Summary: In his latest blog Professor Harden reflects on APMEC 2018 Singapore, Measuring what matters, Bawa-Garba and fake news, Ottawa Conference in Abu Dhabi, and AMEE 2018 in Basel. Description: APMEC 2018 Singapore: Another great meeting
The 15th Asia Pacific Medical Education Conference (APMEC) took place in Singapore in January. This is now an important event on the medical education calendar and more than 1400 participants took part. The theme was Technology: Enhancing education for improvement of patient care. In my presentation Learning and technology, not learning technology I argued that the transformative application of technology to education will move education from the ivory tower to the real world and is likely to benefit patient care if we look at technology from a pedagogical perspective. A theme I highlighted was the move from “just-in-case” learning to “just-in-time” learning and this appeared to arouse particular interest in the conference participants. The need to train students who were adaptive learners featured prominently in the question session immediately following my presentation. Adaptive learning is certainly on today’s agenda. We received more than 150 abstracts on the topic submitted for consideration for AMEE 2018 in Basel. Two short communication sessions, a poster session, a conference workshop and a preconference workshop are devoted to the theme. A special anniversary issue of Medical Teacher this year, edited by Mark Quirk, will also address adaptive learning.

Brian Hodges gave a thought provoking presentation on technology, compassion and healthcare education. He argued powerfully that while healthcare will continue to be underpinned by cognitive skills and technical prowess, it is an anchor in humanism and compassion that will prove the value of the human health profession of the future.

As readers of my blog will already know, I believe that the advantages of nationalising exams as they are currently implemented are outweighed by the disadvantages. In an interesting contribution by Richard Fuller from Leeds, “A ban on big testing”, he raised concern about the large scale, high-stakes tests with a greater focus on psychometric rigour. He suggested that we need to consider more workplace and programmatic approaches to assessment, with learners supported more effectively. We need, he argued, to provide more customised forms of assessment based on learner ability and that the era of large scale “one size fits all” testing may be coming to an end.

Linda Harasim, a professor of communication at Simon Fraser University in Canada, describing herself as one of the inventors of online education, gave a somewhat unusual presentation which took 40 minutes rather than 20 minutes scheduled in the programme. She contrasted artificial intelligence, which seeks to automate and replace the human educator with augmented human intelligence technologies which seek to advance and augment human cognitive ability. She argued strongly against MOOCs and the low level of interaction between teachers and the learner. Peter de Jong suggested in the questions that followed her presentation that this was not necessarily the case. In a workshop session following her presentation session she left some things to think about,

“1. Technology is currently threatening our species rather than augmenting our thinking and learning skills.
2. Technology is truly not infallible, so should not be in control.
3. Digital Technologies are not ethical or trustworthy (Google’s “truthiness”; Facebook’s lies)
4. 2018: 200th anniversary of Mary Shelley’s “Frankstein”[sic] “Am I creating a monster!”
5. First we shape our technologies, then they shape us
6. We need time to think and to discuss
7. Why the rush to adopt AI when it is out to replace us?”

I am always interested in developments in curriculum mapping and Kang Yew Beng from the International Medical University (IMU) in Malaysia provided an interesting case history from IMU. Our ESME course associated with APMEC was well attended with over 60 participants. The AMEE exhibit attracted much attention at the coffee and lunch breaks, although I was mostly occupied at the lunchtime sessions with book signing at the Elsevier stand.

Measuring what matters
Measuring what matters was the theme for the February 2018 issue of Education Leadership, the ASCD journal. The articles in the issue argue that we need to look at authentic assessment rather than what is measured in standardised tests. In an article J McTighe argued that educators need to address three essential questions, “1) What really matters in a contemporary education? 2) How should we assess those things that matter? 3) How might our assessments enhance learning that matters, not just measure it?”. I liked his analogy between authentic tasks and the game in athletics “While the players have to possess knowledge (the rules) and specific skills (dribbling), playing the game also involves conceptual understanding (game strategies) and transfer (using skills and strategies to advantage in particular game situations).  Assessing what matters must include assessing performance in a “game” in addition to tests of requisite knowledge and skills”. I think this is relevant to medical education.

