Association For Medical Education In Europe Research Articles

AMEE Faculty Development Committee internship: A collage of social learning experiences

An internship with the Association for Medical Education in Europe (AMEE) Faculty Development (FacDev) Committee has proven to be a useful approach to engaging and supporting emerging faculty developers through social learning and communities of practice. An essential aspect of this internship process is to expand the membership of the faculty development team, fostering the individual and collective capabilities required to navigate the complexity of implementing AMEE faculty development goals.

A planetary health-organ system map to integrate climate change and health content into medical curricula.

Health professionals must be prepared to address the health risks and impacts of climate change Between 2030 and 2050, climate change is expected to cause about 250 000 additional deaths per year.1 This does not include deaths from pollution, mental illness, extreme weather events and resultant migration and conflict, all of which carry significant morbidity and mortality risks. The medical profession has a responsibility to prepare practitioners and the health system for the escalating challenges of this health crisis. Even though planetary health frameworks, consensus statements, and early teaching experience have begun to be reported,2-10 persistent barriers to the implementation of planetary health concepts, including the health impacts of climate change and the principles of sustainable health care, are evident within medical education.11, 12 Consequently, the implementation of this content into predominantly biomedically focused curricula is frequently piecemeal, opportunistic, unidirectional and poorly related to clinical practice.13, 14 Internationally, the emerging curriculum principles to address this challenge align with global health priorities. Specifically, addressing the socio-economic and environmental determinants of health under the United Nations Sustainable Development Goals framework (https://sdgs.un.org/goals), indigenous eco-health-centric leadership, promotion of systems thinking and change, and experiential, practice-based learning that cultivates interprofessional teamwork, advocacy and leadership development.3-7, 9, 10, 15 A 2019 interactive perspective provides a useful open access resource in this direction.16 More recently, Emory University students and staff reported their experience in the incorporation of climate content into selected aspects of the pre-clinical curriculum.17 In Australia, Medical Deans of Australia and New Zealand (MDANZ) established a Climate Change and Health Working Group, which has proposed graduate outcome statements and learning objectives that incorporate the environment as a health determinant, health care sustainability, and the health effects of climate change.18, 19 At the time of publication, the Australian Medical Council is reviewing the accreditation standards of primary medical programs and has released updates to the National Framework for Prevocational Medical Training, strengthening a top-down national approach to producing climate-aware and prepared practitioners. There are many steps between developing new accreditation standards and actual delivery to learners. The three key strategies are: i) integrate climate change as a cross-cutting core theme, ii) facilitate educators and students sharing knowledge and teaching one another in this emerging field, and iii) relate learning to clinical practice.11 An intermediate step is to link existing organ systems focused preclinical studies with the impacts of climate change on the health of individual patients. In response to these challenges, students and faculty volunteers, all members of the Doctors for the Environment Australia at the University of Melbourne, collaborated to form the Planetary Health Curriculum Taskforce. This group was driven by student advocacy seeking to address a perceived gap in their curriculum. We contend that such cocreation is essential to accelerate the integration of such urgently needed curriculum content by adopting the highest level of pedagogical methods and to model the intergenerational collaboration required to address this “wicked” challenge. We sought to achieve three objectives (Box 1) and conducted our work in three phases (Box 2). First, student focus groups from all years of the medical school identified planetary health learning opportunities within the existing curriculum structure. DEA = Doctors for the Environment Australia. Second, we did a structured literature review, via two student and faculty workshops, to map climate change and health literature content and themes to the classical organ systems framework of first year medicine (Box 3). We incorporated the principles of sustainable health care, such as environmental footprint assessment and valuing the health cobenefits of decarbonisation, as well as the opportunities for medical students to learn applied skills and behaviour. Engagement with the First Nations health team helped us to incorporate Indigenous-led content, an identified area for further action by Australian and New Zealand public health and medical educators.12 WHO = World Health Organization. Source: Reproduced with permission from Burch et al.20 Phase three consisted of expert peer review by seven specialist, generalist and public health clinicians with teaching and research experience in climate change and health. Each clinician was allocated two organ system blocks and instructed to review and edit content for clinical