Going through @dylanwiliam's plenary and pulling out the nuggets!

1⃣ There are no perfect solutions to anything. There are trade-offs. You need to decide which trade-offs you are willing to accept from new/old solutions. (Chesterton's fence)

#AMEE2021 #FOAMed
2⃣ Time spent on one thing means you miss out time on another thing.

Which things are worthy of inclusion and exclusion in the curriculum?

#AMEE2021
3⃣ Teaching is a wicked learning environment. Where students learn things is NOT where they apply them.

This makes working out what is effective teaching, a nightmare!

From Hogarth et al, 2015: journals.sagepub.com/doi/abs/10.117…

#AMEE2021
4⃣a

Teaching motivated students gets great feedback. Try playing @stokecity away on a cold windy night! 😂 bjorklab.psych.ucla.edu/wp-content/upl…

Great lesson performance does not always translate to long-term memory...must be a small amount of struggle. journals.uchicago.edu/doi/abs/10.108…

#AMEE2021
4⃣b

What is applicable in one study from #MedEd might not be applicable to another study - class size reduction in Tennessee Star study ... schools included were not representative edsource.org/wp-content/upl…

#AMEE2021
5⃣a

Be careful when making generalisations in meta-analyses (meta-analyses came from #MedEd)

Publication bias is a huge problem here and may exaggerate the true effect.

#AMEE2021
5⃣b

True effect size, taking multi-centre, replicated studies was 1/3 of reported effect sizes:
nature.com/articles/s4156…

Ioannides (2005): much research is false journals.plos.org/plosmedicine/a…

"If you torture the data long enough, it will confess." (Coase, 1981)

#AMEE2021
5⃣c

In #MedEd, problems with meta-analyses:

- few causal studies
- few studies on intervention strength, e.g. numbers in intervention group
- variability in teaching groups often unaccounted
- do we use sensitive measures with effect sizes tandfonline.com/doi/abs/10.108…

#AMEE2021
5⃣d

#MedEd meta-analyses may not reliable for several reasons:

#AMEE2021
6⃣

Will the solution solve a problem?

What is required for solution to occur?

What is the measurable benefit?

Will the solution work here?

#AMEE2021
7⃣a

Short-term memory limited to 4-7 chunks for 20 seconds

But long-term memory is limitless

So the main purpose of education is to extend long-term memory.

Do our curricula increase long-term memory?

#AMEE2021
7⃣b

Very difficult tasks can be completed but excessively difficult task do not transform to long-term memory.

Cognitive load theory: tandfonline.com/doi/abs/10.310…

#AMEE2021
7⃣c

There are 3 types of cognitive load:

➡️ Intrinsic - the structure/complexity of the information

➡️ Extrinsic - the way the info is presented

➡️ Germane - the way new info integrated with previous learning

Confused? Watch this:

#AMEE2021
7⃣d

Ways to improve things:

⬇️ extrinsic load - simple instructions, remove distracters

⬆️ intrinsic load - start simple getting more complex AND repetition

↔️ germane load - some complex tasks for the high achievers

#AMEE2021
7⃣e

Spaced learning and practice testing are great strategies to improve memory.

Your memory is characterised by storage & retrieval strength.

We can remember old previously learned languages when shown options ... good storage but poor retrieval strength.

#AMEE2021
8⃣

What is formative assessment for?

It's not to tell you what to teach.

#AMEE2021
9⃣

The timing of feedback is important but complex.

Feedback should be more work for the recipient rather than the donor.

Feedback should be less necessary (redundant): we want people who are self-regulating and can give reflect and improve on their own weaknesses

#AMEE2021
🔟

Assessments allows us to draw conclusions but not all conclusions are valid from those assessments.

#AMEE2021
1⃣1⃣

You need reliability for valid conclusions.

But increasing reliability will decrease validity,

e.g. getting great info about all the work or high quality of some of the work neglecting the rest: floodlight metaphor

#AMEE2021
1⃣1⃣

Students - getting better at football is not just by playing football...

...Learning stuff that will come up on the test won't make you good at passing tests!

