Summary: In his latest blog Professor Harden reflects on the recent AAMC Conference in Boston, and discusses competency-based education, the AMEE 2018 Conference in Basel and the Ian Hart Award. Description: AAMC in Boston
I participated in the AAMC annual meeting which was in Boston earlier in the month. We had an AMEE stand in the exhibit hall and it was an opportunity to meet friends and AMEE members and interest others in AMEE activities. A number of schools expressed interest in applying for an ASPIRE-to-Excellence Award. Professor Mohamud A Verjee, who is currently director of a primary care clerkship in Qatar, introduced himself. He was my resident in the medical wards in Dundee in 1978! (See photo at the end of the blog)

I contributed to an interesting session on continuing professional development. Based on what is happening internationally in the field, I suggested five themes or issues that are attracting attention:
  • The status of CPD – whether it was voluntary, a legal obligation or whether there was revalidation required
  • The preparation of students for CPD as part of the undergraduate programme
  • Competency-based CPD
  • Different approaches to implementing CPD in practice
  • Scholarship and research in CPD.
At the end of my presentation we had a poll as to which of the five themes merited most attention. All themes had their advocates but the one that attracted most attention was the preparation of students for CPD as part of the undergraduate curriculum. We had a couple of interesting papers on this at the AMEE 2017 meeting in Helsinki.

Marsha Rappley, current Chair of the AAMC Board of Directors, made a passionate plea to the participants to reduce the cost of education, for example, by shortening the length of the education programme from four years to three years. Darrell Kirch, president of the AAMC, chose for his theme what it means to operate in a landscape where opinion and fake news can be mistaken for fact and the responsibilities of academic medical leaders in relation to this.

There seemed fewer education and education research papers this year and the meeting stopped at lunchtime on the Tuesday rather than on the Wednesday as in past years. At one session, I was struck by the importance of the teacher as a role model in three of the communications although it was not the main theme of the papers. One related to longitudinal integrated clerkships, one looked at career choice and one explored self-assessment. Teachers and clinicians need to show as role models how they seek further information when necessary and evaluate the answers.

Competency-based medical education
I have referred in previous blogs to the emphasis now placed on competency-based medical education. The June issue of Medical Teacher featured a number of articles on the subject and when last counted there were about 10,000 downloads of the articles. Competency-based medical education: The discourse of infallibility was the title of a more recent article in Medical Education by Boyd, Whitehead, Thille, Brydges and Kuper from Toronto. Boyd et al recognised that CBME is an outcome based approach. There is extensive literature on outcome-based education which, as in this article, is often ignored. It is helpful to see a critical review of CBME and to see argued by the authors the need for more work and research in the area. The article is one of a series of articles which, depending on the perspective of the authors, argue either for or against CBME. I worry about this as it risks creating a false dichotomy as to whether you are for or against CBME. This brings to mind the discussions in the 1980s on educational strategies such as an integrated curriculum, community-based education and student centred learning. I was asked then whether I was for or against integrated teaching. This misses the point and prompted me to describe the SPICES model which looked at each of the educational strategies on a continuum (Harden & Laidlaw 2016). I described the integration ladder which explored ten steps towards an integrated curriculum from isolation to transdisciplinary. At workshops and discussions I found that more progress was made by discussing where on the continuum for each strategy the school wished to be rather than arguing for or against a strategy such as integration. I think the same applies to competency-based education today. Rather than a debate we need a constructive dialogue. I am also concerned that discussions about CBME look at it from a narrow perspective and ignore the reasons underpinning the introduction of CBME, including improvements in patient care, patient safety and social accountability. In relation to this, the discussions tend not to look at the alternatives to CBME and how we can tackle what are recognised as problems in the training of our doctors. I hope these issues will be addressed at the second World Summit on CBME to be held in Basel, 24th-25th August, immediately prior to the AMEE 2018 Conference.

Boyd, V.A., Whitehead, C.R., Thille, P. et al. 2017. Competency-based medical education: the discourse of infallibility. Med Educ. Epub. 1-13.

Harden, R.M. & Laidlaw, J. 2017. Essential Skills for a Medical Teacher, 2nd Edition. Elsevier, London.

AMEE 2018
Plans are now well advanced for AMEE 2018 in Basel, 25th-29th August. Almost 300 proposals were submitted for symposia and preconference workshops. The quality was very high and it proved difficult making a final selection to get a balance of themes, speakers and traditional and more innovative topics. The closing date for submissions for short communications, poster sessions, conference workshops and fringe papers is 6th February (https://amee.org/conferences/amee-2018). One of the interesting innovations this year is a track of sessions throughout the meeting devoted to surgery education.

Ian Hart Award for Innovation in Medical Education
I was a close friend, colleague and admirer of the late Ian Hart. We worked on a number of projects together and Ian spent several productive sabbaticals in Dundee when he made important contributions to medical education. Together we launched the first Ottawa Conference in 1985. Ian made important contributions to AMEE. An award has been set up in his memory with the support of the Hart family and AMEE. The award will recognise an individual who has made an exceptional contribution to undergraduate, postgraduate or continuing medical education at a local, national, regional or international level. The closing date for applications is the 7th December 2017 (https://amee.org/awards-prizes/ian-hart-award).

ASPIRE-to-Excellence video
Professor Eliana Amaral in Brazil has been working with colleagues and students to raise awareness of the criteria for excellence in medical education. She writes

                “We started with 25 student leaders last year and this year around 40 attended. It was an Aha moment for most of them”

https://vimeo.com/238679499

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