2023 TEACH Education Day

I wanted to really acknowledge members of the very family who are here p and lives in Brock thank you for being with us today and I know having you here brings additional meaning for many of us in in really remembering Rick and his amazing contributions uh to our medical school and the Legacy that he leaves from all of those all of us who remember him that's the main Legacy any of us will have but also in this case in this particular lecture so um that's why we establish an endowment fund with lots of support from people in this room and elsewhere to fully fund and endowment that would allow us to invite uh internationally renowned experts to come come um give uh the Rick Barry Memorial endowed lecture and so it's my pleasure now to introduce our second annual Richard very PhD and D lecturer um Dr Ronald Harden uh after graduating from medical school in Glasgow Dr Harden completed training and practice as an endocrinologist before focusing his career full-time on medical education he is currently an ameritus professor of medical education at the University of Dundee and editor-in-chief of the internationally renowned Journal medical teacher his former roles include SEC General Secretary and treasurer of Amy the association for medical education in Europe and teaching Dean and director of the Center for Medical Education at the University of dunde Dr Harden's contributions to Excellence in medical education have attracted numerous Awards including the kolinska Institute prize for research in medical education which has been equated to the Nobel Prize for medical education he was awarded by the queen the order of the British Empire for his services to medical education and more recently received the gooy Peace Prize for servicing medical education at a ceremony in Manila um and also an honorary degree of doctors of law at dunde uh earlier this year he received the lifetime achievement award from the president of the National University of Singapore during the 2023 Asian Pacific Medical Education conference so with all of these a you know accolades to him and all of the uh asks that he receives to come and give talks like this it's particularly special that he is with us today he's someone in very high demand uh having a career-long set of achievements that anyone would be extremely proud of during his career Dr Harden has developed new approaches to curriculum planning assessment teaching and learning he pioneered several Innovations in medical education that we talk about every day the oi OB the objective structured clinical examination which has been almost universally adopted as a standard approach to assessment and clinical competency the concept of the Spiral curriculum in which content is Revisited in strategic ways throughout the stages of medical education the spices model uh for curriculum plan it's not the Spice Girls model I think it's spice for curriculum planning uh and models of outcome based medical education that are now becoming very very popular in medical education in the US as well he has published more than 400 papers in leading journals and is co-editor of authoritative guides and handbooks with practical skills for medical teachers as I looked over all of that all of those Publications I was impressed that they were really all geared toward translating Theory into practice in extremely helpful ways uh not only staying grounded as the best medical Educators do in theory but to really put it to use in variety of ways variety of offerings for people who wish to take those Concepts and put them into use in his talk today Dr Harden will be sharing Concepts from two books the eight roles of the medical teacher was published in 2018 and is a resarch I'm sure many of you know well by this time his most recent book The Changing role of medical students was published earlier this year it was co-authored with his daughter Jenny harden a social scientist with extensive experience teaching both medical and social science students so with Great Expectations Dr Harden please join me in welcoming Dr Ron Harden Dean liman thank you for your generous comments and for arranging your journey to come back with us this morning that's difficult thank you very much indeed I've received as you mentioned a number of awards and invitations but really I was especially touched when I received this invitation to address in in the memory of of Rick um it meant a lot to me to receive this invitation thank thank you I appreciated the opportunity I had with Rick to talk talk about medical education and to share sometimes even his challenging views he shared with me his passion for the subject Rick was really a a great guy and I'm genuinely delighted to be here with you today to per celebrate that over the years I've had a number of special memories and one came back to me yesterday sitting in the garden with Patty at her house cuz I remember there a number of years ago when we sat in the garden one delightful evening and had a most marvelous challenging conversation about a range of things medical education but also about gardening which is my other passion um and also we're acced by for me the first time a spectacular demonstration of fireflies in the tree and I've never seen before then or even since then uh the far fibers way so that was a very special occasion Rick played as we all know a pivotal role in the school he was Professor Merit of basic science education but from my personal knowledge of him he influenced medical education really around the globe he was a truly International person and received numerous Awards I perhaps knew most of him when he was president of the International Association of Medical Science Educators where he did an an excellent an EXC job one of Rick's interests always shared with me was his interest in students and teachers and that's why I've chosen that as the theme for my presentation [Music] today we were all in this together I I chose this small brief video just to introduce this theme which I think was one of Rick's Passions the changing role of students and teachers the changing role of students and teachers and that's what I want to explore with you today why this is such an important theme we we tend to think of the curriculum in terms of the learning outcomes content