Latest / Health Ethics Podcast / Academic Chutes and Ladders: Differential Attainment in Medical Education

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Academic Chutes and Ladders: Differential Attainment in Medical Education · Health Ethics Podcast

• 0:09
  Speaker 1: Welcome to Health Ethics, a series of conversations with leading
• 0:13
  Speaker 1: experts about ethical considerations associated with health and healthcare, both
• 0:17
  Speaker 1: locally and globally. I am Brian Pilkington, Professor of Bioethics
• 0:21
  Speaker 1: in the Department of Medical Sciences at the Hackensack Meridan
• 0:24
  Speaker 1: School of Medicine. This series, like its predecessor, which focused
• 0:29
  Speaker 1: on the COVID nineteen pandemic, relies on the idea that
• 0:32
  Speaker 1: challenging ethical issues are best addressed by folks from diverse
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  Speaker 1: backgrounds practically reasoning together, and complements the Health Ethics series
• 0:41
  Speaker 1: with its panel of leading experts from medicine, nursing, politics, economics,
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  Speaker 1: philosophy and the law. Thank you and enjoy the episode.
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  Speaker 2: In today's episode, I speak with Doctor Gabrielle Finn. Doctor
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  Speaker 2: Finn is Professor of Medical Education in the School of
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  Speaker 2: Medical Sciences and Associated Vice President for Teaching at the
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  Speaker 2: University of Manchester. She is also chair of the Association
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  Speaker 2: for the Study of Medical Education. Doctor Finn and I
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  Speaker 2: speak about health Ethics and difference and delve into her
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  Speaker 2: work on differential attainment and medical education.
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  Speaker 3: Welcome everyone to the Health Ethics podcast. It's my great
• 1:31
  Speaker 3: pleasure to be talking with Gabrielle Finn Gabs, thanks so
• 1:34
  Speaker 3: much for joining me today.
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  Speaker 4: Thanks for having me, Brian.
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  Speaker 3: So we're going to talk about differential attainment, which is
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  Speaker 3: something that's well known in many parts of the world,
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  Speaker 3: but not as well known in the US. Just different terminology.
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  Speaker 3: So for our US based audience, and we have folks
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  Speaker 3: who tune in from all over the world, But for
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  Speaker 3: the US folks, what is differential attainment?
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  Speaker 4: So when we were to differential attem we're usually talking
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  Speaker 4: about consistent gaps in academic achievement and progression between different
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  Speaker 4: student groups. When we consider it in the UK, we're
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  Speaker 4: most commonly talking about what we would say protected characteristics
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  Speaker 4: or ethnicity, disability, their socioeconomic background, or maybe students from
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  Speaker 4: a particular international group. It's often used interchangeably with awarding
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  Speaker 4: gaps because we typically look at a degree outcome as
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  Speaker 4: the measure, but not entirely. It's typically looking at the
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  Speaker 4: things that can't be explained by their academic performance or ability.
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  Speaker 3: There's work in different spaces around this, but you're really
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  Speaker 3: a leader in this space. And so and you guys
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  Speaker 3: have a big report that just came out, but before
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  Speaker 3: we get to the report. What brought you into this work?
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  Speaker 4: Right?
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  Speaker 3: You have a background in anatomy, what sort of got
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  Speaker 3: you into doing work in differential attainment.
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  Speaker 4: So one of my previous roles at the university was
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  Speaker 4: as the vice dean for a faculty of Biology, Medicine
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  Speaker 4: and Health. And we have to report to the Office
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  Speaker 4: for Students in the UK around how we are closing
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  Speaker 4: awarding gaps. So there's percentages of students, well the percentage
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  Speaker 4: point difference i should say, between students achieving those highest
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  Speaker 4: marks based on various characteristics. So are you know there's
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  Speaker 4: a difference in black students attaining higher degrees compared to
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  Speaker 4: white students. And I kept getting asked to close the gaps,
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  Speaker 4: but nobody could ever tell me where the gaps came from.
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  Speaker 4: And for me, I just kept coming to this point
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  Speaker 4: that you were witnessing these gaps getting bigger. They're appearing
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  Speaker 4: time and time again. We're seeing so many highly capable
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  Speaker 4: students who were not thriving. And it wasn't because of
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  Speaker 4: a lack of talent or drive, but it really to
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  Speaker 4: me it was as if the system wasn't built with
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  Speaker 4: them in mind. So we decided to take quite a
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  Speaker 4: research led approach to try and understand these gaps, but
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  Speaker 4: to make sure that that approach centered to student voice,
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  Speaker 4: that it wasn't just talking about students as data points
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  Speaker 4: and as deficits, but that it was really trying to
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  Speaker 4: understand them as individuals. And I think for me, it's
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  Speaker 4: a moral, professional, scholarly imperative to really try and better
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  Speaker 4: understand those barriers and to help to dismantle them.
