Summary: In his latest blog Professor Harden provides us with news from Roanoke and addresses the death of MCQs, the scholarship of teaching, learning analytics and ethics, and more Description: News from Roanoke
In June I participated in the International Association for Medical Science Educators (IAMSE) Conference in Roanoke, Virginia, USA. Richard Vari, President of IAMSE, was an excellent host for the meeting and made everyone feel welcome. I was very impressed with the presentation about the Virginia Tech Carillion School of Medicine. This is a relatively new school and has a forward-looking and imaginative curriculum with a major emphasis on research. Students are introduced to clinical medicine from the beginning of their education, and interprofessionalism is a feature of the curriculum, with students taking classes with other health profession students. Every student  is required to complete a research project of publishable quality and students choose topics and mentors in their area of interest. The curriculum includes 1200 hours of research time.

Jeffrey Talman, Associate Dean for medical education at the University of Nebraska Medical Center gave an enthusiastic presentation Generation Z: The new kids on the block. He highlighted the difference between Generation Z students born after 2000 compared to Millennial students born 1980-2000 and argued the need for new teaching and learning strategies. Generation Z students regard establishing personal relationships as important and value live experiences and interactions but not necessarily in the form of a lecture. They value learning which incorporates personal experiences and opportunities for reflection. They are less group-work oriented than Millennials and prefer individual and self-directed learning combined with some group work. They prefer short, frequent messages and value real-time feedback relating to their activities and progress.

We had an AMEE exhibit stand and it was an opportunity to meet AMEE members and to interest others in AMEE. I ran with Adi Haramati an ESME course with 26 participants, many of whom were fairly senior teachers in their school. The ESME certificate is the first stage in the IAMSE Fellowship Programme.

MCQs are dead
I have been thinking a lot about assessment recently and that we need a fundamental change with regard to the tools we use and our overall approach. As John Cookson argued at the end of a recent ESME Online course, “MCQs have had their day and we need to move to Very Short Answer Questions”. This is a move I have previously promoted. The evidence is now clear that Very Short Answer Questions (VSAQs) where the learner responds to the question in one, two, or a limited number of words rather than selecting from a list of choices as in a MCQ offers major advantages. It is a more valid assessment tool and reflects the clinical decision process without the cuing that is inherent in the MCQ. It eliminates the possibility of answering an item simply by chance. The VSAQ is more challenging and provides better discrimination than the MCQ.

In line with a move to authentic curricula we need to include open book exams and pay more attention to portfolio assessment. In line with competency-based education we need to look at the implications of mastery learning for assessment and the use of badges and certificates. Professor Leonard Cassuto described the impact changes in assessment, including the use of certificates had on his course (

What is scholarship of teaching
In my last blog I reported my presentation at the Iranian Conference on Health Professions Education on “The changing roles of the medical teacher” using as a model the eight roles of the teacher from my book with Pat Lilley. I referred to the teacher as a scholar, highlighting that this was not necessarily limited to undertaking research and publishing papers but embodied reflection on teaching, innovating in teaching, and communicating about teaching. Dr Shoaleh Bigdeli, who organised the conference, sent me a paper by one of her students, Dr Mirhosseini, which explores the concept of scholarship of teaching and learning. The paper presents a useful concept analysis with the scholarship of teaching attributes including continuous deep reflection, committed engagement in action, shared communication, a critique and critical enquiry-based approach, context-oriented, and learning focused.

Mirhosseini, F., Mehrdad, N., Bigdeli, S., et al. 2018. Exploring the concept of scholarship of teaching and learning (SoTL): Concept analysis. Med J Islam Repub Iran. 32(96). Epub.

Learning analytics and ethical issues
I have been present at a number of discussions in different contexts about the use of learning analytics. Ethical issues are a recurring concern. In March of 2019, the International Council for Open and Distance Education (ICDE) published a 16-page report on global guidelines regarding ethically informed practice in learning analytics. Issues discussed include transparency, data ownership and control, accessibility of data, validity and reliability of data, institutional responsibility, communications, and consent (ICDE, 2019). A brief overview of the info guidelines surrounding these core issues was published by the International Council for Open and Distance Education.

International Council for Open and Distance Education. 2019. Global guidelines: Ethics in Learning Analysis.

Goodhart’s Law and citation numbers
The metrics used to measure academic success such as the number of publications, citation number, and impact factor have not changed for decades. Fire and Guestrin, in an article in the June 2019 issue of GigaScience, point out that these metrics have become targets and follow Goodhart’s Law, according to which “when a measure becomes a target it ceases to be a good measure”. They analysed more than 120 million papers and demonstrated that the validity of citation-based measures had been compromised and the usefulness is lessening. Academic publishing has changed considerably and we now need to reconsider how we measure success, they argue.

Fire, M., Guestrin, C. 2019. Over-optimization of academic publishing metrics: observing Goodhart’s Law in action. GigaScience. 8(6),

Inspiring students (or trying to)
I was honoured to be awarded by Dundee University the honorary degree of Doctor of Laws at the graduation ceremony in June. A short three minute presentation “to inspire the graduands” was expected. Crafting this I found more difficult than producing a 30 minute presentation on the future of medical education! I don’t know whether this had any effect on the students but the university Chaplain said she liked it. For those interested, here is my presentation.

I feel greatly honoured to receive this degree. Almost 60 years ago, 59 years to be precise, I graduated proudly as a doctor. Life then was simple, or so it appeared to be at the time.

Since then, medical practice has become much more complicated with great advances in medicine, changing healthcare delivery systems and practices including an emphasis on teamwork, and different patient expectations with patients consulting Dr Google before a consultation.
We now have the Fourth Industrial Revolution with a cluster of physical technologies such as 3D printing of human organs, digital technologies including augmented and virtual reality and biological technologies including genetics and genomics. This will radically change the way we live, the way we learn, and the way we work as a health care professional.

Completion of the undergraduate education programme is the first stage of an exciting journey. The changes we are facing bring challenges but also opportunities.

Despite what some might see as doom and gloom, the current controversies and the increased expectations to be addressed, there has been I believe no better time to practice medicine. As has been said a smooth sea never made a skilful sailor. If we don’t challenge ourselves, we will never realise what we can become.

In thinking of work, it is important to pay attention to what gives you joy. Pay attention to your heart and what you know works. If you are enjoying your work, if you are doing things you are proud of, you will find that you are in an inspiring profession.

As you have heard I was once asked about my philosophy for life. I chose the military cadet maxim – risk more than others think is safe, care more than others think is wise, dream more than others think is practical, and expect more than others think is possible.

I urge you to risk, to care, to dream, and to expect. Thank you.