Summary: In his latest blog Professor Harden discusses wellness education, the challenge of achieving excellence in medical education, the observable gulf between diversity and inclusion, and trends among Gen-Z students
Description: Wellness education
I participated in June in the IAMSE meeting in Las Vegas which had as its theme Integrating nutrition and wellness education in teaching the health sciences. Stuart Slavin, formerly associate dean for curriculum at St Louis University School of Medicine, highlighted the importance of the topic. More than one physician every day commits suicide in the USA equivalent to two classes of students in a year. He highlighted the high instance of anxiety and depression among medical students which gets worse as students go through the curriculum and demonstrated that steps can be taken to reverse the trend. Adi Haramati gave for me the outstanding presentation of the meeting. He talked about the need to foster wellbeing in the learning environment. He argued powerfully that the learning environment in the medical school contributes to the deterioration of mental health in medical students. In addressing issues of stress and wellbeing in students we need to focus not only on the individual student but on the student’s learning environment. If we are to tackle the problem of stress and wellbeing a fundamental change in the learning environment in schools is needed.

I became convinced about the importance of the learning environment when Jack Genn from Brisbane spent a sabbatical with me here in Dundee in the 1980s. This led to the publication of an AMEE Guide by him on the learning environment in 2001 which followed an earlier paper which I co-authored with him in Medical Teacher in 1986 (volume 8, 111-124). Later Sue Roff led the work on the development of the Dundee Ready Education Environment Measure, which is now widely used. Adi Haramati is organising a conference at Georgetown in October 2019 with a theme of Strategies to promote the wellbeing of health professionals in the learning environment. Hopefully this will address the importance of the learning environments and its relevance to all the stakeholders.

At the IAMSE conference we organised an ESME course with 27 participants. The energy and insights of the participants was impressive. The ESME Certificate is the first stage in the IAMSE Fellowship programme.

The conference venue was an interesting one with more than 1100 slot machines which one had to navigate to get to the restaurant. At the IAMSE silent auction I was able to purchase three antique books on surgery which we will present to the plenary speakers in the surgery track at AMEE 2018.

Genn, J.M. & Harden, R.M. 1986. What is medical education here really like? Suggestions for action research studies of climates of medical education environments. Med Teach. 8(2). 111-124.

Excellence in medical education
I went directly from the Las Vegas meeting via Phoenix to the AMFEM conference in Mazatl├ín, Mexico, where the theme was Excellence in medical education and the challenges in a complex era. One argument was that excellence is a destination and not everyone can get there. Striving for excellence may even be dangerous and cause serious stress and depression in students and it was suggested that not every student should strive for excellence as it is unlikely they will achieve it. I find this a depressing and negative thought. Every student and indeed every medical school can be excellent at something. The challenge is to identify and build on this. I remember one teacher who received poor ratings on her lectures and was sent on a course on lecturing which made little difference. The answer was not to look at her negative points but instead at what she was good at. Subsequently she took charge of the students’ self-learning area and proved an extremely effective and popular facilitator of the students’ learning, working in a one-to-one relationship with the students.

I remember having to interview a student who was consistently performing poorly and failing in his assessments. On the face of it a discussion about his problems was the agenda for the meeting. Progress was only made, however, when the interview took a new direction. Instead of looking at his weaknesses we looked at his potential strengths. I discovered he was an accomplished artist. With some guidance he worked as part of a student project on the development of a patient education leaflet about asthma which proved very effective and was taken up in practice. He went on to develop an interest and understanding of asthma and participated in a research topic on the subject which led to a publication. His overall performance also improved dramatically.

In a study which we published in the Lancet some students who used a self-learning interactive programme rather than attending lectures found for the first time they scored in the end-of-course examinations in the top half of the class. This encouraged them and gave them self-confidence and a new interest in their studies which carried over to a good performance in the later lecture-based topics.

Trudie Roberts gave an interesting and commanding presentation on failure and how we should respond. It has been suggested that failure is a theme for a future AMEE Conference.

Geoffrey Norman gave a provocative presentation with a fascinating series of studies he had undertaken over many years, comparing print, models and virtual reality in teaching and learning anatomy. What was interesting was that the studies built on each other and told a story over time. Bill McGaghie in Chicago has also demonstrated how research can be done over a period of time with one study leading to another. This is an aspect of research in medical education which is sadly neglected. Too often researchers complete a study and then move on to another area. My only concern with Geoff’s studies were that they were largely laboratory based and did not address students’ motivation. Although no difference in students’ performance may be found after using a high-fidelity as compared to a low-fidelity simulator, in practice students may not engage with a low-fidelity simulator while they may be more motivated to use a high-fidelity simulator.

The problem with diversity and inclusion
The problem with diversity and inclusion and equity was the theme of a piece by Geraldine Cochrane in the Scholarly Kitchen, 22nd June 2018. She argues that the three words diversity, inclusion and equity are often strung together so that some think that the words are synonymous. She adds that they do make an awful acronym, DIE. Diversity efforts are concerned with representation and who is included and she suggests should not be confused with creating an inclusive environment. Diversity focuses on recruitment methods and selection/admissions standards. They bring diverse individuals into the door but if the environment is not inclusive, she questions will these individuals stay?

Trends among Gen-Z students
In his Connected Principles blog (27th June 2018), William Parker highlights presentations at a recent conference he attended. Dr Tim Elmore, an author of 32 books, shared seven statements about today’s students based on his data on emerging generations:

  1. They do not need adults to find information
  2. They are connected but poorly manage relationships
  3. They have the same level of anxiety as psychiatric patients did in the 1950s
  4. They are over-exposed to information earlier than they are ready
  5. They are under-exposed to first-hand experience later than they’re ready
  6. They are cognitively advanced yet emotionally behind
  7. They are biologically advanced yet socially behind