Professor Harden reflects on the recent ASME conference in Belfast, considering the presence of technology within the field and the depth of its involvement in medical education.
I attended the annual ASME meeting in Belfast last week. For me, the outstanding paper was the contribution by Tim Dornan, who is now working at Queen’s University Belfast. He argued that medical education is a complex activity. He used live piano performances to illustrate this using a musical metaphor. Medicine, like music, may be so inherently complex that it loses its essence if you attempt to simplify it. Complex systems, however, do have simplicity at their foundation. He argued that we inappropriately attempt to standardize what we do and that we should not stick to a strict conformity but should improvise in medical education as needed. Greater attention should be paid to work-based learning as it recognises the complexity of medicine. Tim had argued in a previous publication in the Journal of the Royal Society of Medicine the value of an apprenticeship model.
Cynthia Whitehead from Toronto reviewed 50 years of medical education based on an analysis of articles published over this time in Medical Education. As articles from Europe and North America dominate the journal it was not clear the extent to which developments in the west as reported in the journal had differed from what is happening elsewhere in the world. Her conclusions included that we should beware of excessive zeal with a more detached review of innovations and that we should beware the lure of technology with the danger of a field dominated by technology where education becomes eclipsed. An interesting issue arising from her review was whether journals do enough to promote a fundamental shift in medical education practices and whether they simply promote doing better what we are already doing. The same concern could be expressed about papers presented at medical education conferences where the emphasis is on evidence. With this in mind at AMEE 2016 in Barcelona we have introduced for the first time two sessions where participants have the opportunity to express their point of view about changes they would wish to see happen in medical education and at AMEE 2017 we will explore an alternative model for medical education.
I had looked forward to the session in Belfast on Future Directions in Medical Education and Training. I found this disappointing, however, as it mainly evaluated what we were doing at present with no clear visions presented as to the future. As Kevin Eva chairing the session quoted, however, “predicting the future is a fool’s task”. In his blog of July 8th, Stephen Downes highlights an article by Turchin in the Less-Wrong blog of July 3rd which presents in diagrammatic form 21 different future models highlighting the driving force of each and their advantages and disadvantages.
I was interested in two papers on OSCEs presented in one session at the meeting. In the discussions we were reminded of the value of the use of real patients in an OSCE. We were told that at Sheffield Medical School there is a bank of 150 real patients who are used in OSCEs.
In the final morning there were presentations by Richard Canter from Oxford on leadership education and an update on GMC priorities by Martin Hart from the GMC. Unfortunately there was no time available for questions following the presentations. This is a big mistake at conferences. I would have liked to have asked the first speaker whether the same arguments he applied to the doctor as leader would apply to the teacher as a leader. I would have found his response interesting as I am currently working with Pat Lilley on a new book on the roles of the teacher in the healthcare professions. I would have also wanted to push Martin Hart on the GMC’s proposals with regard to national licencing exams. The arguments he gave for this development seemed to me unconvincing. The implementation of a national exam appears to be contrary to all of the trends in assessment such as a programmatic approach and assessment for learning. A national exam also inhibits innovation in medical education and it can be costly to administer. The National Board of Medical Examiners in the USA, for example, employs 500 staff. There was no mention as to where the additional resources to mount a national examination in the UK at the required level will be found. Many may favour the approach but, conferences should serve as a forum for discussion of the arguments for and against.
Richard Canter asked the participants not to tweet during the first part of his presentation, when he recounted a personal experience as a student. I was interested to see that tweeting at conferences was the subject of an article in the BMJ on July 2nd. Arguments for banning tweeting at conference presentations include protecting intellectual property and the danger of hyping or misrepresenting results presented. It was suggested rather than ban tweeting, conference organisers should do more to ensure people know whether contributors consent.
We had an AMEE stand in the exhibition area and made a number of new contacts as well as meeting up again with AMEE members. It was an opportunity to explain about AMEE’s new exciting initiative with MedEdPublish, with its post publication review approach.