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Ranking the league tables

University league tables are becoming something of an obsession. Their appeal is testament to the ‘at a glance’ approach used to convey a university’s standing, either nationally or internationally. League tables attract public attention and shape the behaviour of universities and policy makers. Their demand is a product of the increasing globalisation of higher education, tighter allocation of funding, and ultimately the recruitment of foreign students. Medical schools are not immune to this phenomenon, and are banished to a rung on a ladder year after year according to a formula that aggregates subjectively chosen indicators. While governments and other stakeholders are placing growing importance on the role of league tables, it is necessary to scrutinise the flaws in their methodology and reliability in measuring the quality of medical schools.

Academic league tables, the brainchild of Bob Morse, were developed for the US News and World Report 30 years ago. [1] They were pioneered to meet a perceived market need for more transparent, comparative data about educational institutions. [1-3] Despite being vilified by critics, several similar ranking systems emerged in other countries in response to the introduction of, or rise in, tertiary education tuition fees. [1-3] League tables have since garnered mass appeal and now feature as a staple component of the education media cycle. They often take on the form of ‘consumer guides’ produced by commercial publishing firms who seek a return for their product. [1]

Although in existence for less than a decade, the Times Higher Education (THE) World University Rankings, along with the Quacquarelli (QS) World University Rankings and Shanghai Jiao Tong University Academic Ranking of World Universities are considered the behemoths of international university rankings. They provide a snapshot of the top universities overall and by discipline. From 2004 to 2009 THE, a British publication, in association with QS, published the annual THE–QS World University Rankings, however, the two companies then parted ways due to differences over methodology. The following year, QS assumed sole publication of rankings produced with the original methodology, while THE developed a novel rankings approach in partnership with Thomson Reuters. Many countries also generate national rankings by pitting their universities against each other – Australia’s answer being the Good Universities Guide.

League tables employ various methodologies to rank universities. Most involve a three stage process: first, data is collected on indicators; second, the data for each indicator is scored; and third, the scores from each indicator are weighted and aggregated. [3] The THE rankings use thirteen performance indicators, grouped into five areas including teaching, research, citations, industry income and international outlook. [4] Teaching has a 30% weighting and constitutes a reputational survey (15%), PhD awards per academic (6%), undergraduates admitted per academic (4.5%), income per academic (2.25%) and PhD/Bachelor awards (2.25%). [4,5] QS also uses a similar construct to render their final rankings. In contrast, the Shanghai rankings are established solely on research credentials such as the number of Nobel- and Fields-winning alumni/faculty and highly cited researchers, and the number of non-review articles published in Nature and Science. [6]

The influence of ranking tables has grown to such an extent that various vested interests indulge in rankings for different reasons. [1-3,7-9] A 2006 international survey revealed that 63% of higher education leaders made strategic, organisational, managerial or academic decisions based on rankings. [7] This is not always for the benefit of students or staff, and sometimes simply reflects the desire of a senior team to appear to have had an easily-identifiable impact. It is claimed that rankings have also influenced national governments, particularly in the allocation of funding, quality assessment and efforts to create ‘world class’ universities. [8] Furthermore, there is limited evidence that employers use ranking lists as part of the selection of graduate recruits. [8]

Academic league tables are no strangers to criticism, reflecting methodological, pragmatic, moral and philosophical concerns. Critics argue that ranking lists have applied the metaphor of league tables from the world of sport; a simplistic and incapable tool for evaluating the complex systems of higher education. [3] Rankings are guided by ‘what sells in the market’ rather than the rigorous quality assurance practices of academic bodies.

The world’s main ranking systems bear little resemblance to each other, owing to the fact that they use different indicators and weightings to arrive at a measure of quality. [1-3,8,9,11] According to a study by Ioannidis et al., [10] the concordance between the 2006 rankings by Shanghai and the Times is modest at best, with only 133 universities holding positions in both of the top 200 lists. The publishers of these tables impose a specific definition of quality onto the institutions being ranked, by arbitrarily establishing a set of indicators and assigning each a weight with little theoretical basis. [1-3,8] Readers are left oblivious to the fact that many other legitimate indicators could have been adopted. To the reader, the author’s judgement is, in effect, final. Many academics are of the view that rankings do not take into account the important qualities of an educational institution that cannot be measured by weightings and numbers. [8]

