Summary: IAMSE is the focus of Harden’s Blog this fortnight. Professor Harden also discusses MOOCs and medical errors. Description: Just back from a meeting of the International Association of Medical Science Educators (IAMSE) which this year was held in St Andrews, Scotland.  More than 380 participants took part from 29 countries – the best attended IAMSE meeting to date.  This year is the 600th anniversary of St Andrews University and the medical school was the local host for the conference.  Amitai Ziv was scheduled as the plenary speaker on the second day of the conference but unfortunately was not able to attend because of family problems and I was asked to take his place.  In my presentation I developed further the theme I introduced at the APMEC conference in Singapore in January on ‘the future of medical education lies in greater collaboration.’  The opening plenary for the meeting was given by Sue Black, Professor of Anatomy at Dundee on the subject of ‘Anatomy and Forensic Anthropology – a Metaphor for the Marriage of Basic Science to Medical Practice.’  Her passion and enthusiasm was much appreciated by the audience and it got the meeting off to a great start.  Simon Maxwell in another plenary talked about the need to improve education on prescribing in the undergraduate curriculum and described the proposed national examination on prescribing to be introduced in the UK.  He represented, on a figure, learning about prescribing over the phases as a steep rise during undergraduate years and only a slight additional increment in postgraduate training.  This seems to me a misconception as to what we should see as a true continuum of learning about prescribing across undergraduate and postgraduate training.  I also feel concerned that other disciplines or pressure groups, using prescribing as an example, will lobby for, after completion of the medical courses, additional examinations in their own areas.

Along with Adi Haramati we ran the ESME course for the 7th year at the IAMSE meeting.  We had a particularly enthusiastic group of participants who engaged actively in the course activities, including the lunch time reporting back from the conference.  I found this helpful as I had been asked to be one of the speakers in the final conference session on ‘lessons learned.’  This is always a challenging task.  Rather than identifying by name a small number of papers or sessions I presented eight general conclusions based on my experience at the meeting: (1) We are engaged in an exciting journey in medical education; (2) We have much to gain by sharing our experience and through this a better understanding of what works and what doesn’t work; (3) Alternatives to the traditional lecture should be considered for large group teaching; (4) The teacher is important; (5) The student is a key player; (6) Integration of basic and clinical sciences is not just a dream; (7) Simulated and virtual patients have a role to play; (8) International collaboration is important.  

The idea of the flipped classroom and team-based learning featured prominently in a number of sessions in the programme.  Christof Daetwyler gave a fascinating presentation where he described how a flipped classroom was combined with remote practice and assessment.  Their online web OSCE allowed students to encounter standardised patients on whom they could practice the skills learned in the modules.  Students received individual feedback on their performance and were provided with a personalised web page containing learning assignments to remediate the deficiencies that were identified during the encounter.  I am always interested in developments with regard to the OSCE and saw presented some new ideas with regard to the use of virtual patients in the OSCE.  Technology featured prominently in the programme including a session on MOOCs.  Adi Haramati challenged the presenters as to whether this was a disruptive innovation or a passing fad.  Next year’s IAMSE meeting is back in the USA in Nashville but there was some talk of returning to St Andrews for a future meeting.

We took the opportunity of the meeting in St Andrews to hold prior to the start of the conference a meeting of the new BEME Board.  The formal Board meeting was preceded by a two hour brainstorming session on how teachers might be encouraged to use evidence when making decisions in their day-to-day practice as teachers.  It was decided to establish a new UK BEME collaboration group and it is planned that this will meet for the first time at AMEE 2013 in Prague.  Yvonne Steinert has already made progress with creating such a group in Canada.  Evidence-informed teaching is the subject of two symposia and two short communication sessions at the AMEE meeting in Prague.  The latter will include twelve short presentations on BEME reviews either recently completed or underway.  Appearing in the August issue of Medical Teacher will be an interesting BEME guide by Jill Thistlethwaite and co-workers on longitudinal community and hospital placements in medical education.

The plenary and symposia sessions have now been finalised for the Ottawa 2014 conference to be held in Ottawa in April next year.  These include, I think more than in previous years, provocative presentations that challenge our current practice, for example, in relation to validity, narrative assessment, cheating and the use of the script concordance test.  The closing date for short communications, conference workshops and posters is not until 14th September 2013

Back in Dundee this week we had some meetings about technology and the AMEE 2013 meeting in Prague.  Following on the whole enthusiastic reception for the interactive poster sessions at AMEE 2012 in Lyon with some improvements, we are scheduling again interactive e-poster sessions for Prague.  I will be interested to see how innovative the presenters are using this new medium.  Electronic posters will not only be available in the exhibition area but available for access on laptops or tablets during the conference.  We are also working on making available the conference online for those who are unable for whatever reason to be with us in Prague (currently we have about 3,000 registered to be with us in Prague).  There have been significant improvements in the technology and the streaming since we last offered the conference live online two years ago.

Reports in newspapers of errors in medical practice are not uncommon.  I found particularly worrying, however, the case reported of a pregnant woman with appendicitis who died after trainee surgeons removed an ovary by mistake.  She was discharged ten days later, even although a lab report had shown it was not an appendix that was removed.  She was readmitted still in pain but miscarried and died following a second operation to remove her appendix.  

Chip Paucek, as noted in Wired (July 2013) is building digital universities with the help of £66 million in venture funding.  The aim is to help universities to offer full-scale online degrees.  Since 2008, 2U has helped 2,000 online-only students around the world graduate from establishments such as Georgetown and the University of North Carolina.  Paucek, it is reported, is in the process of closing deals with universities in the UK and Australia.  The Times Higher Education (9th May 2013) reports that in the UK four more universities have announced plans to offer massive open online courses via the UK-based Futurelearn platform.   It was a great disappointment for me that the International Virtual Medical School (IVMEDS) had only limited success in the years after its launch despite considerable enthusiasm for the idea.  I think important lessons were learned and I must write these up.  Perhaps it was an idea ahead of its time.

Students learn more through direct instruction, was the title of a paper by Paul Peterson in Education Next.  In the study reported, 8th graders were followed who had the same classmates in both maths and science, but different teachers.  The impact on student learning of class time allocated direct instruction versus problem solving was estimated.  Direct instruction won.  Students learned 3.6 percent of a standard deviation more if the teacher spent 10 percent more time on direct instruction.  The article generated furious criticism from readers both of the study and the conclusions drawn.  One key issue related to what the good teacher does when talking in front of a class.  If it is a ‘traditional’ lecture, this may be a passive experience for the student, but on the other hand it can be converted by the good teacher into an interactive and challenging experience.  The problem, as noted in the AMEE guide by Brown & Manogue (AMEE Guide No 22), lies not with bad lectures but with bad lecturers.

I received this week an advance copy of the 4th Edition of A Practical Guide for Medical Teachers, edited by John Dent and myself and with a forward by Brian Hodges.  This edition has seven new chapters and 73 authors from 14 countries contributed.  We are having a book signing opportunity at AMEE 2013 in Prague.