Summary: From Harvard to IAMSE and Puerto Vallerta, Professor Harden samples the ample range of medical education treats on today's and future menus.

Description: I have just returned from two weeks in USA and Mexico. My visit started in Boston where I was Tosteson Visiting Professor at Harvard. In their curriculum revision the medical school is looking at closer integration of basic sciences and clinical medicine. Rich Schwartzstein who is playing a leading role believes passionately in the value of the basic sciences in clinical practice. He had published in Chest (2011; 140(6): 1638-1642) a case that provided an example of the application of basic physiologic principles at the bedside to solve a clinical problem. In their curriculum revision they are taking into account the thirteen core entrustable professional activities (EPAs) defined by the AAMC. There is a very active faculty development programme based at the Shapiro Institute with David Roberts playing an active part. The topic for my Grand Rounds presentation was ‘Outcome-based education – the most important trend in medical education for the last decade.’ In this presentation I looked at the key trends in medical education and how outcome-based education was playing a key part. I also ran a workshop on ‘Making learning more effective.’ While in Boston I met with Subha Ramani who is playing an active role in AMEE and Medical Teacher. She has just joined the AMEE Postgraduate Committee.

From Harvard I went via Chicago to Nashville to attend the 2014 IAMSE meeting which was hosted by Vanderbilt University School of Medicine. There with Adi Haramati and Pat Lilley I ran an ESME course. A group photo is shown.ESME-Course-participants-at-IAMSE-Meeting-in-Nashvillesquare-(1).jpg Also you can see three of the nine participants who were presented with the AMEE ESME Certificate in Medical Education for their work following last year’s ESME course. This counts towards their work for the IAMSE Fellowship in Medical Education. All nine participants were presented with the certificate at a plenary session.

There were a number of interesting papers at the IAMSE meeting. Karen Cornell from the University of Georgia gave an excellent presentation on meaningful feedback. She used as a metaphor, the giving of a gift to a friend – did the gift match the friend’s needs and was it delivered and packaged in a way that was appropriate? She talked also about, what is often neglected, – making the learner ready to receive feedback. Mavis Schorn from the Vanderbilt University School of Nursing ran a plenary session on inter-professional education in which a panel including a student were invited to respond to questions from the audience submitted through text messages. A similar approach was used at the Ottawa Conference in April and I was interested in the possible use of the technique at AMEE. While we have text questions from AMEE online participants, face-to-face participants are invited to make their response via a microphone. After the IAMSE session, however, I was less attracted to the idea as it seemed to lack the edge provided by questions being asked from the floor. Much depends on how the questions submitted are filtered and it seemed to me only the questions asking for more information or with positive comments were addressed to the speakers. I know that a number of more searching questions submitted were ignored and not presented.

William Jeffries, Kathryn Huggett and John Szarek ran an interesting session on flipping the classroom. They started off with a YouTube video clip. I thought too much emphasis was given to starting the classroom session with an assessment exercise as in team-based learning. Machelle Linsenmeyer and Alice Fornari ran an interesting workshop on OSTEs as a faculty development activity. I hope that the book on which we are working on the OSCE will include a description of the OSTE to assess teaching skills. In an impressive plenary, David Pedersen from Ross University talked about leveraging emerging clinical technologies to help students learn. He gave some interesting statistics. For example, there are more cell phones than toilets in the US. On the final day John Pelley from Texas Tech University Health Science Center gave an interesting presentation on active learning. Some of the work he described was new to me. Deep sleep he described as necessary for the brain to replay what had been learned – remembering what was thought to be important and saving energy by forgetting what was seen as not important.

While in Nashville, Adi Haramati hosted Pat and myself for dinner. I was interested to hear from him the success of a Colloquium for GUMC Educators in the Health Professions held at Georgetown University earlier in the month. They had more than 50 papers addressing research in education, curriculum innovations and new ideas in medical education included in the programme with some presented in ‘short idea sessions’ and five minutes allocated for each paper. Thinking of this and also of the two minute PhD presentation competitions reported in several countries, perhaps we should look at a session with shorter papers at AMEE.

The final stop was in Puerto Vallarta, Mexico to attend the IV International Mexican Conference in Medical Education. While the participants were almost entirely from the region, there were 21 invited international speakers, each of whom made multiple contributions to the programme. An impressive programme had been put together and I was involved with a number of sessions. These included a session scheduled as a dialogue between myself and Geoff Norman and chaired by Jonas Nordquist. We each had been invited by Jonas to identify what we saw as the five most important developments in medical education in the past five decades and also the three most important areas for research in the coming decade. We disagreed on a number of issues but this added edge to the session and we ended up still friendly as in the photo. Prof_with-Geoff_Normancrop.jpgI think the fact that we looked at the subject from different perspectives appealed to the audience. My list of five most important achievements included the OSCE, student-centred learning, outcome-based education, use of new learning technologies and inter-professional education. Geoff’s list of achievements were evolution of national licensing exams, content specificity, the science of teaching and learning, clinical reasoning and the decline and fall of general skills and dispositions. I challenged him particularly on the notion that national licensing exams were a positive achievement.

There was an interesting symposium on the medical school of the future to which I contributed along with other speakers including Dan Hunt. I was impressed with Dan’s far reaching vision. We also both contributed to another session on excellence in medical education. Dan described from his visits to medical schools in the US what he saw as the ten most important curriculum innovations. In his talk he also referred to ASPIRE and the recent award to the University of Southampton. He had been particularly impressed by the integrated curriculum at El Paso which was a variation of the Calgary clinical presentation model. He has agreed to contribute an article to Medical Teacher based on his perception of the ten most interesting developments.

Adi Haramati, in addition to running a workshop on the theme, gave an impressive plenary session on mind body medicine. He first argued how mind body medicine reflects the physiological interface between the mind and the body. He identified the problems caused through stress and burnout which can be prevented by adopting a mind body approach. He then demonstrated the relation between the mind and the body by inviting the audience to close their eyes and think about a visit to their kitchen. During the visit they took a piece of lemon, sliced it and tasted it. He then asked how many of the audience had actually tasted a lemon and how many had salivated during the experience. More than half of the audience responded positively. It would be interesting to try this sometime at AMEE!

We had an AMEE stand at the meeting which attracted much attention and a number of new members. Both Pat and Madalena Patricio worked hard at the stand. Fun-at-the-dinner-in-Puerto-Vallartasquared.jpgHere is a photo of myself with Madalena at one of the evening dinners.

In all a very exciting and worthwhile two weeks. Now at home catching up with work and the garden before leaving for a meeting in Frankfurt on Monday.