Summary: Professor Harden discusses the current trend of top universities receiving low marks in surveys given to their students and the potential role of the ASPIRE-to-Excellence initiative in changing this. Description: “Students mark down teaching at top universities” was the headline of a feature in the Sunday Times 18th September. Research conducted for the 2017 edition of the Good University Guide shows elite Russell group universities occupy five of the bottom 10 places in a ranking based on students’ satisfaction with teaching quality. Edinburgh University came second bottom in the list and three top London Universities- Kings College London, University College London and Imperial College London –feature in the bottom 10.

As pointed out in the article the poor showing is potentially damaging as the government in the UK has indicated its intention to relate the right to raise student fees above £9,250 a year to a university’s performance in a new teaching excellence framework. This will measure university teaching performance and a key element will be the teaching quality reported in the annual student survey.

The ASPIRE-to-Excellence initiative is focusing attention on the need for quality in teaching and the establishment of the ASPIRE-To-Excellence Academy of schools who have received the ASPIRE accolade is an exciting initiative. Southern Illinois University School of Medicine have received three ASPIRE Awards as featured in their display case shown in the photograph

ASPIRE.jpg



The July to September 2016 issue of Educacion Medica, with Maria Rosa Fenoll-Brunet as guest editor, had excellence in medical education as its theme. As discussed in the article by Simon Drees and Harm Peters, a goal of the ASPIRE Academy is to foster collaboration between excellent medical schools and allow them to exchange experiences and best practices. The academy is organising workshops at AMEE conferences and supporting schools in preparing their application for an ASPIRE award.

Charles Boelen writes in the journal about excellence in relation to social accountability, Trudie Roberts about excellence in assessment and Madalena Patricio about excellence in student engagement – all fields where excellence is recognised in the ASPIRE initiative. It is noted in an article “ASPIRE-to- Excellence” by Dan Hunt and myself, as highlighted in the Sunday Times article, rankings based on research productivity do not reflect excellence in medical education. While processes are in place to accredit medical schools, there has been no measure that recognises their excellence in medical education. As we noted in the article, accreditation is a powerful tool for feedback but by its very nature is limited to establishing and evaluating minimal levels of achievement. The process is not suited to identifying exemplary components of a medical school. This hard truth was confirmed by efforts of the Secretariat of the Liaison Committee on Medical Education (LCME) in the USA. Attempts by survey teams to identify strengths when they visited schools as part of an accreditation visit were abandoned due to concerns about the reliability and validity of the findings. It was concluded that when standards were written to identify gaps and weaknesses it to almost impossible to use them to identify strengths. The decision was taken this year to remove the recognition of strengths entirely from the team report process. This highlights the need for the ASPIRE assessment process that recognises excellence.

During a conversation with staff from an elite university I asked if the medical school was considering applying for an ASPIRE award. The university, ranked highly based on their research activities, had decided after they looked at the criteria for teaching excellence that they did not meet any of these in the fields assessed to date. The question rises as to whether a university and medical school can ASPIRE to achieve excellence in both research and teaching. I hope the answer is yes but we need a greater recognition of this.

Teachers undoubtedly contribute in a major way to excellence in a medical school. The attributes of the effective teacher have been studied extensively and I tried to summarise these in my book with Jennifer Laidlaw -The Essential Skills for a Medical Teacher (with a second edition published in August). I am developing the theme further in a new book with Pat Lilley on the Eight Roles of the Excellent Medical Teacher, to be published next year. In an article in Advances in Health Sciences Education (2016, 21, 833-840) Haws and co-workers found that the attributes of effective teachers as perceived by students, differ between classroom and clinical settings. Preclinical medical students’ ratings of classroom teachers had previously been found to be associated with perceived charisma and physical attractiveness of the teacher. In this new study, twenty seven internal medicine residents had been asked to rate ten teachers whom they had worked with in the clinical rotation. No association was found between physical attractiveness and teaching effectiveness. Clinical skill and charisma were both associated with the rating of the teacher’s effectiveness. The question arises as to whether the difference between the findings in the different phases of the curriculum can be attributed to the different exposure of the students to the teachers or whether there is a genuine difference in what students perceive as making a teacher effective in the different contexts.

What makes a speaker effective at a meeting, as perceived by the conference participants, is a different story. I have been looking at the first batch of evaluation returns from the AMEE 2016 Conference in Barcelona. While some speakers were rated extremely highly by some conference participants others gave them a poor rating. We have some world class speakers lined up for AMEE 2017 in Helsinki and it will be interesting to see the participants’ responses.

Whatever we do in medical education, excellence and quality is on the agenda.