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Please give a briefing of your own observations and outcomes of the congress: : |
AMEE 2016 conference report
27-31 August 2016
Center convencions internacional De Barcelona
Barcelona, Spain
27-28 August first international summit on competency based medical education
This summit organized by international competency based medical education collaboration (ICBMEC).
During these two days I participated in several meetings including plenary, workshops, innovation presentations and discussion panels one pearls and perils of CBME.
The plenary mostly focused on the principles of CBME, including defining of competencies, milestones and Entrustable Professional Activities (EPAs).
In workshops there was focus on how to implement CBME in local context at different levels for example in family medicine or undergraduate levels.
In panel sessions they also tried to provide more on the experiences of different countries especially United States, Canada and Netherlands on implementation of CBME.
In one panel sessions Jason Frank from Royall college of Canada and Brian Hodges from Wilson Centre at Toronto talked about the strengths and weaknesses of current approaches to CBME.
The most important findings for me are as the followings:
Like any other change in practice of medical education on the ground, it should be a plan for leadership of change parallel to the plan on technical aspects.
On both sides it is a huge task and everybody who are interested to implement CBME in his/her field should be aware of this complexity and become ready to tackle with all these challenges. As one of the measures he/should ensure that are thoroughly familiar with different aspects of CBME in depth.
The non-time bound nature of CBME is a real challenge for its implementation. It's very interesting to know that even Royall College which has been involved in CBME in for more than two decades on both theoretical and practical aspects has adopted a hybrid approach, which means some flexibility but not total discard of time bound for residency education in Canada.
The close interaction between competencies, supervision, workplace-based assessment and feedback is very interesting and could provide a good framework for the priorities of implementation of CBME.
It seems some confusion between competencies and different ideas about EPAs. EPAs have been defined as a specific task which a physician should perform without any need to supervision. It should include at least two competencies. The major challenge arises when some authors such as Ole Ten Cate are trying to define large EPAs and small EPAs which are nested in large EPAs. This seems to have some overlap with sub-domains of competencies and I'm not sure that it could add to the General perspective of CBME.
Defining different level for independence is another important aspect of CBME. In this framework we should develop different level of supervision for these different levels of independence. The most important issue here is that the trainer should reach a point that he or she could practice independently during their training period after that he or she should receive only indirect supervision and on demand. It could have directly a major impact on our definition of development phase of our residents in programs and even for our undergraduate program. We should be aware the differences between our UME program in which the graduates have license for independent practice as GPS in comparison to many countries that the UME can practice independently only after at least 1 to two years of a kind of supervision (it may be during residency training or family medicine training program). In this context it man's that we should define the internship phase of our M.D. program as equivalent to the first years of residency training just similar to family medicine. Therefore we should provide learning opportunities for our clerk's to reach the point of independence in a those competencies which have been defined for them and during internship they should practice deliberately under indirect supervision of their trainers.
It's too interesting to me that heat from Ole Ten Cate that mentioned they have modified the definition of EPAs for undergraduate program in such way that graduates from a UME program should be able and entrusted to perform the determined EPAs without need for any direct supervision. This definition Royall match with abovementioned phases of development in our M.D. program in which the clerk's should be entrusted to perform the defined tasks without Direct supervision and then they enter their internship phase which should deliberately practice be at its final stage as an independent GP.
I know that it is in sharp contrast to our practice for clerks and interns in most of the wards but I'm so glad that it is in full agreement with our plan for revision of clinical phase of M.D. program.
I'm sure that implementation of this model is not so easy but could provide a theoretical framework for definition of clerkship and internship phase of our program.
Main conference (29-31 august)
Just as previous years, amee conference includes a complex mixture of plenary, symposia, workshops, short communication, research papers and PhD reports sessions and poster presentations.
I had a short communication about the workshop on interactive lecturing which we hold last year for our faculties. If I would reflect on it, it seems clear that we need more rigors on the evaluation of our interventions and also a better presentation preparation which should includes even a brief overview of the theoretical background of the project and more details on the results.
This year we also have several meetings related to our contribution in Beme collaboration as TUMS BICC.
I attended the PhD session in which two of our best colleagues (Dr Gandomkar and Dr Mortaz) presented their PhD thesis reports. Undoubtedly, it is an honor for our department and TUMS in General that 2 of 12 amee 2016 PhD reports were from our graduates. They did their best and presented very well their thesis in 15 minutes. I'm sure that presentation at such a high level in which some experts such as David Irby attended would be a good milestone for both of them and could help them for future development of their careers. As usual we should overcome the challenge of presenting in English and also how could we elaborate our thoughts in a brief presentation. It seems a challenge for all of us and could not be overcome unless by rehearsal, reflection and feedback.
This year I attended two conference workshops, one of them was about supervision in a competency based program and the second on how to convert a face to face course to an e-learning one.
The topics of both workshops were so interesting to me and I tried to think about our current situation and what should we do on them in our local context.
I also think why none of them could attract me all over the course of workshops. There were some reasons including weakness in enthusiasm and energy during the course of workshop, lengthy presentation of details and lack of a direct connection between the goals of the workshop and its group activities. We could face the same challenges if we do the same in our workshops.
