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#IAMSE21 Faculty Development Session Spotlight: Creating Cases that Integrate Basic & Clinical Sciences

The 25th Annual IAMSE Meeting will feature a host of new sessions throughout the entire conference. One of our first-time workshops is Creating Cases that Integrate Basic and Clinical Sciences: Envisioning the Future of Health Sciences. This half-day faculty development course will be given on Sunday, June 13 and will be led by Christine Hutak-Jacaruso and team.

Creating Cases that Integrate Basic and Clinical Sciences: Envisioning the future of Health Sciences
Presenters:
Christine Hutak-Jacaruso – NYIT College of Osteopathic Medicine
Donna McMahon – NYIT College of Osteopathic Medicine
Swapan Nath – Professor of Medical Education
Todd Nolan – Lake Erie College of Osteopathic Medicine
Naunihal Zaveri – Arkansas College of Osteopathic Medicine
Date and Time: Sunday, June 13, 2021, 10:00 AM – 1:00 PM EDT  

Educators are increasingly seeking ways to integrate basic and clinical sciences throughout undergraduate medical education, as medical education is moving away from the traditional two years of preclinical education followed by two years of clinical clerkships. One way of doing this is to use clinical cases that integrate basic and clinical sciences in several curricular formats that use team-based learning (TBL), case-based learning (CBL) or problem-based learning (PBL) with or without lectures. The outcomes of these curricular modalities will depend on how actively students engage and learn using clinical cases. Therefore, the quality of the clinical cases, clarity of learning objectives, and the learning environment created by the cases are important components in all of the modalities mentioned above. The purpose of our workshop is to provide educators and administrators with the foundations to incorporate these modalities into their curriculum.

For more information on full- and half-day faculty development sessions, and to register for the 25th Annual IAMSE Meeting, please visit www.IAMSEconference.org.

IAMSE Spring 2021 Session 1 Highlights

[The following notes were generated by Michele Haight, PhD.]

Amy Caruso Brown MD, MSc, MSCS, HEC-C , Associate Professor of Bioethics and Humanities and Associate Professor of Pediatrics, SUNY Upstate Medical University, Syracuse, New York, USA  brownamy@upstate.edu

Creating Diverse, Equitable and Inclusive Content in Medical Education

Diversity, equity, inclusion and bias in health sciences education is a compendium of many different perspectives.

Addressing issues related to bias requires a shared definition for commonly used terms. These terms can be positive, negative or both.

  • Prejudice: Preconceived opinion that is not based on reason or experience.
  • Stereotype: Association of a member of a group with a consistent set of traits.
  • Bias: Inclination or prejudice for or against something
  • Implicit or Unconscious Bias: Relatively unconscious and relatively automatic features of prejudiced judgment and social behavior; contrasted with explicitly endorsed beliefs. Implicit to Explicit represents a spectrum, not a dichotomy.

Bias in health sciences education can be placed into four categories:

  • Who?  Who is admitted to medical school? Who is hired to teach?
  • What?  What content is presented to learners?
  • How #1? How are learners taught, mentored and evaluated?
  • How #2? How do learners see health professionals treat patients and families?

There are four categories of bias within the area of content:

  • Scientifically inaccurate information.
    • Promotion of race as a biological as opposed to a social construct, racial essentialism.
  • Overemphasis of certain topics; Neglect of other topics
    • Unequal distribution of time in pharmacology dedicated to men’s and women’s reproductive issues.
    • Disproportionate representation of white skin and white able-bodied images.
  • Promotion of bias, shame and stigma towards people belonging to certain groups or with certain medical conditions.
    • E.g., fat-shaming, poverty=laziness, all patients who speak Spanish are undocumented workers.
  • Irrelevant to medicine and promotes bias and discrimination
    • Humor and microaggressions

What doe bias look like on multiple-choice exams?

  • Diseases associated with specific races
  • Male and female stereotypes
  • Instantaneous judgments of patients with certain characteristics
  • Epidemiology without context
  • Use of race as a proxy for genetics
  • Absence of white privilege
  • Race as meaningful for only non-white identities
  • Race is represented negatively and associated with disparities without mention of community strengths

Bias in content and the learning environment is costly:

  • Lowers faculty productivity and student/faculty retention
  • Reduces quality of care

Our biases are mitigated by our:

  • Positionality
  • Discomfort with discussing racial issues
  • Lack of real-world data
  • Lack of time and effort for closer examination

Current curricular and assessment paradigms in health sciences education make it difficult to identify biases.

