Comments from a Thai Doctor on World Class University Ranking

Dr. Kai, a Thai doctor of a university hospital, gave some comments after having known that "our university" is not ranked in the 200-top list in 2004, focussing on why university doctors have fewer publications than scientists do, and his view for resolving the problems. (Dr. Kai is still at UCL, UK for his training in neuromuscular diseases.)
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I think that's because they (scientists, pdharma's editing) do not have exhuasted clinical service job to do ( I mean they have more time to concentrate on research without doing more boring administrative and clinical job and that's because the basis of work structure is different between the faculty) and they have many PhD or MSc students and teams like a man have 10 limbs to help their projects. Like Queen Square, the good quality research publication is run by PhD students and postdocs as it's a pre-requisite for futher SpR (Specialist Registrar. pdharmas's editing) training and the academic lecturer staff concentrates on research only and service is mostly run by hospital clinical staff. And they are co-operative with each other well. Unlike in thailand, they are just competitive among the others and lack of co-operation and everyone want to be the first author because the system of academic promotion is just score on the first author. For example, Fac of Science and Rama are not cooperative well in doing co-research and you have mentioned before Fac of Science sometimes feel that Rama just use fac of science as a techician! In my opinion, research that could be applied in clinical use or can answer to clinical problem (the clinician know this question but need some basic research support) are worth to do. Not just the research that scientists just want to do to fulfil their satisfaction and the result is just kept on the shelf and cannot apply like many theses of Mahidol. How many of them are referred to and used in practice. Only some of the trop med that are useful esp Malaria and tropical disease. But in the future, I think the trend will be like in Queen Square as there will be more clinician-scientist (2 in one), this basic + clinical research needed will be less problem.

I have raised the policy of dividing staff physician into research-oriented team ( for those who favorite and keen on doing research but do not like teaching or service), and clinical service with teaching oriented (for those who do like teaching and see the patient) and of course the criteria of positional promotion must be totally different criteria. This will booster the research publication.Only researchers will concentrate the research all days and do not worry about the service. But it's impossibles as Rama want 3 in one policy : good teacher, good service and good researcher at the same time so nothing is excellent in each item. I believe a guy can do the best job if that job is his favourite and he has time to concentrate on and under the appropriate circumstance without any distracting factors. Different person has different ability to do his different job.
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It does not mean that I (pdharmas) agree with all of Dr. Kai's comments. My point is that we have to learn from different ideas in order to understand the real problems that might be a blockage for cooperation in the future. I do know that most of our senior staff realize and know about the problems very well and have been trying so hard to improve the situation. Please click comments to see pdharmas's.

Critical Thinking

Critical thinking and problem solving engage three interdependent components: knowledge base, processing skills, and insight (metacognition).

Critical thinking is the art of asking questions.

Which questions should I ask? Should I question the answers to the questions that I ask? Should I question the question? Are some questions better to ask than others? How do I recognize a useful as opposed to an unhelpful question? If thinking is something I do inside my head and I ask all these questions do I have to come up with the answers?”

Tips to start critical thinking
1. Describe – state what it is
2. Analyse – Break it down into its component parts and
3. Name the parts
4. Look at the relationships between the parts
5. What are the possible problems/issues with these relationships?
6. Evaluate the ‘problems’ is it an important issue/ why do you think that?
7. Imagine an alternative
8. Apply steps 1-7 to the alternative.

Another way to organize these eight steps is to use the general categories of
WHAT: background, context, part
HOW: Relationships ofparts, to each other and to the whole
WHY: The meaning of it:Why are the relationships between the parts structured that way
WHY NOT: Alternatives:How could it be different? What would it look like if it was different?

From Julia Hobson’s Critical Thinking workshop, Murdoch University, 2002.

World Class University Ranking Criteria

As we know, there are two main organizations which analyse and report rankings of universities over the world.
1. Times Higher Education Supplement, THES, (for 200-top list)
2. Institute of Higher Education of Shanghai Jiao Tong (SJT) University (for 500-top list)

We already know whether we are on the 2004 list. It is "Law of Karma". Wrong policies never give good results. And now we are given another new policy (about how to give a budget to universities), which I do not think it would make us be in the World Class University List. However, it is beyond a scope of this post that is about ranking criteria.