relevance, strength of evidence, and quality of writing. The final synthesis, inclusion of images, figures and executive summaries were completed by the Curriculum Taskforce student members, with design support from Doctors for the Environment Australia. The outcome was an infographic-rich curriculum resource, a planetary health–organ system map,20 which is being used as a resource in first year medical teaching. Our systematic, student and faculty codeveloped process and clinical focus are an example to others seeking successful integration of planetary health into their curricula. Central to our approach was the application of the three selected models (Box 3). This process identified and explored the multidirectional relationships between broad public and planetary health content and person-centred biophysiological mechanisms. We achieved this by connecting literature content using Model 1 headings (eg, cardiovascular organ system) and Model 2 (relevant social determinants of health) and Model 3 content (relevant major consequences of climate change). As an example, Box 4 shows a mechanism for heatwave-associated acute myocardial infarction from the planetary health–organ system map. Source: Reproduced with permission from Burch et al.20 There is clear recognition by peak Australian medical bodies of the importance of climate change and our professions’ role not just in preparing practitioners, but in advocating for climate-conscious health care and broader mitigation policies.21, 22 This has led to an emergent discussion about planetary health at all levels of Australian medical education. Our methodology and output may assist medical educators in addressing the challenges of integrating climate change education into their own teaching.11 For example, as this approach enables students to share their knowledge and experiences with teachers outside of formal classroom boundaries, it may support the evident lack of medical educators proficient in planetary health teaching. Empowering students as leaders and partners in learning and developing education material is known to improve their effectiveness as learners and confidence in teaching.23 It also explicitly promotes higher order relational and extended abstract reasoning by students (Blooms’ revised taxonomy levels 4–6) — the ultimate task of any curriculum.24 Despite not being formally evaluated, we observed that the students involved in this project achieved the Association for Medical Education in Europe (AMEE) planetary health and education for sustainable health care consensus statement aims of “knowledge, skills, values, competence and confidence”.9 Our mapping output also addresses the need for learning resources that are centralised, accessible and frequently peer reviewed. Our focus on clinical relevance helped narrow the scope of literature and developed the curriculum resource towards use in practice. This strategy connected theory with patient care in a way that ensured concepts could be translated into clinical skills. Even though it was designed for one context, the organ systems structure and clinical relevance also allow learning points to be drawn from this resource for prevocational, vocational and continuing professional development teaching. Our approach also aligns with recent understanding that planetary health is a theme akin to ethics or leadership that should spiral through the core curriculum.11 In this context, biomedical planetary health learning primes students for subsequent clinical training. Our initial successes, including deriving a climate change-themed tutorial from the map and precipitating a review of planetary health curriculum opportunities within the Doctor of Medicine (MD) program redesign, parallel those of the Emory student–staff collaboration.17 The process of expanding the map to cover more of the MD curriculum, regular peer review of emerging evidence and increasing interprofessional collaboration is ongoing and has garnered formal support through seed grant funding.25 We encourage the formal recognition of planetary health as core to any medical curriculum, with dedicated resourcing from the top-down and codesign from the bottom-up. We recognise and value the concurrent higher level advocacy of the MDANZ Climate Change and Health Working Group in supporting our grassroots project,18, 19 as well as allyship from our interprofessional and First Nations health colleagues.25 A remaining challenge, given the assessment-driven nature of medicine, is the development of “assessment for learning” inclusive of planetary health. We have not reviewed the assessment blueprint of the University of Melbourne MD program. However, we propose this as a valuable exercise, as assessment often strongly correlates with students’ prioritisation of content.26 Ultimately, the role of medical professionals in providing leadership, advocating for sustainable health care and adopting evidence-based strategies for the management of planetary health-related risks has been widely acknowledged.9, 21, 22 Our methodology to generate the planetary health–organ system map presents a model for engaging learners through codevelopment of a novel learning resource. Our infographic-rich map also provides an example of systematic integration with existing curricula and an opportunity for strengthening planetary health leadership in medical education. We thank the members of Doctors for the Environment Australia (DEA) for their clinical and research expertise, and the organisation for its graphic support to produce our final curriculum mapping resource. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.

Leveraging medical education resources to enhance instruction in accounting education

The objective of this paper is to provide an introduction to high-quality, practical, and evidence-based instructional resources from medical educators that can be adapted and adopted by accounting educators. The American Accounting Association (AAA) Pathways Commission Final Report set a goal of accounting becoming a learned profession by 2036. An AAA Presidential Scholar has advised that the achievement of this goal will require collaboration with other academic areas inside and beyond the business school. Responding to this call, this paper identifies a subset of Association for Medical Education in Europe (AMEE) Medical Education Guides that are relevant to accounting educators interested in problem-based learning (PBL), team-based learning (TBL), peer assisted learning (PAL) and reflection. Other opportunities for application of the medical resources to faculty responsibilities in teaching, research and service are shared to encourage accounting educators to learn from a well-established learned profession.

Perception of Pharmacy Teachers About Their Roles and Current Practice at Governmental Universities in Sudan.

BackgroundPharmacy educator has a number of roles and responsibilities, an information provider, clinical trainer, role model on-the-job, formal teaching settings, course planner and resource material creator, student assessor, and curriculum evaluator.ObjectiveThis study aimed to assess the perception and commitment of pharmacy teachers in Sudanese governmental universities about their roles and educational responsibilities.Materials and MethodsDescriptive cross-sectional study was conducted at governmental pharmacy colleges in Sudan from November 2020 to July 2021. Data were collected using an online self-administered questionnaire adapted from the Association for Medical Education in Europe (AMEE) Guide No. 20. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 26 and Microsoft Excel version 16.ResultsOut of 125 participants, 61.6% were female and 65.6% were lecturers. Approximately half of them had less than five years’ experience. The most important role perceived and the highest committed one was a lecturer in the classroom setting. Only half of the participants had good perceptions and commitment regarding teachers’ roles. Age, designation, and continuous professional development were significantly associated with participants’ commitment. Also, a significant association was found between the perception and practice of the participants.ConclusionOnly half of pharmacy educators were found to have a good perception and good commitment regarding their role as teachers.

AMEE Consensus Statement: Planetary health and education for sustainable healthcare

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to ‘rapid, far-reaching and unprecedented changes’ to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet. The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals. This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. ‘Consensus’ implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE). To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as ‘the system comprising structures, curricula, faculty and activities contributing to a learning process’. This Statement is relevant to the full continuum of training – from undergraduate to postgraduate and continuing professional development.

Performance assessment: Consensus statement and recommendations from the 2020 Ottawa Conference

Introduction In 2011 the Consensus Statement on Performance Assessment was published in Medical Teacher. That paper was commissioned by AMEE (Association for Medical Education in Europe) as part of the series of Consensus Statements following the 2010 Ottawa Conference. In 2019, it was recommended that a working group be reconvened to review and consider developments in performance assessment since the 2011 publication. Methods Following review of the original recommendations in the 2011 paper and shifts in the field across the past 10 years, the group identified areas of consensus and yet to be resolved issues for performance assessment. Results and discussion This paper addresses developments in performance assessment since 2011, reiterates relevant aspects of the 2011 paper, and summarises contemporary best practice recommendations for OSCEs and WBAs, fit-for-purpose methods for performance assessment in the health professions.

Twelve tips for facilitating and implementing clinical debriefing programmes

Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a ‘guided reflective learning conversation’, is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.

Test Items Validation in the Context of Education Export

It is necessary to develop special assessment tools for international students, which will comply with the principles of evidence-based education. This is especially important in the context of Russian higher education export. Multiple choice questions (MCQs) are an essential part of the assessment and are suited for assessing the knowledge level of international students. The “Organic chemistry” is a basic course for pharmaceutical students, which is necessary for the understanding of principal subjects. The study objective was to develop a normative-oriented model of the “Organic chemistry” MCQs based examination for international students (the specialty 33.05.01 “Pharmacy”) in accordance with the recommendations of the Association for Medical Education in Europe (AMEE). The previously developed interactive “Organic Chemistry Test Simulator”, created at the Sechenov University, was used as the basis for the examination MSQs bank. It was analyzed by five independent experts, who work as teachers of organic chemistry. The average timing and the cut score were determined by the Angoff method, 90 sec and 64%, respectively. Among analyzed MCQs the 3% were found irrelevant, 22% were recommended for revision and modernization. Valid MSCs (600 items) served as the basis for the creation of extended examination MSQs bank. An algorithm for modeling the “Organic chemistry” MCQs based examination was proposed. The standardized examination test has 30 MSQs of different types. The standardized normative-oriented model of the “Organic chemistry” MCQs based examination for international students (the specialty 33.05.01 “Pharmacy”) was validated in terms of relevance and representativeness, optimized in time and cut score.

Twelve tips for organising speed mentoring events for healthcare professionals at small or large-scale venues

Mentors play a critical role in the development of professionals, influencing their job satisfaction, career aspirations and evolving professional identity. A variety of mentoring models exist, each with distinct benefits and challenges. Speed mentoring, based on the concept of speed dating, provides mentees with opportunities to meet multiple mentors over a short time and pose focussed career development questions. At large-scale events such as the annual AMEE (Association for Medical Education in Europe) meeting, speed mentoring sessions can successfully connect aspiring, novice and mid-career educators with international educational leaders to facilitate transfer of valuable insights for professional growth. For some mentors and mentees, this might spur ongoing communications or even longitudinal relationships. In this paper, we aim to provide strategies for planning and implementing speed mentoring events, combining insights gained from the literature and our experience of organising speed mentoring at the 2019 AMEE meeting in Vienna. These tips will be useful to a variety of professionals planning to organise speed mentoring initiatives.

Development of an Instructional Design Evaluation Survey for Postgraduate Medical E-Learning: Content Validation Study

BackgroundE-Learning has taken a firm place in postgraduate medical education. Whereas 10 years ago it was promising, it now has a definite niche and is clearly here to stay. However, evaluating the effect of postgraduate medical e-learning (PGMeL) and improving upon it can be complicated. While the learning aims of e-learning are evaluated, there are no instruments to evaluate the instructional design of PGMeL. Such an evaluation instrument may be developed by following the Association for Medical Education in Europe (AMEE) 7-step process. The first 5 steps of this process were previously performed by literature reviews, focus group discussion, and an international Delphi study.ObjectiveThis study will continue with steps 6 and 7 and answer the research question: Is a content-validated PGMeL evaluation survey useful, understandable, and of added value for creators of e-learning?MethodsThere are five phases in this study: creating a survey from 37 items (phase A); testing readability and question interpretation (phase B); adjusting, rewriting, and translating surveys (phase C); gathering completed surveys from three PGMeL modules (phase D); and holding focus group discussions with the e-learning authors (phase E). Phase E was carried out by presenting the results of the evaluations from phase D, followed by a group discussion. There are four groups of participants in this study. Groups A and B are experienced end users of PGMeL and participated in phase B. Group C are users who undertook e-learning and were asked to complete the survey in phase D. Group D are the authors of the e-learning modules described above.ResultsFrom a list of 36 items, we developed a postgraduate Medical E-Learning Evaluation Survey (MEES). Seven residents participated in the phase B group discussion: 4 items were interpreted differently, 3 were not readable, and 2 items were double. The items from phase B were rewritten and, after adjustment, understood correctly. The MEES was translated into Dutch and again pilot-tested. All items were clear and were understood correctly. The MEES version used for the evaluation contained 3 positive domains (motivation, learning enhancers, and real-world translation) and 2 negative domains (barriers and learning discouragers), with 36 items in those domains, 5 Likert scale questions of 1 to 10, and 5 open questions asking participants to give their own comments in each domain. Three e-learning modules were evaluated from July to November 2018. There were a total of 158 responses from a Dutch module, a European OB/GYN (obstetrics and gynecology) module, and a surgical module offered worldwide. Finally, 3 focus group discussions took place with a total of 10 participants. Usefulness was much appreciated, understandability was good, and added value was high. Four items needed additional explanation by the authors, and a Creators’ Manual was written at their request.ConclusionsThe MEES is the first survey to evaluate the instructional design of PGMeL and was constructed following all 7 steps of the AMEE. This study completes the design of the survey and shows its usefulness and added value to the authors. It finishes with a final, publicly available survey that includes a Creators’ Manual. We briefly discuss the number of responses needed and conclude that more is better; in the end, however, one has to work with what is available. The next steps would be to see whether improvement can be measured by using the MEES and continue to work on the end understandability in different languages and cultural groups.

The ASPIRE-to-Excellence Program: A Global Effort to Improve the Quality of Medical Education.

Publications and organizations ranking medical schools rely heavily on schools' research-oriented and grant-success data because those are the publicly available data. To address the vacuum of evidence for medical education quality, in 2012 the Association for Medical Education in Europe (AMEE) introduced an initiative entitled A Schools Programme for International Recognition of Excellence in Education (ASPIRE) awards. ASPIRE panels of international experts in specific areas of medical education have developed internationally peer-based criteria to benchmark excellence in social accountability, student engagement, student assessment, faculty development, and simulation; they plan to publish criteria on curriculum design and development in 2018. Schools are encouraged to use ASPIRE criteria to challenge themselves and, for a fee, may submit evidence that they have met the criteria for excellence in one or more of the five areas. The international panels then judge the evidence submitted by the school and determine whether an award of excellence is merited.The authors share lessons learned from five years of program experience. Of the 88 schools submitting evidence, 38 have been recognized for their excellence in one of the ASPIRE topic areas. As the number of representatives from the schools that are awarded ASPIRE recognition continues to increase and those individuals find new ways to contribute, hopes are high for this program. Challenges remain in how to better define excellence in low-resources settings, what new areas to take on, and how to keep infrastructure costs down. However, as an example of continuing global interaction for quality improvement, optimism prevails.

Academic outcomes of flipped classroom learning: a meta-analysis.

ContextThe flipped classroom (FC), reversing lecture and homework elements of a course, is popular in medical education. The FC uses technology‐enhanced pre‐class learning to transmit knowledge, incorporating in‐class interaction to enhance higher cognitive learning. However, the FC model is expensive and research on its effectiveness remains inconclusive. The aim of this study was to compare the efficacy of the FC model over traditional lecture‐based (LB) learning by meta‐analysis.MethodsWe systematically searched MEDLINE, PubMed, ERIC, CINAHL, EMBASE, reference lists and Association for Medical Education in Europe (AMEE) conference books. Controlled trials comparing academic outcomes between the FC and LB approaches in higher education were considered eligible. The main findings were pooled using a random‐effects model when appropriate.ResultsForty‐six studies (9026 participants) were included, comprising four randomised controlled trials (RCTs), 19 quasi‐experimental studies and 23 cohort studies. Study populations were health science (n = 32) and non health science (n = 14) students. The risk of bias was high (36/37 articles). Meta‐analyses revealed that the FC had significantly better outcomes than the LB method in examination scores (post‐intervention and pre–post change) and course grades, but not in objective structured clinical examination scores. Subgroup analyses showed the advantage of the FC was not observed in RCTs, non‐USA countries, nursing and other health science disciplines and earlier publication years (2013 and 2014). Cumulative analysis and meta‐regression suggested a tendency for progressively better outcomes by year. Outcome assessments rarely focused on behaviour change.ConclusionsThe FC method is associated with greater academic achievement than the LB approach for higher‐level learning outcomes, which has become more obvious in recent years. However, results should be interpreted with caution because of the high methodological diversity, statistical heterogeneity and risk of bias in the studies used. Future studies should have high methodological rigour, a standardised FC format and utilise assessment tools evaluating higher cognitive learning and behaviour change to further examine differences between FC and LB learning.

Are good attributes of medical teachers more important than the learning style: a glimpse into the future of medical education and learning

Teachers in medical school have the golden opportunities to shape and change the future of medical discoveries, by inspiring new generation of medical doctors for research, education, and clinical trials. For some medical students, they can determine the choice of their medical subspecialty. A good teaching of best quality will be delivered when there is deep understanding of different educational learning theories that influence leaning. It is expected that medical education will focus on: integration of information between basics sciences and clinical sciences, changing learning structure and learning in community and remote settings, authentic curriculum (adding social and behavioural sciences) and students and student engagement. The concept of students; engagement with curriculum was endorsed by the General Medical Council (GMC) in 2011 and the Association for Medical Education in Europe (AMEE) in 2015. The four key principles that can be applied by medical teachers in their day to day teaching are based on the feedback, activity, individualisation, and relevance. Importantly, feedback provides basis for correcting mistakes, clarifying goals, and reinforcing good practices. The activity meant to indicate that student is actively involving in learning. Individualisation meant to be learning experiences that matches the need of individual student. The relevance of the materials taught (clinical, basic sciences and social and behavioural sciences, communication skills, professionalism and evidence-based medicine). Therefore, the role of the teachers may be more important than the leaning style, especially in medicine and in particular academic medicine. In this review, I will explain why the adoption of theories of learning style may decrease the potential of doctors to explore other beneficial options that add more diversity and success to their career and be part of the academic medicine. It is possible that the attributes of our good medical teachers can influence our progress in our medical career rather than the learning style.

Registrars teaching undergraduate medical students: A pilot study at the University of Pretoria, South Africa

Background. Registrars play a vital role in teaching undergraduate (UG) medical students. Previous studies indicate that registrars contribute as much as 30% of medical students’ knowledge and that up to 20% of a registrar’s time is spent on teaching UG medical students. The Association for Medical Education in Europe (AMEE) Guide No. 20 defines 12 roles of a teacher, including an on-the-job role-model. Objective. To evaluate the perception and attitudes of registrars with regard to their role as teachers of UG medical students. Methods. A questionnaire-based study with qualitative and quantitative aspects was conducted at the Faculty of Health Sciences, University of Pretoria, South Africa. Results. Despite numerous attempts, the response rate to the study was very poor, with only 25 registrars participating. This pilot study indicated that registrars were mostly involved with on-the-job training, followed by ward rounds and practical sessions. The attitudes towards teaching included that registrars deemed teaching as beneficial, with only three indicating that it should not be done by registrars. Advantages of teaching included own learning opportunities and gaining confidence in teaching. Registrars’ own workload and lack of time hampered teaching. The majority of registrars indicated that receiving training with regard to teaching would be useful. Conclusion. Our pilot study concurs with international studies, indicating that the benefits of teaching medical students include knowledge acquired by registrars. Studies showed that the knowledge obtained in this manner outweighed that obtained by self-study/attendance of lectures. The on-the-job role-model as part of teaching is applicable to registrars. The international literature indicates that until recently registrars were not offered a formal teaching programme. Our study echoed this, with only one student indicating that it is not necessary, as registrars should not be expected to teach.

ASPIRE-to-Excellence Academy

The ASPIRE-to-Excellence Academy was recently founded at the 2015 Association for Medical Education in Europe (AMEE) conference in Glasgow. The academy is new pillar of the ASPIRE-to-Excellence initiative by AMEE, which aims at promoting and encouraging medical schools in achieving excellence in the categories of assessment, student engagement, social accountability or faculty development. The Academy panel consists of the members of the ASPIRE Board and representatives from schools which have been recognised with an ASPIRE-to-excellence award in one or more of the categories. Major goal of the ASPIRE-to-Excellence Academy is to foster collaboration between excellent medical schools and to allow them to exchange experiences and Best Practices. The Academy members are organising workshops and symposia at international conferences to inform medical schools about the ASPIRE-to-Excellence programme and the areas for recognition in excellence as well as to support medical school in preparing their applications.

The editorial term of Professor Henry Walton (Volumes 10-31).

As part of our continuing celebration of the 50-volume history of Medical Education,1 this editorial is the second in a series that offers a retrospective look at the phases of the journal marked by each editor's tenure. It is the last that I will write on someone else's behalf. Unfortunately, this is necessary because Professor Henry Walton, our second editor-in-chief, passed away in July 2012,2 exactly a week before the Henry Walton Prize was awarded by the journal for the first time. He was aware that this prize had been named in his honour and, in hindsight, his reaction to the news seems ominous because I have come to realise that it was his final correspondence with me. In a missive sent in May 2012, he wrote: ‘Honoured and delighted. Just out of hospital, AND WILL WRITE FURTHER’ [sic]. I share that note because the emphasis so clearly demonstrates that Henry remained passionate about both medical education and Medical Education right to the end. Like my first contribution to this series,3 this editorial is not meant to be about the editor per se, but aims to cast a reflective light on an easily defined period in the journal's history. It is particularly hard to separate the man from the journal in this instance, however, as Professor Walton's tenure as editor-in-chief lasted 21 years, nearly a quarter of his life, and represents a record that is unlikely ever to be broken. His contributions and longevity led the Association for the Study of Medical Education (ASME) to award him the title ‘Editor Emeritus’. It is equally hard to imagine ever writing a piece on the journal during Walton's tenure without using an art-associated metaphor, given that he was such an avid collector, and it is doubly fitting to do so because many journals make decisions about the contents of their publication through a hanging committee. As someone who has experienced his fair share of rejections, I initially inferred this title to represent a rather morbid description of the group's task. In reality, the notion of a hanging committee is drawn from the art world, in which it describes a group that decides which pieces should be hung on the walls of an exhibition space. It is a reference that I value deeply because although we strive to prioritise the empirical examinations that science promotes, every journal article is best thought of as an imperfect representation of the world that is offered to prompt reflection and provide insight, and its appeal always resides in the eye of the beholder.4 Given his passion for art, perhaps it is not surprising that the predominant themes of the period of Walton's curatorship include diversity and compassion. He described compassio medici as the ‘regard for humanity shown by students and practitioners of medicine’.5 In doing so, he shrewdly argued that evidence for the importance of compassio medici ‘is confirmed by the efforts to feign this quality by those lacking it’.5 That regard for humanity was clearly represented in the journal during this period based on the volume of consideration given to ways of determining how students themselves could be treated as humans. Many articles made it clear that the medical education community was concerned with student satisfaction while simultaneously pushing to eradicate belief in the existence of a single method of instruction that would be right for all students,6 or a single personal background (academic or otherwise) that would best position one for a successful career in medicine.7 This created a productive tension represented by Walton's argument that ‘while variety of method and content is desirable, variation of standard is not’.8 Walton himself personified that dual focus as he became founding president of both the Association for Medical Education in Europe (AMEE), a group that was brought together to examine, celebrate and learn from the different approaches to medical education taken across different contexts, and the World Federation of Medical Education (WFME), an organisation formed to create high standards and to encourage medical schools around the globe to achieve them. Medical Education continues to enjoy an association with the WFME, which is worth noting in this context because its efforts during the period of Walton's editorship might best epitomise the focus of the journal at that time. In 1988 the WFME released the Edinburgh Declaration, which outlined 12 principles aimed at augmenting existing educational practices.9 Since their publication, these principles have remained core to the focus of our field1 and no fewer than four of them are represented by chance in this issue alone. Of course not all such lines of inquiry from Walton's tenure have stood the test of time. Fortunately, for example, the scintillating debate about whether or not large textbooks should be split into multiple volumes seems to have run its course. Who could have ever questioned the argument that ‘having the text divided into six separate handsome volumes makes for more comfortable handling than would be the case with a single great tome’?10 What has clearly stood the test of time, however, is the tone set by Medical Education during Walton's leadership which decreed that the field should be international in scope and focus. Such breadth had been evident during the preceding years,3 but Walton's first act of shortening the journal's name from The British Journal of Medical Education sent a clear message that the journal and the field ‘should have wider aspirations’ and that he would not settle for what he called ‘parochial and colonial implications’ (H Walton, personal communication, 2012). By curating an art gallery with such breadth of appeal, Walton laid an enormous challenge before us. He did so, however, with the confidence of someone who was convinced that ‘medical education has reached a state of readiness for responding, as never before, to the needs of communities for improved health care, both on a national and international basis’.11 As further evidence of that readiness, and in keeping with the theme of identifying treasures for the discerning collector, we have dedicated the entirety of this issue to the section we call ‘Medical education in review’. In it you will find nothing but scholarly syntheses of the literature on topics ranging from selection,12 through examinations of performance development during training,13 to ways to conceive of clinical supervisory competencies that are learning-focused.14 The papers included are deliberately diverse with respect to the methodologies they use in order to reflect the fact that, even in the context of literature synthesis, it is important to match the approach with the problems being addressed. Further, I believe this represents the aesthetic value enjoyed by our field because, frankly, it would be an awfully boring gallery if every picture were to be painted the same way. In addition to commentaries on the individual articles, we have also invited three well-known ‘art critics’ (i.e. individuals who have built their academic reputations in part upon their critical analyses of review methodologies) to facilitate our tour by offering overarching thoughts on the purposes of and strategies for reviewing literature in effective, meaningful and insightful ways.15-17 We hope you enjoy your visit to the gallery and, if you do, please tell a friend and purchase a souvenir in the gift shop as you exit.

The active participation of German-speaking countries in conferences of the Association for Medical Education in Europe (AMEE) between 2005 and 2013: a reflection of the development of medical education research?

Objectives: Medical education is gaining in significance internationally. A growing interest in the field has been observed in German-speaking countries (Austria, Germany, Switzerland) since the early 2000s. This interest is not, however, reflected in an increase in the number of publications on medical education of German-speaking authors in international professional journals. The following investigation examines the potential use of active participant numbers of German-speaking researchers at AMEE conferences as a means of measuring said development. Methods: The AMEE conference proceedings from the categories poster presentations, short communications, research papers and plenary presentations from the years 2005-2013 were examined for evidence of Austrian, German and Swiss participation. The abstracts were subsequently analysed in terms of content and categorised according to study design, methodology, object of study, and research topic.Results: Of the 9,446 analysed abstracts, 549 contributions show at least one first, last or co-author from Austria, Germany or Switzerland. The absolute number of contributions per conference varied between 44 in 2010 and 77 in 2013. The percentage fluctuated between 10% in 2005 and 4.1% in 2010. From the year 2010 onwards, however, participation increased continually. The research was predominantly descriptive (62.7%). Studies on fundamental questions of teaching and learning (clarification studies) were less frequent (4.0%). For the most part, quantitative methods (51.9%) were implemented in addressing subjects such as learning and teaching methods (33%), evaluation and assessment (22.4%) or curriculum development (14.4%). The study population was usually comprised of students (52.5%).Conclusions: The number of contributions from Austria, Germany and Switzerland peak at the beginning and at the end of the evaluated period of time. A continual increase in active participation since 2005 was not observed. These observations do not reflect the actual increase of interest in medical education research in German-speaking countries.

Henry Walton

Henry Walton, who died on 13 July this year, aged 88 years, was an extraordinary man who made outstanding contributions to this journal and to medical education more widely. He edited the journal in its various forms for more than 30 years. It was his vision and drive that transformed the British Journal of Medical Education into the International Journal of Medical Education and then into, simply, Medical Education. The global reach and worldwide responsibilities of medical education lay at the heart of his work and his achievements. Henry grew up in South Africa and graduated from the medical school in Cape Town. After postgraduate training in London and New York, and subsequent to a short period back in South Africa, he was invited to take up a Chair in Psychiatry at the University of Edinburgh in 1963. His clinical research interests included suicidal behaviour, alcoholism and the inter-relationships of physical and mental illnesses presenting in general hospitals. From the outset of his career in Edinburgh, Henry devoted much of his time to research in higher education, completing a PhD in the teaching of psychiatry in the mid-1960s and helping to found the Society for Research in Higher Education in 1971. Within higher education, medical education was Henry’s passion. His role in creating and developing institutions devoted to improving medical education is unequalled: he was secretary and then president of the Association for the Study of Medical Education (ASME), a founder and the first president of the Association for Medical Education in Europe (AMEE), and a founder and first president of the World Federation for Medical Education (WFME). In 1986 the University of Edinburgh appointed Henry to the Chair in International Medical Education. In this role and as president of the WFME in 1988, Henry organised the World Congress in Medical Education that produced the Edinburgh Declaration. The 12 principles set out in that document have proved to be of great influence. In particular, they underpin the WFME global standards that represent a benchmark for quality in medical education and are applied directly or indirectly in countries across the world. Henry was honoured with many awards, notably the Gold Medal of the Albert Schweitzer Academy of Medicine in 2003. This list of achievements does not capture the unique style that Henry brought to all his activities. I had the privilege of working with Henry in both his clinical and educational spheres. He was gracious and charming in manner, but tenacious in the pursuit of his goal: his was a steel hand in a silk glove. Silk is an appropriate description; immaculate in his attire, Henry was never afraid to dress with an edge of flamboyance in the conservative world of medicine. Art collecting was the other enduring passion that Henry pursued with energy, determination and success. As in his dress, he was eclectic: his collection contained challenging examples of modern art, as well as drawings by various of the Old Masters and Chinese jade pieces. High quality was his only requirement for the decision to purchase. Variety and individuality attracted him in art, in psychiatry and in medical education. In his clinical work, Henry insisted on a rigorous personality description, as well as an illness diagnosis. In medical education, he was particularly interested in the learning that takes place in small groups. In all three spheres, he wished to understand the interactions of an individual with his or her specific context and environment. The quality of his art collection led to its acceptance in 2010 by the National Galleries for Scotland. Henry’s art collection is one of his legacies; the Edinburgh Declaration is another, but the third, in my view, is his greatest: Medical Education. This journal continually develops and changes because Henry set it free from the limitations and preoccupations of one country to enable it to become a forum for those interested in improving medical education, wherever they live and work.

Medical education in Saudi Arabia: An exciting journey

Medical education is on today’s agenda. What students learn, how they learn, where they learn and how the learning is best organised and assessed are questions being addressed, not only by medical education enthusiasts or educational researchers but more generally by healthcare professionals, the public and politicians. The increased interest and participation in local, national and international meetings on medical education, such as the Conference organised by the Association for Medical Education in Europe (AMEE), which now attracts 3000 participants, is evidence of this growing interest in the field. An expanding number of texts on the subject such as ‘A Practical Guide for Medical Teachers’ which is now in its fourth edition are now available. The number of papers submitted for publication on the subject is also expanding. Each week in the Medical Teacher office, almost 25 new manuscripts are received for consideration. In Saudi Arabia, there has been a corresponding increase in interest in medical education and a rapid expansion in the number of medical schools, with the number doubling over the past five years to 31 (Bin Abdulrahman 2011). The Saudi Deans Committee and the Saudi Society for Medical Education have been active in the field of medical education, and among their contributions has been the development and publication of a learning outcome framework – ‘Saudi Meds’ (Zaini et al. 2011). Medical education departments are a feature of many medical schools in the Kingdom and these have been a focus for developments in the field. In this supplement to Medical Teacher, some of the interesting on-going work in medical education is summarised. The 13 papers published were selected from almost 40 papers submitted, as a result of a review process involving regional and international referees, with the aim of providing an overview of some of the work in medical education currently underway in the Kingdom. In medical education, there has been a move from a teacher-centred to a student-centred model (Harden et al. 1984) with recognition that the importance of the student is paramount. It is therefore significant that seven of the papers included in this supplement address issues specifically relating to the student. The move to ‘self-directed learning’ has been more appropriately referred to as ‘directed self-learning’ (Harden & Laidlaw 2012), with the teacher’s role as one of the facilitator of the learning through the provision of guidance for students as to what they should learn and the options available to support this. Al-hazimi (2012; this supplement), based on his experience with a cardiovascular module at King Abdulaziz University, Jeddah, describes how a study guide can be used to support student learning. Much has been written about students’ engagement with PBL. Alghasham (2012; this supplement) from Al-Qassim College of Medicine offers an interesting perspective. He reports how students with different learning styles respond in different ways to PBL. This is an interesting area for further exploration in the pursuit of creating learning opportunities more personalised and tailored to the needs of the individual student. Another paper by Alamro and Schofield (2012; this supplement) from the same Medical School describes how traditional PBL can be supported with online discussion forums. The learning environment to which the student is exposed

Performance in assessment: Consensus statement and recommendations from the Ottawa conference

In 2011 the Consensus Statement on Performance Assessment was published in Medical Teacher. That paper was commissioned by AMEE (Association for Medical Education in Europe) as part of the series o...