Dr. Caruso Brown has developed a checklist instrument for identifying content biases; this tool is publicly available at https://tinyurl.com/UpstateBiasCheklist

Guiding Questions for examining content include the following:

  1. Why is the content at risk for bias?
  2. How might it impact learners?
  3. What is the goal/learning objective for this part of the content? Why is the content there in the first place?
  4. Should it be changed?
  5. How should it be changed?

There are four recommended methods for changing content:

  • Remove content
  • Replace content with images that challenge stereotypes
  • Add content
  • Apologize (last resort)

Mapping the attributes of hypothetical patients used in the curriculum via the spreadsheet provided in the checklist tool provides an opportunity for a systematic review of potential biases across the curriculum. This type of review also helps to identify the pervasiveness of biases across the curriculum and provides the opportunity to enhance equity within the curriculum.

Addressing Bias in Content Development

  1. Offer faculty and students a session unpacking race as a social construct before they start learning from case studies or real patients.
  2. Use tables to track representation over entire courses and curricula. Regularly reassess for over or under representation. (Equity mapping)
  3. Practice counter-stereotypic imaging.
  4. Incorporate discussion of structural and social determinants of health into cases including a discussion of a patient’s relative vulnerability or privilege based on the patient’s racial classification.
  5. When race and stereotype may align within the case, faculty should talk explicitly about that and promote stereotype replacement, individuating and perspective-taking.
  6. Consider introducing the patient’s race in a paragraph with additional information about the patient’s family and social and cultural background, rather than in the first sentence.

Pros and Cons for Including Race in Case Development:

Pros

  • People notice race
  • Racial and ethnic identities and experiences matter and can impact care
  • Learners often make assumptions about race if it is not mentioned

Cons

  • It is easy to fall back on race as proxy for genetics
  • Faculty are not trained to view racism as a risk factor
  • Faculty do not want to write about rare combinations

Say hello to our featured member Molly Johannessen

Our association is a robust and diverse set of educators, researchers, medical professionals, volunteers and academics that come from all walks of life and from around the globe. Each month we choose a member to highlight their academic and professional career, and see how they are making the best of their membership in IAMSE. This month’s Featured Member is Molly Johannessen, PhD.

Molly Johannessen, PhD
Director of Education and Teaching and Associate Professor of Physiology
University of Medicine and Health Sciences

How long have you been a member of IAMSE?
Consistently since 2017 I believe, but I have been involved in some capacity through random engagement since 2012.

Looking at your time with the Association, what have you most enjoyed doing? What are you looking forward to?
When I discovered the work and the mission of IAMSE in 2012, I found a group of educators all who thought like I did and who really worked together to support the learning and growth of their colleagues. At the time I did not know this was unique, but I do now. This society is my professional society and where I learn to be the best educator I can be and where I lean on others to support my professional growth. A physiologist by training and now an administrator who focuses more on curricula, faculty development and student support initiatives, I find that everyone I meet at meetings and through involvement inspire me to continue working towards doing my best to help learners in the healthcare field. Over the last year, I have gotten involved in a few committees including the Student Professional Development Committee as well as the 2022 Program Committee, but my favorite addition to my time this last year has been dropping in on the bi-weekly IAMSE Café sessions. As an extroverted people-person, COVID has taken its toll on my energy in engaging with other humans, but these meetings give me face-time with others and remind me frequently of the great work that others are doing to improve healthcare education. I value the time and the frequency and it has been an absolute mental lifesaver over the last several months!

Tell me a bit about your time with the Student Professional Development Committee? Why did you join? What projects are you working on? Etc.
To me, learners, and more specifically students, are at the root of everything I do. Although in my newest role as Director of Education and Teaching at the University of Medicine and Health Sciences I have my hands involved in faculty development, curriculum discussions and student support, (my efforts) all root back to students. (I work on) ensuring that we have the best avenues to help learning occur and the training of new healthcare providers and healthcare educators. Through working with the Student Professional Development Committee, I am able to keep my interest in seeing students flourish at the forefront of my committee experiences. The students are quickly becoming our colleagues and the more we can help support them in this process, the more we can create space for them to shine, the better legacy we are leaving for those who come next.