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  Speaker 3: Really, so, before we get into sort of broad comments
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  Speaker 3: about the report, do you look at this research endeavor
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  Speaker 3: as a socio political endeavor, as a cultural endeavor? Is
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  Speaker 3: this really just medicine medical education specific? Sort of take
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  Speaker 3: a step back and help us situate differential attainment work,
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  Speaker 3: both the report and the work you do, but sort
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  Speaker 3: of more broadly.
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  Speaker 4: Yeah, I mean, differential attainment exists everywhere. It's omnipresent, it
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  Speaker 4: will happen. It's you know, we would say primary school,
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  Speaker 4: but you know, kindergarten right the way through high school
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  Speaker 4: and universities. Will be the same in workplaces. But it's
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  Speaker 4: something that I don't think people pay enough attention to.
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  Speaker 4: You asked about it, whether it's social or political or specific,
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  Speaker 4: I mean, it's both differential attement I think reflects broadly
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  Speaker 4: structural inequities, and that sort of permeate through education through society. Obviously,
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  Speaker 4: the stakes are typically a bit higher in higher education,
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  Speaker 4: and in medicine it's probably uniquely high. I think that's
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  Speaker 4: where in our systems we disadvantage certain students even more.
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  Speaker 4: We don't just fail them, but we limit the diversity,
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  Speaker 4: the effectiveness, the empathy, that representation perhaps of the future
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  Speaker 4: healthcare workforce. If we don't graduate students because of a
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  Speaker 4: particular protected characteristic, then what are we saying to patients
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  Speaker 4: and to future corehos that people look, think and sound
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  Speaker 4: like you don't belong in this space. I just think
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  Speaker 4: there's so much tacit messaging going on here. Yeah, you know,
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  Speaker 4: it's an endemic problem, but the implications I think in
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  Speaker 4: medical education or health professions education for me, are particularly acute.
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  Speaker 3: Not an uncommon argument, and I think a powerful one
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  Speaker 3: that acting in any sort of way which leads to
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  Speaker 3: the marginalization of a particular group, has those right to
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  Speaker 3: borrow your words, the tacit messaging that folks who are
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  Speaker 3: part of that group may not be as important. And
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  Speaker 3: that's so, But let's pull back in your line about
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  Speaker 3: moral imperative, So can you say a little bit more
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  Speaker 3: about why you find this work to be a moral imperative,
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  Speaker 3: why I find addressing differential attainment to be moral imperative,
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  Speaker 3: And then I want to jump back to the sort
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  Speaker 3: of prudential and practical stuff too, So just for you,
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  Speaker 3: why have you found this? Yeah?
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  Speaker 4: I mean, I don't know any educator who could sit
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  Speaker 4: back know that there are particular groups within their core
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  Speaker 4: hearts who are being actively discriminated against and disadvantaged by
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  Speaker 4: the education system, by society as a whole, and not
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  Speaker 4: try to act. I don't want to link it too
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  Speaker 4: much to the findings of the report, but what we
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  Speaker 4: have looked at is trying to understand the different context
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  Speaker 4: in which differential attainment exists. It isn't you would think,
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  Speaker 4: wouldn't you that if we're talking about progression and outcomes,
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  Speaker 4: that differential attement is an assessment problem. And the data
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  Speaker 4: that we have shows yes, there is an element of that.
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  Speaker 4: Assessments aren't inclusive. For example, there are issues with curriculum
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  Speaker 4: and not being representative, but actually a lot of it
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  Speaker 4: is caused by the daily battles at students space. It's
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  Speaker 4: about not having their basic hierarchy of needs met. Lots
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  Speaker 4: of students. I can't speak to the US context on this,
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  Speaker 4: but we have a lot of students in real poverty.
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  Speaker 4: We do all of these active schemes to bring in
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  Speaker 4: first generation students. We would use the term widening access
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  Speaker 4: students who've maybe are from disadvantage backgrounds, your parent has
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  Speaker 4: gone to university, there may be a caregiver. They can
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  Speaker 4: have lots of these widening participation flags. We work to
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  Speaker 4: bring them into the system, but then we don't do
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  Speaker 4: anything to support them and to make sure they thrive.