sequence teaching learning methods and assessment and I heard some very good description of your own curriculum here this morning but a way back some years ago Joseph Schwab gave this semin paper on the curriculum he said yes these are all very well in the curriculum but key to the curriculum he call them common places key to the curriculum are the teachers and students that what is the curriculum it's not just the learning outcomes the content Etc is the teachers and students and way back some 63 years ago in the Scottish medical journal there's a paper on the future of the curriculum and so dere D Lop who was physici to to the queen at that time said it's important to remember the actual details of the curriculum matter little in comparison to the selection of students and teachers students and teachers if these are any good any system will work pretty well if they're indifferent the most perfect curriculum will fail to produce results students and teachers are the key elements and that's what we're talking about today that's why I chose it as the theme and I think Rick would have approved this this notion of the changing role of teachers and students because someone asked me last night in your garden what did I see as the most important development in medical education and really it's what I'm talking about today it's the most important development in the next decade I believe will be this changing role of students and teachers as partners together working together as in that aare video clip in the International journey of students as partners it talked about students and teachers working in Partnership to enhance learning and teaching to enhance learning and teaching it was a shared responsibility and we talked about this in the book I just published earlier this year with with my daughter that was a new experience for me as well the changing role of medical students and we talked about in that book the roles of students as information processors curriculum collaborators even students as assessors students as teachers P assisted learning scholar professionals and facilitators of their own learning and the reason for writing that book we had written a couple years before with bat Wily this book The Eight roles of the medical teacher and someone several people said to us but that's all right but what about the student these are the roles for the teacher but the other key partner in the process is the student the teacher and student as partners we talk in that other book about the roles of the teacher as information provider facilitator curriculum developer assessor role model manager scholar and professional these are exciting times in medical education all sorts of developments but if they're to succeed some of these exciting new technologies new educational strategies I'm arguing today it all depends on the teacher and the student these are the ingredients the secret ingredients of success and whatever these changes we're planning in the next decade or Beyond it matters this collaboration just a small video clip here we need to collaborate but what does that mean collaboration is more than just working together with others to really work together effectively especially when resources are tight we need to invest in good collaboration okay good collaboration means sharing the responsibilities risks benefits and the credit good collaboration also means that everyone who is involved Works toward a common goal collaboration between students and teachers what I want to suggest that there are a number of challenges we have facing Us in Health Professions education a number of challenges information overload challenge of future proofing our students the challenge of delivering an authentic curriculum of an authentic assessment to go along with the curriculum and finally this challeng ship of scholarship in education and I want to suggest that if we are to meet these important challenges the only way we can proceed is by looking at how we can do this in Partnership teachers working with students so I want to look at each of these and just point out the changing role that teachers and students have if we have to meet these five important challenges first the the challenge of information overload I think we're all familiar with this we know that knowledge is doubling every 73 days was the last figure I saw in in the biomedical Sciences huge information overload we know there more than 60 ,000 diagnosis in medicine more than 6,000 intervention do we expect our students to know all of these and these are rapidly changing that figures I think about three years out of date there's probably many more now the literature there's more than 24 million records and even more alarming these are expanding at the rate of 2,100 new articles every day information overload how we we going to deal with this problem Illustrated this example here see we've got this jar and we can't get all the Marvels into it there's been a huge expansion of knowledge but the time for training isn't increased when I completed my undergraduate course in Glasgow it was a five-year course it's still a five-year course but just look how much more information there is and I think we have to accept that all the information required by a doctor for his lifelong practice in medicine can't be covered in the curriculum and the implications therefore of this phenomenon for teachers and students how do we behave what do we do differently firstly in terms of the roles of the teacher one of the traditional roles is as information provider I was an endocrinologist and when I was a junior lecturer I thought my job was to pass all my information about enology onto the students this is Paul warley the de at fenders and he gave a talk at I Amy I don't know if R was there or not but in San Diego a few years ago and he pulled out his iPhone and he said to all the teachers present look are you wasting your time giving lectures because all your students need to know about your subject is better taught probably on this iPhone use your time more productively for other problem solving or other activities the teacher really should no longer be be simply seen as a transmitter of information but we should be curators of information there's huge amount of information out there we're talking ear