education leadership research scholarship

SAAHE podcast on building a career in HPE

In addition to the In Beta podcast that I host with Ben Ellis (@bendotellis), I’m also involved with a podcast series on health professions education with the South African Association of Health Educators (SAAHE). I’ve just published a conversation with Vanessa Burch, one of the leading South African scholars in this area.

You can listen to this conversation (and earlier ones) by searching for “SAAHE” in your podcast app, subscribing and then downloading the episode. Alternatively, listen online at

In this wide-ranging conversation, Vanessa and I discuss her 25 years in health professions education and research. We look at the changes that have taken place in the domain over the past 5-10 years and how this has impacted the opportunities available for South African health professions educators in the early stages of their careers. We talk about developing the confidence to approach people you may want to work with, from the days when you had to be physically present at a conference workshop, to explore novel ways to connect with colleagues in a networked world. We discuss Vanessa’s role in establishing the Southern African FAIMER Regional Institute (SAFRI), as well as the African Journal of Health Professions Education (AJHPE) and what we might consider when presented with opportunities to drive change in the profession.

Vanessa has a National Excellence in Teaching and Learning Award from the Council of Higher Education and the Higher Education Learning and Teaching Association of South Africa (HELTASA), and holds a Teaching at University (TAU) fellowship from the Council for Higher Education of South Africa. She is a Deputy Editor at the journal Medical Education, and Associate Editor of Advances in Health Sciences Education. Vanessa was Professor and Chair of Clinical Medicine at the University of Cape Town from 2008-2018in health and is currently Honorary Professor of Medicine at UCT. She works as an educational consultant to the Colleges of Medicine of South Africa.

conference workshop

FAIMER Brazil: Initial thoughts

IMG_20130224_170315I was lucky enough to be invited as a guest Faculty member for the FAIMER Brazil residential sessions in Beberibe (near Fortaleza, Brazil) from 23 February – 6 March. FAIMER is an international programme aimed at developing capacity in medical education and research around the world, and includes an institute in South Africa (SAFRI), where I am a Faculty member. One of the most interesting aspects of FAIMER (IMO) is the emphasis they place on the cross pollination of ideas and experiences between Faculty members from different regional institutes. I thought that since I’ve been here for a few days, it was time to post about my initial thoughts.

The most immediate challenge was the language barrier (see an upcoming post on using Google Translate in preparation for coming here). While most of the Brazilian Faculty members can speak English quite well, the sessions are obviously conducted in Portuguese. The few of us here who only speak English have been quite ably assisted by local Faculty members who helped us get a basic understanding of the context of presentations. However, today was the first day that the translator was back. He’d been given a few days break since the first group had already been working for a week before I got here, and as soon as the day began I realised how much I’d been missing. Having all of the sessions translated in real time makes an enormous difference and I can’t thank the organisers enough for this consideration.

The other thing that I noticed almost immediately was the cultural difference between the Brazilian group and African Fellows. While we’re quite conservative in how we conduct ourselves, both professionally and socially, the Brazilians are incredibly social. Every evening that Faculty and Fellows can be found relaxing by the pool after the daily sessions have ended. It makes me think that we’re quite a boring lot at SAFRI, since we tend to retire to our rooms after the day’s progress.

Today we had some feedback from the 2012 Fellows experiences in the distance learning modules. Each group takes it in turn to create and run a distance learning module on some aspect of teaching and learning, and the rest of the Fellows are the “students” who learn as part of the module. I made a few notes since this is an area that’s close to me, and it was interesting to note that many of these challenges are similar to those we face with our students.

  • There were significant challenges with using a wiki for collaborative work.
  • Careful planning among group members can’t be emphasised enough.
  • Almost all groups had a tendency to increase the complexity of their projects, mainly because everyone is really enthusiastic and they want to implement all of their ideas.
  • Real time conversation with Skype was essential to projects’ success. Email is great but for the more detailed planning, real time is essential. I noted that this group is way more sophisticated in their use of online tools for planning and implementing distance learning modules, compared to our SAFRI groups.
  • They emphasised the importance of agreeing on a universal “language” – ways of explaining and understanding topics, since often different people in the group had a different way of thinking about the content. They needed to ensure that everyone on the team was on the same page.
  • They noted different levels of technological skills within the “teaching” group, as well as the “student” groups. They suggested that designers pay attention to this to avoid leaving collaborators behind.
  • There was some discussion about who takes ownership of the the module, and the impact that has on implementation, leadership, and participation.
  • There was a concern about addressing non-participation among both “teachers” and “students” in the different groups?