Criteria of THES:
- Peer Review Score
- Int'l Faculty Score
- Int'l Student Score
- Faculty/Student Score
- Citation/Faculty Score
You can find more detail at http://www.thes.co.uk/worldrankings/

For the criteria of SJT University, there are four criteria and six indicators.
1. Quality of Education
- Alumni of an institution winning Nobel Prizes and Fields Medals: 10%
2. Quality of Faculty
- Staff of an institution winning Nobel Prizes and Fields Medals: 20%
- Highly cited researchers in 21 broad subject categories: 20%
3. Research Output
- Articles published in Nature and Science: 20%
(For institutions specialized in humanities and social sciences, N&S is not considered, and the weight of N&S is relocated to other indicators.)
- Articles in Science Citation Index-expanded and Social Science Citation Index: 20%
4. Size of Institute
- Academic performance with respect to the size of an institution: 10%

And here are the data sources SJT University uses:
- Nobel laureates
- Fields Medals
- Highly cited researchers
- Articles published in Nature and Science
- Articles in Science Citation Index-expanded and Social Science Citation Index

It does not mean that all those criteria are perfect, but at least it gives us ideas how to improve our universities.

What are the Characteristics of our Medical Graduates?

Medical graduates I am mentioning mean the graduates of the university I work for, in Thailand. I do know that our educators and high-ranked medical teachers have already had their goals for our graduate for years. Are those goals be reached properly?

Here are the key characteristics I agree with and would like our medical graduates to be.

1. Able to deliver effective patient-centered care.
2. Honest with high ethical standards
3. Knowledgeable in biomedical sciences, evidence-based practice, and societal and cultural issues
4. Critical thinker; problem-solver
5. Able to communicate with patients and others
6. Able to collaborate with patients and other members of health care team
7. Committed to improving quality and safety
8. Committed to life-long learning and information mastery

Skills to Enhance Problem-based Learning

Medical and health professionals who have used PBL in the classroom have reported symptoms of weak group process and interaction skills among the students. These problems compromise the learning process. Hitchcock and Anderson identified five different small group dysfunctions:
Apathy, or lack of meaningful interaction.
· Limited or focused discussion that ignores other aspects of an issue.
· Dysfunctional group member who does not participate or perform work equally with others in the group.
· Scapegoated student, who becomes ignored by other group members.
· Domineering student who disrupts, or prevents others to learn through the process.
For faculty, poor interpersonal skills (as determined through informal interviews) can lead to:
· A class becoming hostile towards the instructor due to frustration over learning.
· An over-reliance on tutors and/or professor in solving problems and completing tasks.
To be a learning team, the learners need to have the interpersonal skills that will help them become an effective team.
The skills necessary for successful teaming include:

1. consensual decision making skills,
2. dialogue and discussion skills,
3. team maintenance skills,
4. conflict management skills, and
5. team leadership skills.

Without these skills being adequately developed, student learning can be frustrated.

For more details about how to develop these skill: Med Educ Online [serial online] 1997;2,3.

Comments from a Thai Doctor on PBL and Good Teacher

I've received two e-mails from my friend, Kai, who is a medical doctor working and teaching at a university hospital in Bangkok, Thailand. He allows me to post his comments on this blog. His two comments occured after he read the article "Reform of undergraduate medical teaching in the United Kingdom: a triumph of evangelism over common sense" that I sent to all of you.

1st Comment:
11/01/05- "I am happy to see this article as you know I have never agreed with PBL teaching since I was a medical student. I think the main problem is the teachers themselves who cannot teach the student effectively. They cannot select which parts of knowledge are essential and have to be emphasized. I see most the academic lectures in UK could summarise the essential fact of knowledge within 30 minutes of presentation. Thai lecturers or elsewhere will say the time is not enough for me to lecture. Some of Thai senior teachers in the University just want to follow US academic teaching system which was claimed to be modernised but it's a hell indeed. I am not surprised why basic clinical skill and knowledge (need to be taught and emphasized) of the old generation UK consultants are better than new generation of UK consultants and perhaps US consultant or doctors elsewhere (investigation dependent due to unsecure knowledge). Should we follow US with new teaching PBL?"

