BMJ 1999;318 ( 8 May )

Editor's choice

"I don't know": the three most important words in education

The BMJ wants to do better with education. We are clearly "in the education business," and the ABCs, for example, which are based on educational theory, continue to be one of the best read parts of the journal. But we want to go further by publishing more educational research, increasing the educational value of all the material we publish, and developing new educational forms on our website. This issue is a step towards achieving our educational aims.

Our increasing interest in education is partly a response to the rising importance of continuing medical education (CME) and continuing professional development (CPD). But these terms create such negative associations in the minds of many doctors: bureaucracy, compulsion, point scoring, stupid questionnaires, dull lectures, money making, and a lack of evidence of effectiveness. Education should be fun. This sadly is a foreign notion to many doctors, often, I believe, because of medicine's tradition of education by humiliation.

Medical education is, however, changing, like most else in medicine. David Pencheon, a doctor/teacher/ researcher from Cambridge, recently came and spoke to us about those changes. In the old world you were expected to know what you should know, learning was thought to be complete at the end of training, and uncertainty was discouraged and ignorance avoided. In the new world the most important thing to know is what you don't know. And you should feel good about not knowing. Pencheon plays a game with medical students. He asks them increasingly difficult questions, which they usually keep trying to answer, guessing as they go. Eventually a student will say, "I don't know." Pencheon awards that student a tube of Smarties. "Those three words," he says, "are the most important words in education."

Learning is now lifelong, and ignorance and uncertainty are OK. Learning is about knowing how to find out what you don't know. (See Pencheon's full list of contrasts on the BMJ's website.) These new attitudes need to be shared with patients. Patients may take time to celebrate ignorance in their doctors, but pretending to know when you don't is rapidly becoming old fashioned.

The issue on education comprises an editorial on the need for evidence based medical education (p 1223); papers offering guidance on evaluating educational interventions (p 1265, p 1267, and p 1269); two randomised trials of educational interventions (p 1246 and p 1251); and articles on fashions in medical education (p 1272), whether continuing medical education works (p 1276), and learner centred approaches in medical education (p 1280).

Footnotes

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Relevant Articles

Time for evidence based medical education

Stewart Petersen
BMJ 1999 318: 1223-1224. [Extract] [Full Text] [PDF]

Randomised controlled trial of educational package on management of menorrhagia in primary care: the Anglia menorrhagia education study

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BMJ 1999 318: 1246-1250. [Abstract] [Full Text] [PDF]

Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study

U N Premaratne, J A C Sterne, G B Marks, J R Webb, H Azima, and P G J Burney
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BMJ 1999 318: 1265-1267. [Extract] [Full Text] [PDF]

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Linda Hutchinson
BMJ 1999 318: 1267-1269. [Extract] [Full Text] [PDF]

Evaluating educational interventions

M Wilkes and J Bligh
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Rapid Responses:

Read all Rapid Responses

"Let the buyer beware"

Gerry Silverstein
bmj.com, 9 May 1999 [Full text]

..... but I know someone who does !

Philip Stowell
bmj.com, 4 Mar 2001 [Full text]