So, those are a few notes on my initial impressions after the first few days here in Fortaleza. I expect that I’ll have more to add once I’m more involved in the projects of the second years, who only arrived yesterday. Here are a few pictures from my time here in Fortaleza.

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Twitter Weekly Updates for 2012-06-18

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Twitter Weekly Updates for 2012-03-05

  • I will be giving a short presentation as part of my contribution to the SAFRI session currently being held in Cape… #
  • Busy with SAFRI 2012 but had to get out for a walk today #
  • A summary of some really innovative ideas in the education space #
  • Born This Way Foundation: guided by research #
  • We’re All Criminals #
  • Why humans have computers, and chimps are stuck with sticks via @zite #
  • Hi Anne Marie. This looks interesting. I’d love to hear what progress you make. #
  • This looks way cool (Google set to revolutionize mHealth and medicine with Google Glasses?) #
  • #SAFRI2012 Day 2 has kicked off with the Tiger Mother leading the sessions on research project development #
  • #SAFRI2012 Too often we get caught up in the “doing” but then we lose sight of the “being” #
  • #SAFRI2012 Create the space in which personal creativity is allowed to come through #
  • #SAFRI2012 Be open to the possibility of change #
  • #SAFRI2012 has begun. SAFRI is an initiative to develop capacity in medical education & research in Africa. Welcome to the new 2012 fellows #
  • @SRoyPhoto no holiday, but teaching on a course and need to stay over for the duration, just in Newlands so not far #
  • @SRoyPhoto still here, going to be away for a few weeks, but maybe when I’m back? Must catch up on your time in india #
  • @SRoyPhoto Hey man, nice pics 🙂 #
twitter feed

Twitter Weekly Updates for 2011-07-18

  • Some beautiful photos from around Cape Town over the past few days (not mine) #
  • Amazing weekend at the #caperoyale hotel. Recommend it for any special occasions / celebrations. Friendly staff & great food. Thanks #
  • Beautiful day at Greenpoint Park, can’t believe what amazing weather we’re having #
  • Over 1 billion items shared every day on Google+ #
  • @GoodTasteMag loved the rib eye steak 🙂 Service was fantastic, really good experience #
  • @ShanLatimer sitting outside at #1800 in the middle of winter at the #caperoyale Cape Town is fantastic 🙂 #
  • View from the pool deck of the #caperoyale #
  • Staying at #caperoyale for the weekend, really impressed so far, great service ( #
  • On social networks: “If you’re not paying for it, then you are the product” #
  • Hey Google — being social is not an engineering problem #
  • Does Google+ solve the privacy problem or make it worse? #
  • Further Thoughts on Blogging Profs. #
  • Slow Academia « The Thesis Whisperer #
  • Learning with ‘e’s: Going the extra mile #
  • “Analytics” interventions « Gardner Writes Indictment of standardised testing #
  • Learning with ‘e’s: Going the extra mile Too nervous to try and step outside the box #
  • “People who live in the intersection of social worlds are at higher risk of having good ideas” (Burt, 2005) via Anderson, ALT-C presentation #
  • “Relationships, more than information, determine how problems are solved or opportunities exploited.” (Looi, 2001) via Anderson, ALT-C prez #
  • Championing open access to research #
  • Applications for FAIMER / SAFRI Fellowships in 2012 now open at #
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Twitter Weekly Updates for 2011-07-04