2nd Comment:
12/01/05- "However, what I believe (sound not scientific but you cannot refuse!) is only a good teacher will help medical student achieve the goal of medical learning (my personal experience of medical studying). Good medical teacher I mean is the one who pays attention to the students during teaching, who can make everything simple for student (no matter how foolish the student is except mental retard student which is not relevant here in reality) to understand, remember (without forget unless they are demented), and ability to think or solve problem by themself finally. Teachers must know the point that the students are usually not understand and clarify to them. Good teacher should have ability to teach or train poor medical student to be a good one. Moreover, good teachers must have ability to demonstrate how they can apply basic science knowlege into clinical practice (good basic science-clinical correlation).

In general (mean not everyone), PhD non-doctoral scientists who are never encounter in clinical practice are difficult to integrate that. On the contary, Research based doctor who, in their whole life, sit in the research laboratory and know everything in molecular detail well and do not see or touch the patient quite often may also have some difficuty to do so. Perhaps they possibly do not know what the students do not understand and they do not understand why students do not understand as they understand everything themselves too well but cannot explain in lay term. Clinical Medical consultants whose knowledge is excellent in every area but are not willing to teach, in my opinion, are rubbish and are not a medical teacher. However all of these are not significant if you are good teacher. Good teacher, probably rarely found nowadays indeed, is always a good teacher no matter how the curliculum will change. The student or learner will absolutely be the judgement. So, Have we ever shown a consideration to our medical students evaluation or complaint? I think medical teaching process is definitely not the same as other educations especially Su-ko-thai-thum-ma-ti-raj self study programme by post because it determines life and death of people.

Someone in this world will definiely not agree and do not want to hear or face the truth from a past medical student."
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What is my view (pdharmas's) is that PBL is inevitable for most of the universities in Thailand. What we have to do is to make it right. Is PBL we are running "REAL/PURE" or "modified" PBL? If it is the modified PBL, can we guarantee it will not cause damage? Problem-solving (content-based) skill is not the only one goal of REAL PBL. Communication and group-working skills are also the important goals. Even the moral aspect also can be cultivated during the scientific PBL classes; such as how students accept different ideas without hidden internal violence. All of these will help not only improve doctor-patient relationship when the students become a doctor, but also help society better. It would be a failure of PBL if it was only used to stimulate students to search how to solve the case, despite the student-centred, even though we have good content-based instructors.
Complaints from students are very important and should be recorded for further long-term follow-up (evidence-based) and course evaluation.

A Good Teacher....Am I?

There are striking similarities about what good teachers say about teaching. On at least ten propositions, the contributors are in near or total agreement:

1. The teacher's main task is to guide students through the learning process, not to dispense information:
"Teaching is not about imparting information. Teaching is about giving students room to learn how to think for themselves." (Law)
". . . teaching is less a matter of professing than it is finding means for students to discover their own virtuousness." (Architecture)
". . . I am on hand not to argue positions or provide entertainment but to facilitate an encounter between texts and minds." (English)

2. The goal of teaching is to help students read, speak, write, and think critically—and to expect students to do these things:
". . . I see it as one of my prime duties as a scholar-teacher to stretch [students'] abilities, open their eyes, and require of them as much as I think they can produce." (Classics)
"The amount of information imparted in the classroom is less important than the dialogue we begin with our students, that collective intellectual enterprise in which we seek to foster critical thinking and experimentation with new ideas, in which we engage our students in that elusive pursuit of the truth, wherever it may lead." (History)

3. Learning is a "messy" process, and the search for truth and knowledge is open-ended:
"The very impossibility of ever arriving at an account of a tradition or of ways of looking for once and for all, the contingency of it all and yet the persistence of our attempts to do so is at the center of all my teaching." (Art History)
"In dealing with any really hard problem, most scholars will probably admit they do not know of a single right solution . . . Students should not be given the impression that they have arrived nowhere simply because no single right solution has been found." (Law)
"Just as in real life, my problems may have several answers. This irritates everyone; students want precise, tidy problems. But my job is to teach them how to take messy, vague questions and transform them into a precise model which can then be attacked." (Mathematics)

