kristo’s blog

Which is more important...the Diploma or the Education?

Files Vanished, Young Chinese Lose the Future

I had wanted to comment on this article in the nytimes...but it must have struck a nerve out there, since they closed the comments...

Anyway, this article really struck a chord with me...

After handing in all of the necessary forms and documents to graduate from medical school, the university administration office lost my libretto...

This was in the 70's, in Italy...a country (and a time) famous for its inscrutably confucian, beautifully handwritten, baroque bureaucratic traditions...

But for all of its faults, it is a country that I dearly love...and not only for having generously and graciously given me my formal medical education and degree...

I don't know how things are today, but the libretto was a one of a kind document that had each of my exams written in it, along with the date of the exam, my grade, and most importantly...the professor's signature...

All of this information was also recorded on computer sheets and signed by the professor (after signing the more personal and dramatic libretto)...

but in those earliest days of personal computers, each of the day's exam sheets were apparently meant to be entered into some university computer database that (as far as we students knew) may or may not have ever existed...

The bottom line was that if I hadn't made photocopies of each of the pages of my libretto, I couldn't have graduated until each of those computer sheets were found...

and I was told that the process could take months...

I was also immensely fortunate to have taken the advice of friends to make those simple photocopies before handing in that amazingly precious document...   

Now as an educator, what I find so subversively and perversely important about this headline is the question of what is ultimately more important...? 

The education (i.e. the educated student)...or the diploma?

In a world where greater and greater numbers of people are being given (or rather going in to debt) buying expensive educations...the number of fraudulent pieces of paper out there must be rather large...

Either that, or we're all being duped into spending literally thousands of dollars having our educational credentials examined, verified, and re-certified every time we make a move....

And so I suppose that we must have both...

The papers (along with the necessarily expensive certified paper sniffers) as well as those graduates who can readily demonstrate their true education...

But producing a bona fide piece of paper is not the same thing as demonstrating an education...!

Or is it?

Of course not...!

But unfortunately, here is compelling evidence for the dominance of the damn piece of paper...bona fide or not...

what an awful shame!

...and yet there but for the grace...

a learning curve isn’t something easily bent...

This excellent nytimes article by Doctor Richard Friedman certainly speaks to the issue of difficulties associated with the practical / experiential education required for expertise (and with it...confidence).

Like any good / excellent teacher...he questions his own methods in terms of contributing to the problem...and continues to care about the reality of the situation and improving the outcome for his students and their patients.

I can offer a clinical observation of my own...which is that unfortunately, we learn the best and the most from our clinical mistakes.

It is not our successes that help us to grow in expertise as clinicians...in fact, they can often contribute to the blindness of ego.

But our clinical failures...and especially our (inevitable in training) brain-farts, general clinical naivete and ignorance...and the subsequent problematic (for our patients) results...are what make us grow...and benefit all subsequent patients.

There was a baseball player who spoke of the definition of game experience / seasoning expressing essentially the same idea...saying (in effect) that experience is what you wish had never happened...

Sad...I suppose....

Unfair for patients...possibly....

But a learning curve isn’t something easily bent to fit our convenience....

kristo    

a little St. Patty silliness from the website attic...and...a teacher’s tale...

attending a jesuit prep school in nyc meant having a holiday on march 17th every year....

but not my freshman year.... all of us in 1G fucked up miserably on our first huge latin midterm...and zane rodriguez, our exasperated latin teacher forced us to come to school on st. patty’s day for a make-up exam.

for some reason or other, not only was I determined to ace this make-up...but I actually did. and was the only guy (man oh man...gender segregation in high school is just not cool...) to do so...prompting praise from mr. r, and some degree of scorn from my cohort....

the point though, is that forever after (from high school, through undergraduate and med school) I looked for ways of studying class material so that I could learn and memorize it as well as I was able to for that first forced make-up...and almost always (i.e. nearly without exception) failed to do so....

yeah, there were a few successes here and there...but most material seemed to resist any and all of my efforts to gain some sort of mastery of / over it....

but it turns out that mastery of book material (which is essentially called theory) is a pretty relative sort of thing...and that just passing exams is pretty much of a dead end in itself.... something I think of as jumping through hoops.... and it’s really up to the teacher to make an exam some sort of relevant learning experience...and not just a delusional theoretic exercise...

of course I say delusional because for a medical student to imagine being able to actually help anyone based on theory alone seems to be a pretty common misconception...one that we’re all pretty much disabused of on the very first day of our internship.

(and just for the record...I eventually learned all of theory necessary to practice medicine, and jumped through every hoop known to man...or at least all medical students and board certified specialsts...)

anyway...as a teacher, I really bust my ass trying to make up relevant exams and lectures for my chinese medicine students.... but just as often feel that I’ve somehow come up short....

but book learning is really only half of the story...especially in medicine.... clinical experience is the other half...and teaching that is a completely different animal.... one that I’ve had plenty of experience with as well...from both sides of the fence...

in point of fact...experiential knowledge is called empiric. and an empiricist is one who knows things pretty much only by way of experience. and such a person, who is heavy on experience and light on theory is also known by a very quaint but useful term...

a quack....

of course that begs the question...what do you call his counterpart...i.e. the guy heavy on book learning and theory....

I suppose nerd would qualify... 

and now just recently I came across a most excellent word that fully explains the concept of properly integrating theory and praxis / experience...

it’s called expertise....

and there are no saints among that crowd.... but no sinners, either...

just real people...