Summary: In his latest blog Professor Harden reflects on his time in Abu Dhabi for the 18th Ottawa Conference, looks at the upcoming agenda for AMEE 2018 and for medical education as a whole, and finally discusses the upcoming IMEC meeting in Kuala Lumpur. Description: Messages from Ottawa 2018 in Abu Dhabi
The “good”, the “new”, the “controversial” and the “uncomfortable” have been themes at Ottawa Conferences on the assessment of competence in the health care professions (Hart & Harden 2000). They featured at the 18th Ottawa Conference in Abu Dhabi, 10th-14th March. In opening the conference, attended by more than 1000 participants from around the world, I suggested that established approaches to be discussed at the conference include the OSCE, the progress test and portfolios. New approaches to be explored included the use of entrustable professional activities, learning analytics, and new approaches to selection. Controversial approaches were the situational judgement test, national licensing examinations and competency-based assessment. The uncomfortable issues to be addressed included the problem of the failing student, the assessment of attitudes and the revalidation of doctors. The conference was opened by Sheikh Nahyan bin Mubarak Al Nahyan, Minister of State for Tolerance who, in welcoming conference participants to the Emirates, made a thoughtful presentation on the importance of education and the education of healthcare professionals (captured in the photograph). I was impressed with Sheikh Nahyan’s leadership and vision when, in 1984 under his chairmanship as Vice-Chancellor at Al Ain, I sat on a small transition committee to establish a new medical school in the Emirates.

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Perhaps at conferences we should hear more about and learn from failures as well as successes. Indeed this was suggested as a theme for an AMEE Conference. Meghan McConnell from Ottawa is to be congratulated for reporting at the Ottawa Conference the problems encountered when she tried to design an OSCE to assess and differentiate between the non-medical Expert CanMEDS roles. The group had to admit failure and returned the grant money that had been assigned to support the work. It was not clear whether the lack of success was due to a need for greater clarity and understanding of the different CanMEDS roles, a difficulty with the OSCE as an assessment tool, a problem with the approach adopted to implementing the OSCE or a need for wider consultation and input. Unfortunately there was no time to discuss the important issues raised as she spoke for 20 minutes rather than the 10 minutes allocated for the presentation. Chairs are instructed to keep the speaker to time but some find it difficult to interrupt the speaker. Some meetings use a red light warning system or the time remaining is shown on the screen. I have attended a meeting where the microphone was cut off 30 seconds after the allocated time.

The conference ended with powerful presentations that reported the work being done on updating three of the Ottawa Consensus statements on assessment of professionalism, good assessment practice and selection. The professionalism group chaired by Brian Hodges reported that the consensus statement originally published in Medical Teacher following the Ottawa Conference in Miami had attracted much attention and had had an important impact on the assessment of professionalism in countries around the world. Hopefully this will be documented in a paper. The proposed revised consensus statements were further refined with input from conference participants during the meeting. Drafts for discussion will be posted on the AMEE website (www.amee.org) prior to finalising updated statements. We will be looking at updating the other consensus statements on use of technology in assessment, performance assessment, research and assessment and assessment of interprofessional competence at the next Ottawa Conference in Kuala Lumpur in 2020. We would welcome suggestions as to other topics that could be the focus for a consensus statement.

In the final plenary at the conference Stephanie Hering from the Swiss Centre of Accreditation spoke on Educating tomorrow’s doctors – accreditation and quality assurance of medical education. In her presentation she listed the range of outcomes assessed. In the discussion that followed the presentation I raised whether sufficient attention had been paid to general abilities – there was no reference to abilities such as creativity. This seemed to generate some interest and several people spoke to me afterwards about the importance of assessing the ability in future doctors to bring about change, to innovate and to be creative. A recent article in the Sunday Times reviewed the new Curriculum for Excellence programme in Scottish schools and discussed whether schools should “teach facts or creativity”. Lindsay Paterson, professor of education policy at Edinburgh University argued that “facts combined with creativity make for the perfect formula” but it is difficult to implement this in practice.

The conference dinner was at a camp in the desert, after a thrilling ride over the sand dunes. At the desert camp we had a display of local culture. The photograph shows me with a falcon.

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Hart, I. & Harden, R.M. 2000. The Ottawa Conferences: the good, the new, the controversial and the uncomfortable. Med Teach. 22(4). 331-3.

Today’s agenda in medical education and AMEE 2018
We had a record number of manuscripts submitted for AMEE 2018 – about 3800. Each has been reviewed by three or four reviewers and we are now putting together the final programme. I always find it interesting to see the range of topics addressed and how this changes from year to year. This year there appeared to be more on the agenda about mentoring, EPAs, burnout and stress, and empathy. There is a continuing emphasis from last year on anatomy and selection. An issue raised by a few reviewers is “What is medical education?” Some reviewers questioned, for example, whether work with children at school with a view to interesting them in a career at medicine was relevant and whether relevant was the wider civic responsibilities expected of a doctor such as in relation to climate change.

We received 82 submissions from which we have to select 12 to include in the Points of View sessions at AMEE 2018. These highlight a number of important controversial issues in medical education including the fact we are educating students out of creativity, we need to tackle burnout, the potential of CBME and the need for constructive criticism, the need to talk about failures, tensions in postgraduate training that should be resolved, the case for computerised adaptive testing in progress tests, clinical sabbaticals for non-clinical educators, fundamental judgement reluctance, curiosity in medicine, patients assessing a doctor’s performance, the problem with PBL, how we manage fatigue, and the use of immersive technology. I will be interested to hear the conference participants’ reactions to the issues raised.

Manya Whitaker, assistant professor of education at Colorado College describes in ChronicleVitae how to get the most out of a conference. She recommends preconference workshops, networking opportunities and the exhibition with book stands.

IMEC 2018
I leave early next week for a meeting of the Academic Council of the International Medical University and the 2018 International Medical Education Conference (IMEC) in Kuala Lumpur. I will comment on the programme and papers presented in my next blog. For my own opening plenary I have chosen for my main message the theme “Dream, decide, do” from the newly published book Open to Think by Dan Pontefract and applied the thinking to the further development of technology enhanced learning in medical education. We should not use technology simply to do better what we are already doing but should use it imaginatively and creatively to improve learning.