The absolute most-inspiring of moments I have at any conference and have had at IAMSE meetings is when I see students present (research). It can be an idea of how they have expanded their coaching programs, or developed curricula to support something they felt was more difficult to learn, or research they have explored and are presenting on a poster. Any time we open up space for students to demonstrate their growing professional experiences, I am likely to be found smiling proudly in the corner cheering them on!

What interesting things are you working on outside the Association right now? Research, presentations, etc.
The COVID pandemic has stirred up the lives of many over the last year and I am no different. A year ago I was representing Kaplan Medical as their Medical Learning Consultant in supporting a number of institutions utilize their resources more effectively. When the pandemic hit there was downsizing and my role was cut. However, I landed proudly on my feet supporting one of Kaplan’s partner institutions, the University of Medicine and Health Sciences as the Director of Education and Teaching and Associate Professor of Physiology. I was able to bring my experience with Kaplan and curricula at various institutions and my love of learning and helping students to support the already great work of this institution and their mission to educate uniquely skilled and diverse medical professionals through personalized education. Our basic science campus is in St. Kitts, and our students attend a transition semester in Maine before continuing onto rotations throughout the United States. I, however, am located in Wisconsin, so I have been involved in ensuring there is support of faculty, curriculum, and students through distance measures. A challenge in and of itself, one area I have focused a lot of my energy recently has been on trying to create space for community. With almost all of our pre-clinical students continuing to learn remotely and our faculty located in various locations due to the pandemic, creating space to have community has become ever-more important. Through weekly faculty journal clubs and drop-in lunches over zoom to student drop-in sessions multiple times each week, I am surrounded by the energy of the institution to support my own energy in learning each day!

Anything else that you would like to add?
Thank you to IAMSE for providing an avenue for educators to meet with, grow with, and learn from fellow educators. As a lifelong learner who wanted to go into education, I had a community to discuss these things with while in graduate school but lost that community when I entered professional teaching. I was surrounded by a lot of educators, but not all of them were focused as deeply as I was on learning. Within IAMSE you know that no idea is too outside the box, no question is too challenging, and you will always be supported in your effort to help others learn and become the best healthcare educators they can be, all while supporting the training of the very best healthcare practitioners! In these times, I think we need each other in these efforts more than anything!


Want to find more opportunities for students in IAMSE? Join the New Educator and Scholar Training (NEST): A Professional Development Workshop for Students at #IAMSE21 in June! Registration for this workshop is complimentary for students when registered for the meeting!

Hauer & Teherani to Present “Achieving Equity in Assessment for Clinical Learners”

The IAMSE 2021 Spring webinar series will explore strategies for inclusive teaching. Recognizing that unconscious bias is a crucial and contributory step in this endeavor, this series will explore how to recognize unconscious bias and create diverse, inclusive and equitable content for both the basic science curriculum and the clinical learning environment. The third session in the series will feature Karen Hauer and Arianne Teherani from the University of California, San Francisco (USA).

Achieving Equity in Assessment for Clinical Learners 
Presenters: Karen Hauer MD, PhD and Arianne Teherani PhD
Session: March 18, 2021 at 12pm Eastern Time

In this session, the presenters will review evidence on bias and inequity present in assessment with a focus on clinical learners and the effects of inequitable assessment practices on grades and awards. They will discuss the components of an equitable assessment system and share strategies to minimize bias and promote equity.

IAMSE Winter 2021 WAS Bonus Session Highlights

[The following notes were generated by Andrea Belovich, PhD.]

In response to the enthusiastic reception of the IAMSE Winter 2021 WAS series, “The USMLE Step 1 is Going to Pass/Fail, Now what do we do?,” an additional webinar was presented by Dr. Elise Lovell, Clinical Professor of the University of Illinois at Chicago and Co-Chair of the Coalition for Physician Accountability UME-GME Review Committee (UGRC) on February 25th, 2021. During this sixth and final webinar, made available free-of-charge to registrants, Dr. Lovell provided a cutting-edge update of the UGRC’s work to review the transition from Undergraduate Medical Education (UME) to Graduate Medical Education (GME).

Dr. Lovell began by introducing the composition and mission of the Coalition for Physician Accountability. The Coalition is a collaboration between the national organizations responsible for the education, assessment, accreditation, certification, and licensure processes ranging from UME to practicing physicians. (A full list of member organizations is available on the Coalitions’ website [1].) As a collective, the Coalition’s mission is “to advance health care and promote professional accountability by improving the quality, efficiency, and continuity of the education, training and assessment of physicians” [2].

