Summary: Dr Neel Sharma Description: I write this having survived my first medical education conference… kind of! Professor Ronald Harden kindly gave me the opportunity to share my views on the OSCE as a trainee during the recent Ottawa conference in Perth. I remember initially agreeing to this with great enthusiasm. However when the day arrived and I was sitting on the main stage, with of course the pioneer of the OSCE and other global experts, I immediately thought to myself what had I signed up for. The main stage was a strange experience. Firstly I was blinded by the lights so could barely look up. Professor Harden introduced me and it was time to talk. I have delivered presentations before but for some reason this felt different. I was also acutely aware Professor Terence Stephenson, chair of the GMC, was in the audience and as I am currently on a sabbatical abroad I wanted to ensure there would be no license issues on my return following what I would say. I thought about joking about this but decided not to. I introduced myself with a dry form of sarcasm, as is my usual style, regarding my current no conflicts of interest but the potential for conflicts that may arise during the Q and A. Safe to say no one laughed. An academic conference seems rather cut and dry I was thinking. As I’m not prolific in the field I thought to give a short introduction of my experience at different institutions and how I am not an academic researcher in medical education but rather enjoy disseminating my views from the shop floor as someone on the receiving end of reform. Often educational interventions are a top down approach I find with little trainee influence. The crux of my talk centered on the value of the current OSCE in initial clinical years with a move towards more real life real time decision making OSCES in situ. We note evidence to suggest issues on the transition point of exiting students to actual working life and I therefore wanted to put forward an approach of greater assessment in the working environment looking at a holistic approach governed by feedback. I previously wrote about the need for real time feedback in a short editorial correspondence piece (http://journals.lww.com/academicmedicine/Fulltext/2013/11000/The_Importance_of_Real_Time_Feedback_in.5.aspx) During my talk I used videos to highlight that in real life often doctors make mistakes yet in an OSCE such similar errors would be frowned upon. The current form of WPBAs doesn’t help to capture real life working situations due to their fragmented nature, lack of educator engagement and retrospective approach. As I slowly got into the swing of my presentation I realized I shot over time and decided to skip to my closing slide. One audience member told me what I suggested was simply not feasible. I wasn’t sure how to answer to be honest… maybe because I realized I was a trainee in a room of senior educators. So I played neutral and said it was simply a suggestion and that the concept would involve learners being graded holistically and still objectively. Interestingly after my talk several conference attenders told me they agreed with what I had said and that I had successfully held educators’ feet to the fire. And that it was important to do so. The next day I was tasked with presenting my findings from a study on students’ perceptions of the UK's situational judgement test (SJT). The study had highlighted concerns from students regarding the test subjectivity and ranking difficulties, the over emphasis on SJT scores and the simple fact that how could it be possible to answer such situational aspects with minimal on the job working. Pilot data I had gathered from faculty also seemed to suggest concerns regarding subjectivity and no evidence for improvement in long term outcomes. It was a side room session yet I was much more apprehensive. Firstly I could see the audience this time and the room was filled by representatives of the Work Psychology Group behind the test. Definitely a frog in the throat moment. But I persevered. I raised questions about the fact that as a trainee I am still facing new situations and that this is normal working life as a doctor. And that if medical students are being tested surely senior doctors should be too. I even highlighted a question from the SJT AMEE guide saying how it is truly difficult to know how to rank such options when in reality one would do most things listed, bar option D (for those interested it is the q regarding Mrs Anderson who is asked to go home following being classified fit for discharge). Even though such a test didn’t exist when I left medical school in 2007 I truly feel sorry for students today and the pressures they face. It seems nothing is good enough. Interestingly the AMEE guide highlights in its closing paragraph the current lack of evidence linking SJT scores to performance as a foundation doctor and ISFP reports note concerns from students regarding fairness and relevance. After I concluded speaking there was an eerie silence followed by strong applause. I definitely felt outnumbered yet was told I was brave for being transparent and should not give up my cause in doing what I felt was right. The SJT won’t disappear for now I am guessing. It seems to have become an easy default to job allocation. It certainly shouldn’t be ranked the same as the educational performance measure in my view. And an objective interview process should be considered. I flew out the next day thinking whether to attend follow up conferences. One thing that struck me as concerning was the over dominance by educationalists and very little trainee input. Why are all the plenaries by seniors? Shouldn’t we consider an opening plenary by students highlighting their concerns and then asking educators for their responses? Most of the discussions centre on educators attempting to achieve consensus among themselves which seems to be overtly biased and possibly irrelevant. I also wrote previously about the need for patients to be involved in educational reform, another group lacking from conferences http://blogs.bmj.com/bmj/2015/05/22/neel-sharma-reforms-in-medical-education-are-we-missing-something/ The BBC’s Question Time programme allows the audience to first pose questions to panel members on typically UK based political issues. Maybe there is room for something similar in medical education.