Further resources:

@P_A_Kirschner and @MirjamN's blog:
3starlearningexperiences.wordpress.com

#AMEE2021

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More from @DipeshGopal

10 Sep
@RaoMala @GraceOkoli and I write in @JHHypertension: nature.com/articles/s4137…

🧵 THREAD on why we need to seriously re-consider race in the @NICEComms hypertension guidance: Image
1️⃣ There is a small difference in ACE inhibitor blood pressure response between Afro-Caribbean and White people.

bmcnephrol.biomedcentral.com/articles/10.11…

bmj.com/content/371/bm… Image
2️⃣ Stereotyping all Afro-Caribbean people as being low renin responders is not based in science:

nature.com/articles/10011… Image
Read 10 tweets
30 Aug
Excited to be at @AMEE_Online at this workshop on teaching students during remote consultations @RoaaUK @Dr_UmarChaudhry

#AMEE2021
Interesting discussion about what students felt about remote consultations: @AcademicGP

ethics of consenting patients
usefulness for OSCEs
higher clinical risk so less exposure to them
⬆️ growth of verbal cues
⬇️ growth of gut feeling

#AMEE2021
Unsurprisingly @trishgreenhalgh @ejosipcar @bmj_latest paper about remote consultations in primary care was mentioned: bmj.com/content/368/bm…

#AMEE2021
Read 9 tweets
25 Jul
I read all 288 pages @food_strategy, and this is what I learnt

🧵 THREAD

1/

TL;DR - our food system needs multi-level intervention to improve our health, healthcare systems, biodiversity and climate emergency

14 recommendations and the govt has 6 mths to respond.
2/

Deforestation, climate change and overfishing is all linked...to food production.

Food production contributes to 33% and 20% of UK of global greenhouse gas emissions.

(air travel = 3.5% global emissions)

There is a huge biomass of farm animals for food production.
3/

Diet has huge implications for human health.

In 1980, on average, 57% of a household’s grocery budget was spent on ingredients for home-cooked food.

By 2000, this had fallen to 35%, while the share of processed foods which required little preparation rose from 26% to 45%.
Read 17 tweets
21 Jul
🧵 THREAD on @TheBMA report on medical staffing in England which did not get much airtime last week:

bma.org.uk/advice-and-sup…

Whilst the numbers are increasing, we just don't have enough doctors, esp GPs. #NHS #medtwitter

Here's the evidence:

@sbattrawden
@ShaunLintern
2/

We have some the lowest number of doctors per population in Europe. Image
3/

Whilst the number of hospital doctors is rising, the numbers of GPs has not despite record numbers of new trainees.

With more and more work being diverted to primary care without resourcing and funding, can we be surprised? Image
Read 18 tweets
2 May
1/

🧵 THREAD on critiquing lifestyle medicine from

article from @dnunan79 @dnblane @mgtmccartney just published in @BJGPjournal: bjgp.org/content/71/706…
2/

🗣️ "... we focus on the unintended consequences of uncritical endorsement and application of lifestyle medicine including the infiltration of pseudoscience, profiteering, and the potential for widening health inequalities by a continued focus on the ‘individual’."
3/

🗣️ "We have two main concerns here:

1⃣ the opportunity taken by some to link alternative medicine practices to lifestyle medicine

2⃣ the association of some ‘lifestyle medicine practitioners’ with commercial opportunities" Image
Read 11 tweets
21 Mar
🧵 THREAD on BIAS in MEDICINE #MedTwitter #FOAMed

1a/

BIAS:

➡️ is integral to how we see people/make diagnoses: can't be removed

➡️ affects research questions that get asked, who gets funded, what gets published and in which journal

@FutureHealthJ: rcpjournals.org/content/future…
1b/

Bias training:

➡️ increases bias awareness

➡️ doesn't decrease biases (no evidence base)

➡️ bias training ignores communication, provides no debiasing interventions, doesn't measure motivation

➡️ doesn't address structural problems

Read: ncbi.nlm.nih.gov/pmc/articles/P…
2/

Shoutout to the amazing team:

@UlaChetty

@patrickod9

@returnofcam

@jodieblackadder

And Prof @damienridge who shaped the manuscript.

Hundreds of papers, hours of lectures/books, many drafts to get here.

Thank you 🙏🏽
Read 26 tweets

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