To provide the audience with context for the development of the Coalition’s UGRC, Dr. Lovell shared the four recommendations resulting from the Invitational Conference on USMLE Scoring (InCUS) in March 2019:

  • Consider score reporting changes, e.g., pass/fail; composite score; categorical/tiered scoring for USMLE
  • Research on how USMLE is (or is not) related to performance in residency and/or practice
  • Continue work to address group (racial/demographic) differences in USMLE
  • Undertake comprehensive overview of UME-GME transition system

Dr. Lovell emphasized that while the first recommendation regarding the USMLE Step 1 P/F scoring has received significant attention from the medical education community, the InCUS recognized that the USMLE Step 1 numerical score was merely one factor of many that contributes to the broader problems surrounding the UME-to-GME transition. After briefly discussing the progress being made towards meeting the first three recommendations, Dr. Lovell focused on the fourth InCUS recommendation: the review and overhaul of the current UME-GME transition system. This review process was anticipated to involve eight major areas of focus: 1) Improving the application process, 2) Reducing the number of applications submitted by applicants, 3) Improving transparency of the UME-GME transition process, 4) Identifying potential adjustments to the Match, 5) Improving Program Directors’ ability to more holistically review applicants, 6) Improving the trust/transparency of medical school-based assessments, 7) Reviewing the role of standardized testing in UME-GME transition, and 8) Developing assessments for other important measures beyond knowledge.

As the InCUS developed the recommendation to review the UME-to-GME transition, the Coalition for Physician Accountability was identified as the organization best suited to addressing the task. In September of 2019, the Coalition formed a Planning Committee (PC) to identify the construct and membership of the UME-GME Review Committee (UGRC), develop a process for selecting UGRC membership/leadership, and determine key questions, deliverables, milestones, timeline, and budget for the UGRC.

As a result of the PC’s efforts, membership of the UGRC is comprised of representatives from each of the Coalition member organizations, as well as medical students, resident physicians, members of the public, and support staff. Along with Dr. Lovell, Dr. George Mejicano was selected to co-chair the UGRC. Areas of focus for the UGRC were identified to include fit of applicants for residency programs based on abilities and interests, increase of trust between medical schools and residency programs, and mitigation of reliance on licensing exams during the application process. In addition, the UGRC’s focus encompasses ensuring fairness for all types of applicants (allopathic, osteopathic, and international medical graduates) while considering cost and the potential for systemic bias and diversity issues throughout the transition from UME to GME. The broader scope of the UGRC was also determined to include consideration of specialty-specific competencies, including when and how specialty-specific preparatory training for residency should occur, as well as where responsibility should rest in resolving any gaps in residency readiness.

Once established, the UGRC created four work groups to address the charges from the Coalition’s Planning Committee, and added their own overall considerations of diversity, equity, inclusion, fairness, student wellbeing, and the public good. The work groups were also asked to proactively anticipate outcome assessment of their recommendations and to plan for research for continual modification to support the formation of an iterative review process of the UME-GME transition going forward.

Work Group A’s focus is on ensuring residency readiness by identifying competencies students should be learning during UME and improving the advising process as students choose residencies for application. Work Group B’s charge is to improve the mechanics of the application/election process from the UME perspective, which includes information sharing by medical schools with residency programs, residency application content, and application mechanics (e.g., away rotations, etc.). Work Group C’s task is to improve the mechanics of the application/election process from the GME perspective, including information sharing by residency programs with medical schools, interview processes, and the match process with an emphasis on considering financial and opportunity costs to students. Work Group D is concerned with post-match optimization and improving the “soft transition” into residency during the fourth year of medical school. In particular, this group is addressing how to ensure that junior residents are prepared to meet specialty-specific competencies and how responsibility for any readiness gaps should be shared in the interest of patient safety and students’ professional development. This process is anticipated to involve information sharing/feedback from the residency program back to UME in order to more successfully educate and prepare future students.

