discussed by the august British Medical Journal a while back.