TED Talk: The Global Learning Crisis


I thought I’d pass along this recent very powerful TED Talk. In this blog, we’ve talked about the international evaluation of student learning using the international PISA exam, an exam given to 15 year-olds around the world. This exam also includes elements assessing critical thinking. Ms. Karboul references the higher standing of countries that have invested and focused on student learning.  If there is one message, it is that learning takes a village. Also, the speaker distinguishes between education and learning. How do we get to the latter?

The global learning crisis — and what to do about it

15:09 minutes ·  from TED@BCG Milan – October, 2017

“The most important infrastructure we have is educated minds, says former Tunisian government minister Amel Karboul. Yet too often large investments go to more visible initiatives such as bridges and roads, when it’s the minds of our children that will really create a brighter future. In this sharp talk, she shares actionable ideas to ensure that every child is in school — and learning — within just one generation.”

Medicine: An “Uncertain Science”? Here’s where “Critical Clinical Thinking” comes in..


The profusion of facts obscured a deeper and more significant problem: the reconciliation between knowledge (certain, fixed, perfect, concrete) and clinical wisdom (uncertain, fluid, imperfect, abstract).

Those were the words of Dr. Mukherjee (Mukherjee, 2015) as he reflected on his didactic and clinical training in medicine.  He reflects on the seemingly constant “greyness” of decision-making in the real medical world, even with the best diagnostic tools. He also reflects on the fundamental deficiencies of his formal training in preparing him for some of the uncertainty.  If the training of M.D.’s is so “uncertain,” do we, in veterinary medicine, dare to think differently about our clinical practices?  If so much is about using good judgment when facts are missing or inconclusive, and much is also about self-reflection and correction, then what is called for is “critical clinical thinking,” “clinical reasoning,” or “clinical problem-solving.”

Often, this skill is considered the “magic” that somehow passes from a clinical year or residency mentor. Why does this have to be some deep dark secret?   Indeed, it has always been accepted that those in training would just get better at this as they were immersed in the clinic. But why should we postpone giving practice at such skills of self-reflective thinking?

I generally don’t make a practice of touting my own work, preferring to note that of others.  However, as first author of the attached manuscript in J. Vet. Med. Education (jvme.0216-032r1pub), I have the privilege of sharing this document as a whole, as we’ve tried to add to the prior works of veterinary educators like Herron et al. (1990), Ramaekers et al. (2011), and Buur et al. (2012) who have sought to tackle this subject in the context of veterinary education.

Herron and colleagues noted that the standard 3 years of basic science led to no improvement in overall performance on the Watson-Glaser Critical Thinking Appraisal, but, of great concern, found a regression  in the “the ability to determine the strength of an argument.” In that publication, it was first proposed that problem-solving might best be taught in a discipline-specific context, and starting in the first year.

More recently, Ramaekers and colleagues (2011) described the art of pattern recognition that is typical of expert diagnosticians, called “illness scripts.” Furthermore, that these are necessary to move a novice clinician to an expert.  Buur and colleagues (2012) showed that overall veterinary student performance on a general critical thinking skills tests (California Critical Thinking Skills Test) did not improve following a 2 year problem-based curriculum.  Our study of first year veterinary students also showed no overall improvement in student performance on a third general critical thinking skills test (Cornell Critical Thinking Test X) following a year-long series of practice case analyses, but did show improvement in pre-developed rubric scores associated with attributes of critical clinical thinking.

So, critical thinking is best taught and evaluated within the context of the constructs of one’s professional domain. Therefore, as veterinary educators, we should be concerned about providing appropriate practice with clinical problem-solving from the very beginning of the curriculum, ideally maintaining the effort until they graduate.   And one more thing…it’s a team sport.

As always, please share your experiences and thoughts on this topic.


Buur JL, Schmidt P, Smylie D, et al. Validation of a scenario-based assessment of critical thinking using an externally validated tool. J Vet Med Educ.2012;39(3):276–82. Medline:22951463 http://dx.doi.org/10.3138/jvme.0112-009R .

