10.3 Impact

ICE is a framework, an approach to assessment and the construction of learning opportunities that, like CBME, is learner focused and malleable. Each student is on their own path and learning will not be linear. The ICE framework gives freedom to the student to understand and interpret the competencies and roles that go far beyond a tick box approach to skill acquisition. ICE is not a rubric applied to student learning; it is the pedagogical freedom for educators to structure experiences that will result in opportunities for students to take their Ideas, content, and information and test it in new contexts, to see it from different angles and to construct it in novel ways.  It’s the realization that student experiences, creativity and imagination drive real learning. The content blocks of the pre-clinical medical education can be used in specific disciplines in prescribed and formulaic ways, but the transformative learning for medical students comes when they have the space to apply a piece of information from a lecture, with the memory of a previous patient encounter to a patient seen in an entirely different context.

The tension between Ideas and Connections in medical education is reflected in the tension between the rational sciences learned in the sterility of a lab and the messy reality of real-life and disease as experienced by patients. The practice of medicine, not a purely technical or scientific enterprise, is an art informed by science. In order to apply scientific and classroom/laboratory learning to patient care, students must learn how to make Connections and apply information learned in one context to a variety of other contexts which may or may not resemble the original learning context. So, a true assessment of students’ capacities and skills will necessarily interrogate their ability to make Connections—to bridge the pre-clinical/clinical divide. ICE is explicit in the ways it values the meaning-making required to connect new learning to old, and the associated necessity of structuring learning and assessment opportunities that invite demonstration of those connections. Medical education has a long history of assessing ideas and skills, and ICE makes it clear that we are not yet assessing the full range of skills and capacities we are teaching and which we expect of physicians. There remains much work to do.