Summary: For Professor Harden’s 100th blog, he reflects on how medical education has evolved during his blogging time and what lies ahead for AMEE as well as medical education. Description: I was surprised to find this was my 100th Blog with my first blog written almost four years ago. Medical education has continued to evolve over this period.  Outcome and competency-based education is now the norm with more recently added the concept of Entrustable Professional Activities (EPAs).  While some schools have discontinued problem-based learning, other schools, as can be seen in the PBL listserv ([email protected]) continue to be active in the area.  Case-based learning and clinical presentation models (what I have described as task-based learning in the AMEE Guide on the subject) have attracted increasing attention.  In some situations lectures have been replaced by team-based learning and the flipped classroom.  Longitudinal clinical clerkships have justifiably attracted more attention.  In assessment we see a paradox where there has been a move to more programmatic assessment across the curriculum, as described by Cees van der Vleuten, while at the same time there have been arguments for introducing in the UK a national exam at the end of training.  The fact that in the UK medical students are assessed by their medical school rather than through national licensing examination, using a GMC approved appraisal, has allowed schools to develop and experiment with new ideas and maintain a school philosophy as noted by Peters and Livia (Medical Education, 2006, 40, 1020-1026).  There will be further discussion about the merits of a national exam at the Ottawa 2016 Conference in Perth.  

Areas where I would like to have seen more progress include curriculum mapping, adaptive learning and the continuum of education across undergraduate, postgraduate and continuing medical education.  Significant progress has been made, however, with regard to recognising the importance of teaching alongside research as the aim of a university.  The ASPIRE initiative has demonstrated that excellence in a medical school can be recognised in the three areas currently assessed – Assessment of Students, Student Engagement in the School and the Curriculum, and Social Accountability of the Medical School.  A fourth area has been added, Faculty Development, with the panel chaired by David Irby.  Schools to be recognised in 2015 for their excellence in medical education will be presented with their awards at AMEE 2015 in Glasgow.  In the UK, the new Minister for Universities and Science, Jo Johnson, has pledged to bring in a teaching excellence framework that creates incentives for universities to raise the quality of teaching.  “There must be recognition of excellent teaching – and clear incentives to make ‘good’ teaching even better,” he said, conceding that “some rebalancing of the pull between teaching and research is undoubtedly required”.  Queen Mary University of London, I was interested to see, have recently advertised for staff to be appointed to support quality teaching in the university.  QMUL has as a major initiative to work towards a target of 100% of staff who teach having or working towards a teaching qualification by 2018/2019.

In thinking about changes in medical education, Steve Hargadon in his July 6th blog, The Learning Revolution has Begun, puts forward the challenging idea that ideas “spread because they are good at spreading not because they are inherently valuable”.  He suggests that deep and thoughtful ideas take more time and effort to understand and communicate thereby limiting their spreadability.  In my new book with Pat Lilley and Madalena Patricio, ‘The Definitive Guide to the OSCE’, to be launched at AMEE 2015 in Glasgow, we examine the reasons behind the spread of the OSCE as an approach to assessment.

Some time ago, I advocated in an article with Neil Stamper the concept of a spiral curriculum.  Over the years this has attracted a lot of attention.  I leave for a meeting of the Japan Society for Medical Education this coming week.  In my plenary talk on the OSCE and Outcome Based Education I have been asked to address the concept of the spiral curriculum.  This week I had an interesting visit from Ian Scott who has had a major role to play in the development of a new medical curriculum at the University of British Columbia.  He tells me a major feature is the concept of a spiral curriculum.  I was particularly interested in the attention being paid in the new UBC curriculum to how the students’ identity as a doctor develops over the curriculum.

We have had excellent feedback from our recent ESME Online Course with a number of enquiries for our next course scheduled for September.  This may include a group of teachers from Cambodia and another group from Saudi Arabia.  The diversity of course participants from around the world is one of the strengths of the programme with the different approaches described challenging participants to think about education in their own context.

We are now in the final stage of preparation for the AMEE 2015 Conference in Glasgow.  The pre-conference workshops and the conference sessions address many of the current problems and exciting developments in medical education today.  More than 3000 individuals with an interest in education in the healthcare professions from around the world will participate in the conference.  For those not able to be with us in Glasgow we have significantly enhanced what we are offering through AMEE Live Online.  Those enrolled (Register for AMEE Live Online at - will be able to join not only the plenary and symposia sessions, comment and ask questions of the speakers but also have access to the ePosters and the full conference programme including abstracts for the short communication and poster sessions.  They will also be able to hear during the conference breaks interviews with conference participants.  A new feature of the meeting this year will be a Writer-in-Residence.  Hedy Wald will capture gems and reflections emerging from the programme and conversations during the meeting.  Another innovation will be a Hackathon which claims to be the best ever Hackathon in medical education bringing together those who have problems but no technology solutions with those who have solutions but no problems.

I leave for Japan next week and will report on the meeting in my next blog.