Statistical discrepancies also compound the tenuous nature of league tables. Often institutions are ranked even when differences in the data are not statistically significant. [1-3,8] There have been many instances where data to be used in compiling ranking scores are missing or unavailable, especially in international comparisons. [1-3,8] Moreover, data availability is a source of bias, whereby publishers opt for convenient and readily-available date, at the expense of accuracy and relevancy. [1-3,8]

Another cause for concern is that rankings place a significant emphasis on research while minimising the role of education in universities. [5] Most educators would recognise that the indicators for quality teaching and learning are limited. [1-3,8] Various proxies for teaching ‘quality’ are used, including average student-staff ratios. [1-3,8,11] The lack of robust data relating to teaching quality is attributed to its difficult, expensive and time-consuming nature. [2] When considering that teaching quality is one of the key dimensions of medical education, its neglected importance severely compromises the meaning of any data produced by these tables.

The main mechanism for quality assurance and evaluation amongst medical schools at present is regular accreditation by national or regional accreditation bodies. [5] The Australian Medical Council (AMC) is responsible for setting out the principles and standards of Australian medical education, including assessment. The ‘one-size-fits-all’ approach of ranking tables is a futile means to effectively measure the quality of medical schools. Medical education is characterised by a range of unique indicators, for example, clinical teaching hours and global/rural health exposure. As a direct consequence of accreditation bodies, most medical schools deliver a consistent level of education and yield competent interns to practice in the Australian healthcare system. By contrast, league tables are over-simplified assessment tools for evaluating the quality of medical education, and even have the potential to harm the standards of education. [10]

Although league tables are not exalted and revered to the same degree as in the US or Europe, Australia is inadvertently heeding this imperious trend. League tables are nothing more than ‘popularity polls’, and should not become an instrument for measuring the quality of universities and medical education.

References

[1] Usher A, Savino M. A world of difference: a global survey of university league tables. Toronto (ON): Education Policy Institute; 2006 Jan. 63 p.

[2] Stella A, Woodhouse D. Ranking of higher education institutions. Melbourne: Australian Universities Quality Agency; 2006 Aug. 30 p.

[3] Marginson S. Global university rankings: where to from here. Asia Pacific Association for International Education. 2007 Mar 7-9; Singapore. Melbourne: Centre for the Study of Higher Education; 2007 Mar.

[4] Baty P. Rankings methodology. Times Higher Education; 2011 Oct 6. [updated 2012; cited 2012 Apr 7]. Available from: http://www.timeshighereducation.co.uk/world-university-rankings/2011-2012/analysis-rankings-methodology.html

[5] Harden RM, Wilkinson D. Excellence in teaching and learning in medical education. Med Teach. 2011;33:95-6.

[6] Liu NC, Cheng Y. The academic rankings of world universities. Higher Education in Europe. 2005 Jul;30(2);127-36.

[7] Hazelkorn E. Handle with care [Internet]. Time Higher Education; 2010 Jul 8. [updated 2010 Jul 8; cited 2012 Apr 7]. Available from: http://www.timeshighereducation.co.uk/story. asp?storycode=412342.

[8] Lee H. Rankings of higher education institutions: a critical review. Qual High Educ. 2008 Nov;14(3):187-207.

[9] Saisana M, D’Hombres B. Higher education rankings: robustness issues and critical assessment. Luxembourg: Office for Official Publications of the European Communities; 2008. 106 p.

[10] Ioannidis JPA, Patsopoulos NA, Kavvoura FK, Tatsioni A, Evangelou E, Kouri I, Contopoulos-Ioannidis DG, Liberopoulos G. International ranking systems for universities and institutions: a critical appraisal. BMC Med. 2007 Oct 25; 5(30).

[11] McGaphie WC, Thompson, JA. America’s best medical schools: a critique of the U.S. news and world report rankings. Acad Med. 2001 Oct; 76(10):985-92

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Articles Editorials

Humble beginnings to life changing discoveries

Welcome to Volume 3, Issue 1 of the Australian Medical Student Journal. As always, we hope this issue offers excellent food for thought for budding doctors and researchers.

From our deputy editor, Hasib Ahmadzai, comes an editorial reflecting on the role of medical students in medical discoveries in the past. It goes to show that when medical students get to work, it is amazing just what we can achieve!

Australian of the Year and plastic surgeon Prof Fiona Woods entertains us with stories of how her early experiences stretched her mind and informed her later discoveries. Our other guest author, Sir Gustav Nossal, uses his decades of research experience in immunology to provide an insightful discussion on the serious inequalities present in global health.