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  Speaker 4: And I just think addressing that is, you know, it's
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  Speaker 4: absolutely crucial we have. I think academia is having a
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  Speaker 4: moral panic around AI and academic integrity. I've had several
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  Speaker 4: conversations about that today with colleagues, but people don't seem
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  Speaker 4: to have that same level of panic about the inequities
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  Speaker 4: in the system, and that baffles me. Yes, very long
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  Speaker 4: winded answer, Sorry.
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  Speaker 3: No, no, No, that was really helpful because I think it
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  Speaker 3: it tied together the prudential and the practical reasons right
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  Speaker 3: sort of looking out the kind of workforce that communities
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  Speaker 3: want trained and order that you can get good care
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  Speaker 3: right for patients, and that's what you're looking for at
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  Speaker 3: the end of the day. But the moral imperative, I mean,
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  Speaker 3: if you bring someone into something and then you don't
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  Speaker 3: offer the necessary supports to do it well, I mean,
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  Speaker 3: it really puts folks in a bed, puts folks in
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  Speaker 3: a bad and it's a variety of those features. And
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  Speaker 3: I take the point. I mean, the power of artificial
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  Speaker 3: intelligence has sort of swept everyone, but there's I mean,
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  Speaker 3: there's there are other issues that are still ongoing, and
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  Speaker 3: there's a lot of issues with AI and medicine too. Actually,
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  Speaker 3: for folks who listen to the podcast, we had Kyle
• 10:01
  Speaker 3: Tafourion recently talking about climate change considerations, one of the
• 10:05
  Speaker 3: great vps at hackensach Ready in health in New Jersey,
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  Speaker 3: and so there's a lot with AI. But back to
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  Speaker 3: differential attainment and medical education. So some of the conversations
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  Speaker 3: around differential attainment around students who are you know, first
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  Speaker 3: generation medical students coming from marginalized backgrounds, coming with sort
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  Speaker 3: of different features when they come into medical education. Things
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  Speaker 3: have gotten a little bit trickier in the United States.
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  Speaker 3: And I know you're not in the US, so you know,
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  Speaker 3: do what you can with this, But you're a big deal.
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  Speaker 3: You're an international leader in health professions education, you lead
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  Speaker 3: as me, you have I think the pulse of the globe,
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  Speaker 3: at least a bit on medical education is what's going
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  Speaker 3: on in the US with sort of political leaders in
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  Speaker 3: the US asking institutions to not consider diversity, equity, inclusion,
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  Speaker 3: and sort of restricting how institutions of higher education operate
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  Speaker 3: relative to aims, which seems similar to the good work
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  Speaker 3: that you're doing and the work that comes out in
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  Speaker 3: this report. Is any of this influencing leaking in bouncing?
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  Speaker 3: I mean, do these topics pop up in the UK?
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  Speaker 3: Or is what's going on in the US not impinging
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  Speaker 3: upon or influencing your work in differential attainment?
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  Speaker 4: It is, and in many complex ways. There's been some
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  Speaker 4: really positive influence from the US in terms of work
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  Speaker 4: to decolonize curricular anti racism training and medical curricula in
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  Speaker 4: over recent years and events you know, like George Floyd
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  Speaker 4: and things have really had a positive influence I think
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  Speaker 4: in curricular spaces. But then it's a very tricky space
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  Speaker 4: to work in now, isn't it. With we would say EDI,
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  Speaker 4: but I think the US, I think these debates forced
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  Speaker 4: us to perhaps sharpen our language and to think more
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  Speaker 4: about the evidence based and to really articulate clearly why
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  Speaker 4: equity matters. You know, there are a lot of students
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  Speaker 4: who are seeing more doors close towards them, and I
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  Speaker 4: think we've got a responsibility to try and help them
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  Speaker 4: and to encourage their learning in as many different ways
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  Speaker 4: as we possibly can.
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  Speaker 3: I appreciate you mentioning George Floyd. The anniversary of George
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  Speaker 3: Floyd's death is five years ago, about a month ago,
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  Speaker 3: and we saw sort of similar responses in the US
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  Speaker 3: and medical education, partly due to the activism and needs
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  Speaker 3: of our students. So we had students who really pushed
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  Speaker 3: for at least in my small circles medical education to
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  Speaker 3: think about the racism in the US, structural issues and
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  Speaker 3: what's going on, and so we had a number of
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  Speaker 3: ethic sessions that we were able to build only because
• 12:58
  Speaker 3: of the student's response to what was going on in
• 13:00
  Speaker 3: the world. So yeah, I mean, these things are a
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  Speaker 3: mixed bag, but yeah, there's significant concern in the US,
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  Speaker 3: least in my small circles about features in this area
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  Speaker 3: in light of some changes of the highest levels of government.