4. Good teachers love their subject matter:
"Here is my advice. Don't teach if you don't like the subject matter. If you love it, don't hide it. Wear your zeal on your sleeve, shout it, show it, sing it. The rest will take care of itself." (Economics)
"A short philosophy of teaching might be, 'Love your subject and convey that love; all else is secondary.'" (Physics)
". . . we have a unique power to make our classes come alive with the excitement of discovery and the love of creative learning that drive our own lives." (Chemistry)

5. Good research and good teaching go hand in hand. Students' engagement with the subject is enhanced by knowing about the teacher's own research, and the interaction with students often provides new insights into the research:
"My experience as a professor and as Chancellor contradicts the popular misconception that teaching and research conflict with one another. Exciting classes stimulate scholarship, and active research enriches teaching." (Mechanical Engineering)
"Presenting recent research in classes adds a sense that we are all still learning, not just reviewing knowledge, and student response has been enthusiastic." (Integrative Biology)
"The integration of research and teaching has been for me a two-way process. Not only have I involved students in my research and related my research to my teaching; I have also participated in and learned much from student research projects. Most of my work related to student research has been at the undergraduate level. I think undergraduate students are capable of doing original research and have encouraged them to participate in the advancement of knowledge." (Ethnic Studies)

6. The best teachers genuinely respect students and their intellectual capabilities:
"I insist upon taking students seriously—seriously enough to argue with them, seriously enough to snap their heads off if they cannot show me logical bases for their assertions, and seriously enough to retreat in open confusion when they disagree with me and show me I have in fact misunderstood the materials I have presented." (English)
"Few things can compete with the teaching of eager, talented, well-prepared and demanding students that crave, in fact, demand, precision and excellence . . . How lucky I really am." (Mechanical Engineering)

7. Good teachers are rarely satisfied with their teaching. They constantly evaluate and modify what they do:
"There is no room for complacency in teaching, and that's one of the things I love about it." (Environmental Science, Policy, and Management)
"At any given moment I may feel that I am not doing a good job in my courses, and feel my preparations are inadequate, or that I am giving students short shrift. I realize I have thought this about my teaching during every term of every year since I started to teach." (English)

8. Good teachers usually had good teachers, and they see themselves as passing on their own teachers' gifts to a new generation of students:
"As I watched my teacher think out loud, inviting us to think with him about the material, I suddenly got the point. Instead of trying to fit some new material into my scholarly bag of knowledge, or attempting to come up with a response, I allowed my teacher's passion, his sense of wonder, to inhabit me. That kind of experience is what I try to offer students in my teaching." (Economics)
"For many of us, it was the special things that happened with teachers that shaped our paths to success. My aim is to offer the best that I was served." (Psychology)

9. Good teachers treasure the small moments of discovery in the classroom and the more enduring effect they have on students' lives:
"But the true rewards, the point of it all, are those moments of insight when a student suddenly brightens with radiant excitement and says, 'Oh, now I get it!' and does 'get' something to which access had been blocked. A small miracle." (Political Science)
"Teachers live for moments . . . when realization glows like a cartoon lightbulb over a student's head." (Public Policy)
"I have watched students learn things I never knew while I was supposedly teaching them, and do things that may well be beyond my capabilities while I was supposedly directing their research. And I have watched them continue that performance for years after leaving Berkeley. There is an enormous satisfaction in that." (Materials Science and Mineral Engineering)

10. Good teachers do not see teaching as separate from other activities; rather, they see their lives as remarkably integrated:
"The activity of teaching seems to me particularly blessed, for it allows me to spend my time with what I love and gives a oneness to my life that students value—in the literal sense, appreciate. One might say that my business is my hobby—or that I have no hobbies. I am always working—or never working. Whatever the formulation, the result is a wholeness to one's intellectual, even one's physical life." (Music)
"Very few teachers can match their professional work and their classwork as near-perfectly as this. One of the great advantages of Berkeley, I believe, is that so many faculty members are able to lead intellectual lives as unified as mine." (Journalism)

Extracted from Office Educational Development, University of California, Berkeley

When is PBL not PBL?

I've read this article of Gwendie Camp, and found it interesting.

