Summary: After a recent trip to Leiden, Netherlands, for the annual IASME meeting, Professor Harden gives us an insight on activities that occurred during the conference. Description: I returned last week from Leiden, The Netherlands where I was participating in the annual meeting of the International Association of Medical Science Educators (IAMSE).  Transport was relatively easy as there is a newly established flight from Dundee airport to Amsterdam which is only 30 minutes by car from Leiden.  About 400 participants attended the meeting.  As on previous years, along with Adi Haramati, I ran an ESME course.  I found the discussions during the course interesting and it appeared to be well received.  One of the course participants, Mary Steinmann, a psychiatrist from the University of Utah, described how she used residents as simulated patients in OSCEs and this gave the residents an interesting perspective.   Another course participant, Aykut Uren, an Anatomist at Georgetown, described how he only taught anatomy where he could make it clinically relevant to the students.  He also described some interesting games he used to make the learning more active.  The ESME Certificate in Medical Education which participants receive if they complete their assignment following the course is the first step in the IAMSE Fellowship Award.  The eleven participants from 2015 who completed the coursework were presented with their AMEE-ESME certificate in Leiden.
 
 
The theme for the meeting was ‘Learning Assessment: Connecting health science and clinical competence.’  There were a number of contributions to the meeting on the integration of basic sciences with clinical medicine and more than eight papers or sessions addressed competency-based education and the use of entrustable professional activities (EPAs).  In an opening plenary presentation Olle ten Cate highlighted how traditional psychometrics does not fit well with assessment in the workplace and the need for expert judgement which cannot always be made fully explicit.  He emphasised that competence is best defined as a threshold in a continuum of competence.  He highlighted the development of entrustable professional activities as a holistic approach.  He described ad hoc entrustment decisions happening every day which are formative and summative entrustment decisions based on multiple sources of information which serve as certification and licensing for practice.  He indicated that the curriculum at Utrecht was being redesigned based on EPAs but did not give details.  Unfortunately there was not an opportunity for participants to ask questions at the end of the presentation.  You can hear Olle’s views on entrustable professional activities by viewing the recording of his presentation on the topic at AMEE Live 2015 in Glasgow.
 
In a subsequent plenary Geoff Norman in as always a provocative and insightful presentation attacked competency-based education as implemented and what is described as a smooth growth of competence over time with the concept of a competence rather than a time-based curriculum as described by Olle.  Unfortunately Olle was not present to defend his views.  Geoff also criticised competency-based education as detracting rather than encouraging attention to be paid to the soft skills.  He agreed, however, with my point that this may be a function of the framework used for competencies and it certainly does not apply for the Scottish Doctor where attitudes is one of the domains in the middle circle of the three circle model. 
 
We heard many excellent ideas about making the basic sciences relevant and integrating them with clinical medicine.  These were mainly, however, evolutionary rather than revolutionary concepts and much of the assumption was still that students would have a preliminary period of training where the emphasis was on the basic sciences followed by clinical teaching later, although with some introduction of clinical teaching in the early years.  As Peter Garland, former professor of biochemistry in Dundee suggested, however, perhaps we need a more fundamental revision where students start off with clinical training and following this study the basic sciences when they understand the need for them.  To some extent this is a model adopted at Hoffstra Medical School in New York where students spend the first six weeks of the curriculum working with paramedics in dealing with emergencies.
 
Cees van der Vleuten gave a polished presentation on programmatic assessment emphasising the importance of validity in assessment and the move from assessing simply knowledge to assessment of a range of competencies.  He highlighted that there was no magic bullet when it came to assessment and that one needs to bring together evidence from a number of data points or sources - ‘one measure is no measure.’  He emphasised again the importance for professional judgement and that objectivity is not equal to reliability.  A number of subjective judgements can provide a robust picture of competence.  In describing programmatic assessment he used the metaphor of the orchestra.  In what has been a controversial theme he also highlighted the need to forward feed information from a student’s assessment in one phase to their next phase of study.
 
Of the focussed and short communication sessions I attended, I was particularly impressed with a session by Neil Osheroff and Cathleen Pettepher from Vanderbilt - From theory to practice: implementing milestone based assessments for pre-clerkship medical students.  This was a good example of programmatic assessment in practice with the collection at different periods of time of information from a range of sources including peer assessment and self-assessment.  Students were assessed on a range of competencies.  Among the successes reported included that previously undetected problems with a student were identified at an earlier stage of training, a richer and more accurate form of feedback was provided and the assessment had a positive impact on students learning.
 
Thinking of conferences I was interested in the 30 May 2016 blog by Pat Thomson https://patthomson.net/2016/05/30/conference-paper-to-journal-article-understanding-and-using-the-difference/  She discussed converting a paper presented at a conference to a journal article and the differences between the two types of papers.  The first point she made is that the journal article is often more specific, more bespoke, than the conference paper.  A reworked paper needs to say why the paper is important to the journal readers and to build on what they are already likely to know about the topic.  This means checking the papers already published in the journal and ensuring that appropriate connections are made.  Secondly, she suggested that the journal article should attend to any weaknesses of the conference paper.  Questions following a conference presentation may indicate areas that could be developed further in a paper.  An oral conference presentation compared to a written paper may get to the point more clearly, may use more vivid metaphors, may provide one preferred definition, may summarise the literature more economically and may provide a particular example.
 
I wrote this blog just before leaving for Cancun, Mexico where I am attending the 20th Panamerican Conference of Medical Education / 5th International Congress of Medical Education.  I have three presentations to make, one on excellence in education in a medical school, another on excellence in a medical teacher and a third on cultural competency in the curriculum.  More about the meeting in my next blog.