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The UCL Medical School 2012 Medical Education Conference: a summary
8 August 2012
Professor Peter Delves discusses the main themes and issues covered at this year’s conference.
Image courtesy of UCL Medical School
For the second UCL Medical School Medical Education Conference the theme was Teaching, Learning and Assessing in the Workplace. This followed a highly successful conference held in June 2011 which explored the impact that Tomorrow's Doctors (2009) has had on the UCL MBBS curriculum. This year’s event, which took place on 11th June 2012, was attended by 120 delegates. They were mostly from London and the South-East with approximately 30% UCL staff and the rest mainly clinicians from our teaching hospitals, with a few colleagues from the General Medical Council and the Royal College of Physicians.
The opening address was given by Professor Sir John Tooke, Vice-Provost (Health) and Head of the Medical School at UCL, who discussed the future of medical education both at UCL and more broadly within the UK. Sir John stressed that the changes currently occurring within the NHS presented significant opportunities for enhancing medical education. He was particularly encouraged by the fact that the NHS Future Forum recommendations to the UK government included 'Education and Training' as one of four themes. The Forum asserted that to deliver the NHS of the future all staff, not just professional staff, will require access to Continuing Professional Development (CPD). In response to a question from the floor, Sir John was able to reassure us that the government was very aware of the absolute importance of education and training in the NHS.
The UCL Partners Academic Health Science Partnership is responsible for 42% of all postgraduate medical education training in London. Particularly highlighted was the recent successful Medical and Dental Education Commissioning System (MDECS) bid by UCLP which will involve the delivery of Certificate, Diploma and Master’s courses to medical trainees. A strong foundation in science and clinical reasoning is absolutely core in order to make an accurate diagnosis, something we all want our doctors to be able to do. Sir John also reminded us that UCL Medical School was ranked first in London (and fourth in the UK) in the most recent National Student Survey, with an impressive overall student satisfaction score of 95%, but that we need to be constantly evolving and innovating in what is a challenging and exciting time to be involved in medical education.
Second up was Professor Janet Grant (Director, Centre for Medical Education in Context), who discussed developing as a medical educator. She stressed that medical education was the combination of knowledge, skill, practice and professional context and commended the UCL Medical School in its goal of producing 'The UCL Doctor', "A highly competent and scientifically literate clinician, equipped to practise patient-centred medicine in a constantly changing modern world, with a foundation in the basic medical and social sciences."
Professor Grant discussed the three stages of medical education: Basic Medical Education, Postgraduate Training and CPD, each of which has different characteristics. Competence is ensured by situational learning with immersion in the context of practice.
The final plenary session of the morning was given by Dr Gavin Johnson, Consultant Gastroenterologist at UCH and Senior Lecturer in Medical Education at UCL Medical School. Gavin discussed workplace-based assessment (WPBA), emphasising that this was a necessary activity to ensure public confidence, provide evidence of competence, drive learning, improve trainee confidence and rebuke legal challenges.
We were shown a picture of Miller’s ‘pyramid of competence’ (Miller, 1990), which is useful for mapping assessment methods to the four tiers of the pyramid. The bottom level of the pyramid is labelled ‘knows’ and can be assessed using simple true/false multiple-choice questions (MCQs). The next level up is ‘knows how’, which can be assessed using single best-answer questions (SBAs). Objective Structured Clinical Examinations (OSCEs) and mini-clinical evaluation exercises (mini-CEX) can assess the penultimate ‘shows how’ level, and for the final apex, ‘does’, assessment is by methods such as multi-source feedback (MSF) and the acute care assessment tool (ACAT).
The pros and cons of WPBA were outlined, and it was highlighted that the educational impact of assessment was often not investigated. Although there are many clear advantages to WPBA there are issues regarding time (for both the trainee and the assessor), appropriate physical space, potential conflict between the role of supervisor and assessor, the desirability of calibrating assessors throughout the UK, the validity of assessment methods, and how WBPA (which is formative in nature) informs summative decisions. The need for evidence-based consensus on how summative decisions are reached was also emphasised.
Delegates then split into four groups to participate in workshops that covered Enhancing feedback on workplace-based assessments; Making every moment count: strategies for teaching when time is short; Credentialing your teaching; and Student assistants: what’s new?. The word from the street is that, as with the afternoon workshops, these formed an incredibly valuable part of the conference. Certainly the one that I attended on making every moment count was useful even from the perspective of someone who is neither a clinician nor directly involved in clinical teaching.
After a splendid lunch, the plenary sessions continued with a double-act of the two Deputy Directors of UCL Medical School, Dr Deborah Gill and Dr Ann Griffin, giving a talk entitled ‘You’re not at school now: exploring participation and learning’. Learning as knowledge acquisition and as participation was discussed, as were the difficulties associated with the fact that the workplace’s prime role is not for learning. The question of whether we still value the concept of apprenticeship was also raised.
The conference then took on a distinctly international flavour, with presentations from Professor Karen Mann (Dalhousie University Canada and Manchester [UK] Medical School) and another double-act, this time from Christoph Pimmer (University of Applied Sciences North-Western Switzerland) and Professor Norbert Pachler (Institute of Education, University of London).
Professor Mann discussed the evidence in relation to the effectiveness of workplace-based learning, emphasising that this was actually the main type of learning that doctors are exposed to and that an empowering and encouraging environment is essential. Trainees need to ‘feel like a doctor’ whilst at the same time having adequate supervision. It is therefore important that there is a strong sense of community. The fact that learners desire feedback but don’t want it to be negative also needs to be carefully handled.
The Swiss/London duo then discussed their research, which aims to disentangle the dynamics of learning in clinical contexts. They suggested that doctors have roles as students, actors and participants, and that when functioning in an ‘actor’ role they are self-directed and autonomous, learning more and more in this role throughout their careers.
Prior to this presentation, there were again four workshops (including coffee, a mid-afternoon essential at any conference), this time covering Team learning; Should medical schools worry about prejudice in their students?; Focus on feedback; and What makes a good doctor? Can situational judgment testing deliver a better class of medical professional?.
Proceedings were rounded off by Professor Jane Dacre, Director, UCL Medical School, whose closing remarks reminded us that we had managed to pack politics, policy, theory, assessment, evidence and research into a single day. Jane, Deanne Attreed and their colleagues are to be congratulated on organising such an invigorating conference.
All of the presentations from this conference are available on the UCL Medical School website.
Peter J Delves, Vice-Dean (Education), UCL Faculty of Medical Sciences
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