Summary: In his latest blog Professor Harden looks into the growing interest in student engagement, the teaching of excellence and university rankings, the need for access to references, the presence of threshold concepts in medical education, rapid reviews, and developments in scholarly communications in the last 40 years. Description: Growing interest in student engagement
Student engagement remains very much on the agenda with evidence of increasing student interest in their curriculum and in the teaching and learning process. April saw the conclusion of the fourth Essential Skills in Medical Education (ESME) Student course led by John Dent and Richard Hays. George Tendwa, a student in Kenya, satisfactorily completed the course and the course assignments. He had problems with internet connectivity from where he lived and walked significant distance each day to the nearest village to contribute to the group discussions. Students participated in the course from Australia, New Zealand, Kenya, Thailand, the Caribbean, the UK, Germany, Turkey, France, Morocco and Cambodia. A particularly enthusiastic group of students from Cambodia not only took part in the course activities but formed a small local group to discuss developments in medical education and possible improvements in their curriculum. Michelle McLean from Australia served as both a facilitator on the ESME course and the ESME student course and reported that she found it easier working online with the students. We hope to have reception at AMEE 2018 in Basel for students who have completed the ESME course. There is also continued interest in the ASPIRE-to-Excellence Student Engagement theme.

Teaching Excellence and University Rankings
Farzand Ali drew my attention to an article which appeared in the Economist 17th May 2018 How Global University Rankings Have Changed Higher Education. Around 20 global league tables have now been published and these have focused the minds not only of universities but of governments on what needs to be done to ensure excellence. In Germany the government invested more than €4.6 billion by channelling money to institutions which might become world class universities. This rankings race, however, it was noted, has increased emphasis on research. None of the rankings include teaching quality. The article argues that the rankings may in fact be contributing to a deterioration of teaching as the quality of the research has little bearing on the quality of the teaching. Indeed, it is suggested that academics who are passionate about their research may be less inclined to spend their energies on students and so there may be an inverse relationship. Hopefully the ASPIRE-to-Excellence initiative will, with time, address the problem with the inclusion of excellence in teaching as a criteria by which excellence can judged in a university. Already the list of ASPIRE award holders highlights schools where excellence in teaching can be found.

The need for access to references
An interesting issue was raised on the listserve of the World Association of Medical Editors. A contributor reported that completing a review of a paper for a journal he found a reference that he needed to check. It turned out to be behind a paywall and to access it he would have to pay $31.50. He suggested that reviewers should be given a copy of references behind paywalls. He went on to argue, more generally, that perhaps references that were not freely accessible should be forbidden and that this may reduce the impact factor of some journals and encourage them to change their policy.

Are there threshold concepts in medical education?
The idea of threshold concepts is important, I believe, in relation to tackling the important problem of information overload and is in itself a threshold concept. Linda Martindale from the medical school in Dundee whose PhD was in this area gave an interesting lunchtime session in Dundee Threshold Concepts: The jewels in the curriculum, exploring troublesome and transformative learning in higher education. She provided a useful reference to a paper by Glynis Cousin and also described a website which provides a source of information on work and publications in the area (

Here are my suggestions about threshold concepts in medical education. It would be interesting to have your views:
  • A teacher has distinct different roles and these should be recognised
  • Facilitation of learning by the teacher is more important than information transmission
  • Teaching, learning and assessment should be authentic and related to the real world of medical practice
  • Education programmes should be outcome-based rather than time-based
Much of the work on threshold concepts can be attributed to Roy Land. He is an entertaining and informative speaker and has agreed to talk on the subject at the AMEE 2019 meeting in Vienna.

Cousin, G. 2006. An introduction to threshold concepts. Planet. 17(1). 4-5.

What are rapid reviews?
There is continuing interest in the production of systematic reviews relating to medical education and we receive a number for consideration for publication in Medical Teacher in addition to BEME reviews. Systematic reviews are demanding in terms of time and resources, and a “rapid review” process has been proposed (Barends et al 2017). A rapid evidence review search may be limited to a number of databases and excludes the grey literature. Only a limited amount of key data is extracted and critical appraisal is limited to quality appraisal to methodological appropriateness and quality. It has been suggested that a rapid education review might take only several weeks where a systematic may take more than a year. Pat Thomson in her Patter blog of 14th May describes her own approach to a rapid evidence review or, as she calls it, a “quick lit” rapid evidence reviewing.

Barends, E., Rousseau, D.M. & Briner, R.B. (Eds). 2017. CEBMa Guideline for Rapid Evidence Assessments in Management and Organizations. Version 1.0. Center for Evidence Based Management, Amsterdam. Available from

Development in scholarly communications in the last 40 years
This year is the 40th anniversary of Medical Teacher. It is also the 40th anniversary of the Society for Scholarly Publishing. To mark this occasion the leading chefs of The Scholarly Kitchen were asked their views as to the most important developments in scholarly communications in the last 40 years. Their answers included
  • The internet, with increased accessibility and radically increased searchability
  • The actions by funding agencies of scientific research to get involved in the downstream activity of publishing
  • The pace at which information is made available and questions answered
  • Desktop publishing, which was the start of digital publishing
  • The open-access funding model, with a journal able to accept every submission that met its criteria for publishing. This included the ability to publish replicated findings and confirmatory articles, which is the bedrock of scientific knowledge
  • The fibre-optic cable on which the digital world is built
I find the Scholarly Kitchen a valuable and thoughtful blog ( and this brief summary does not do justice to the range of views expressed in the recent post.

More than 50 million views on creativity
I have referred in previous blogs to the need to encourage creativity in students. I was interested to note that Ken Robinson’s TEDTalk on the subject has had more than 51 million views as highlighted in e-School News Today, 21st May 2018. In the presentation he challenges schools to promote and inspire creativity. The article recognises that it is difficult to know where to start and some teachers aren’t sure if it is possible.