Herron MA, Wolf A, DiBrito W. Faculty and student attitudes toward problem solving and independent learning in the veterinary medical curriculum. J Vet Med Educ. 1990;17(1):19–21.

Ferguson DC, McNeil LK, Schaeffer DJ, Mills EM (2017) Encouraging Critical Clinical Thinking (CCT) Skills in First-Year Veterinary Students, J. Vet. Med. Ed. 44(3):531-540. Published online, Sept. 1, 2017, http://jvme.utpjournals.press/doi/pdf/10.3138/jvme.0216-032R1

Mukherjee S. The laws of medicine: field notes from an uncertain science. New York: Simon and Schuster; 2015. http://www.simonandschuster.com/books/The-Laws-of-Medicine/Siddhartha-Mukherjee/TED-Books/9781476784847

Ramaekers SPJ, van Beukelen P, Kremer WDJ, et al. An instructional model for training competence in solving clinical problems. J Vet Med Educ. 2011;38(4):360–72. Medline:22130412 http://dx.doi.org/10.3138/jvme.38.4.360 .



Nevertheless He Persisted


Last week, I had the honor of attending a memorial service at the University of Illinois for Dr. Fred Kummerow, a long-“retired” but never inactive member of the department I headed for almost 10 years. Fred was an inspiration to me personally to always remain physically and mentally active, and yes, limit my consumption of French fries! But as a scientist, the biggest lesson the 102 year old member of our department provided was to be resolute, personally and politically, when it came to scientific facts.

Fred was a yesteryear example of a “Dreamer” when he came to the U.S. as a child from Germany to live in Milwaukee, and became a citizen when his parents did. As described in the following video and article in the New York Times, he is best known for his having identified trans fatty acids in human fat tissue as early as 1957, reporting it in Science, and having it lead to his being shut out of significant federal funding because the dogma of cardiologists was that cholesterol intake was leading to heart disease.

Fred pushed back as a centenarian by communicating directly to the public with his book entitled, Cholesterol is Not the Culprit: A Guide to Preventing Heart Disease.  https://www.amazon.com/Cholesterol-Not-Culprit-Preventing-Disease-ebook/dp/B00IJ26UR8.  He had determined that it was oxysterols (oxidized cholesterol) produced by processing and overcooking of fat that were actually leading to the change in endothelial membrane structure and calcium deposits in coronary arteries. Trans fats and oxysterols were the culprit, and he eventually sued the Food and Drug Administration to have trans fats banned completely from processed foods by June 2018, a ban that he, unfortunately didn’t live to see. In other words, butter and eggs were fine and margarine and fried foods was what was going to cause heart disease. He lived by this advice to the age of almost 103.

Video on the announcement of trans fat ban: https://youtu.be/XSfMPeZuCsw

Obituary in the New York Times: https://www.nytimes.com/2017/06/01/science/fred-kummerow-dead-biochemist-ban-trans-fatty-acids.html

I can vouch that he was able to support an active laboratory until he was 101 years old, primarily with gift funds, a rarity these days. When he had to turn to non-federal grants, he found support from the egg industry, and was lambasted by no other than the then-notorious columnist Jack Anderson for what Anderson and many others felt was a conflict of interest. Fred saw it as a pragmatic solution to advance his science and was not influenced by who funded it. Beyond that, he was a consummate single-minded optimist with regards to essentially running his lab almost month-to-month, and for the decade I knew him, generally raised the funds to continue. We called him the “Energizer Bunny” of private fund-raising from those who believed in his work.  Although I can’t prove it, at the age of 100, he may have been the oldest scientist ever to apply for a grant from NIH. Unfortunately, he didn’t receive that grant; nevertheless he persisted.

So, why am I writing about Fred in this educational blog? Because he followed the EVIDENCE of his science like a hounddog, even when it was unpopular, and detrimental to his research funding. Fred’s story isn’t “old-school”; it is highly relevant today.