The award for best article for Volume 3, Issue 1 of the AMSJ goes to Matthew Bray and Daniel Keating for their original research on ‘Immunisation and informed decision making amongst Islamic primary school parents and staff’. Their research was considered by editorial staff to be robust in methods and offering a unique perspective on an issue that is not often considered by practitioners in Australia.

As a young journal, we host many changes each time we go through the publication process as we strive to continually innovate and bring readers the highest quality of student research publication.

The editorial department has undertaken many of these changes. One of our aims has been to make the AMSJ a truly Australia-wide medical journal. This issue is the first for which we have recruited editorial and production staff from almost every state. Our team has welcomed seven new editors and now represents ten different Australian universities. With both rural and urban students on board, we believe that the AMSJ is well equipped to encourage research across a wide range of medical practice settings.

This is also the first time that the publication process has primarily taken place through email and teleconference, rather than face-to-face meetings. We have particularly benefited through the adaptation of cloud technology. With this change, remote collaboration has been made easier and more efficient.

While we have engaged Australia on an organisational level, this issue sees further efforts to bring equal readership and access to the journal for all Australian students, regardless of location. This has culminated in distribution to not just every medical school in Australia, but also their 50 rural clinical schools and campuses.

Furthermore, the AMSJ website has seen many advances to keep pace with current technology, including a touch-friendly mobile website (which can be found on your smartphone at www.amsj.org).

Other upcoming events include the next round of recruitment for the AMSJ team in August this year. We would strongly encourage enthusiastic and dedicated medical students to apply for one of the many roles available. This is a unique opportunity to become part of a growing national organisation which encourages development of critical thinking, teamwork and research publication skills.

We would like to extend our thanks to all of the voluntary AMSJ staff and external peer reviewers for their invaluable efforts in the production of this issue. To our readers: thank you for your continued support and we hope you will share our passion for medical student research.

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Editorials

The great wall of medical school: A comparison of barrier examinations across Australian medical schools

Figure 1: Miller’s Pyramid of Clinical Competence with Associated Assessment Methods. Adapted from 2, with permission.
From the moment that a medical student receives their university offer until the moment they take the Hippocratic Oath in front of proud family and friends, they will tread a path only taken by a select number before them. However, with medical schools now in every state and territory of Australia, the journey will not be identical for all students. For some, this will be a marathon, with continuous assessment peppering the entire journey, while others will encounter multiple large hurdles, interspaced with periods of calm. Despite this very different experience of medical school, all will ultimately compete for an increasingly competitive pool of internship positions, which represent the key to unlocking their future medical careers…

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Book Reviews

A neuroanatomical comparison: Blumenfeld’s Neuroanatomy through Clinical Cases vs. Snell’s Clinical Neuroanatomy


Blumenfeld H. Neuroanatomy through Clinical Cases, Second Edition. Sunderland: Sinauer Associates; 2010.

RRP: AU$119.95

Snell, RS. Clinical Neuroanatomy, Seventh Edition. Baltimore: Lippincott Williams & Wilkins; 2009.

RRP: AU$107.80

As stated by Sparks and colleagues [1] in their comparison of Clinically Oriented Anatomy and Gray’s Anatomy for Students, studying anatomy can be a challenging endeavour. This is true even more so for the study of neuroanatomy, which many students find particularly overwhelming. In the neuroanatomy textbook arena stand two ‘gold standard’ textbooks: Neuroanatomy through Clinical Cases, by Hal Blumenfeld, and Clinical Neuroanatomy, by Richard Snell. Inspired by the aforementioned comparative anatomy textbook review in the previous issue of the journal, I ponder the question: Which neuroanatomy textbook is superior, the more established Snell or the newer Blumenfeld?

I begin my comparison with a consideration of their similarities…

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Feature Articles

Reflections on an elective in Kenya

In Africa, you do not view death from the auditorium of life, as a spectator, but from the edge of the stage, waiting only for your cue. You feel perishable, temporary, transient. You feel mortal. Maybe that is why you seem to live more vividly in Africa. The drama of life there is amplified by its constant proximity to death.” – Peter Godwin. [1]

Figure 1. Baby hospitalised for suspected bacterial pneumonia.

Squeezing into our rusty mutatu (bus), we handed over the fare to the conductor, who returned to us less than expected change. In response to our indignant questioning, he defiantly stated, “You are mzungu (white person) and mzungu is money.” This was lesson one in a crash course we had inadvertently stumbled into: “Life in Kenya for the naïve tourist.” More unsettling than being scammed in day to day life, however, was the rampant corruption in the hospital and university setting.

