Summary: Evidence-based medicine’s six dangerous words and Season’s greetings from Professor Harden. Description: Scott Braithwaite from New York University School of Medicine writing in JAMA (2013, 310, 2149-2150), suggests that there are six dangerous words that in evidence-based medicine lead to false inferences for decision making – these are “there is no evidence to suggest.” He gives two examples: “There is no evidence to suggest that ambulances when compared to taxis to transport people with acute GI bleeds reduces pre-hospital deaths” and “There is no evidence to suggest that looking both ways before crossing a street compared to not looking both ways reduces pedestrian fatalities.” Both statements are clearly absurd as foundations for decision making, yet they are technically correct. He notes that absence of evidence is not evidence of absence. He recommends that we should abolish the phrase, “There is no evidence to suggest” from our writing and instead substitute one of the following four phrases:

1.    “Scientific evidence is inconclusive and we don’t know what is best;
2.    Scientific evidence is inconclusive, but my experience or other knowledge suggests ‘X’;
3.    This has been proven to have no benefit; or
4.    This is a close call with risks exceeding benefits for some patients, but not for others.”

If you didn’t join the MedEdWorld webinar by Jason Frank from the Royal College of Physicians and Surgeons of Canada on Step-by-Step Implementation of Competency-based Medical Education on Wednesday, December 11, 2013, you missed an interesting and helpful presentation on the subject. He looked at the different steps in implementing competency-based medical education. He included reference to entrustable professional activities (EPAs). A recording of the webinar will be available on the MedEdWorld website’s archives in January.

We receive letters which make the effort put into organising and facilitating the Essential Skills in Medical Education (ESME) Courses Online worthwhile. One such letter was from Samatha Dunnet, who is now in Chiang Mai, Thailand and is working on a one-year training course for medics working in the Burmese Jungle where she is using the principles covered in the ESME Course.

Reference was made to the OSCE in the WHO Report just published, Transforming and Scaling Up Health Professional Education and Training. Policy Brief on Regulation of Health Professions Education. “A circuit of OSCE (Objective Structured Clinical Assessment) stations mapped to essential competencies provided by international professional associations can provide an efficient, effective, and sustainable means of objectively measuring competency before registration and re-registration. The OSCE – which uses structured role plays, standardised patients, anatomic models, and validated checklists – has been widely promoted for formative and summative assessment of students in nursing, midwifery, and medicine, but has not been adopted by regulators.”

What’s in a name? is an editorial by Della Bradshaw in the December 2013 Bradshaw highlights a trend to move to snappy five-letter names for business schools. She suggests four easy rules for re-branding:

1.    If you already have a strong brand, build on it.
2.    Make sure the pronunciation is obvious in different countries.
3.    Give some idea of where the school is situated.
4.    If you go for a new brand, make sure it means something sensible.

I was interested particularly in her argument not to throw out an existing brand if it is a strong one. There have been discussions over the last few years whether the AMEE brand should be changed, given that AMEE is an international organisation with more than half of its members now outside Europe and more than 100 different countries participating it its annual meeting. Also the use of “medical” has attracted attention as AMEE caters for all health professions educators. In the same way, BEME (Best Evidence Medical Education) has been criticised as highlighting “medical” while it covers different healthcare professions.  We should probably, however, not lose these two important brands.

Jeff Cobb in a November blog highlighted five learning mega trends to be thankful for – one of these was technologies to support learning. He refers to Evernote, which he says has become indispensable to him for all forms of writing and information management. I was interested to see that in the list of Top 100 Tools for Learning in 2013, published by Jane Hart, Evernote has rapidly advanced up the list and is now in sixth, just behind Twitter, Google Drive/Docs, YouTube, Google Search, and PowerPoint.  I am going to explore its use further.

My 2013 Cura Personalis Award from Georgetown University in Washington, DC, USA, was featured in eContact, the University of Dundee eNewsletter. It appeared just above an item “Bra Collection Helps to Free the Girls”. Apparently hundreds of bras donated by students and staff and universities and colleges are helping tackle human trafficking and slavery in Africa. More than 750 bras were donated, equating to 54 kilos, which have been shipped to Mozambique, where they will be given to women who have been affected by human trafficking and slavery.

A resolution was passed at last year’s World Health Assembly whereby WHO was tasked with responsibility of developing a standard protocol and health workforce assessment tool. A technical working group has been set up and I was invited to join the first meeting of the group in Geneva last week. I was intrigued by the different ways the group members interpreted at our meeting in Geneva the concept of an assessment tool. My plan was to travel from Geneva to Copenhagen to participate in a related meeting with a group at the WHO European Headquarters who are also working in the area. Unfortunately, after waiting six hours at Geneva Airport on Thursday evening, the flight to Copenhagen was cancelled due to adverse weather conditions in Copenhagen. I had no alternative but to spend the night at the Geneva Airport and return direct to the UK on Friday morning.

Trevor Gibbs spent three days with us in Dundee last week working on BEME and other AMEE matters, including the ESME Course and the new AMEE ambassador initiative, which has as its aim having individuals support AMEE in different parts of the world. One of the first things we hope ambassadors will do is to contribute to MedEdWorld news from their region that might be of general interest to members.

The preliminary AMEE 2014 programme for Milan will be on the AMEE website and hard copies will be circulated to those on our mailing list. I think we have a very exciting programme with something to interest everyone. In response to my email inviting suggestions about new uses for space to encourage learning, Jonas Nordquist, who is leading the plenary session on the topic, has received more than 40 responses! Others are still welcome.

We have also been processing the second round of 2013 submissions for the ASPIRE to Excellence in Education Awards. These are now with the assessment panels. The closing date for the next round is March 30, 2014.

This will be the final blog for 2013. You may be interested to try a 2013 current events quiz produced by Survey Anyplace just for fun.  Season’s greetings and very best wishes for 2014 to all readers!