this morning and yesterday at the Garden as well about the different resources available to help our students now particularly relating to coid so we should be curators of this information there's a very interesting paper in the AIL medical teacher John cookson talked about this notion of curators it's an interesting Insight he compared it to curators in art museums and so on and we are curators for our students of information and the role of our students are also changing in response to this information overload they have also responsibility as information processors information processors and what they have got to find the strategies to improve their information processing we often don't even think about teaching this but we know not much more about how information is stored and how it's used from sensory memory working memory long-term memory to output and how can we help our students to develop these stages and these strategies they can become better information processors so that's the first role of thinking of our students but there's another even or more important role the students are not just recipients of information but they should be taught as information Seekers because no longer can Rec cover all the information they need in medical school when they qualify for a lifetime practice they've got to find out and seek the information themselves and Chuck fredman in this article talked very much about this he said well three things as teachers we should be doing in medical school is helping our students to ask the right question secondly to identify source of information where the goal to find the answers and thirdly evaluating the answer and with this topic isue false truths and so on it's very important these are the three things we should teach our students as information Seekers this is my granddaughter Cara and I said to her I need to phone your mother what's her phone number and do you know it and she said yes I know it I said well what is it then and she went and her bag and took out her iPhone I said I thought you said you knew it she said I do know it here it's in my iPhone information seeking so information overload the first challenge that we've got to think what's our role as teachers and what's the students role in processing information the Second Challenge I've suggested perhaps one that's not so well recognized but I think there should be high up students and school's agendas now is future proofing their students future proofing what do I mean well this is was my grandson Rory and ages ago he dressed up like this and said to me I think he was trying to please me he said I I'm going to be a doctor but what do I need to learn to be a doctor what do I need to learn to be a doctor now it was interesting I was thinking at that time that he would going to medical school maybe no everywhere than 2028 he'd be finishing undergraduate program in 2033 he would complete his postgraduate training in 2039 if it all successful but he'd be practicing medicine till the year 2074 and the question is what would you have to learn to become a doctor how do future proof Rory for practice in 2050 and Beyond was really a key question how to Future proof him I was sitting at our graduation of our students in dunde and thinking some of them will be still practicing medicine 30 years later probably many more and have we really taught them how they'll practice it for their lifelong learning so the roles of the teacher I think we've got to think one of our key role of our teachers is to prepare our students for lifelong learning it's not what we teach them in what I taught our students in endocrinology is probably redundant how will they prepare them for lifelong learning we talked about this move to self-directed learning I prefer the word directed self- learning because I think teachers still have a role to help students direct their learning helps students to direct their learning so if there's some sort of obstacle in the future for their Journey students have got to cross this obstacle using the Navy teach as teachers we can help them lay stepping stones so they can cross this obstacle so as teachers we still have a role to help our students in this future Direction and the students too have a role in facilitating their own learning changing facilitating their own learning thinking of the future and they're preparing themselves for lifelong learning they realize that not what they need this week to pass next week's exam are they preparing for lifelong learning there's a lot been written about this notion of self regulated learning the Amy guide on the topic where students take control of their own learning so students have a different role now it's not what they're taught in the lectures that matter but are they taking control of their own learning and inde for example this is just taken some of our notes on the student choices curriculum designed so that students can design do the work individually or in pair do they want to use the self assessment we provide at the beginning or the end of a program do they want to read text and some of the online programs or do they want to listen to an audio commentary when do they want to study and for how long and in what depth these are all choices the student has to make in regulating their own learning and in personalizing their learning to their own specific needs so future poing the student a key challenge for us in the future with implications for the student and how approaches they're learning how as we as teachers approach our teaching are we really preparing our students for lifelong learning and the students preparing themselves for lifelong learning the third challenge I put up is an authentic curriculum I think we all know the report and the landet report and the quotation from Frank to professional education has not kept paced with these challenges largely because of fragmented outdated and static curriculum that produce ilip graduates he saying the curriculum is not kept paace and isn't and abusing inquit graduates so the the challenge is are we developing a curriculum that will prepare our students for their work and meeting the needs of the patients they're serving and it's a notion of an authentic curriculum I think it's a challenge our Learners have to develop the