QUOTE:

• PBL fits with tenets of adult learning theory. Student autonomy, building on previous knowledge and experiences, and the opportunity for immediate application are all well-known to facilitate learning in adults.
• Knowles, considered the "father" of adult learning theory, proposed that appropriate conditions for adults to learn effectively include the following: a learning environment characterized by physical comfort, mutual trust and respect, mutual helpfulness, freedom of expression, accepting of differences, where learners perceive the goals of the learning experience to be their own goals, where learners accept a share of responsibility for planning and operating the learning experience and therefore have a commitment to it, where learners participate actively, and sense progress toward their own goals.
• Norman and Schmidt reviewed experimental evidence supporting possible differences in students' learning that could be attributed to PBL. They concluded that there is not yet any evidence that PBL curricula result in improvement in general (content-free) problem-solving skills, although they caution that problem-solving skills independent of content acquisition may not exist. However, there is evidence that PBL students retain knowledge much longer than students taught conventionally, although their initial learning may be less extensive. There is preliminary evidence that PBL students may be better able to transfer concepts to new problems. And lastly, it is evident that PBL does have a large impact on self-directed learning skills, and on students' motivation.
• The reasons why PBL is "catching on" is the desire of faculty or administrators at schools which have not yet implemented PBL to avoid "missing the boat". In other words, there is a temptation to join the parade or get on the bandwagon so as to not be perceived as behind the times. Unfortunately, this motivation can too often lead to only half-hearted implementation of PBL, which does not capture the "spirit" of PBL.

When is PBL not PBL?
The characteristics of "pure" PBL:
- problem-based learning is active,
- adult-oriented,
- problem-centered,
- student-centered,
- collaborative, integrated, interdisciplinary,
- utilizes small groups and
- operates in a clinical context.
Then, any program which does not place students in tutorial groups of, say, 5-10 students is not "pure" PBL. If the program is "teacher-centered" rather than "student-centered," the heart of "pure" PBL has been lost.

When, then , is it not "pure" PBL? When it is discipline-specific, case-based (or problem-stimulated) but not student-centered, when much of the instruction is still in traditional formats such as lectures and labs, and when the assessment of student performance rests solely or primarily on content acquisition. When a PBL course must be buried within a surrounding set of traditional courses, it is not "pure" PBL, as students will have lost the time necessary for independent study.

From: Problem-Based Learning: A Paradigm Shift or a Passing Fad? MEO 1996;1:2

The value of basic science in clinical diagnosis: creating coherence among signs and symptoms

Medical EducationVolume 39 Issue 1 Page 107 - January 2005
Nicole N Woods, Lee R Brooks & Geoffrey R Norman

Conclusions Knowledge of basic science may have value in clinical diagnosis by helping students recall or reconstruct the relationships between features and diagnoses.

Reform of undergraduate medical teaching in the United Kingdom: a triumph of evangelism over common sense

BMJ 2004;329:92-94 (10 July), doi:10.1136/bmj.329.7457.92
Gareth Williams, Alice Lau

Summary points
1. Traditional medical training produces doctors with a sound knowledge base that allows them to practise across a broad spectrum of medicine
2. Reformers aim to cut the student's factual knowledge base, while replacing traditional teaching methods with student led and problem based approaches
3. There is no evidence that the "new" strategies will produce better doctors, and a risk that students with inadequate knowledge will become poor clinicians
4. A rigorous comparison of "traditional" versus "new" curriculums is urgently needed to determine the best strategy for training doctors

Comments
- Reform of undergraduate medical teaching in the United Kingdom: Evidence base for problem based learning is growing
Jill MorrisonBMJ 2004 329: 798-799. [Letter]
- Reform of undergraduate medical teaching in the United Kingdom: Unfunded reform always ends in reaction
Julian T HartBMJ 2004 329: 799. [Letter]
- Reform of undergraduate medical teaching in the United Kingdom: Students are too many to be assessed individually in general hospitals
Charles FoxBMJ 2004 329: 799. [Letter]
- Reform of undergraduate medical teaching in the United Kingdom: "Problem based learning" v "traditional" is a false debate
Joshua D R PayneBMJ 2004 329: 799. [Letter]
- Reform of undergraduate medical teaching in the United Kingdom: Evangelism triumphs over common sense for ophthalmology
Michael P ClarkeBMJ 2004 329: 799-800. [Letter]

Collection of useful papers up to 2004

Older J.
Anatomy: a must for teaching the next generation.Surgeon. 2004 Apr;2(2):79-90.