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  Speaker 3: So we'll still in the US context, is there a
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  Speaker 3: case that ignoring differential attainment is simply bad medicine or
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  Speaker 3: bad education? I mean, you made the positive case strongly,
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  Speaker 3: and we should have a third person on here who
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  Speaker 3: sort of doesn't go in for differential attainment, so you
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  Speaker 3: can have the critical edge. But I see the moral
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  Speaker 3: imperative that you see. I see the practical benefits of it.
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  Speaker 3: Any Yeah, I mean, is it just folks who don't
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  Speaker 3: go in for it? Is this just bad medicine or
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  Speaker 3: bad education?
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  Speaker 4: We could be naive and kid ourselves that you know,
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  Speaker 4: higher education is a meritocracy, but it isn't an undoubtedly
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  Speaker 4: ignoring We can't ignore it. If we do, it perpetuates bias.
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  Speaker 4: I think it erods trust with us and our learners.
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  Speaker 4: It withsts their potential. It narrows the pipeline of diverse
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  Speaker 4: healthcare professionals, which would arguably weaken our capabilities and capacity
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  Speaker 4: to deliver that persons centered care that we purport as
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  Speaker 4: a discipline to care so much about, and rightly so.
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  Speaker 4: I think in education terms, it just starts our assessments.
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  Speaker 4: It undermines quality. I mean, for me, ignoring differential attainment
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  Speaker 4: is negligent. I feel really, really strongly about it because
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  Speaker 4: I was a naive going into the research that we've done,
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  Speaker 4: thinking that it would be an assessment issue, not that
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  Speaker 4: it would be an everything issue. If I can be
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  Speaker 4: indulgent and give you an example, I interviewed a black
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  Speaker 4: student at the University of Manchester and they were telling
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  Speaker 4: me that they had come into the university on the
• 15:00
  Speaker 4: metro and being racially profiled in terms of you know,
• 15:05
  Speaker 4: ticket checking. They noticed none of their white peers were
• 15:09
  Speaker 4: questioned about their ticket validity. They got to the university
• 15:13
  Speaker 4: early that morning because we were offering free haircuts on campus,
• 15:18
  Speaker 4: but nobody could cut afro hair. They then went to
• 15:21
  Speaker 4: try and buy hair oil at one of the shops.
• 15:23
  Speaker 4: We don't sell it. There's just shampoo for regular white hair.
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  Speaker 4: They then have to, you know, all of these sort
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  Speaker 4: of events, and then we expect them to turn up
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  Speaker 4: at the same lecture as every student and learn and
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  Speaker 4: perform in the same way when they're already dealing with
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  Speaker 4: so many different issues before they even make it onto campus.
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  Speaker 4: That's why it matters so much. We can't disaggregate the
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  Speaker 4: everyday lived experiences of our students. Everything that's happening at
• 15:53
  Speaker 4: home in society politically, and their university learning experience. We're
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  Speaker 4: not They're not learning in a vacuum diviid of any context.
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  Speaker 4: They're learning in a real world situation where every decision
• 16:07
  Speaker 4: we as an institution, every decision the government, international government's
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  Speaker 4: makes impacts upon their learning on a daily basis so
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  Speaker 4: important that we have to think about this holistically a.
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  Speaker 3: Great set of points and an illustrative case. And so
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  Speaker 3: for I mean, big deal people like you and medical education,
• 16:23
  Speaker 3: we're thinking about this and it's it's important work. My
• 16:27
  Speaker 3: background's in philosophy, so I like pouring over, you know,
• 16:30
  Speaker 3: details and papers. But even I know that if I
• 16:33
  Speaker 3: give a lecture, all the students don't hear the lecture
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  Speaker 3: in the same way, even if they're all there for
• 16:37
  Speaker 3: the same words, right, And so when we think about
• 16:40
  Speaker 3: the varying contexts one students show, I mean, and this
• 16:43
  Speaker 3: seems unto naive generally, but it baffles me at some
• 16:48
  Speaker 3: points when folks push back on this sort of sociological
• 16:50
  Speaker 3: consideration and say, well, oh, it was in the lecture.