One of the most interesting plenary this year was about the uncertainty and tension which brings to the institutions. Dr Glenda Eoyang emphasized on the existence of uncertainty in daily practice of health care systems and also in education and reminded all of us that igniting this important aspect of educational system could not helpful. It divided our practice in finite and infinite games. The infinite games which most of our activities in the education is as such are open without well defined borders, multi-dimensional and non linear. These games could not be treated as finite games. We need adaptive actions in which we cyclically should define three issues; what, so what and now what.
The other interesting plenary was about medical education in difficult situations. In this plenary two presentations hold by one faculty members from Rwanda, which described the enormous efforts and courage they put to establish a new university that serve the community.
The next presentation in this plenary was about students experience on how to promote the medical education on the student side in difficult situations. One of the students from Poland emphasized that the difficult situations are not limited to poverty, war and political instability but also even with those countries without them; the medical education has a difficult situation. Then she talked about the challenges that students’ have in themselves that lead to retraction of medical students being involved in Medical education affairs. Among them are lack of motivation, lack of awareness and knowledge about medical education and finally lack of consistent representation. She suggested some remedies for each of these challenges. One of the most important points in her presentation was the importance of such involvement not only for the institutions but also form medical students self developments.
BEME related meetings
As I mentioned before, this year I attended the meetings related to beme collaboration. First was the BEME board meeting and the second was Translation into practice committee.
At beme board meeting, after introduction of all members, the agenda was talked about one by one. The most important items of the agenda were the activities of beme 4 committees and relationship between BICCs and beme around these four committees’ activities and also financial issues around beme initiatives. The first item has been discussed in some details and the most interesting thing was clarification by Professor Harden that said “the four committees represent four areas of beme collaboration and its related BICCs activity”. It means that we could not focus only on developing systematic reviews. It’s clear that doing systematic reviews is one of foremost priorities of beme collaboration, but we should remind ourselves that the ultimate goal of BEME initiatives is medical education which is deeply rooted in evidences and developing systematic reviews are one of the steps in this long and challenging road.
The second challenging item of the agenda which was about the financial aspects of beme initiatives, just similar to the previous discussions about this issue was somewhat inconclusive. As the final remarks on it, the beme board asked all the committees to find some way for financial support of their activities.
I feel that we need to concentrate more on TUMS BICC activities in all four fields of conducting systematic reviews, training, research and translation into practice. The major challenge for it is limitation of time that all of us could devote to it. I hope that on return to Iran, we could talk more about how we could energize BICC activities and come to some solutions.
The second beme related meeting which I attended was the “translation into practice committee” as the substitute of Dr Nejat which is the member. Most of the time of this meeting was focused on the challenges between 2 different perspectives on the priorities of the committee. One which represented by Dr Aliki Thomas (from McGill University who is somehow the most expert people in the committee in the field of knowledge translation) who emphasized on the methodological rigor of developing simple guidelines based on available evidences and the second one by janusz Janczukowicz from Lodz University in Poland and Antonio Candido from beme collaboration which emphasized on the request of beme board from the committee to have a definite product in the coming months (may be no later than January 2017). The other important issue which I brought to the agenda of the committee was a practical definition of the fields of activities of the committee. It seems unclear and may be confined unconsciously to only developing some guidelines. The final challenging discussion was about the extent of the meaning of knowledge translation. Is it incorporate the field of implementation or not. Some believe yes and some people answered no to this important question.
Finally the committee has decided to work on 7 simple guidelines in 7 important topics to save time for the committee and ensure the board that the committee is working and at the same time clarify the challenging aspects of committee activities including development of a framework for constructing an evidence based guidelines.
Meeting with Professor Gordon
Based on previous correspondence with Professor Gordon, the President of WFME, we had a meeting in Barcelona during it we discussed on several topics including the progress of self study of TUMS MD program and upcoming WFME team visit in mid-October 2016, discussion about the possibility of some scholarship activities related to accreditation and our self study, and also a proposal promoted by the secretary of UME Council (Dr Changiz) to start the formal process for recognition of our UME accreditation system by WFME, and finally a brief review of the process for revision of our UME program Standards (which for the first time developed in 2005).
The meeting was so fruitful and we covered all the meeting agenda items. Professor Gordon is so interested in working with Iran. He preferred to start the formal process of the recognition after WFME visit from TUMS MD program.
Directors of MSc Program meeting
Meeting with professor Norcini
Final marks
This year TUMS Participated with 7 faculty members (Dr Gandomkar, Dr Mortaz, Dr Mohammadi, Dr Mojtahedzadeh, Dr Pakdaman, Dr Shirazi, and me) and 4 PhD students (Miss Ahmari, Dr Saleh, Miss Yakhforoushha and Miss Zarghi) in amee 2016 which is the largest team from an Iranian university in this well known international meeting. Although this shows an increase in the number of TUMS delegates in amee in comparison with previous years, but when compare to the total number of faculty members in TUMS and also in comparison with other countries show a major deficit in our representation in such an educational meeting. The high cost of the conference especially registration fee and difficulties in getting visa from European embassies in Iran could be considered as the major challenges which Iranian delegates faced. |