We need to be teaching our students to be hounddogs for the best scientific facts, and as veterinary educators, we should try to listen to the evidence of the field of education at large when it comes to how students learn.  

Losing the ‘Sage on the Stage’ – Is it Time?


Photo from the Washington Post, July 29, 2017

Today’s article by Lenny Bernstein in the Washington Post describes the University of Vermont Medical School moving almost totally away from lectures in its curriculum. In fact, it is following the trend in medical schools started by Case Western University 13 years ago.

Medical School without the ‘Sage on the Stage’ – Washington Post
The key elements may be blended online/face-to-face learning, interactive discussions, etc., but the evidence shows, the lectures are not the most effective way to foster learning. Active learning needs to be a bigger part of what we do in veterinary medicine soon. Let’s keep an eye on the University of Vermont, discussed in this article, Harvard, Stanford and Case Western medical schools. We should be actively discussing how to overcome the impediments, for the sake of our students, and perhaps our profession. It is about creating student-centric collaborative learning opportunities for students. The reason that blended learning has gained headway is because the online platform allows customization of the student learning experience, adaptation to student needs, and embedding of formative assessment (Piehler, 2016).The expectation should be achievement of a certain level of competency,  and, ideally, would allow for differing rates of completion. 

Such  experiential learning has been shown to drive deep-seated long-lasting learning. In a meta-analysis of 45 educational research studies showed a 35% improved learning outcome in blended learning environments (p<0.001) when compared to purely face-to-face instruction. Purely online instruction was not different than purely face-to-face instruction (Means et al, 2013).
Research supports the approach. As outlined in the article, another team of researchers reported in the Proceedings of the National Academy of Sciences the analysis of 225 studies comparing active learning vs. lectures. Active learning improved test scores about 6 percent, but what was more impressive was it reduced the tendency of a student to fail by 33% (Freeman et al., 2014). Isn’t part of our job as teachers to keep curiosity levels high, and to help students achieve a certain level of achievement?

It is coming to a veterinary school near you very soon….but who will be the first?  Perhaps the most feasible approach is to create blocks of instruction that employ blended learning, and allow the most interested faculty to demonstrate to their colleagues and students that the initial transitional effort is worth it, even if it just increases the level of student engagement (i.e. curiosity and student-centered learning). Given academic promotion systems at most Research I universities, each institution may need to rethink how it defines successful teaching. Is it only by high student evaluation scores, or is it by the demonstration of longer term learning, through the sometimes uncomfortable processes (for both “sages” and students) of allowing students to drive their own learning through interactive case scenarios or collaborative problem-solving? Isn’t that what they’ll need to do as graduates anyways?

Freeman S, Eddy SL, McDonough M, Smith MK,  Okoroafora N, Jordt H, Wenderotha MP (2014).  Active learning increases student performance in science, engineering, and mathematics. Proc Nat Acad Sci 111(23):8410–8415. URL: http://www.pnas.org/content/111/23/8410.full; accessed July 29, 2017.

Means, B., Toyama, Y., Murphy, R., and Baki, M. (2013). The effectiveness of online and blended learning: A meta-analysis of the empirical literature. Teachers College Record, 115 (030303): 1-47.

Piehler C (2016) Three ways blended learning improves student outcomes. The Learning Counsel, URL: http://thelearningcounsel.com/article/3-ways-blended-learning-improves-student-outcomes. Accessed July 23, 2017. 

Adoption of Innovative (and Effective) Instructional Technology is limited by “The Fear of Looking Stupid”


This article in Times Higher Education reports on a study by anthropologist  Lauren Herckis of Carnegie Mellon University that concludes that many faculty, despite evidence of positive learning outcomes, avoid innovative instructional technology because of “The Fear of Looking Stupid.”