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  Speaker 3: I get that it was in the lecture, and you said,
• 16:55
  Speaker 3: you know, Professor X said it in the way that
• 16:57
  Speaker 3: Professor X thought was easily under standable and accurate. But
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  Speaker 3: I mean, I notice differences if a lecture happens before
• 17:05
  Speaker 3: or whatever. We do all interactive sessions, all right, So
• 17:08
  Speaker 3: if my l is if it's before lunch or after lunch,
• 17:12
  Speaker 3: if it's a Monday, after the end an exam on
• 17:15
  Speaker 3: a Friday, and so for folks to recognize those features
• 17:19
  Speaker 3: as changing the context in which learners understand things or
• 17:22
  Speaker 3: how they might and not to recognize this as yeah,
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  Speaker 3: baffles me.
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  Speaker 2: But is it?
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  Speaker 3: So I want to get into the report a little bit,
• 17:29
  Speaker 3: is it? Uh? So I want to talk about the
• 17:31
  Speaker 3: report a little bit, and so the name of the
• 17:34
  Speaker 3: report and we will link to this uh for everyone
• 17:37
  Speaker 3: who's listening to the podcast. It's a good read and
• 17:40
  Speaker 3: it's illustrated. So well. I mean, I was very very
• 17:44
  Speaker 3: happy when I saw that, Gavin, You're you're always sort
• 17:46
  Speaker 3: of on the uh, on the cutting edge of this,
• 17:49
  Speaker 3: but that hollywoods uh was illustrated. So that's excellent. So
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  Speaker 3: you're the lead author on this report, the Game of
• 17:55
  Speaker 3: Academic Privilege Exploring Differential Attainment at the University of Manchu.
• 18:00
  Speaker 3: So and the loaded Dice with the snakes and the
• 18:04
  Speaker 3: shoots the ladders. I mean that just I think frames
• 18:07
  Speaker 3: the report. Well, but what would you say, And again,
• 18:11
  Speaker 3: folks may read this, they may read the short summary,
• 18:13
  Speaker 3: they may read the whole thing, but what are a
• 18:15
  Speaker 3: handful of sort of the key takeaways from this report.
• 18:19
  Speaker 4: Well, you've mentioned the illustrations, and I think perhaps that's
• 18:22
  Speaker 4: a good place to start. So we did title the
• 18:26
  Speaker 4: report the Game of academic Privilege because we've used with
• 18:29
  Speaker 4: my friend Holly, who's a clinician and a fantastic illustrator,
• 18:34
  Speaker 4: drawn a metaphor for the findings of this report, which
• 18:38
  Speaker 4: was around that a game of academic privilege, that snakes
• 18:41
  Speaker 4: and ladders where some students got are presented with so
• 18:46
  Speaker 4: many snakes, whether that's you know, they're protected characteristics, income,
• 18:53
  Speaker 4: racism in the system, whatever it might be, whereas others
• 18:56
  Speaker 4: have all the ladders up. You know, their their cisgender,
• 18:59
  Speaker 4: there from a background where lots of you know, their
• 19:02
  Speaker 4: parents have been to university for example, and that you know,
• 19:05
  Speaker 4: we've got students who just no matter how hard they try,
• 19:08
  Speaker 4: they keep rolling these kind of loaded die. And I
• 19:11
  Speaker 4: think it just speaks to the whole you know, all
• 19:14
  Speaker 4: of the findings. Is the report really that differential attainment
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  Speaker 4: is caused by everything. One of the big take ons
• 19:22
  Speaker 4: for me was the impact of representation in curricula and assessment.
• 19:27
  Speaker 4: Should say as well that students are often presented with
• 19:33
  Speaker 4: a white, eurocentric viewpoint in their learning. I should say
• 19:37
  Speaker 4: that the report talks about students across the institutions, not
• 19:41
  Speaker 4: just medical students, but all of the points are relevant.
• 19:44
  Speaker 4: That they don't see themselves within the curricula. They don't
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  Speaker 4: see people I caught who look, think and sound like me.
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  Speaker 4: And to students, that means they're disengaged with material. It
• 19:54
  Speaker 4: means that they don't see themselves continuing on the pipeline
• 19:58
  Speaker 4: and in studying and kademia, in medicine, whatever that might
• 20:02
  Speaker 4: be for them. I used to teach anatomy, as you know,
• 20:06
  Speaker 4: and whenever we present images in anatomy, it is always
• 20:09
  Speaker 4: that archetypal representation of a white athletic male Tarso when
• 20:15
  Speaker 4: do we show a disabled body, when do we show
• 20:19
  Speaker 4: images on non white skin, we don't very rarely. I mean,
• 20:25
  Speaker 4: there are more efforts now, but if you look consistently
• 20:28
  Speaker 4: across students curricula, the amount of profiling that happens, or
• 20:33
  Speaker 4: the absence of different of representation is phenomenal and really
• 20:39
  Speaker 4: negatively impacts students. Vignettes in exam questions would be a
• 20:45
  Speaker 4: good example, where the heart attack case in medicine is
• 20:50
  Speaker 4: always in the UK an fifty something year old Asian shopkeeper.
