Summary: In his latest blog Professor Harden looks at drawing as a learning tool, the plans for AMEE 2020, Scholarship, the problem with meetings, and more. Description:

Drawing as a powerful learning tool

3-Star Learning Experiences is an evidence-informed blog for learning professionals. Kirschner and Neelen, in the September 10th 2019 blog, highlight the power of drawing as a learning tool. They quote the work of Wammes et al. which demonstrated that the reason that drawing is a powerful learning strategy in improving learning outcomes is that when you draw something, you integrate three types of processing:

  1. Cognitive elaboration
  2. Pictorial coding
  3. Motoric coding (when you draw something you also create a motoric trace in your brain)

By integrating all three, you create a contextually rich representation that facilitates and improves remembering/learning.

In a previous Blog I featured the work of Morium Howlader, a general practitioner who studied medical art, she provided us with imaginative illustrations drawn while making notes to a presentation by Paul McMenamin at AMEE 2017 in Basel, Switzerland. These can be seen here.

Perhaps we should encourage our students to make greater use of drawing as an aid to learning.

Kirschner, P.A., Neelen, M. 2019. And the Winner is....Drawing! 3-Star Learning Experiences. Accessed on 9th September 2019 at

Wammes, J.D., Meade, M.E., Fernandes, M.A. 2017. Learning terms and definitions: Drawing and the role of elaborative encoding. Acta Psychologica, 179, 103-113.

New features at AMEE 2020

Plans are well underway for the AMEE 2020 Conference in Glasgow, 5th-9th September. We will be looking at the predictions made at our 2000 conference, Horizon scanning in medical education – A 2020 Vision and look at where education may be going in the next 10 or 20 years. Another theme of the conference will be sustainability. Glasgow is hosting the UN Climate Change summit also next year, with an expected 30,000+ delegates – somewhat more than AMEE’s conference! I was interested to see in a recent article in the Times Higher Education argued that while working towards more sustainable campuses and conferences, more important was the inclusion of sustainability as a theme in the curriculum.

The reference to exploring an escape room as a feature of the 2020 Conference has attracted attention and I would be interested to hear from anyone who has experience with organising such a facility. We had three short communications in Vienna on the theme.

Scholarship – are you showing your work?

Are you showing your work? is the theme of the Mission to Learn Lifelong Learning blog of 10th September 2019. It argues that a lot of learning is lost because people don’t do a good job of showing their work to others. They may capture only the explicit steps – the type of information you find in an average instructional manual or recipe book. More information is needed. It is suggested that as scholars the teachers should show work to others and that this involves three elements.

  1. Firstly, as you engage in any new learning or teaching experiences take the time to ask “what have I done that will be useful to others who want to learn what I have learned or taught”?
  2. Secondly, capture in more detail what you are doing as you go, including taking screenshots where appropriate.
  3. Thirdly, share your work with others, including using social media. This is what scholarship in medical education is about.

A symposium on scholarship in medical education is planned for AMEE 2020 in Glasgow. AMEE has set up a working group to produce an agreed definition of what we mean by “scholarship”.

What’s wrong with meetings?

To a greater or lesser extent, as part of our job, we attend meetings. Often these do not feel productive. Allison Vaillancourt, Vice President, Business Affairs and Human Resources and Professor Practice, School of Government and Public Policy at the University of Arizona, invites us to think about meetings we are leading and are attending and ask these questions :

Who is doing all or most of the talking?

Who is not listening?

Who can’t seem to break into the conversation?

And most important, what are we going to do to break those patterns?

Part of the problem, she argues, stems from repeat offenders: leaders who dominate discussions and people who feel ignored in silence. I was disappointed at some recent meetings to find that some of the participants whose opinion I valued and who had a potential useful contribution to make to the discussion were not invited by the chairman to speak. Alisson Vaillancourt describes how, at the beginning of a meeting she is chairing, she writes down everyone’s name and then makes tick marks as each person speaks. She then tries to create space for those who are not speaking. Although people don’t like rules, she suggests that it may be useful to have some rules such as “raise your hand to speak”. She suggests that one strategy is to rotate the leadership and responsibilities of the meeting which gives powerful people a chance to listen. It is hard to be both a meeting facilitator and a full participant. Few of us can balance both roles effectively.

Backward design relevant to medical education

I find of interest the trends in education outside medical education. As described in Essential Skills for a Medical Teacher the concept of outcome-based education was described by Spady in schools in the US in the 1990s. The most recent version is “Backward design”, a term that comes from a larger framework called “Understanding by Design”, developed by Grant Wiggins and Jay McTighe. Mike Feldstein gives a useful explanation of this approach which I think very much applies to what we are trying to do with outcome- and competency-based education. He suggests that at its most basic the idea is that educators should be asking “what are the learning goals” from the moment they start planning their course. “Rather than starting with a collection of content and activities and putting it into a sequence, educators should start by articulating the end goals for the students (where an end goal is broad enough to encompass high-level and non-cognitive goals such as “a love of reading”)”. Feldstein highlights three key tenets of Understanding by Design (UbD):

  • The UbD framework helps focus curriculum and teaching on the development and deepening of student understanding and transfer of learning (i.e., the ability to effectively use content knowledge and skill).
  • Understanding is revealed when students autonomously make sense of and transfer their learning through authentic performance.
  • Teachers are coaches of understanding, not mere purveyors of content knowledge, skill, or activity.

There is a close parallel to what we are trying to achieve in outcome- and competency-based education.

In the same blog Feldstein also refers to another education development with parallels in medical education – programmatic formative assessment.

Wiggins, G., McTighe, J. 2012. Understanding by Design® Framework. ASCD. Accessed on 16th September at

Feldstein, M. 2019. The Content Revolution. e-Literate. Accessed on 16th September at

Top cited articles in impact factor journals

I was interested to note that in 2018 the top cited article in impact factor medical education journals was A BEME systematic review of the effects of interprofessional education: BEME Guide no 39 by Scott Reeves and colleagues. In 2017 Medical Teacher was also top placed with the top cited article by Olle ten Cate Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No 99.