Bawa-Garba and fake news
The case of Dr Bawa-Garba, a trainee paediatrician who was convicted of manslaughter and struck off the GMC register last month, has attracted much attention in the general, education and medical press. She was convicted in 2015 of manslaughter following the death of a six year old child. She did not recognise the early features of sepsis and the implications of seriously deranged blood gas results and failed to fully communicate the implications to a consultant. When the child suffered a cardiac arrest the patient was wrongly identified as another child with a DNACPR order. Court action taken by the UK General Medical Council (GMC) led to her erasure from the medical register last month. This has caused an outcry in the medical profession. A major concern was that it was claimed that her portfolio in which she acknowledged her mistakes had been used by the prosecution against her. One can well understand the very real concern if a personal reflective diary is used subsequently in the case against a doctor. The fact is, however, that despite the numerous reports and concern expressed, the prosecution did NOT use Bawa-Garba’s portfolio as evidence in her trial. There are other issues in relation to her case, however, which are legitimate matters of concern, especially the issue of system failures in the hospital in relation to the case, including inadequate staffing levels. The profession also needs reassurance that there can be a “safe space”, akin to that in the airline industry where doctors can admit errors in practice. In a letter in the British Medical Journal, Terence Stephenson, GMC Chair, has noted that the GMC will lead a review to explore how the law of gross negligence manslaughter is applied to medical practice.

The reporting of her case and the wide assumption that the prosecution had used her e-portfolio in the case against her, as a piece of “fake news”, has distracted attention away from the other issues in the case, in particular the system failures. Fake news is now widely recognised as a problem in reporting. Addressing the challenge of fake news is the subject of a Westminster media forum seminar on 26th April in London. The Open University, in their 2017 report on the 10 innovations of note includes “Navigating post-truth societies”. It is suggested that the ability to evaluate and share information responsibly should be integrated in the curriculum.

Ferguson, R., Barzilai, S., Ben-Zvi, D., Chinn, C.A., Herodotou, C., Hod, Y. et al. 2017. Innovating Pedagogy 2017: Open University Innovation Report 6. The Open University, UK.
Stephenson, T. 2018. GMC chair’s reply to Nick Ross’ letter. BMJ. 360. 323.

Ottawa Conference – Abu Dhabi
I leave this week for the 18th Ottawa Conference in Abu Dhabi. I have been working on my presentation in which I explore in more depth the changing roles of the medical teacher. I mentioned in an earlier blog I normally allow in an area where I already have an interest about 30 hours preparation time for a presentation. I was interested to see in an article published by the Association for Talent Development (ATD) in response to a survey that in average 38 hours was used to develop one hour of face-to-face training. I will report back in my next blog on the Ottawa Conference.

Defelice, R. 2018. How long to develop one hour of training? Updated for 2017. Association for Talent Development. Accessed on 28/02/18 at https://www.td.org/insights/how-long-does-it-take-to-develop-one-hour-of-training-updated-for-2017

AMEE 2018 Basel – record submissions
Plans for AMEE 2018 in Basel, Switzerland in August are well advanced and I think we will have an exciting and informative programme. We received 3766 abstracts for consideration – an increase in 7.5% from 2017. Each abstract has been assigned to three reviewers and we are grateful for everyone who has contributed to the review process. The track on surgery education, being tried for the first time, has attracted a lot of attention. We are working on a new format for the AMEE booth in the exhibit hall. I look forward to seeing you in Basel. If you are not able to attend you might like to join the AMEE Live Online sessions where you can hear the inspirational and world-leading plenary speakers and also a range of symposia on important current topics in medical education. As before students will make an important contribution to the meeting. IFMSA had more than 1200 student applications to join the student task force for the meeting!

Student engagement
It’s great to see students increasingly engaged with medical education. As mentioned above, they make an important contribution to the AMEE annual meeting.

More than 30 students from around the world are currently enrolled on the third ESME student course led by John Dent, Richard Hays and Cate Kennedy. Students who complete the course and the assignment will receive the ESME Certificate in Medical Education. It is also great to see the increasing number of letters addressed to Medical Teacher received from students commenting on papers published by teachers.

Talking of student engagement, I was interested to see an article in e-School News which reports that some schools in Colorado, USA, arrange for students to be part of the interview process when new teachers are appointed. Students interview candidates, observe them giving a lesson and provide input into the selection of new teachers.
Beck, P. 2018. How next-generation learning supports every student. eSchool News. Accessed on 02/03/18 at https://www.eschoolnews.com/2018/03/02/next-generation-learning-supports-every-student/