• 20:57
  Speaker 4: The person who breaks their bonds and ends up in
• 20:59
  Speaker 4: orthopedics is always a black student who's been a black
• 21:02
  Speaker 4: teenager who's been up to no good. You know all
• 21:04
  Speaker 4: of that, and we don't think about how this impacts
• 21:07
  Speaker 4: our learners. So I think representation is significant, and there's
• 21:12
  Speaker 4: a lot about accessibility to curricula and inclusive assessment. I'd
• 21:17
  Speaker 4: like people to challenge people because often colleagues think that
• 21:22
  Speaker 4: inclusive assessment means less robust, it's not trustworthy, rather than
• 21:27
  Speaker 4: thinking about it through the lens of trying to support
• 21:30
  Speaker 4: learners to do their best. We talked earlier a little
• 21:32
  Speaker 4: bit about you know, the AI moral panic, and I
• 21:35
  Speaker 4: think that's having a really detrimental impact upon students. A
• 21:39
  Speaker 4: lot of the progress we made in the inclusive assessment
• 21:42
  Speaker 4: space I think is now going back over because people
• 21:46
  Speaker 4: are so worried about the trustworthiness and reliability of their
• 21:50
  Speaker 4: assessment that we're losing the progress we made in sort
• 21:55
  Speaker 4: of enabling students to perform to their best.
• 21:59
  Speaker 3: A ton of interesting to pick up on the vignettes,
• 22:02
  Speaker 3: and the representation point I think is a powerful one.
• 22:05
  Speaker 3: And I know a bit about this, thank so a
• 22:07
  Speaker 3: wonderful colleague at the Hackensack grinte In School of Medicine,
• 22:10
  Speaker 3: doctor Jennifer Zeth, who's doing a bunch of work on
• 22:13
  Speaker 3: skin images and sort of ensuring that the collection of
• 22:16
  Speaker 3: images is appropriately represented. But say a little bit more
• 22:22
  Speaker 3: about AI and how you think this affects assessment. And
• 22:27
  Speaker 3: I'm the ethics guy at my medical school. So I'm
• 22:30
  Speaker 3: the annoying professor who has forced other people to have
• 22:33
  Speaker 3: short answers on exams instead of the multiple choice questions
• 22:36
  Speaker 3: because I probably don't write a good multiple choice question.
• 22:39
  Speaker 3: But also I just can't. I don't know how to
• 22:41
  Speaker 3: assess whether a student really has engaged with the relevant
• 22:45
  Speaker 3: ethical considerations in a case by checking off C or
• 22:50
  Speaker 3: B or A and the paragraphs it's owner the students
• 22:53
  Speaker 3: have to write on my exams. But you learn so much,
• 22:55
  Speaker 3: And so that's sort of the very small little assessment
• 22:59
  Speaker 3: lens that I have my ethics world say more about
• 23:01
  Speaker 3: how AI is or responses to AI and considerations of
• 23:06
  Speaker 3: reliability might be running a foul of all of the
• 23:10
  Speaker 3: work that's been done in terms of holistic assessment.
• 23:13
  Speaker 4: Absolutely, so what I'm seeing so one of my roles
• 23:18
  Speaker 4: is such a leading the strategic side of assessment across
• 23:22
  Speaker 4: our institution, and what we're seeing is more and more
• 23:25
  Speaker 4: colleagues refusing to conduct assessments other than close book procted
• 23:32
  Speaker 4: and vigilated on campus assessment. People do not want to
• 23:35
  Speaker 4: risk that a student could use artificial intelligence in any way,
• 23:41
  Speaker 4: and so because of that moral panic, what's happening is
• 23:46
  Speaker 4: everyone's trying to get all our assessments back on campus.
• 23:49
  Speaker 4: We don't have the capacity for it. Physically, it cannot happen,
• 23:53
  Speaker 4: but we're losing all of the work that we've done
• 23:56
  Speaker 4: to really help students who may be nerod i've urgent,
• 24:00
  Speaker 4: who may have physical issues that they need additional support for.
