I began to see parallels with the process. "The momentum increased with ... morning it was hard to have to pack up and come away. It is no wonder that the con-.
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A conference without a programme Iona Heath
I enjoy art galleries, but I have a snobbish antipathy to guided tours and I cannot bear to be in the same room as a painting by Francis Bacon. So, there I was last June trapped among strangers on a guided tour of Oslo's Astrup Feamley Museum in a room replete with Francis Bacons. In other circumstances I would have walked away but, as I felt obliged to stay, I began slowly to confront the distorted anguish in the paintings. I began to see parallels with the process
"The momentum increased with more joint proposals generated from the discovery ofshared interests. " of acknowledging the pain and anguish in the life of the patient sitting across the desk in general practice. I was forced to reflect and I began to learn. It was the first night of the second "learning in medicine" conference and it set the tone for the whole event. It was to be a conference without a programme, which brought medical teachers together to learn, simply by reflecting on their own experience of both learning and teaching. Three full conference days followed. Each started with one or two short keynote addresses designed to provide ideas to trigger discussion and thought. All the rest of the time was given over to parallel workshops. Leaders and topics for the first day had been prearranged but thereafter the programme was blank and we were free to generate our own. This was where the real excitement
began. Every evening there was a plenary at which participants put up posters proposing a workshop topic for half or all of the following day. Each was invited to speak briefly to their proposal and then we all signed up to our preferred workshops. Some topics clearly overlapped and unions were brokered; a few fell through lack of interest. Each day the momentum increased, with more joint proposals generated from the discovery of shared interests during the previous day's work. Topics included liaisons between generalists and specialists in medical education, total quality improvement, personal plans for continued self education, remedial continuing medical education, and facilitating learner centred education. One workshop on competency assessment ran 202
through the whole three days, and it was often difficult to decide whether to stick with a group that was working well to explore a subject at greater depth or to move on and join another group, meeting different participants and discovering new perspectives. By the third day ideas for workshops were surfacing all the time and the following morning it was hard to have to pack up and come away. It is no wonder that the conference evaluation questionnaire showed overwhelming support for a third conference to be held in June 1997. The organisers asked that each workshop should be reported and that content and process should be reported separately by different rapporteurs. A computer room was made available and there was a tight evening deadline for the production of reports on floppy disc which were then passed to the heroic, night working producers of the daily conference newsletter which was available by coffee time each morning. The process of writing and reading the reports heightened the atmosphere of reflection and constructive evaluation. It was challenging and exciting. Participants from all the Nordic countries, Britain, Canada, the United States, Germany, Spain, and Lithuania found enormous areas of common interest and experience. Lasting friendships were made, but the whole exercise was not without its problems. Perhaps the most important was the variable quality of the workshops. With a wide variety of choice it was frustrating to find yourself apparently stuck in a dysfunctional setting. Part of the problem seemed to be different understandings of how the workshops were intended to function. Most participants treated them as an opportunity for small group learning, with the leaders facilitating the participation of all members in the learning process, but others seemed to be using the model of a tutorial or seminar where the leader is there to teach. In this model, not all participants became actively involved, which seemed a shame. The language skills of the participants made this all the more important. The conference was held in English and those with English as their first language were humbled by the extraordinary ability of our colleagues from the Nordic countries and elsewhere to discuss difficult topics sensitively and articulately in a language they do not use in their daily work. Some did say, however, that they found it difficult to articulate their thoughts quickly enough to contribute effectively in groups which were dominated by speakers whose first language
was English. Skilled workshop leadership is essential and it may be that an introductory session to set agreed ground rules for the workshops would have been useful. The reporting of the workshops threw up another problem. The description of content was relatively straightforward, but process was difficult and some of the reports drew attention to this. The problem is that the description of process involves issues of value judgment relating to the quality of the
"The process of writing and reading the reports heightened the atmosphere of reflection and constructive evaluation." interaction and, often, the skills of the group leaders. This raises the whole range of issues about how to provide effective feedback on the performance of our peers, which was not pursued at the conference but could be addressed at the next conference. A public statement in a newsletter is perhaps not the best mode of feedback and it may be that we should explore an adaptation of the Havelock-Pendleton rules, which were developed to emphasise positive feedback in consultation skills teaching. This could be done either by the whole group or by the designated rapporteur and the leader. The process would begin with the leader describing what part of the workshop process had seemed to go well; the rapporteur or the other members of the group would then do the same. Next, the leader would say what might have gone better and, only then, would the rapporteur or the other members of the group do the same. This might generate an agreed statement of the workshop process which could be published and achieve improving performance through the process of peer review without causing hurt. This all happened nearly a year ago. I continue to reflect on the issues we raised and I recall no other course or conference so clearly. I am grateful for the shared belief of Colin Coles of Southampton and Hans Asbjorn Holm of Oslo that conference organisers can and should cede control to the participants, teachers to learners, and for showing us all that it works. I plan to be in Oslo again in 1997. I must open the negotiations with my partners.-IONA HEATH is a general practitioner in London
BMJ VOLUME 311
15JuLY1995