Times Higher Education article

As most academics are researchers and evidence is held as important, it is disturbing that the fear of a downward bump in one’s student evaluation scores seems to give faculty pause, even when improved learning outcomes are potentially possible.  So, my question is two-fold:  1) How do we raise the academic value for faculty who seek and achieve improved learning outcomes, and over what timeframe (1 week, 1 month, 1 year, 3 years, 5 years?) and 2) How do we balance the instructor’s student evaluation scores by putting them into this perspective?

As President Franklin Delano Roosevelt once said, “The only thing we have to fear is fear itself.”


Thoughts of a Learning Entrepreneur


Elliott Masie is a learning entrepreneur.

He has run his “Learning XXXX” programs for over 25 years, usually in Orlando, FL. Here are the plans for the latest one:

Learning 2017

David Tollon and I had the pleasure of attending in 2014 and 2015. It was the first time I ever saw educators treated like rock stars.  I think he also single-handedly legitimized the process of finding, and reviewing (yes, “vetting”), and collecting existing educational materials on the Internet, calling it “curating.”  His meetings are known for their myriad of slogan buttons and one I proudly collected was one claiming that I was a “CURATOR”.   THOSE highlighting Masie’s highly produced programs we attended included Salman Khan of KhanAcademy , Logan Smalley of TED Ed and co-founder of Apple Computer, Steve Wozniak, as well as popular entertainers who discuss the role of continual learning in their professions.

As Elliott Masie is a thought leader in education, training, and often muses over the potential educational role of evermore pervasive digital technology, I thought it would be useful to pass along his July 5 newsletter projections as a direct quote (italics added):

* Learners as Designers: Our learners are designing and producing more and more of their own learning pathways.

* Open Content Expands Radically: Content from “open” sources like TED, YouTube are growing radically.

* Duration of Learning Activities Shrink: Classes, webinars, video and even coaching gets smaller and concise..

* Learning Systems Stretch Beyond LMS: Talent, learning apps and other systems push LMS down under.

* Machine Learning May Evolve Design: Can AI and machine learning shift the creation of learning activities.

* Shoulder to Shoulder Learning Comes Back: OJT (On-Job Learning) and OJL (On-Job Training) are re-emerging with workplace job aids.

* Video Chat Extends Social Collaboration: Click and connect with colleagues anywhere.

* User Experience Spins the Process: Creating learning with user design elements at the core.

* Curation Empowers the Learner & Organization: Content and context from anywhere for everyone.

* Curiosity, Mobile Devices and Search Engines for Learning Everywhere! YES!

Veterinary medical educators should be paying attention to these trends if we are to keep up and to continue to motivate our students. Help move the needle!

Perhaps the Best Rationale for Blended Learning I’ve Heard


Every now and then you run across an argument made by someone else that you’d wished you had the clarity (or temerity) to make oneself!

I am currently participating in a course entitled “Blended Learning” offered by Illinois Online Network (ION).  It had highlighted a faculty perspective video by Dr. Matthew Stoltzfus, who teaches general chemistry at the Ohio State University.  I then noticed that he did TED talk that includes in it a very graphic example of the fact that chemistry and medical education has practical requirements, yet chemistry and medical education has not changed (in his example in over 700 years) away from the large lecture halls that evolved after the printing press.


 The reality is that our biomedical students don’t read much any more, and we don’t often require them to do so. I particularly like Stoltzfus showing data from studies that show EEG activity when they watch TV, attend lectures and compare that with sleep! I won’t ruin the punchline but at least go to the following section of that video around 2 minutes into the video, and you’ll see what I mean.  Otherwise, I highly recommend the entire video for his discussion about where technology should be “necessary” for education, but not “necessary” to just capture and repackage lectures.  He describes the new insights provided by classroom technology like Learning Catalytics by Dr. Eric Mazur and colleagues of MIT, and purchased by Pearson in 2013:

Learning Catalytics (Pearson)

So, Stoltzfus concurs: We will always need teachers, but we need them not to be just lecturing anymore.