• 24:05
  Speaker 4: We're not giving students the opportunity to demonstrate their learning
• 24:08
  Speaker 4: in different ways. You give the example about the MCQ
• 24:13
  Speaker 4: and that you know, what we're going to see is
• 24:15
  Speaker 4: more assessments of the law order cognitive recall rather than
• 24:20
  Speaker 4: enabling students to demonstrate those higher levels of learning because
• 24:24
  Speaker 4: all creativity is gone. I saw some really good examples
• 24:28
  Speaker 4: of assessment, and I just hope that we don't lose
• 24:31
  Speaker 4: that because of a fear of cheating. So people, you know,
• 24:34
  Speaker 4: instead of asking students to write an evolution essay, one
• 24:39
  Speaker 4: of my colleagues gets the students to go to the
• 24:41
  Speaker 4: museum in Manchester and pick two different species and film
• 24:45
  Speaker 4: a sort of a vlog as they walk around discussing
• 24:49
  Speaker 4: the various evolutionary characteristics of these animals and things. And
• 24:55
  Speaker 4: if we we're always fearful of students cheating, if that
• 24:58
  Speaker 4: leads every decision that we then the learning culture is
• 25:02
  Speaker 4: just going to be destroyed. I mean, you can't put
• 25:04
  Speaker 4: AI back in the box. Pendora's box is open, the
• 25:07
  Speaker 4: horse has bolted. We need but we do need to
• 25:10
  Speaker 4: put the learner at the center still, and I think
• 25:12
  Speaker 4: just try and encourage people to have open conversations with students.
• 25:16
  Speaker 4: Assume that they will use AI in any sort of
• 25:19
  Speaker 4: assessment that isn't on campus, but teach them how to
• 25:23
  Speaker 4: critique those resources. I'm sure I think the irony for
• 25:26
  Speaker 4: me is lots of the colleagues that you know, are
• 25:29
  Speaker 4: outraged by the use of it. I use it themselves.
• 25:32
  Speaker 4: They just don't want students to cheat opperceived to be.
• 25:34
  Speaker 4: But is it cheating if they use a tool? I
• 25:37
  Speaker 4: don't know. I mean, that's a whole podcast in itself,
• 25:40
  Speaker 4: isn't it. It's just trying to get people to not
• 25:43
  Speaker 4: lose all of the progress we've made in terms of
• 25:45
  Speaker 4: the ecommoda that we've put in place for students with
• 25:50
  Speaker 4: various issues, because that's you know, that progression to acknowledge
• 25:55
  Speaker 4: individual learning needs is something we should be proud of
• 25:58
  Speaker 4: and fight to keep in the sector.
• 26:00
  Speaker 3: I think, yeah, yeah, I mean that's the as out
• 26:03
  Speaker 3: of the box, and I mean it's such a powerful tool.
• 26:07
  Speaker 3: All I was gonna say physicians, but all sorts of
• 26:09
  Speaker 3: folks in the work that they do are going to
• 26:12
  Speaker 3: be using it now and through the future. So I
• 26:14
  Speaker 3: think your point about having this sort of ability to
• 26:16
  Speaker 3: interact with it critically, know what it can do, use
• 26:19
  Speaker 3: it well right, avoid the mistakes and all that sounds
• 26:22
  Speaker 3: like the right, the right kind of thing. And then
• 26:25
  Speaker 3: they're big, right philosophical questions about what are doctors and
• 26:30
  Speaker 3: nurses health professionals generally and just sort of folks in
• 26:33
  Speaker 3: all different kinds of professions. What do those professions look
• 26:36
  Speaker 3: like in ten, twenty, thirty, fifty years. I mean, do
• 26:39
  Speaker 3: we have physicians in one hundred years? Maybe these are
• 26:42
  Speaker 3: big and interesting questions. But to go back on the
• 26:46
  Speaker 3: kind of important holistic assessment, which I think, really I
• 26:49
  Speaker 3: think it captures better. And again this is my sort
• 26:52
  Speaker 3: of small corner of the world I think. And this
• 26:57
  Speaker 3: is not the most sophisticated or interesting thing. I mean,
• 26:59
  Speaker 3: students don't show up to ethically, or I guess they
• 27:01
  Speaker 3: do in the similar but you know, I'm not taking
• 27:03
  Speaker 3: in them to museums. But if you can write a paragraph,
• 27:06
  Speaker 3: I mean, they're always on exams. If students listening to
• 27:09
  Speaker 3: this will see if this causes trouble. But students to
• 27:11
  Speaker 3: answer answer the question without any of the relevant ethical principles.