  • U.N. Report Declares Internet Access a Human Right | Threat Level | #
  • #saahe2011 officially over. It was a wonderful conference made possible by the participation of health educators from all over the country #
  • Papert Being a revolutionary means seeing far enough ahead to know that there is going to be a fundamental change #
  • Papert The impact of paper in education has led to the exclusion of those who don’t think in certain ways #
  • @dkeats When people are “experts” in a domain they can be blinded to great ideas in other fields and so miss opportunities to drive change #
  • @dkeats Agreed. I’ve had to work really hard to convince people in my dept that I’m not the “computer guy”, I’m the “education guy” #
  • Innovation is about linking concepts from different fields to solve problems, its not about doing the same thing with more efficiency #
  • “How do you learn enough of the words to make sense of the discipline?” #saahe2011 #
  • Presentation by David Taylor on the use of adult learning theories #saahe2011 #
  • Jack Boulet speaking about the challenges and opportunities in simulation-based assessment #saahe2011 #
  • Mendeley Desktop 1.0 Development Preview Released #
  • Social media is inherently a system of peer evaluation and is changing the way scholars disseminate their research #
  • @dkeats Wonder if the problem has to do with the fact that much “ed tech” is designed by Comp Scientists, rather than Social Sci? #
  • @dkeats Also, people have the idea that LMSs have something to do with T&L, & then struggle when it can’t do what they need it to #
  • @dkeats To qualify, the problem isn’t resistance, its misunderstanding. The conversation always ends up being about technology #
  • There’s a huge difference between “learning” & “studying”, not in terms of the process but ito motivation & objectives #
  • @thesiswhisperer conf is for health educators, mostly clinicians, many of whom are amazing teachers but for whom tech is misunderstood #
  • In a workshop with David Taylor, looking at using adult learning theories #saahe2011 #
  • Blackboard is a course management system, it has little to do with learning. Use it for what its designed for #saahe2011 #
  • Trying to change perception that technology-mediated teaching & learning isn’t about technology. Not going well #saahe2011 #
  • Just gave my presentation on the use of social networks to facilitate clinical & ethical reasoning in practice contexts #saahe2011 #
  • Deborah Murdoch Eaton talks about the role of entrepreneurship to innovate in health education #saahe2011 #
  • Social accountability is relevant for all health professions ( #saahe2011 #
  • Charles Boelen talks about social accountability at #saahe2011 keynote, discusses its role in meeting society’s health needs #
  • First day of #saahe2011 over. Lots of interesting discussion and some good research being done in health science education #
  • Concept mapping workshop turned out OK. Got a CD with loads of useful information…a first for any workshop I’ve attended #saahe2011 #
  • Many people still miss the point when it comes to technology-mediated teaching & learning. Your notes on an LMS is not teaching or learning #
  • At a workshop on concept mapping, lots of content being delivered to me, not much practical yet #saahe2011 #
  • Noticed a trend of decreasing satisfaction from 1-4 year, even though overall scores were +. Implications for teaching? #saahe2011 #
  • Banjamin van Nugteren: do medical students’ perceptions of their educational environment predict academic performance? #saahe2011 #
  • Selective assignment as an applied education & research tool -> gain research exp, improve knowledge & groupwork #saahe2011 #
  • Reflective journaling: “as we write conscious thoughts, useful associations & new ideas begin to emerge” #saahe2011 #
  • Change paradigm from “just-in-case” learning to “just-in-time” learning #saahe2011 #
  • Benefits of EBP are enhanced when principles are modelled by clinicians #saahe2011 #
  • EBP less effective when taught as a discrete module. Integration with clinical practice shows improvements across all components #saahe2011 #
  • Students have difficulty conducting appraisals of online sources <- an enormous challenge when much content is accessed online #saahe2011 #
  • Looking around venue at #saahe2011 10 open laptops, 2 visible iPads (lying on desk, not being used), about 350 participants…disappointing #
  • EBP isn’t a recipe (or a religion), although that is a common misconception #saahe2011 #
  • Prof. Robin Watts discusses EBP and facilitating student learning. EBP isn’t synonymous with research #saahe2011 #
  • “A lecture without a story is like an operation without an anaesthetic” Athol Kent, #saahe2001 #
  • Kent drawing heavily on Freni et al, 2010, Health professionals for a new century, Lancet. #
  • #saahe2001 has begun. Prof. Athol Kent: the future of health science education #
  • Portfolios and Competency Really interesting comments section. Poorly implemented portfolios aren’t worth much #
  • @amcunningham I think that portfolios can demonstrate competence and be assessed but it needs a change in mindset to evaluate them #
  • @amcunningham will comment on the post when I’m off the road #
  • @amcunningham Can’t b objective as I haven’t used NHS eportfolio. Also, its hard 2 structure what should be personally meaningful experience #
  • @amcunningham Portfolios must include reflection, not just documentation. Reflection = relating past experience to future performance #
  • @amcunningham Your delusion question in the link: practitioners / students not shown how to develop a portfolio with objectives #
  • @amcunningham Also spoke a lot about competency-based education and strengths / limitations compared to apprentice-based model #
  • @amcunningham Very much. Just finished a 4 day workshop that included the use of portfolios as reflective tools in developing competence #
  • Final day of #safri 2011 finished. Busy with a few evaluations now. Spent some time developing the next phase of my project. Tired… #
  • Last day of #safri today, short session this morning, then leaving for #saahe2011 conference in Potchefstroom. It’s been an intense 5 days #
  • Papert: Calling yourself some1 who uses computers in education will be as ridiculous as calling yourself some1 who uses pencils in education #
  • Daily Papert 10 years ago, Papert warned against the “computers in education” specialist. How have we responded? #
  • Daily Papert Defining yourself as someone who uses computers in education, is to subordinate yourself #
  • YouTube – Augmented Reality Brain When this is common in health education, things are going to get crazy #
  • @rochellesa Everyone needs some downtime, especially at 10 at night when you’re out with your wife 🙂 Seems like a nice guy, very quiet #
  • @rochellesa The large policeman he’s with isn’t keen tho. Mr Nzimande has asked 2 not b disturbed. Understandable when u want to chill out #
  • I’m sitting in a hotel in Jo’burg & Minister of Higher Education Blade Nzimande walks in and sits down next to me. Any1 have any questions? #
assessment curriculum education research teaching