ability to perform in the workplace as the doctor so is it have we got a curriculum that trains our students to work better in the workplace as a doctor you will see must I'll be moving down Ivory Tower or as in this cartoon have we got the medical at one side the Ivory Tower and then we're assuming with some sort of leap of faith these students who go through our Ivory Tower training will perform well in the real world will meet the needs of the patients they're about to serve and what we need is an authentic curriculum that will do just that that will bridge this this gap between our ivory Tower and the real world an authentic curriculum so our first role as a teacher in curriculum development is to make sure that we've got an authentic curriculum that would do just that and the role of students as a partner they can help us work on this authentic curriculum it was an article in the Times Higher Education talked about a useful Pair of Hands it said the rise of students as curriculum Consultants even students working with us in developing the curriculum this was an article we published a medical teacher written by two students from Imperial College in London and during coid They seized the opportunity to work over and take charge and they ran the curriculum for several weeks developed new resources and to is student driven but Shan cedia in the article says however students as partners this might raise some eyebrows after all AR teachers there to teach and students there to learn and she commented that they overcame an obstacle but when they started this work people didn't believe it because weren't you there just to learn we're there to teach the teacher there to teach but said this was a very conservative view but by the time they finished this was completely changed and teachers had now appreciated their grow as partners in the process students as curriculum collaborators students evaluating the curriculum students as membership of curriculum committees and as I suggested with the Imperial Co Sharon's work as co-producers of the curriculum there was in Edinburgh my daughter was involved with this course in Edinburgh where she teaches producing a course for educating patient with physical activity and students actually took charge of this course the collaboration in developing this course they developed the course content developed the learning resources the learning approaches students worked on it as co-collaborators and this was another case study from Keel University with a self student partnership to develop authentic pbl courses and these were two students who had experienced of cyal cell disease and they developed from their lived experience a a program for students by the student so many examples that this isn't just science fiction this is a reality students can actually help and develop the curriculum but not only authentic curriculum helped with by the students but authentic assessment but here in the real world it's not that easy at [Music] all CU When Hearts get brok his real tears and fall in the real world is not that easy at all and assessment is not easy in the real world in fact it's probably the area where there's most disagreement between even experts in the subject but teachers and students have a changing role in assessment it's important for the teachers to look at authentic assessment Don Melnick chairman of the national board wrote some time ago it's the curriculum that instructs teachers what to teach but it's the exam that instructs students what to learn so what we set in the exams if it's not authentic if it's nothing to do with practice of medicine students won't bother learning it so it matters what we do to deliver as teachers an authentic assessment and for students too they have a changing role in assessment as assessors of competence I think they can help us check the authenticity of assessment they should be on the Committees that are responsible for the curriculum and for assessment and think can is this assessment we're having does it match what are the learning outcomes or competences expected but beyond that I think they have an important role in self assessment a ro self assessment this is a a family out for a picnic on the river but they really haven't assess their own situation very well and I think we need to think about self assessment and I really like this quote from if mind matters we must constantly remind ourselves but the ultimate purpose of evaluation is to have students become self-evaluating if students graduate from our schools still dependent on others to tell them when they're adequate good or excellent and we've missed the whole point of what education is about so the challenge of education help our students to evaluate themselves again back to thinking a few slides back these students or may be still practicing 17 2060 or whatever beyond that are they competent they've got to assess themselves so checking authenticity of assessment self assessment but there's a third changing role for student we need to think about and this is challenging to us as teachers is the role of students as peer assessment we're talking about how do we assess students attitudes it's important one of the competencies but how do we do that and I'm suggesting peer assessment students can p important role in this it's difficult but it's an important role just give an example of the problem this is Harold Shipman I don't know what you know the tragic story of Harold Shipman he was a general practitioner a family physician in the UK and this I think can't happen now but a number of years ago he was responsible for the death of more than 300 of his patients I mean just think of respon to the death of more than how can that happen he graduated from medical school went into general practice and I happen to know someone who was in the same year of him at at school and she said to me look we weren't surprised to read about this at all he was a terrible with patients we never dream for example of having if he was a doctor treating ourselves or our families he just complet with the wrong attitudes to Medical practice and yet he got 10 in the top 10% of the class for a in the exams and graduated but he but who knew about this maybe some of the staff had ideas but it's the student who really understood