Dr. Lovell then provided an overview of the UGRC’s process and work-to-date. Following up from a well-planned and intentional virtual brainstorming session held January 14th and 15th, 2021, the UGRC’s work groups have achieved/established the following: 1) Communication framework including bi-directional Stakeholder engagement; 2) Central Repository for reference literature; 3) Work Group level-setting (defined present status of UME-GME transition and data resources); 4) Root cause analysis of current problems; 5) Consideration of “what’s good/worth keeping” from current state; 6) Envisioned success, including measurement of outcomes; 7) Solicited Stakeholder visions of the transition’s future Ideal State.

Dr. Lovell then invited audience members to follow UGRC meeting updates on physicianaccountability.org, and provided an expected timeline for the delivery of the URGC’s recommendations, which are currently being built. These draft recommendations will be reviewed by the UGRC in March 2021, and made available for public review in April 2021. Final UGRC recommendations are expected to be delivered to the Coalition for Physician Accountability in May 2021.

The URGC is currently seeking UME-to-GME innovation input from stakeholders, which will be accepted through March 12th, 2021 [3].

References:

  1. Coalition for Physician Accountability. https://physicianaccountability.org/members/
  2. Coalition for Physician Accountability. https://physicianaccountability.org/about/
  3. “UME-to-GME Review Committee (UGRC) Seeks Input on “Innovations” being Used in UME-to-GME Transition.” Coalition for Physician Accountability. https://physicianaccountability.org/wp-content/uploads/2021/02/UGRC-Innovations-Invitation-1.pdf

Baker & Eley-Sanders to Present “Strategies to Recognize & Address Implicit or Explicit Bias in Small Group Teaching “

The IAMSE 2021 Spring webinar series will explore strategies for inclusive teaching. Recognizing that unconscious bias is a crucial and contributory step in this endeavor, this series will begin by exploring how to recognize unconscious bias and create diverse, inclusive and equitable content for both the basic science curriculum and the clinical learning environment. The second session in the series will feature Charlotte Baker and Karen Ely-Sanders from Virginia Tech Carillion School of Medicine.

Strategies to Recognize and Address Implicit or Explicit Bias in Small Group Teaching 
Presenters: Charlotte Baker DrPH, MPH, CPH and Karen Ely-Sanders MS, EdD
Session: March 11, 2021 at 12pm Eastern Time

Health science education is undergoing a revolution towards utilizing small group teaching settings to provide students with opportunities to apply basic science principles to clinical cases. These sessions may include traditional problem-based learning, clinical skills groups, case-based applications and other approaches. Inherent in these approaches is the important educational value of individual socialization. In an inclusive learning setting, diversity among students and faculty working together in close proximity heightens and enriches the learning experience. However, the existence of implicit and even explicit bias can sabotage the learning environment by disenfranchising individuals. As medical learners and educators, we have the shared goal of fostering an inclusive learning environment. To that end, this webinar will highlight real-world examples of bias and micro-aggressions that could occur in the small group setting. These examples will not only be demonstrated and discussed, but subsequently followed by constructive strategies faculty and students can use to address bias in the learning environment. Using role play and interactive discussions, this webinar will help equip faculty and students with the tools needed to foster a welcoming, healthy, and productive learning environment.

#IAMSECafe Presents, “Conducting and Disseminating MedEd Scholarship”

Stay connected with your colleagues around the globe and join us for this week’s IAMSE Cafe round table discussion. Please join our host,  Kelly Quesnelle of  the WMU Homer Stryker M.D. School of Medicine as she leads a discussion on traditional, non-traditional and guerrilla strategies for getting medical education research out into the world. 
 
Tuesday, March 2, 2021 at 10AM EST â€“ Conducting and Disseminating Medical Education Scholarship. Journals are one avenue, and the gold standard, for sharing scholarship, but what about all the other channels? Dr. Quesnelle will lead a large group community of practice discussion, as well as smaller breakout discussions, about how to lead and share your medical education research in and out of journals.

To join the meeting please click here. The meeting password is IAMSECafe or, if you are calling in from a phone, the numeric password is 778130.
 
Make sure to join us on the first and third Tuesday of each month for more IAMSE Cafe Sessions! Looking for previous sessions? Visit www.IAMSECafe.org for a complete archive of the series. 
 
We look forward to seeing you this week!

Caruso-Brown to Present “Creating Diverse, Equitable and Inclusive Content in Health in Medical Education”

The IAMSE 2021 Spring webinar series will explore strategies for inclusive teaching. Recognizing that unconscious bias is a crucial and contributory step in this endeavor, this series will begin by exploring how to recognize unconscious bias and create diverse, inclusive and equitable content for both the basic science curriculum and the clinical learning environment. The first session in the series will feature Amy Caruso-Brown from Upstate Medical University (NY, USA).