SAFRI 2011 (session 2) – day 4

Reliability and validity


Important for assessment, not only for research

It’s the scores that are valid and reliable, not the instrument

Sometimes the whole is greater than the sum of the parts e.g. when a student gets all the check marks but doesn’t perform competently overall e.g. the examiner can tick each competency being assessed but the student doesn’t establish rapport with the patient. Difficult to address

What does the score mean?

Students are efficient in the use of their time i.e. they will study what is being assessed because the inference is that we’re assessing what is important

Validity can be framed as an “argument / defense” proposition

Our Ethics exam is a problem of validity. Written tests measure knowledge, not behaviour e.g. students can know and report exactly what informed consent is and how to go about getting it, but may not pay it any attention in practice. How do we make the Ethics assessment more valid?

Face” validity doesn’t exist, it’s more accurately termed “content” validity. “Face” validity basically amounts to saying that something looks OK

What are the important things to score? Who determines what is important?

There are some things that standardised patients can’t do well e.g. trauma

Assessment should sample more broadly from a domain. This improves validity and also students don’t feel like they’ve wasted their time studying things that aren’t assessed. The more assessment items we include, the more valid the results

Scores drop if timing of assessment is inappropriate e.g. too much or too little time → lower scores as students either rush or try to “fill” the time something that isn’t appropriate for the assessment

First round scores in OSCEs are often lower then later rounds

Even though the assessment is meant to indicate competence, there’s actually no way to predict if practitioners are actually competent

Students really do want to learn!


We want to ensure that a students observed score is a reasonable reflection of their “true ability”

In reliability assessments, how do you reduce the learning that occurs between assessments?

In OSCEs, use as many cases / stations as you can, and have different assessor for each station. This is the most effective rating design

We did a long session on standard setting, which was fascinating especially when it came to having to defend the cut-scores of exams i.e. what criteria do we use to say that 50% (or 60 or 70) is the pass mark? What data do we have to defend that standard?

Didn’t even realise that this was something to be considered, good to know that methods exist to use data to substantiate decisions made with regards to standards that are set (e.g. Angoff Method)

Should students be able to compensate for poor scores in one area, with good scores in another. Should they have to pass every section that we identify as being important? If it’s not important, why is it being assessed?

