Conference Wrapup: reported by Linda Heun
"What have we learned and where do we go from here?"

The following summarizes the comments of three educational leaders who each summarized an aspect of the 2002 Ottawa Conference and their challenge for the future.

1. Donald Melnick, National Board of Medical Examiners, identified the following trends:
   • Objectives have become more important than formats and are focusing on integrations, linking practice and learning, connection with communities, ethics, and professionalism
   • There is more to life than MCQ and simulations. Assessment now uses games, puzzles script concordance, POEMs, student drawings.
   • There is increased globalism and more collaborative networks
   • Increased use of technology as a central teaching and assessment medium with on-line education, email for student/professor connectivity, the foundation for OSCEs, teachnology in SP training, and the use of virtual reality
   • Assessment is pervasive. From admissions data to CME there is a strong focus on developing and validating tools.

   He also identified the following challenges to the medical education community:

   • We have to look for the most value and focus on the cost/benefit ratio in our practices. "We live in a world of scarce resources and immense need."
   • We must appreciate relevant disciplines outside ours, especially measurement and cognitive psychology. He suggested we attend one conference a year outside our own field.
   • We must raise our sights to the vast world of practice. "Most doctors are NOT in medical schools. Most patients are care for outside the academic context."
   • We must encourage more creative contributions from colleagues outside North America and Europe.
   • We must share more with other health professions. "We must ask ourselves what we can learn from other professions."
   • "We need road maps for the improvement of medical education."

   The main challenge, he summarized, is to address how we can communicate with and excite our colleagues in medical education. He indicated that those present at the Ottawa Conference are a small fraction of the entire medical education community. "It is a tribute that so much positive change has taken place by so few people."

2. Richard Reznick, University of Toronto, was introduced as an evangelist for research in medical education. As he is a surgeon, he indicated he would present a biopsy of the conference.

   He suggested the following lessons from an institutional perspective:

   • Get wired in for instructional technology
     -Technology is an enabler. Check to see how much you’re spending on information technology. It is a fundamental change in the delivery of education. "We have an unparalleled opportunity for changing practice through a digital approach."
   • Invest in faculty
     -Faculty are powerful role models. The human element will forever be important. "Teaching is an applied art and can be taught."
   • Recognize similarities across medical education – "You’re not so unique"
     -He asked, "why do we need 160 medical curricula in North American? Is a cardiac surgeon in Barcelona so different from one in Calgary. We are wasting time and effort. Globalize or face distinction. We must inter-professionalize NOW!. We must develop a real synergy in deploying the strength of the health science faculty."
   • Respond to the public to prepare future physicians for better care giving
     -We must focus on the themes of the competent profession, communication, medical errors, licensure, and certification renewal,
   • Research is the key!
     -We must promote research about health professions education and reward it.
3. Ronald Harden, University of Dundee, focused his summary on what it takes to be an effective medical educator. He used a model that visualized three points on a triangle to represent enabling a medical educator to a) "do the right thing" b) "do the thing right", and c) have the "right person doing it" (functioning as a professional).

   He pointed to the following trends:

   • The move to student-centered learning in both large and small group teaching situations.
   • Clinical teaching taking its place as the keystone in the education of competent physicians. In this context he cited students preference for teaching with real patients and the increased use of bedside medicine. He suggested that we train patients to teach students about their conditions.
   • The increased use of peer tutoring and the use of email as a tool to improve teacher/student relationships, even in face-to-face courses.
   • The importance of a concordance between learning outcomes and assessment and the of management tools, including electronic learning management systems and curriculum mapping.
   • The pressure from students to include new technology, including simulation and use of PDAs.
   • The impact of new technologies on assessment including more sophisticated stimuli, wider range of learning outcomes, more automated scoring, adaptive testing, and automated test construction. He further sites the importance of standard setting, considering patients and other stakeholders in assessment.
   • The increasing use of the OSCE for assessment. He urged the creation of assessment boards capable of ensuring the development and quality of the evaluation process as we move toward nationwide introduction of the OSCE as a format for summative assessment.
   • Increased focus on understanding the principles of education, indicating that theory is as important as techniques. He also cited the need to understand item response theory throughout (including emerging new item types, new response modes, challenges in standard-setting, accommodation for learning disabilities, reliability and validity issues) as well as the importance of learning in context (external physical context, internal semantic/cognitive context and internal emotional/commitment context).
   • The importance of faculty attitudes and ethics.
   • Primary role of decision making and best evidence medical education. He stressed the responsibility that faculty have to improve the system.
   • Increased stress on the personal development of faculty. He suggested the use of standardized students in staff development programs.