McLean M.
A comparison of students who chose a traditional or a problem-based learning curriculum after failing year 2 in the traditional curriculum: a unique case study at the Nelson R. Mandela School of Medicine.
CONCLUSIONS: C2001 students had clearly embraced PBL. They were now medical students, largely because of PBL activities underpinned by a sound educational philosophy. This unique case study has provided additional evidence that PBL students are generally more content with their studies than their conventional curriculum counterparts.Teach Learn Med. 2004 Summer;16(3):301-3.

Steinert Y.
Student perceptions of effective small group teaching.Med Educ. 2004 Mar;38(3):286-93.

Azer SA.
Becoming a student in PBL course: twelve tips for successful group discussion.Med Teach. 2004 Feb;26(1):12-5.

Hendry GD, Ryan G, Harris J.
Group problems in problem-based learning.Med Teach. 2003 Nov;25(6):609-16.

Herzig S, Linke RM, Marxen B, Borner U, Antepohl W.
Long-term follow up of factual knowledge after a single, randomised problem-based learning course.
CONCLUSION: A small-scale exposure to PBL, applied under randomized conditions but in the context of a traditional curriculum, does not sizeably change long-term presence of factual knowledge within the same discipline.BMC Med Educ. 2003 Apr 02;3(1):3.

Roche WP 3rd, Scheetz AP, Dane FC, Parish DC, O'Shea JT.
Medical students' attitudes in a PBL curriculum: trust, altruism, and cynicism.Acad Med. 2003 Apr;78(4):398-402.

Prince KJ, van Mameren H, Hylkema N, Drukker J, Scherpbier AJ, van der Vleuten CP.
Does problem-based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy.Med Educ. 2003 Jan;37(1):15-21.

Gilkison A.
Techniques used by "expert" and "non-expert" tutors to facilitate problem-based learning tutorials in an undergraduate medical curriculum.Med Educ. 2003 Jan;37(1):6-14.

Willis SC, Jones A, Bundy C, Burdett K, Whitehouse CR, O'Neill PA.
Small-group work and assessment in a PBL curriculum: a qualitative and quantitative evaluation of student perceptions of the process of working in small groups and its assessment.Med Teach. 2002 Sep;24(5):495-501.

Khoo HE.
Implementation of problem-based learning in Asian medical schools and students' perceptions of their experience.Med Educ. 2003 May;37(5):401-9.

Khoo HE, Chhem RK, Gwee MC, Balasubramaniam P.
Introduction of problem-based learning in a traditional medical curriculum in Singapore--students' and tutors' perspectives.Ann Acad Med Singapore. 2001 Jul;30(4):371-4.

Hay PJ, Katsikitis M.
The 'expert' in problem-based and case-based learning: necessary or not?
Clinical Trial
Randomized Controlled Trial
Med Educ. 2001 Jan;35(1):22-6.

Houlden RL, Collier CP, Frid PJ, John SL, Pross H.
Problems identified by tutors in a hybrid problem-based learning curriculum.Acad Med. 2001 Jan;76(1):81.

O'Neill PA.
The role of basic sciences in a problem-based learning clinical curriculum.Med Educ. 2000 Aug;34(8):608-13.

Yu HY, Wu ZA, Su MS, Yen DJ, Luk HR, Chao YC, Liao KK, Lin KP, Yu SM, Liu HC.
Problem-based, small-group tutorial learning in clinical neurology for second-year medical students.Zhonghua Yi Xue Za Zhi (Taipei). 2000 Aug;63(8):598-604.

Antepohl W, Herzig S.
Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study.
CONCLUSIONS: Students considered PBL to be an effective learning method and favoured it over the lecture format. Furthermore, students reported positive effects of PBL in terms of use of additional learning resources, interdisciplinarity, team work and learning fun.Med Educ. 1999 Feb;33(2):106-13.

Comments and Suggestions