Norm-referenced critera are not particularly useful to determine competence. Standards should be set according to competence, not according to the performance of others

Standard setting panels shouldn’t give input on the quality of the assessment items

You can use standard setting to lower the pass mark in a difficult assessment, and to raise the pass mark in an easier exam

Alignment of expectations with actual performance

Setting up an OSCE

  • Design
  • Evaluate
  • Logistics

Standardised, compartmentalised (i.e. not holistic), variables removed / controlled, predetermined standards, variety of methods

Competencies broken into components

Is at the “shows how” part of Miller’s pyramd (Miller, 1990, The assessment of clinical skills, Academic Medicine, 65; S63-S67)

Design an OSCE, using the following guidelines:

  • Summative assessment for undergraduate students
  • Communication skill
  • Objective
  • Instructions (student, examiner, standardised patient)
  • Score sheet
  • Equipment list

Criticise the OSCE stations of another group


Assessing clinical performance

Looked at using mini-CEX (clinical evaluation exercise)

Useful for formative assessment

Avoid making judgements too soon → your impression may change over time


assessment curriculum education learning research students teaching workshop

SAFRI 2011 (session 2) – day 2

“Teach” a group of colleagues about “Assessment”. Here are some notes I took in preparation for a 5 minute teaching session

What is assessment?

“Defines for students what is important, what counts, how they will spend their times and how they will see themselves as learners. If you want to change student learning, then change methods of assessment” (Brown, Bull and Pendlebury)

Integrate assessment into teaching and learning in a way that includes students in the process

Feedback is an important part of assessment

  • Should be frequent
  • Must identify gaps and provide direction to help students close the gap
  • Stimulates deep learning
  • Feedback should be task-centred, not emotional / personal

Assessment linked to outcomes i.e. are we assessing what we say is important for our graduates to be able to do (alignment)

Students can be involved in self-assessment and peer feedback but it needs to be scaffolded / structured. Should be used for different reasons

Personal and professional development. Do we assess for good physio’s or good people? Peer assessment can be used to encourage formation of professional behaviour and interpersonal dimensions

Move away from a testing culture to an assessment culture i.e. away from an emphasis on procedures and products of assessment to emphasis a process of assessment → deep learning. Difference between “knowing what” and “knowing how”


  • Assessment practices that improve teaching and learning (Luckett & Sutherland)
  • Assessment in medical education (Epstein)

Feedback as an educational tool

Start with the positive, then move on to negative. Also, feedback doesn’t have to even include a negative. We can also use it to highlight good work / understanding. As long as it is always given with the intention of moving the student forward. I would argue that splitting feedback into “positive” and “negative” might have little value anyway. Students will often latch onto the “negative” and forget anything positive you opened with. Can feedback be neutral, aiming only to highlight how the student can move forward?

Feedback should always be aimed at “closing the gap” between what is currently known and where the student should be i.e. it should always be formative

It should not be personal or have a value judgement assigned. The purpose is to identify a problem with a behaviour / skills / competency /etc. not with the person

Identify what they do know, what they don’t know and how to improve

Use feedback as an opportunity for self-assessment e.g. How do you feel about that? What do you think you could have done better? What did you do well?

Needs to be given as soon as is appropriate. Some feedback may be better given in private, or in a group, depending on the context

Be kind / sensitive / aware / empathic

Acknowledge if you are at fault e.g. arriving late for a feedback session / tutorial

Be aware of power relationships

Feedback should be continuous

Follow up on your feedback

The feedback should be written down at some stage, either by the student or teacher. Verbal feedback given in the moment may not be remembered later

It’s not only important to identify what students got wrong, but also to try and determine why they got it wrong


Curriculum development

Whose needs does the curriculum address? Ultimately, the community who will be served by the graduates of your course → the aims & objectives of the course must be aligned with community needs

Harden’s 10 Question model for curriculum design

“How is the detail of the curriculum communicated”, especially to first year students? Are students aware of how what they’re doing right now is relevant to the course they signed up for e.g. why am I studying physics, I want to be a sports physio?


SPICES model of educational strategies:

  • Student-centred ↔ Teacher centred
  • Problem-based ↔ Information gathering
  • Integrated ↔ Discipline-based
  • Community-based ↔ Hospital-based
  • Electives ↔ Standard programme
  • Systematic ↔ Apprenticeship-based or Opportunistic

There are models that can be used to determine where a curriculum lies on each of the spectrums listed above

Is a curriculum set in stone, or is it dynamic?