this and if we'd asked the students if the school had asked the students about his attitude and buil in some student dimension for Attitudes it would have been found out that he was inappropriate and should not have qualified so students have a role in assessment authentic assessment and finally scholarship in education we're hearing much more about the need for evidence-based practice in education and scholarship in education and as teachers I think there's a changing role as Scholars changing role where we have to much more reflect on what we're doing as teaching reflect on it we've got to review the evidence there's evidence out there the best evidence medical collaboration I think we now published over 100 guides with evidence on different aspects of education and we've got to undertake re research and I know some of that happening here research in medical education and innovate bring about changes in education these are all responsibilities for the next decade and they've got to communicate about what we're doing at meetings on medical education so the teacher as a scholar but also one of the key roles of the student the student is also scholar and school's got to work with as a partner in reflecting on the teaching it's a partnership and in reviewing the evidence and searching innovating and communicating and almost impressed at the Amy meetings some of the presentation some of the best presentations on research and education is given by students and in our Journal medical teacher uh way back in 2000 there very few student as co-authors only about 2% but by 2010 it had risen to about 10% of papers but look by 2017 it was over 15% of the papers were co-authored by students I really need to update this to to last year and I expect it's even higher so students are really showing genu collaborating co-authoring papers working with staff with teachers in research and medical education reflecting on it and communicating it in the journal so a true Partnership of teachers and students so I've highlighted what I saw as five challenges facing us in The Next Period information overload future proofing our students the need for an authentic curriculum and authentic assessment and the importance of scholarship and education and I think for all these if we have to face these challenges we must to think about the implications for students and teachers and recognize there's a changing role things aren't as they were five or 10 years ago there's a changing what do we mean by being a good teacher what do we mean by being a student the role is changing and I've tried to summarize some of these in this session on the changing role of teachers and students why do I stand up here anybody to feel taller no thank you for playing Mr Doon I stand upon my desk to remind myself that we must constantly look at things in a different way see the world looks very different from up here you don't believe me come see for yourselves come on come on just when you think you know something you have to look at it in another way even though it may seem silly or wrong you must try now when you read don't just consider what the author thinks consider what you think you have to look at something in a different way and that's I suppose what I'm suggesting that we need to do is to look at things in a different way in terms what's the role of teachers and students not the traditional role when I qualified all these years ago and when in the report from Australia a number of years ago said things won't change because of the conservatism of the medical teachers and medical profession things have to change but we've got to look at it in a different way and in education leadership it talk about giving students more ownership of the learning students as partners in the learning process indeed we've talking in the last few years about threshold Concepts in medicine what are the things students really need to know before they move on to the next phase in the medical curriculum well maybe rather provocatively I want to challenge Us by suggesting that there are some threshold Concepts in medical education as teachers if we have to go on thinking about how we're working in curriculum committees and developing ourselves as teachers there's a threshold concept and what I'm going to suggest is a threshold concept that we've all got to matter master is this acceptance of this changing role that we have as teachers and the changing role students have as working with us as partners this is an important threshold concept the student has a partner and in our book we talk about this participation ladder where in the bottom step there's no participation by students no partnership with them in the curriculum and at the top uh students are complete control as they we for a short time at Imperial uh probably both ends of the ladder are not attainable but the question is where do we want to be as a school where does the school want to be on this ladder of student participation we suggest there are eight different steps how actively we want to work with students in the curriculum as we move up the ladder there's more involvement of students as we move up the ladder there's shared decision making as we move up the ladder there's more equality and we destroy away from this hierarchy is very strong embedded in US conservatively and medical schools so where do we want to be on this ladder the the the last slide I want to end just with this it's the book by Thomas fredman who probably know from other books The World is Flat and so on he said in this book he was once waiting for a visitor and the visitor arrived 20 minutes late who was very apologetic and he said don't apologize for being late thank you because what has done has given me time to think I don't normally have time I'm so busy with my day-to-day work that I don't have time to think and what waiting for you has given me time to think and what I think situations like this opportunities to attend me and to talk about these challenges facing Us in medical education are time for us to think so thank you for again for inviting me Deen and colleagues delighted to be with you and I'd be pleased I think we have a few minutes to have your comments on perhaps at times provocative views but challenging views on medical education thank you.