Summary: Ottawa 2014, empathy and Al Imam University feature in Harden’s Blog this fortnight. Description: I left shortly after my last blog for Saudi Arabia where I was paying a brief visit to the Al Imam medical school.  I also met with Professor Khalid Bin Abdulrahman, who chairs the ASPIRE Student Engagement panel and, along with Stewart Mennin, is co-editing with me a new text - an International Handbook of Medical Education - which is to be published as part of the prestigious Routledge Handbook series.  The Al Imam University in Riyadh has 80,000 students, 30,000 of which are studying at a distance.  I was interested to see that the medical school is moving to scheduling electives for all five years on Wednesday mornings and opening each elective or student selected component to students in all years.  This will be an interesting example of peer-assisted learning, with students from different years working together on a particular elective.  I cannot recall seeing a description of such an experience before.  On returning to my hotel room after dinner, just before leaving for the airport for my return journey, I found that my room key was not working.  Nor did two further keys issued by the reception desk.  Fortunately, I had my passport and wallet with me and wondered whether I would have to abandon my case in the room.  The engineer was summoned and the problem was quickly solved - a new battery in the electronic lock was required and this was fitted very quickly.

I left shortly afterwards for Ottawa where we had a series of meetings regarding the 2014 Ottawa Conference which is returning to Ottawa.  Again a problem just before departure!  This time it was a fire alarm in the hotel.  The first Ottawa Conference was in Ottawa in 1985.  In 2014 it will be a combined meeting with CCME (Canadian Conference on Medical Education).  There will be joint plenaries and separate streams.  We had an excellent response to the request for proposals for pre-conference workshops and symposia and had a rich set of submissions from which to choose.  The call for oral communications and posters will go out towards the end of this month or early June.  The meeting itself is scheduled 25-29th April 2014 including two days of pre-conference workshops on assessment.  Ottawa is an excellent location for the meeting and the new conference centre meets our needs and has been well designed.  Talking of conferences, I note in the May issue of Meetings & Incentives Travel that pharmaceutical companies paid more than £40 million in 2012 hosting British doctors at meetings and conferences.  Unfortunately, I suspect that few were meetings in medical education.  The same issue of M&It reported that more than 1.3 million meetings took place in the UK in 2011 with total attendees spending just under £40bn – a useful impact on local economies.  The AMEE 2015 meeting will be in Glasgow.  Glasgow has now been voted the Best UK Convention Bureau for the last seven years.

I always find it interesting to see how a model I have described such as the ‘SPICES’ model or the ‘Integration Ladder’ (Medical Education, 2000, 34; 551-557) is used in different contexts.  The SPICES model was the theme for my third webinar for the ESME online course this week.  My attention was drawn to a reference to the ‘Integration Ladder’ in Clinical and Experimental Ophthalmology (2007, 35; 310-317).

In the daily papers this week was advice by Professor David Gradwell, the UK’s first full-time Professor of aviation medicine, that one should not attempt to do important work when travelling by plane as the reduced pressure makes it harder for the brain to make use of oxygen in the air, so diminishing its performance.  It made me wonder whether the same impairment applies to the flight crew and whether when they are trained on the ground in simulators and their decisions monitored, this is done at the equivalent of 8000 feet air pressure.

A number of papers were submitted for AMEE 2013 on the important topic of empathy and a short communication session has been scheduled on this at the conference.  An experience this last weekend highlighted for me that this is not just an academic topic.  My wife, following a slip on a step while shopping, sustained a fracture of her radius and ulna and required to be admitted to have a plate fitted.  Sitting in hospital for three hours and watching the junior doctors’ interactions with patients in the Accident and Emergency department made me realise that something was lacking – empathy.  No doubt they were technically competent and the situation is obviously a difficult one.  I feel sure, however, that the doctors could have done more to identify with and understand the patients’ situations and feelings.

I noted that the Baltimore Sun reported recently that “A large section of brick fa├žade fell off a National Institutes of Health research facility on the Southeast Baltimore campus of John Hopkins Bayview Medical Center, reviving concerns about a building that opened two years late because of other problems.  The building houses researchers that are part of the National Institute on Aging.”

My daughter, Jennifer, a social scientist working with the medical school in Edinburgh, was talking recently at the Scottish School of Primary Care meeting in Inverness.  One theme of her presentation was, while it is important to work at an individual level in terms of patient care, to make real change one also needs to look at the bigger picture.  The poem by Bertolt Brecht (c-1950) eloquently makes the point.  

A Bed for the Night
I hear that in New York,
at the corner of 26th and Broadway,
A man stands every evening
during the winter months,
And gets beds for the homeless there,
by appealing to passers-by.

It won't change the world.
It won't improve relations among men.
It will not shorten the age of exploitation.
But a few men have a bed for the night.
For a night the wind is kept from them.
The snow meant for them falls on the roadway.

Don't put the book down on reading this, man.

A few people have a bed for the night.
For a night the wind is kept from them.
The snow meant for them falls on the roadway.
But it won't change relations among men.
It will not shorten the age of exploitation.

I think the same applies not only to patient care but to medical education.  We put much effort into the details with regard to the curriculum, teaching and learning methods and assessment, but have for the most part neglected the bigger issues where more fundamental change is needed such as a true continuum of education with abolition of the silos of undergraduate, postgraduate and continuing education.