“Diseases of the curriculum” (Abrahamson, 1960s)

You can’t teach everything (there’s just too much) but you can help students become self-directed learners, which is what clinicians are. We don’t have all the answers but we know how to find the answers that will help fill the gaps in our knowledge / understanding. If students think they’re supposed to know all the answers, then that’s an enormous burden to carry

How do we select students who had a poor secondary education but who have the potential to be good (great?) therapists / clinicians? How do you support them?

You should always look for competence in students, no matter what curriculum design you use

A discipline-based approach doesn’t challenge students to engage with the later stages of Bloom’s taxonomy

Problem-based learning helps to create a more authentic learning environment / experience and allows the integration of pre-clinical and clinical science

“The contribution of South African curricula to prepare health professionals for working in rural or under-served areas in South Africa: a peer review evaluation. SAMJ, 2011, 101:34-38

What happens to students when they leave? Should this be a question we consider during curriculum planning?


  • Informative
  • Formative
  • Transformative

“If you can’t explain it simply, you don’t understand it well enough” – Einstein

conference education learning research students teaching workshop

SAFRI 2011 (session 2) – day 1

A few days ago we began the second SAFRI* session of 2011, which will lead into the SAAHE conference** later in the week. Every day I take notes and will try to put them up as we go along bearing in mind that a lot of what we do is workshop-based. The notes are a combination of points given by presenters, and my own reflections that were sparked by something that someone said. My thoughts are in italics.

Achievement: changed the way I think about the world (word = clinical education)

Challenge: helping others to see the world the way I do

Never give up…or Give up often? Come up with lots of ideas, some will be good, some not so good, some terrible. Test them all (even if only mentally) and throw away the ones that don’t stand up to being tested. Analogy with digital cameras and taking loads of photos because the cost is zero and you can delete the poor ones.

Find the underlying principle that can be generalised to many contexts i.e. details aren’t necessarily important

Why did I miss the diagnosis? (Bordage, 1999) → “Less is better” i.e. foundations are good to build on

We tend to focus on student behaviour, instead of their learning e.g. “students must attend class and pay attention”…but if you’re not interesting, then why should they attend? What is it about their presence that somehow ensures that “learning happens”? If they’re not going to listen to you (and if they can pass the exam without attending), then why do we place so much emphasis on their presence?

Teach an approach to discovery, rather than a list of things

Dual processing theory (a universal model of diagnostic reasoning)

  • How do we reason through clinical problems?
  • Make observations and identify signs / variables
  • Query your existing database i.e. your pre-existing knowledge
  • Identify associations between the observed variables and your own database i.e. pattern recognition
  • If existing knowledge is insufficient, query an external database (e.g. patient / textbook)

If you go through the above process enough times, you “get experience” → add more patterns to your internal database

I’m sure the above process is more eloquently and comprehensively described elsewhere

Dancing naked in the mind field” – title of a book that perfectly describes why I blog…putting my thoughts, reflections and experiences out there and by doing so, exposing myself while sharing.

Having a diagnosis frees you from having to think. This has implications for when you’re tired / stressed / pushed for time, in that in those circumstances you can’t think and so latch onto a diagnosis. Students experience the same thing when they’re looking for answers. Having the answer means they don’t have to think because thinking is hard and places a high demand on system resources.

There’s a strong emotional response / association with diagnoses that are made intuitively i.e. without an analytical reasoning process

Talking out loud externalises a reasoning process that is often obscured and hidden from the student

“Diagnostic error and clinical reasoning” (Norman & Eva, Medical Education, 2010)

“construct referenced” as it relates to feedback?

Black , P. & William, D. (1998). Assessment and classroom learning, Assessment in Education, 5, pp. 7–75


  • “Classroom assessment techniques” (Angelo & Cross)
  • Rushton, A. (2005). Formative assessment : a key to deep learning ? Medical Teacher, 27(6), 509-513
  • Nofziger, A. C., Naumburg, E. H., Davis, B. J., Mooney, C. J., & Epstein, R. M. (2010). Impact of Peer Assessment on the Professional Development of Medical Students : A Qualitative Study. Academic Medicine, 85(1), 140-147

*SAFRI (Southern Africa FAIMER Regional Institute); FAIMER (Foundation for Advancement of International Medical Education and Research)

**SAAHE (South African Association of Health Educators)


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Twitter Weekly Updates for 2011-06-27