Summary: In his latest blog, Professor Harden discusses his return from APMEC 2017 and looks at opening a presentation, an international medical education ladder, the Uber-fication of education, generic skills, accountability for our products and two interesting meetings coming up in March. Description: APMEC 2017
I am just back from the 14th Asia-Pacific Medical Education Conference (APMEC) in Singapore. It proved to be another successful conference with more than 1100 participating in plenary sessions, small group sessions, poster displays and workshops. The AMEE exhibit attracted a lot of attention and a number of new members joined. Richard Hays, editor of MedEdPublish, met at the stand individuals interested in publishing in MedEdPublish and also others interested in joining the AMEE-MedEdPublish panel of reviewers. There was continuing interest in my books Essential Skills for a Medical Teacher and The Definitive Guide to the OSCE with a book signing session at lunchtime on the first day.
We had 52 participants in the ESME course. Those who complete their assignment, demonstrating that they have applied lessons from the course to their own teaching programme, receive the AMEE ESME Certificate in Medical Education. This now serves as credits for a number of Master courses around the world. In Singapore the ESME certificate is part of the Certificate in Health Education Course and is also part of the Singapore Residency Education Track.

Opening a presentation
It has been my privilege to have been invited to give a plenary presentation at all 14 conferences. Given the theme for this conference – “From globalisation of education to global healthcare” – my theme was The roles of the teacher in global education and global healthcare – what would happen if the teacher was not there? I believe the first minute and last minute of any presentation are probably the most important. With this in mind I have used a number of strategies to open my presentations including the use of a relevant piece of music, headlines from a newspaper article, a provocative quote or a story such as Zigland and the Blue Mountain Grass. I started rather differently on this occasion. I challenged the audience as to what Brezhnev’s Soviet Union in 1980, the hegemony of the Catholic Church in Ireland in the 1990s and the Lehman brothers in 2007 had in common. The answer, as highlighted in “An avalanche is coming: higher education and the revolution ahead”, by the Institute for Public Policy Research in the USA (2013), was that what seemed to be established institutions suddenly and without warning collapsed. The point made in the report is that the same fate could befall universities.

An international medical education ladder
I developed this argument in relation to international medical education and described an international medical education ladder with steps on the ladder:
  • Isolation: Local focus for the curriculum, teachers and students (The bottom step)
  • Mobility:  Mobility of staff and students
  • Globally focussed curriculum: Global health competencies addressed
  • Informal partnership: Collaboration with one or more international schools sharing learning resources and ideas relating to the curriculum
  • Formal partnerships: Elements of the course developed jointly and formally shared, for example learning resources and assessment
  • Unbundling the curriculum: Unbundling or disaggregation of the curriculum. The school does not provide all of the curriculum elements
  • Joint degree: Students trained in two or more schools and recognised by a joint degree.
I explored in particular the concept of internationally unbundling the curriculum and how this will change the role of the teacher. Finally in my presentation I challenged participants to consider what their role would be as a teacher over the coming years in relation to international dimensions of medical education and to vote which step on the ladder their school could reach.

Uber-fication of education
At the meeting it was suggested to me that perhaps we need a Uber-ification of education. An interesting thought! Colleen Flaherty had a feature on how academics need to rebuild public trust in higher education (https://www.insidehighered.com/news/2017/01/27/academics). One comment on the article referring to education, was “I suspect we are taxi-companies in the Uber age”.

Generic skills
A feature in medical education has been a move to an outcome- or competency-based approach with attention paid to generic competencies such as communications skills and critical thinking as well as to the traditional medical disciplines. I was interested to note in a recent blog by Kim, Care and Ditmore that there has been a similar movement in education more generally (https://www.brookings.edu/blog/education-plus-development/2017/01/24/new-data-on-the-breadth-of-skills-movement-in-education/). As part of the Skills for a Changing World project a study was made as to the degree to which the breadth of skills was reflected in national education policies and curricula in 102 countries. There was a strong indication that education systems were expanding beyond traditional academic disciplines, although there was a variation across countries. The most frequently identified skills were “creativity”, “communication”, “critical thinking” and “problem solving”.

Accountable for our products
We are increasingly being held accountable in medical education for the doctors that we produce and for problems that may result from poor practice. The medical director of an NHS Trust in the UK was accused by the General Medical Council of not investigating or intervening with regard to complaints against an obstetrician and gynaecologist. Outside medicine I noted the case of the lorry that, because of faulty brakes, ran into a crowd of pedestrians, killing four and seriously injuring others. It was not the young, inexperienced lorry driver who was put on trial but the mechanic who serviced the lorry and the owner of the haulage firm. They were sentenced to five and seven years in jail. In this week’s British Medical Journal, Simon Stevens, head of the NHS in England argued that as teachers we have a responsibility for our graduates and for a major overhaul of medical training that focuses more on the needs of the modern NHS. With the 1500 extra training places in the UK, he noted “It will take 10 years plus for those new doctors to be working in frontline clinical practice, but we’ve got to use the opportunity to ensure that the curriculum, the training experiences, and the support that undergraduates get are aimed at the health service we will have in 10 or 20 years–as against the health service of today, let alone 10 or 20 years ago…We would like to see a strong emphasis on primary care and psychiatry as well as a recognition of the importance of comorbidity and frailty, and a whole range of other things.” At AMEE 2017 meeting in Helsinki, we are looking more fundamentally at the sort of doctor we should produce.

Two interesting meetings in March
I am currently working on my presentations for, at what look like being, two interesting meetings. One is the first MedEdDXB2017 in Dubai, March 2nd and 3rd. International contributors are addressing topics including “Learner-centred education”, “Preparing the MD of the future”, “Community and patient involvement”, “Patient safety”, “Simulation”, “Use of technology” and “Compassion and healthcare education”. The second conference is a joint conference with AMEE “Training tomorrow’s doctors for China”, 16th March to 19th March in Guangzhou, China. While this conference is principally aimed at participants from China, anyone internationally who is interested in an update on what is happening in medical education in China and future developments would find the conference of interest. The conference is being organised by Trevor Gibbs together with Professor Xiao and other staff in Guangzhou. Themes include “Curriculum planning”, “Teaching and learning practical skills” and “Assessment”, with an international panel of speakers. AMEE will have an exhibit at both conferences and I would be pleased to meet with any AMEE members participating.