IMEX Report - Utrecht site visit 2006

This paper reports on the experiences with the first IMEX site visit in Utrecht, which was launched in the fall of 2006.

Introduction
The International Medical Educators Exchange programme IMEX is an international faculty development programme to serve senior teachers in the participating medical schools. These are UMC Utrecht at Utrecht, (The Netherlands), McGill University at Montreal (Canada), Karolinska Institutet at Stockholm (Sweden), Dalhousie University at Halifax (Canada) and University of Nicosia Medical School (Cyprus). The exchange program offers sites visits with groups of maximum 10 IMEX visiting scholars, of one week each, at all host locations. Enrolment in the programme includes at least three site visits, one of which is at the home medical school. Information of procedures is to be found in the IMEX website www.imexchange.eu.

Participants and organizers October 2006

Objectives and general approach
The first IMEX site visit took place from 16 till 20 October 2006 and was hosted by the University Medical Centre Utrecht, the Netherlands. This kick-off site visit turned out a rewarding experience for both participants and organizers. A group of six IMEX participants (2 from Stockholm, 2 from Utrecht, 1 from Montreal and 1 from Halifax) engaged in an intensive week programme, meant to offer insights in various aspects of Dutch medical education and the Utrecht medical curriculum, with much room for discussions, generation of new ideas, observation of teaching moments and some opportunity to teach, and encounters with Utrecht colleagues in one's own field. Important moments of the week were the daily end-of-the-day reflections. This returning programme elements worked as a tool for conscious progress throughout the week, reflection on personal experiences and the sharing differences and commonalities between host and home institutions and they served as moments of evaluation.

Preparation of the Utrecht site visit
The Utrecht week programme was devised in July 2006 and gradually shaped more in detail in August and September. All participants had been asked to send personal information. One of these was a 'biosketch' including areas of interest pertaining to education. This information was used to seek opportunities to get IMEX scholars in touch with colleagues with common interest or workfields. One IMEX participant had actively located Utrecht colleagues for the literature and requested to get in touch. Participants were sent the course folder in order to get an idea of the programme, read more about their fellow IMEX participants and to be informed on some practical things at location. During the week, a full time reservation of one room with data projector and flip chart for the IMEX group proved very valuable.

Programme and activities
In order to meet participants' learning objectives and to match with their different backgrounds, the IMEX programme was shaped by not only fixed, but also optional elements from which participants could freely choose according to their personal interests. In the course of the week the fixed moments decreased, which allowed for reshaping the programme with the group in the last days. Optional elements included meetings with Utrecht staff and presentations of Utrecht staff. The IMEX participants appeared stimulated to build the programme together and therefore themselves suggested to contribute by taking own material or ideas from home to discuss. This led to additional personal presentations on current or past projects by each visiting scholar, during lunch breaks. The schedule below shows a brief overview of main programme elements. Each day started with a morning meeting and resulted in a end-of the day meeting for personal reflection. Wednesday was scheduled to engage in relaxation and to get a flavour of Dutch culture by visiting Amsterdam and the island Marken. An overview of the programme can be viewed below.

Daily reflection meetings
Participants found the reflection moments valuable parts of the programme. Besides expressing personal experiences, thoughts and ideas, and to order important highlights of the day, it was also a moment to be together and discuss certain topics a little deeper. A mix of jottings, reflections, ideas and questions, taken from the flipcharts are: the impact of culture on education; the use of the "study island" on the internal medicine ward; the interesting vicinity of basic science and clinics in Utrecht; unexpected insights from viewing your own curriculum with the eyes of foreign beholders (domestic participants); how use your experience for stories in case based teaching?; differences between educational research and basic science research; design framework for portfolio CanMEDS; impressive motivation of elective anatomy students; how filtered is information when it reaches teachers and how does teaching filter information?; teaching how to deal with uncertainty and appraisal of level of evidence; the use of community based teaching; learning to ask really good questions. The Utrecht IMEX co-ordinator and assistant were always present at the moments of reflection.

Social programme
The social activity planned on Wednesday was a welcome break during the intense course week. It served to get further coherence and small group integration and added to the whole experience and the success of the week.

Evaluation
Given it being a novel initiative and the fact that participants did not exactly know what to expect beforehand, it was nice to experience that the outcome of the week was evaluated/rated highly. IMEX appeared to have reached its major goal: to offer insight into other medical schools, in this case Utrecht, by being on location and actually talk to experts, students and observe and practice teaching. Some highlights of the week programme were: Integration: the case of anatomy, to explain Utrecht's philosophy of integrating basic science with clinical teaching, listening to the 6th year Utrecht student presentations within the obligatory teacher training module for students, and the personal meetings, which were enfolded by actually experiencing and reflecting upon the educational environment within a small group. From the evaluation some succesfull elements and some elements that could be improved in the future are listed below:

Successes:

A few quotes from participants
"Before I thought 5 days was a bit long, but after it, it could be even longer. Look forward to the next rotation!" "I learned many things, not only from the programme, but especially from the other participants and the students. 'Feeling' the teaching sessions together and discussing them is magic!" "This was the most valuable learning experience I have ever had!" "Many thanks for your effort hospitality + graciousness= one of the best 'Faculty Development' experiences I have ever had" -December 2006