Summary: In his latest blog, Professor Harden discusses preparing students for practice, how to make lectures interactive, authors and reviewers, declining single authorship, block teaching, and more Description: Preparing students for practice
Following participation in the ESME course in Singapore in January 2019 Dr Wilbert Ho established a new OSCE for final year medical students during their attachments as interns in general medicine. I was very interested to see how he analysed the OSCE and developed it in terms of an outcome-based approach, the SPICES model, and the FAIR principles. The aim was to help train students to display a spectrum of competencies expected of a competent house officer. He thought that the previous learning in the apprenticeship based educational environment was too opportunistic. The OSCE was developed to provide a platform for exposure of students to situations which were felt to be critical for house officers to manage.

How to make lectures interactive
Making lectures interactive and not just a passive transmission of information experience is on the agenda. The use of personal response systems is a useful solution. Many teachers, however, lack the necessary experience to make best use of the approach. A resource guide from the University of British Colombia provides helpful advice about the questions to be asked, how to incorporate the questions in a lecture, and how to deal with unexpected situations. Ten purposes are described for the questions.
  1. Quiz on the reading assigned in preparation for the class
  2. Test recall of lecture point
  3. Do a calculation or choose next step in a complex calculation
  4. Survey students to determine background or opinions
  5. Elicit/reveal pre-existing thinking
  6. Test conceptual understanding
  7. Apply ideas in new context/explore implications
  8. Predict results of lecture demo, experiment, or simulation, video, etc.
  9. Draw on knowledge from everyday life
  10. Relate different representations (graphical, mathematical...)
Authors and reviewers
We receive about 35 new manuscripts each week to consider for publication in Medical Teacher. We are dependent on reviewers for guiding us as to whether a manuscript should be published and if so what changes we would recommend to the authors. We do publish a list of reviewers in the journal each year and I know that reviewers use their experience as evidence of their scholarship in medical education. I am concerned, however, that we are not able to reward reviewers for the time they contributed. I was pleased, therefore, that Taylor and Francis have agreed that reviewers will be given free access to all 2000+ Taylor and Francis journals online for a month following the review. I have to confess that I am irritated when a potential reviewer indicates that he or she is too busy to undertake reviews while at the same time submitting articles for consideration for publication which they expect others to review. Should publication in the journal carry a commitment to reviewing another paper?

Single authorship is declining
Times Higher Education reviewed (4th July 2019) the position with single authorship of published articles. In 2001 in all disciplines single author publications made up 21% of articles indexed. By 2017 this had dropped to 10.8%. We have seen a similar change in Medical Teacher. In 2000 about 90% of papers published had authors from the same institutions and this had dropped to 46% in 2017. The number of authors of a paper from different countries had risen from 2% in 2000 to 30% in 2017. The number of single author papers in the Times Higher Education article varied in the different disciplines. In 2017, solo authors accounted for some 78% of publications in history compared with 28% in economics and 2.4% in organic chemistry. It was suggested that the decline in single authorship may have been impacted by a shift towards crediting authors who might not have been named on papers in the past. The move to multiple authorship from different institutions and different countries is evidence of increasing collaboration in medical education.

Block teaching
Block teaching, where students take a series of month-long courses with no other classes at the same time, was discussed in the Times Higher Education (13th June 2019). Apparently the results from Victoria University in Melbourne which switched to the Block system in 2017 show that overall student pass rates rose by 7.9% points to 84% between 2017 and 2018, with even greater gains from students from non-English speaking and low-income backgrounds. The success, it is suggested, reflects that the human brain does best concentrating on a single topic. Professor Helfland, a Colombia University astronomy professor, is quoted as saying “If one focuses on one thing at a time, it’s remarkable the depth you can get into in four weeks”. I am not sure if block teaching has been tried or considered in medical education. Perhaps integrated system-based teaching where a system such as the cardiovascular system is the focus for two months is analogous.
Basken, P. 2019. Scholars “ignore” data on better teaching practice. Times High Educ. 13 Jun, pp.19.

Medical education and Sherlock Holmes
I had not previously appreciated that the original inspiration for Sherlock Holmes was medicine. According to an Instagram forwarded to me by Lawrence Sherman, Sir Arthur Conan Doyle based his master of deduction on Dr Joseph Bell, a surgeon who taught at Edinburgh Medical School, and highlighted in his teaching a logical observation method and the importance of the small details when examining a patient.

A telepresence robot
I am very struck with the development of telepresence robots. The idea is that if a student, as a result of an illness or for some other legitimate reason is unable to attend the lecture a robot attends on their behalf. The robot is positioned in the classroom for the student and then the student uses a tablet to control at a distance the robot’s line of sight and display facial expressions on the robot’s face. The robot can listen and hear the instructor and other members of the audience and can ask and respond to questions. Although there were problems with internet connection the preliminary results look promising.
MacNeill, F. 2019. A technical perspective on a telepresence robot. University of Brighton. Accessed at: