Controversies in Med Ed via ICENet Summit 2014: Milan

By Jamiu Busari  (@jobusar)

On August 29, 2014, the second international ICENet Summit took place in Milan, Italy. In attendance were 18 international clinician educators (CEs) from North America, Asia, Australia, Mid-East and Europe. The event, which was a follow up to the inaugural summit in Prague last year, featured four dynamic CEs who pitched separate controversial ideas. The provocateurs aimed to challenge and stretch the thinking of attendees, and generate new ideas based on different cultural, educational and professional backgrounds.  There were many take-home messages and challenges for the participants to reflect on when they returned home.

Provocateur 1:  Dr. Steven A. Lieberman
Senior Dean for Administration, University of Texas Medical Branch (UTMB)

Controversial issue:  “Medical education accreditation bodies should forbid all clinical ‘block’ rotations lasting less than one year.”

Dr. Lieberman argued that medical education accreditation bodies need to forbid all clinical “blocks” of less than a year because they are too discrete without an interdisciplinary focus.  He argued that block rotations do not adequately prepare trainees to address the evolution of chronic disease processes and fail to facilitate the acquisition of clinical competence and professionalism.  

He supported his views with evidence showing that longitudinal integrated clerkships (LIC) facilitated more continuity and stronger connections with patients, as well as more interactions with faculty. Students felt that LIC’s contributed to satisfying learning environment, confidence-building, and was more rewarding than the traditional block rotations. Participants were encouraged to reflect on:

  • how to integrate primary care with secondary care in LIC;
  • how to identify external factors influencing students choice for LIC (e.g. family, job opportunities post-graduation); and
  • how traditional power structures must change to accommodate networks of learning.

Provocateur 2:  Dr. Abeer Arab (@draaarab
Anesthesiologist and CE, King Abdulaziz University, Jeddah, Saudi Arabia

Controversial issue:  “Training CEs is a myth.”

Dr. Arab argued that training to be a CE is a myth. She argued that most Clinician Educators begin their careers as clinicians and later undergo some form of informal training in medical education. Only a handful of them, however, are actually formally trained in medical education prior to their clinical specialization. She believes that common definition of a CE doesn’t exist; there are varying degrees of how much a C or an E, one is.  This insight resulted in a new generative language about the concept of CEs where there could be big, small, medium C and/or Es, all depending on an individual’s stage of professional development.

Some of the highlights of the session, included:

  • the need to keep an eye out for potential CEs and nurture them;
  • realize that immersion in a specific context is an effective instrument for change; and
  • equipping junior CEs with leadership and change management skills.

Provocateur 3:  Dr. Fremen Chihchen Chou
Physician educator, Department of Education and Clinical assistant professor, Emergency Medicine at the China Medical University Hospital (CMU), Taiwan, China

Controversial issue:  “Education theories pose a dilemma for Clinician Educators.”

Dr. Chou pushed the audience with his thought-provoking description of educational models (i.e. copying, following, transforming or creating) and the relations between the content and pedagogical knowledge of physicians. With the aid of illustrative slides, Dr. Chou described how the interactions between these concepts could be regarded as a “congenital anomaly.” The highlights of the discussion that ensued included the (over) emphasis of educational theory in medical educational research and the importance of transferability versus generalizability of research findings. Poor collaborations between clinicians and educationalists were a commonly encountered dilemma that everyone agreed with in the session.

Provocateur 4:  Prof. Dame Lesley Southgate
Professor, Medical Education at St George’s Hospital Medical School, London, UK

Controversial issue:  “Clinician Educators and educationalists are divided by language and may never understand each other.”

Professor Southgate argued that different vocabularies are used in medical education by CEs and educationalists. Both groups inhabit different worlds, leading to misinterpretations and (sometimes) hostilities between constituencies. Going on further to establish her point, she described that while the basic competencies for physicians are well articulated in CanMEDS, ACGME, GMP frameworks, etc., the judgment of these competencies in trainees in clinical practice is incredibly unreliable. She advocated that the purpose of workplace assessments should be to assess for learning rather than assessment of learning. There was a heated debate on how to standardize differences in the way individual competencies were defined and how to implement EPA’s in practice.

Summit participants left with new knowledge, a sense of accomplishment, and reaped the benefits of a highly interactive and provocative session with international peers.

We are looking to grow our network and hope to see you and your colleagues at the third ICENet Summit, which will be held in conjunction with the International Conference on Residency Education (ICRE), on Sunday, October 26, 2014.  For more information, or to register, please contact us at at icenet@royalcollege.ca.

ICEnet Summit 2014: Milan Attendees
ICEnet Summit 2014: Milan Attendees