Sunday 22 April 2012

The man in the iron knee



The photograph above was taken four years ago, on a trip with my son along the road on the South East side of Loch Ness. Note the bent right knee. This appears in many of the pictures taken at this time - in others I am sitting down, sometimes also with a grimace of pain. The cause of this distress was psoriatic arthritis, which affected my right knee and developed from an irritating pain to crippling agony over a period of two years. Standing with my leg straight became impossible. Walking became an ordeal. I changed in two years from a man who ran up stairs to one who took the lift whenever he could. Even the shortest journeys required careful planning and the use of a car whenever possible. Even so, a trip of a quarter of a mile would leave me in severe pain and sweating with exhaustion.

Pain also crippled the soul. I was less able than I had been to stand up to the usual bullies and egoists that are found in most organisations (and certainly in universities). My sense of personal effectiveness declined, and the avoidance of pain occupied an increasing part of my waking thoughts. Psychologically, I became a painful knee with a man attached.

My return to health required surgery, which replaced my right knee with one made from titanium. This only took place after the NHS tried and failed with the various non-surgical alternatives, from steroid injections to physiotherapy and orthotics. Eventually, my wife and children urged me to request a knee replacement. I went to my GP, and a referral to an orthopaedic surgeon followed almost immediately. The surgeon explained in great detail the operation, the risks involved, and the probable outcome. There was no waiting time for the operation in the local NHS unit, where I spent four nights in a private room with en-suite facilities. After discharge, I received aftercare from physiotherapists and various home adaptations from occupational therapists. None of this of course required any negotiation with an insurance company or personal payments for treatment.

I spent an elated three months living without knee pain, until the back pain began. It seems that adapting to prolonged pain when walking had twisted my back. This was followed by further physiotherapy advice and some adaptations at my workplace. But by then, I had become tired of the long journey to work and took early retirement. Now I have lost weight, walk good distances, and live without pain. I still have the yellow car though.

Monday 2 April 2012

How to teach skills

There is a crisis at the heart of British education - not university fees, academy schools, or the declining standards of A levels, but the inability of our education system to produce sufficient people with the right kinds of skills needed by employers. How could this happen after two decades in which there has been a massive increase in university admissions? The answer is that universities are good at teaching knowledge and the skills needed to generate and analyse knowledge, but not very good at teaching the skills needed in other workplaces. Expanding the number of people who go to university therefore diminishes the proportion of new entrants to the labour force who have appropriate skills when they begin work.

What is the best way to teach skills? There is a useful example from history. In the middle of the Battle of Britain in the summer of 1940, the RAF upgraded 1050 of its fighter aircraft by installing new constant-speed props. These added 7000 feet to each plane’s altitude and significantly reduced wear and tear on aircraft engines. The way this was done is a model for how to promote innovation and how to teach skills. The new props were developed by de Havilland, who formed a team of expert fitters to tour each airfield. Each squadron was told to select its best fitters, who were trained by the expert team. Training involved three stages: the expert team would first demonstrate one installation; then supervise the squadron’s fitters as they carried out another installation; and finally assess the squadron’s team when they carried out an installation without supervision. If all went well, the expert team would move to the next squadron.

This three stage model of demonstrate-supervise-assess is the basis for all successful programmes for teaching skills. Of course, the de Havilland team was teaching one skill to people who already had many skills in this field. Most occupations require hundreds, if not thousands, of individual skills, and this means that training people to become skilled doctors, plumbers, or lawyers takes years rather than days. Most skills training also involves starting with newcomers who, unlike the fitters in RAF squadrons, initially lack relevant background skills. Some skills can be assessed quickly, but others (particularly those involving an ability to respond to emergencies or to deal with difficult or distressed people) require observation over a long period of time.

The example from the Battle of Britain also shows another essential feature of skills training: it should be done by the most skilled practitioners. These are the best people to judge what counts as skilled practice, and therefore also the best people to supervise trainees and assess whether they are sufficiently skilled to be counted as a competent practitioner.  This model of training, supervision and assessment by the most skilled practitioners has been a key principle in all trades and professions since they existed. Of course, skilled practitioners also need to be knowledgeable practitioners, and so training in professions and trades has traditionally involved more formal classroom teaching, often on a day-release basis.

And that was how almost all professions and trades were trained until recently. Most lawyers, nurses, professions allied to medicine, and librarians did not go to university, but gained their professional qualifications while working in a junior capacity in their chosen occupation. Most craftsmen became apprentices, and attended colleges of further education on day-release. The exceptions to this model, in Britain at least, were divinity and medicine. These were taught at university, although a university degree was not a pre-requisite for a medical career until well into the 19th Century. Teaching medicine at university had the advantage of making it easier to standardise the curriculum and the way it was taught. There remained an emphasis on acquiring skills because students spent much of their time in practice settings under the supervision of medical professors, who were chosen as being the most eminent practitioners in their specialty.

All this changed during the last 30 or so years. Virtually all professions are now taught either as a university degree or following a university degree. This has enhanced the status of these professions, but it has come at a cost. Universities have become vast institutions competing for funds from the state and research funding bodies. Competition for funds has meant a greater emphasis by the universities on their research output, often at the expense of the quality of teaching. This affects the recruitment of senior academic staff, including those who are responsible for teaching skills. As an example, medical professors are now appointed not primarily for their skills as practitioners, but for their research record, even where this exclusively involves experiments with mice and rats in laboratories.

As universities have sucked up educational funds and ever more students, the teaching of skills for the rest of the population has been allowed to atrophy. In Germany, over half of all young people complete an apprenticeship, taught in companies and vocational colleges. Indeed, as many as 40% of all employees in Germany have completed an apprenticeship. The proportion is similar in Australia. In England, it is 11%. Apprenticeships in most countries take three or more years to complete. In England, the equivalent figure is between one and two years.

It is hardly surprising, therefore, that Britain has needed to import trained people from the rest of the EU at the same time that it has record numbers of young people out of work. The failure to train all our young people in vocational skills not only harms the British economy, it also demonstrates a cruel neglect of the young people themselves.