Amy Caruso-Brown

Creating Diverse, Equitable and Inclusive Content in Health in Medical Education 
Presenter: Amy Caruso-Brown MD, MSc, MSCS
Session: March 4, 2021 at 12pm Eastern Time

Bias, shame, stereotype and stigma are pervasive in healthcare, with detrimental effects on the learning environment, student and faculty retention, and the health of our patients and communities. How can educators learn to create diverse, equitable, inclusive content? In this webinar, Dr. Caruso Brown will provide a concrete framework for educators, exploring examples of how to effectively address racism and other forms of bias and structural oppression in medical science education.

We Can’t Wait to See You at #IAMSE21!

June 2021 is just around the corner and the preparations for the next IAMSE annual meeting are at full speed. Attendee registration opened in January and we are already off to a strong start! I would like to again remind you about the opportunity to participate in supporting the International Association of Medical Science Educators at our 2021 Meeting. http://www.iamseconference.org

I have included a copy of our exhibitor brochure for your review. Download Here

The 2021 Annual IAMSE Meeting will be held virtually from June 12-17, 2021. At the meeting faculty, staff and students from around the world who are interested in medical science education join together in faculty development and networking opportunities. Sessions on curriculum development, assessment and simulation are among the common topics available at the annual meetings.

I look forward to working with you to make this educational event successful for all involved and hope to see you in June!

Sincerely,

Julie K. Hewett, CMP, CAE
IAMSE Association Manager

Check Out Our 2021 Events of Interest Schedule

Each year we eagerly await the announcement of educational and professional meetings and events all over the world and, as soon as that information is available, we add it to our Events of Interest Schedule.

While most in-person events have gone virtual, they are joined by the increasing number of standalone seminars, webinars, open discussion calls and online courses and series! Visit our page for more information on these upcoming events and many more:

Don’t miss upcoming events, planned virtually and in person throughout the year. If you would like us to add an event that you think your colleagues may enjoy, send the info to support@iamse.org.

Reminder* Elise Lovell to Present FREE Bonus Webinar – February 25

Based on the enthusiastic response to the Winter IAMSE Series entitled “USMLE STEP-1 is Going to Pass/Fail: Now What Do We Do?,” IAMSE is excited to add a special follow up session on February 25th at 12:00 pm on an update from the important work of the UGRC. The session will be presented by one of the UGRC Co-Chairs: Elise Lovell, an emergency medicine physician and the prior chair of the Organization of Program Directors’ Associations (OPDA).

Registration is limited to the first 1000 participants!

We encourage you to join us for this free session but please note that we can only host the first 1000 participants. The archive of the recorded session will be made freely available on our website after the broadcast.

The Coalition for Physician Accountability: UME-GME Review Committee

Presenter: Elise Lovell, MD
Session: February 25, 2021 at 12pm Eastern Time

Learner Objectives:
At the end of this session, attendees will be able to:
Describe the history and background leading to the creation of the UME-GME Review Committee (UGRC)
Identify the goals, work process, and timeline of the UGRC


More information on the Winter 2021 Webcast Audio Seminar Series, including information on how to register for access to the archives, can be found by clicking the button below.

#IAMSE21 Welcomes Stewart Mennin as Plenary Speaker

The 2021 IAMSE meeting offers many opportunities for faculty development and networking and brings medical sciences and medical education across the continuum together. This year’s main topic is Global Perspectives on Health Sciences Education. The final of four keynote speakers is Stewart Mennin from Human Systems Dynamics Institute, Brazil.


Stewart Mennin

Ten Global Challenges in Medical Education: Lessons from the field
Presenter: 
Stewart Mennin – Human Systems Dynamics Institute, Brazil
Plenary Address: Thursday, June 17, 2021, 10:00 AM – 11:15 AM EDT  

Medical Education varies from school to school, from institution to institution, and from culture to culture.  At the same time,  there are similarities among global challenges that stand out regardless of scale, the specificity of local context and point of view.  Ten of the most pressing issues and challenges that inform our present work and future directions are highlighted and discussed.

For more information on Dr. Mennin and to register for the 25th Annual IAMSE Meeting, please visit www.IAMSEconference.org.