Summary: In his latest blog Professor Harden gives his thoughts on returning from IAMSE in Burlington, how to evaluate the flipped classroom, the problem in applying information, the errors often made regarding an effective learning strategy and more. Description: Thoughts from IAMSE in Burlington
Just back from an interesting IAMSE 2017 meeting in Burlington, Vermont, USA. According to Bill Jeffries, among the many claims to fame for Vermont is that it is the state with the happiest twitter users. The conference was hosted by the University of Vermont School of Medicine. In welcoming the participants the dean, Dr Fredrick Morin, reported that the school had made the decision to transition by 2019 from lectures to an active learning programme. The school had received an astonishing $100 million grant to support the transition.

We had an AMEE exhibit and associated with the conference we ran with Adi Haramati an ESME course. I was impressed by the 26 participants, many of whom were experienced teachers.

How do you evaluate the flipped classroom?
Inevitably one of the themes talked about at the meeting was the flipped classroom, with the expression of different viewpoints. I was left wondering about the evaluation of the initiative. How long is it necessary to implement an innovation before passing judgement on its success? I remember my experience many years ago implementing a self-learning programme in endocrinology. It was at least four weeks into the programme before students fully appreciated the value of the programme which replaced the standard lecture course. As with many innovations, another key factor which may be difficult to quantitate is the preparation and commitment of the teachers. On what criteria should one evaluate the success of the initiative? Some studies look only at student and staff opinions. While this is of value it is not enough. Others look at the performance in examinations, usually knowledge-based MCQs, but I think this misses the point of the flipped classroom. If it was simply about knowledge transmission, there are many arguments for the traditional lecture. An advantage of the flipped classroom, however, is that it encourages the student to take more responsibility for their own learning and to think more about the application of knowledge to practice.

A problem in applying information
The first plenary presentation at the conference was by Eric Mazur – The confessions of a converted lecturer. He reported that he thought he was a good teacher until he discovered that his students were simply memorising information rather than learning to understand it. He demonstrated this by engaging the conference participants with a short presentation on the theme of thermal expansion. He then posed a problem for the participants to tackle. Imagine you have a rectangular steel plate with a circular hole in the middle. What happens to the size of the hole when the plate is heated? Does it 1. Increase in size, 2. Remain the same size, or 3. Decrease? He invited the participants to come to their individual decision and then to discuss it with their neighbour and perhaps come to a revised conclusion. What do you think? The correct answer is at the end of the blog.

We often get it wrong about an effective learning strategy
Active retrieval promotes meaningful learning was the theme of a plenary presentation by Jeffrey Karpic. Students frequently choose to engage in inferior strategies like repetitive reading when learning. In contrast, practicing actively reconstructing one’s knowledge while studying has an important effect on long term learning. Incorporating retrieval practice into educational activities is a powerful way to enhance learning. The effectiveness of simply repetitive reading as a learning strategy is a cognitive illusion and can be considered as “labour in vain”. Other effective learning strategies he highlighted were elaboration (going beyond the material studying and thinking how it relates to prior knowledge), organisation (putting the material into an organisational scheme), looking at similarities and distinctions (how are concepts similar or different?), variability (learning in different situations) and spacing (engaging over time). Spacing was the rationale for my advocating a spiral curriculum in Dundee (Harden and Stamper 1999).
Harden, R.M. & Stamper, N. 1999. What is a spiral curriculum? Med Teach. 21(2). 141-3.
http://www.tandfonline.com/doi/abs/10.1080/01421599979752

Should we admit students on the basis of their rationality?
The importance of rational decision making in healthcare was made by Pat Kroskeri in the final plenary presentation. The principal cause of mistakes by individuals is how individuals think (procedural knowledge) and not what they know (declarative knowledge). He discussed the two types of decision making – intuitive and rational. More time needs to be spent in the curriculum on decision making and promote reflective practice. He went as far as suggesting that, because of its importance, rationality should be assessed as part of the admission and selection process for medical studies. It is now possible to estimate a rationality quotient which he believes is of more relevance to medicine than an IQ as we need students who have an enhanced ability to make rational decisions. Vote if you agree or disagree in this week’s poll. I suggested that the concepts he highlighted about decisions made by doctors in medical practice might be applicable with regard to teachers in teaching practice. This is an area I think needs further exploration.

What about open book exams?
There were a number of short communications at the meeting that attracted my interest. One particular one was whether physicians can develop an understanding of the relationships between multiple metabolic pathways and underlying health and common disease states without necessarily memorising those pathways. The suggestion was that memorisation of pathways actually inhibits relevant learning. The Association of Biochemistry Education have been exploring making available for students during examinations a copy of a metabolic pathway (metabolicpathways.stanford.edu/map). I suggested that this was a first step towards moving to an open book examination which more closely represents the real world.

AMEE 2017
We continue the final preparations for AMEE 2017 in Helsinki and have almost 3500 participants enrolled. I have talked on a Skype call with Peter Wardell the magician who is the speaker in the opening plenary of the Sunday evening and I was impressed about the potential messages he has for medical practice and how thinking like a great magician can elevate our day-to-day interactions with patients. If you are not able to join us at AMEE 2017 in Helsinki you can participate in plenary and symposia sessions or view later recorded videos through AMEE Live Online from the convenience of your own home or office by registering on the AMEE website (https://amee.org/conferences/amee-2017). We are repeating this year the Hackathon, run previously in Glasgow. I understand that more than 1500 students applied to participate in the Hackathon. If you are joining us in Helsinki there are still some places available in the preconference workshops including two on Sunday 27th August afternoon on Top Tips for Teaching Social and Behavioural Sciences in Medical Education and A practical approach to contextualising assessment in the biomedical sciences.

OSCE in Russia
There is growing interest in medical education in Russia. Zalim Balkizov has made an important contribution and promoted AMEE in the country. I was interested to hear from Zalim that since 2017 the OSCE has been adopted to accredit all medical graduates (more than 40,000) in Russia. A training programme was put in place for examiners and chairs of the examination commission.
 
Answer to the Mazur problem
When the plate is heated, the circular hole in the centre expands in size as the atoms in the steel around the hole need more space with the raised temperature. This could have been deduced from the information in his presentation but more than half the participants did not.