Summary: In his latest blog Professor Harden looks at developing wisdom in schools, the number of appointments in medical education, the increase in students publishing in Medical Teacher, Baumol's cost disease, and the Tyranny of Metrics Description: Wisdom
In the section on the teacher as an information provider in my new book with Pat Lilley, Eight Roles of the Medical Teacher, published by Elsevier in July, we describe the concept of the information pyramid. At the bottom of the pyramid is awareness of a topic and at the top is wisdom. George Couros has a useful blog on the theme of developing wisdom in children in schools ( He quotes from The Seven Decisions: Understanding the Keys to Personal Success by Andy Andrews, “Seeking wisdom is not the same as gaining knowledge: Knowledge is a precursor to wisdom. Wisdom includes an intuitive element, an insight gained from personal experience that serves us as we make choices in our lives. Seeking wisdom should be a continual process.” An example Couros gives is “knowledge is knowing a tomato is a fruit. Wisdom is not putting it in a fruit salad”. He asks in the blog whether in education sufficient attention is paid to the importance of “wisdom”. Wisdom, he argues, should be nurtured at all levels in education.

Appointments in medical education
It has been suggested that the number of appointments in medical education are under threat with current financial constraints. I was pleased to see advertised lecturer posts in medical education in Cardiff and Dundee. AMEE advertised and will shortly be appointing a member of staff with educational expertise to develop further the ESME courses and other AMEE educational initiatives.

Students and Medical Teacher
I have been impressed by the number of well written and thoughtful letters submitted by students to Medical Teacher in which they comment on papers published in the journal. The authors appear to come from four or five UK medical schools. I don’t know whether this constitutes part of their curriculum or they received particular training relating to critical reviewing and writing. Having a publication does count, however, when it comes to finding a postgraduate appointment

Baumol’s cost disease
I mentioned in my last blog Larry Cuban’s book on change in the classrooms in the USA from 1880 to 1990. In his recent blog [] of 12th August 2018 he described how introducing an innovation to increase efficiency can end up with more inefficiency. This paradox of efficiency is Baumol’s cost disease [] disease . An example is given of transportation: fuel efficient cars introduced to reduce gas emissions increase demand for such vehicles putting more cars on the road and increasing gas emissions, not decreasing. In universities computerisation of records and administration has been associated with an increase not a decrease in administrative staff. With regard to the introduction of new technologies it is suggested that technologically induced efficiency may lead to inefficiencies with student dropouts and frustrated teachers and students. It is argued that we have no valid way to make a cost efficiency argument for learning. The issue of cost in education, however, is attracting some attention. The extent to which Baumol’s cost disease is really relevant in medical education is a matter of speculation. Increasing class size need not necessarily lower the quality of the education experience and technology can be used to increase efficiency.

The Tyranny of Metrics
Reference was made to the book The Tyranny of Metrics by Jerry Muller at the 2nd Summit on Competence-Based Medical Education in Basel last month. The book highlights how teachers, doctors, researchers, and managers are driven to sacrifice the professional goals they value in order to improve their numbers. Metrics, it is argued, encourages a focus on a test or measurement and the test scores create perverse incentives for teachers, argues Muller. This is very true of national examinations in medical education.

The key components of metric fixation described by Muller are:

“The belief that it is possible and desirable to replace judgement, acquired by personal experience and talent, with numerical indicators of comparative performance based upon standardized data (metrics);

The belief that making such metrics public (transparent) assures that institutions are actually carrying out their purposes (accountability);

The belief that the best way to motivate people within these organizations is by attaching rewards and penalties to their measured performance, rewards that are either monetary (pay-for-performance) or reputational (rankings).”

Metric fixation, he argues, is the persistence of these beliefs despite their unintended negative consequences when they are put into practice.

Bill Burdick drew my attention to a video of a presentation Muller made which is well worth looking at

Muller, J. 2017. The Tyranny of Metrics. Princeton University Press, USA.