Without proper research funding, how can medical education be evidence based?BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h3445 (Published 26 June 2015) Cite this as: BMJ 2015;350:h3445
- Julian Archer, clinical senior lecturer in medical education1,
- Chris McManus, professor of psychology and medical education2,
- Katherine Woolf, senior lecturer in medical education2,
- Lynn Monrouxe, director of medical education research3,
- Jan Illing, codirector4,
- Alison Bullock, director5,
- Trudie Roberts, director6
- 1Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
- 2University College London, UK
- 3Institute of Medical Education, Cardiff University, UK
- 4Centre for Medical Education Research, University of Durham, UK
- 5Cardiff Unit for Research in Medical and Dental Education, Cardiff University, UK
- 6Leeds Institute of Medical Education, University of Leeds, UK
- Correspondence to: J Archer
“It is a mistake to think you can solve any major problems just with potatoes”—Douglas Adams
We regularly hear about the costs to healthcare when doctors get it “wrong.” Each year, an estimated 98 000 people die in the United States and nearly 12 000 in England, as a result of preventable medical errors.1 2 In the US these deaths are estimated to cost $29bn (£18bn; €26bn).1 The NHS spent over £1bn (€1.4bn; $1.6bn) on litigation claims in 2012-13 alone.3 Since 2010, four UK-wide reviews of healthcare failings have all called for a change in the culture of the healthcare workforce,4 5 6 7 acknowledging that “culture will trump rules, standards and control strategies every single time.”8 Although defining culture is complex,9 central has to be good staff support, training, and management, which in turn “nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.”10
Getting it “right” saves lives and money and is deceptively simple. We invest in high quality research into the education, training, and relicensing of our clinical workforce and translate the results into practice. But despite the obvious need to grow the evidence base, research funding remains small.
Cancer Research UK spent over £350m on research last year.11 Figures for how much is spent on research into medical education are not readily available, but we know that only a few publications on research into medical education arise from externally funded research,12 13 14 and a US study in 2005 found that the median funding was $15 000.14 A recent survey from Wales found that just five of the 45 respondents “active” in medical education research were a named principal investigator or co-principal investigator on grants totalling £100 000 over four and a half years. Only 24 indicated any funding at all. Respondents cited the lack of funding as the greatest barrier to undertaking research into medical education. In the US, there have been fresh calls to rectify similar chronic underspending.15
Clinical research to fight cancer and other major illness clearly benefits society, but without highly trained doctors the advances from that research could not be put into effective practice. Yet at times it seems as if we spend money on bigger faster engines, better suspension, and flashier bodywork yet buy the cheapest oil. Without the best oil, replenished and maintained, the whole machine slowly grinds to a halt—rusted and broken from the inside.
While medical educators may be part of a “vibrant” community16 they remain the ugly ducklings of medicine.17 Far too often research into medical education is undertaken by enthusiastic amateurs: educators and clinicians working unpaid in their own time. But like other research fields, most progress is made when academics have dedicated funded time to work on complex issues and how these link to patient benefits.18
There are signs of hope. There have been some successes in building capacity in medical education research internationally.16 19 In the US, the Institute of Medicine has recently proposed a “transformation fund” to support innovation and research in graduate medical education15; however, this is part of a wider funding stream that will support the financing and structures of training. Similar policy has already been developed in England, with Health Education England (HEE) funding and delivering postgraduate training.20 The challenge, yet to be realised, is to ensure that a substantial proportion of HEE’s £5bn pot is ring fenced for research in healthcare education. The National Institute of Health Research in England has, since its conception, shown a willingness to fund individual fellowships, doctorates, and programme grants. It has expressed a desire to fund more, but in order to reach the understandably high threshold for competitive funding we need some pump priming.
Willingness of funders is not sufficient for medical education research to succeed in transforming lives. It also needs a commitment from medical education researchers to become a viable and attractive network of academics by showing that their research has an effect on real world problems.21 Research into medical education has the potential to improve medical students’ and doctors’ learning and wellbeing as well as how healthcare is delivered. But these improvements must be focused on ultimately improving the health of patients.22 Medical education researchers need to properly communicate the importance of their research, translating its findings for the medical profession, the wider healthcare community, the academic community, research commissioners, and the public.23
Rigorous research into medical education by experts in the field is seriously threatened by the lack of funding. Yet the potential effect of this type of research is huge: in shaping doctors, the clinical team, workforce planning, leadership, team working, patient safety, policy, and healthcare delivery and ultimately improving healthcare culture for the benefit of patients. Medical education researchers and funding bodies both have a role in overcoming the lack of funding and realising the potential gains in fully supporting research in this area. In addition, researchers need to work together to better explain how our work is directly relevant to medical practice and funders need to increasingly recognise and value medical education research.
Healthcare education is about developing the best doctors, nurses, and other members of the clinical team to deliver the best care to patients; healthcare education research is about providing the evidence to achieve it. Without oiling the healthcare machine with the best research, funded appropriately, the rest of the expensive healthcare infrastructure will never work effectively. We can no longer leave medical education research to chance.
Cite this as: BMJ 2015;350:h3445
Competing interests: We have read and understood BMJ policy on declaration of interests and declare JA has personal funding as a NIHR career development fellow in medical education until 2017 and also has research funding from the Department of Health policy research programme, the General Medical Council (GMC), Higher Education Academy, Health Foundation, and General Dental Council. He advises the National Clinical Assessment Service on regulatory research in respect of multisource and patient feedback. TR is president of the Association for Medical Education in Europe (AMEE), which supports scholarship in medical education. She has received funding from the GMC, ESRC, and EU. KW is a member of the Association for the Study of Medical Education education research group, which promotes medical education research and funding. AB has funding for medical education research from Health Education England/Academy of Medical Royal Colleges and the Wales Deanery. LM has funding from the GMC and AMEE. JI has research funding from the Department of Health to develop the education outcomes framework and Health and Care Professions Council to explore revalidation.
Provenance and peer review: Not commissioned; externally peer reviewed.