• 27:16
  Speaker 3: But they did something new and it actually works for
• 27:18
  Speaker 3: the question. That's something you will never get in a
• 27:20
  Speaker 3: multiple choice assessment, but illustrates a kind of creative creativity
• 27:24
  Speaker 3: that answered the question. Well, So your points on on AI,
• 27:28
  Speaker 3: I think are well taken, and I don't I mean
• 27:31
  Speaker 3: to go back to the earlier point you made, which
• 27:33
  Speaker 3: I also thought was very powerful I mean educators want
• 27:35
  Speaker 3: to put students in the best situations to succeed. Right,
• 27:39
  Speaker 3: you show up to medicals to who you show up
• 27:41
  Speaker 3: to learn a health profession. You want folks to do well,
• 27:45
  Speaker 3: and so to ignore sort of these important findings on
• 27:48
  Speaker 3: differential attainment, to focus solely on someone not cheating on
• 27:52
  Speaker 3: an assessment, which may or may not yield the most
• 27:55
  Speaker 3: helpful I'm with you, we need a third person who
• 27:59
  Speaker 3: doesn't like any of this stuff to really get into
• 28:01
  Speaker 3: the nitty gritty. But let me get one or two
• 28:03
  Speaker 3: quick questions and I'll let you go one. Given your
• 28:07
  Speaker 3: long experience in medical education in different sorts of roles,
• 28:11
  Speaker 3: any advice for medical students health profession students generally who
• 28:17
  Speaker 3: are in training now, So if you can tell them
• 28:21
  Speaker 3: one thing as a seasoned educator, what would that be?
• 28:24
  Speaker 4: Know that the system's flawed but you're not. If you're
• 28:27
  Speaker 4: experiencing barriers, it's not about personal failure. It's you know, seek,
• 28:34
  Speaker 4: seek allies, seek supart, speak up, demand more. I think
• 28:40
  Speaker 4: we need to teach learners to take care of themselves.
• 28:43
  Speaker 3: Sounds exactly right, and you have the chops to back
• 28:45
  Speaker 3: it up, all right. The last question I'll get you
• 28:48
  Speaker 3: on this. For folks who enjoyed this conversation or interested
• 28:52
  Speaker 3: in learning more, they'll check out the report. We'll link
• 28:55
  Speaker 3: to it. What's the next big project for you, what's
• 28:59
  Speaker 3: the new book, what's the I mean, you always have
• 29:00
  Speaker 3: a million things going on. What's the next initiative on
• 29:04
  Speaker 3: the horizon that you're really excited about.
• 29:06
  Speaker 4: So we've taken the findings from this report and we're
• 29:09
  Speaker 4: now working on a project in the institution called Representation Matters.
• 29:14
  Speaker 4: So we're going to try and produce resources, toolkits, training
• 29:19
  Speaker 4: for colleagues to help them think about representation within their curricula,
• 29:24
  Speaker 4: within their assessment. And I'm not just talking about having
• 29:27
  Speaker 4: diversity in care studies. I think what I'm really talking
• 29:30
  Speaker 4: about is truly embedding student voice within their curricula. It's
• 29:35
  Speaker 4: about core creation. One of the things I am proud
• 29:38
  Speaker 4: of in the report is that we've used lots of
• 29:40
  Speaker 4: participant vice poetry, and students have recorded some of the
• 29:44
  Speaker 4: poems to really advocate for themselves and to demonstrate the
• 29:49
  Speaker 4: issues that they face. So we want to use creative
• 29:52
  Speaker 4: approaches such as the poetry and the illustrations as well
• 29:56
  Speaker 4: to really try and empower colleagues to do better.
• 30:00
  Speaker 3: Excellent, and we will keep an eye on all of
• 30:02
  Speaker 3: that work that's coming out. Thanks everyone for listening. I've
• 30:05
  Speaker 3: been speaking with Gabrielle Finn Gabs. I really appreciate the time.
• 30:09
  Speaker 4: Thank you, Thank you, Brian.
• 30:11
  Speaker 1: Series is a production of the Health Ethics Lab, and
• 30:14
  Speaker 1: I am grateful to colleagues in the Department of Medical Sciences,
• 30:17
  Speaker 1: the IHS Library, and the Hackensack Ready in the School
• 30:19
  Speaker 1: of Medicine for making this collaboration possible. To learn more
• 30:23
  Speaker 1: about our work or to engage with the series content,
• 30:26
  Speaker 1: reach out to me Brian Pilkington at Brian dot Pilkington
• 30:30
  Speaker 1: at hmh N dot org.