We completed our placement at Kenyatta National Hospital, the largest referral centre in Kenya, with 1,800 beds, 50 wards and 24 operating theatres. I was based within the paediatric ward and paediatric emergency department…

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Feature Articles

A week in the Intensive Care Unit: A life lesson in empathy

Empathy and the medical student – Practice makes perfect?

The observation of another person in a particular emotional state has been shown to activate a similar autonomic and somatic response in the observer without the activation of the entire pain matrix, not requiring conscious processing, but able to be controlled or inhibited nonetheless. [2] This effectively means that when we see someone in physical or emotional distress, we too experience at least some aspect of that suffering without it even needing to be in the forefront of our consciousness. As medical students we are constantly told to “practice” being empathetic to patients and family members. What we are really practicing is consciously processing this suffering we unknowingly share with these people in order to develop rapport with them (if not just to impress medical school examiners).

We are taught an almost automated response to this distress, including a myriad of body language and particular phrases, such as “I imagine this must be very difficult for you,” to indicate to a patient that we are aware of the pain they are in. Surveys amongst critical care nurses have shown that gender, position, level of education and years of nursing experience have no significant relationship with the ability of a person to show empathy. [1] Thus it could be said that empathy is less of a skill which can be practiced until perfect, and more of a mindset that makes us as human as the people we treat…

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Feature Articles

Self-taught surgery using simulation technology

During my elective term in early 2010 at the Royal Free Hospital, London, I was presented with a fantastic opportunity: to learn how to perform a laparoscopic gastric bypass procedure. The challenge was for myself, a medical student and complete novice in laparoscopic surgery, to use the hospital’s state-of-the-art screen-based simulation technology to become proficient in a specific operation within six weeks in this rapidly advancing area of surgery.

My training was to be undertaken using the Simbionix LAP Mentor (Simbionix, Cleveland, Ohio, USA): an advanced piece of technology made up of a computer with simulation software and accompanying hardware, consisting of ports and instruments. The difference between this and a video game is the presence of haptic feedback; when you hit something or pull it, you feel the corresponding tension, making it a highly realistic representation of surgery…

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Guest Articles

How fortunate we are – Alden Harken

Prof. Alden H. Harken

As students of medicine, you will soon be educationally unique – with a body of knowledge that no one can ever take away from you.

When you receive your MBBS, the society and community in which you live is making a statement of trust in your abilities. With that trust you will be afforded extraordinary privileges and esteem. However, with the esteem and privilege comes the heavy responsibility of your patients’ well-being. You are all remarkably capable – and, remarkably fortunate to be so capable…

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Guest Articles

‘We want you to be our mother’ – Fiona Stanley

Figure 1. Population pyramid demonstrating the relative youth of Australia’s Indigenous population, 2009.

Surely we don’t need any more research? Surely we know what to do to improve Aboriginal health? Surely we know the best environments for healthy child development? In this article I provide a rationale for Aboriginal child health research, give a history of my own personal journey in Aboriginal child health from the 1970s to 2011, give examples of our research and its application to improve outcomes and how we have provided the environment to build the careers of Aboriginal researchers; and finally, end with several recommendations.

The aims of the Telethon Institute for Child Health Research (TICHR) are fourfold:

  1. To conduct high quality research;
  2. To apply research findings (not only our own) to improve the health and well being of children, adolescents and families;
  3. To teach the next generation of health researchers; and
  4. To be an advocate for children, for research and for social justice.

We do all this by…

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Guest Articles

Medical research at the cutting edge – Alan Trounson

Prof. Alan Trouson

Introduction

I have had the experience of working in two major areas of human medicine that have been challenging and rewarding, and have provided some of the most heated debate on medical ethics and disturbance of established social mores. In many respects this made the developments even more difficult because they were frequently and avidly opposed by entrenched religious, political and gender advocates. The medical developments have been extremely successful. In the first place, human in vitro fertilisation (IVF) whose genesis occurred in the 1970s and 1980s has resulted in more than five million births worldwide and can no longer be simply quantified. In some countries with liberal health support systems, more than 3% of all live births are by IVF. The second great quantum development resides in stem cell based therapies, whose influence will be even more pervasive and influential, and whose significance is only just being evaluated in preclinical and clinical trials. This work has evolved from discoveries in bone marrow transplantation in the 1980s and 1990s and embryonic stem cell discoveries between 1998 and 2000…