Forced to reflect as opposed to research in medical education
I am currently a gastroenterology trainee with a keen interest in medical education. I wholeheartedly agree that the state of medical education research from a funding perspective is a concern. And furthermore that without true evidence for many of the innovations that headline each week we can simply not reach a firm conclusion as to what is truly beneficial long term.
My journey so far in education has been more of a reflector than a researcher. Plagued by a lack of funding as a trainee, I am left to educate myself in the field online through journal form in the main. I am unable to attend conferences due to cost and unable to afford a formal medical education degree programme. Whatever money I could put aside over several plus months was used to complete a certification course which at least provided an overview of the various theoretical principles. I would certainly consider myself part of the ‘enthusiastic amateur’ tribe as the authors describe. As a trainee I am subject to the various reforms that are in flux, from teaching methods, assessment style, and portfolios of competency. I reflect as I feel as a trainee I am able to spot first-hand potential pitfalls in theoretical translation to clinical practice. Pitfalls that may not be seen first-hand by senior educators pushing a theory forward; many of whom are not clinicians or who are no longer practicing. My reflections I hope are read by educators and hopefully those who have sufficient funding to undertake formal research. The limitations I witness and experience are in urgent need of solutions. Examples of concerns arising from innovations include: the lack of expert feedback during problem based learning, the lack of feedback from all forms of assessment, the lack of engagement from supervisors with portfolio completion and so on.
I am currently on a sabbatical in Asia which further highlighted limitations with educational intervention. Often we find a single centre promoting a new innovation, which is never truly replicated by others, but simply snowballed globally as a one size fits all approach. For research to be truly rigorous we must observe a multi centred approach, randomisation and minimise bias. Educators promoting a strategy may themselves be biased. It is true to say that many current innovations have been lifted from other disciplines. Problem based learning is an example of such used initially in the business field. Yet in medicine we don’t see much in the way of field specific strategies. Maybe the lack of funding is reason for this. Furthermore in keeping with Ben Goldacre’s editorial, selective publication of research in itself can bias outcomes as can the lack of reporting of conflicts of interest as noted also by Eimear Hally and Kieran Walsh [1] [2]. Cultural differences also play a significant role which is too often ignored. Innovations in the West cannot be lifted to the East. And educators who have taught globally are witness to this.
We are now seeing a huge push towards the use of technology enhanced learning. Yet despite the many advantages, we have to be cautious of the fact that many centres simply can’t afford the costs involved. And even for those centres that can, are we hindering the doctor patient relationship with an over reliance on machines? It seems that despite all the simulated exercises on communication we are still getting it wrong [3]. Therefore if funding is provided we need to ensure it is directed appropriately based on actual evidence.
As doctors, patient management is always patient centred. In the UK, any concerns patients have regarding their care can be made evident courtesy of PALS. In medical education, the effects of an innovation are often reported only by students. Yet ultimately it is patients that are on the receiving end. Therefore more needs to be done to include patients in medical education based research and funding should be allocated accordingly.
I shall continue on in my journey, reflecting and gathering insight as best I can.
I second the authors’ closing comment.
1. Goldacre, B. and C. Heneghan, How medicine is broken, and how we can fix it. Vol. 350. 2015.
2. Hally, E. and K. Walsh, Competing interests and medical education. Medical Teacher, 2014. 36(9): p. 825-825.
3. GMC. Record number of complaints against doctors - GMC report. 2012; Available from: http://www.gmc-uk.org/news/13895.asp.
Rapid Response:
Forced to reflect as opposed to research in medical education
I am currently a gastroenterology trainee with a keen interest in medical education. I wholeheartedly agree that the state of medical education research from a funding perspective is a concern. And furthermore that without true evidence for many of the innovations that headline each week we can simply not reach a firm conclusion as to what is truly beneficial long term.
My journey so far in education has been more of a reflector than a researcher. Plagued by a lack of funding as a trainee, I am left to educate myself in the field online through journal form in the main. I am unable to attend conferences due to cost and unable to afford a formal medical education degree programme. Whatever money I could put aside over several plus months was used to complete a certification course which at least provided an overview of the various theoretical principles. I would certainly consider myself part of the ‘enthusiastic amateur’ tribe as the authors describe. As a trainee I am subject to the various reforms that are in flux, from teaching methods, assessment style, and portfolios of competency. I reflect as I feel as a trainee I am able to spot first-hand potential pitfalls in theoretical translation to clinical practice. Pitfalls that may not be seen first-hand by senior educators pushing a theory forward; many of whom are not clinicians or who are no longer practicing. My reflections I hope are read by educators and hopefully those who have sufficient funding to undertake formal research. The limitations I witness and experience are in urgent need of solutions. Examples of concerns arising from innovations include: the lack of expert feedback during problem based learning, the lack of feedback from all forms of assessment, the lack of engagement from supervisors with portfolio completion and so on.
I am currently on a sabbatical in Asia which further highlighted limitations with educational intervention. Often we find a single centre promoting a new innovation, which is never truly replicated by others, but simply snowballed globally as a one size fits all approach. For research to be truly rigorous we must observe a multi centred approach, randomisation and minimise bias. Educators promoting a strategy may themselves be biased. It is true to say that many current innovations have been lifted from other disciplines. Problem based learning is an example of such used initially in the business field. Yet in medicine we don’t see much in the way of field specific strategies. Maybe the lack of funding is reason for this. Furthermore in keeping with Ben Goldacre’s editorial, selective publication of research in itself can bias outcomes as can the lack of reporting of conflicts of interest as noted also by Eimear Hally and Kieran Walsh [1] [2]. Cultural differences also play a significant role which is too often ignored. Innovations in the West cannot be lifted to the East. And educators who have taught globally are witness to this.
We are now seeing a huge push towards the use of technology enhanced learning. Yet despite the many advantages, we have to be cautious of the fact that many centres simply can’t afford the costs involved. And even for those centres that can, are we hindering the doctor patient relationship with an over reliance on machines? It seems that despite all the simulated exercises on communication we are still getting it wrong [3]. Therefore if funding is provided we need to ensure it is directed appropriately based on actual evidence.
As doctors, patient management is always patient centred. In the UK, any concerns patients have regarding their care can be made evident courtesy of PALS. In medical education, the effects of an innovation are often reported only by students. Yet ultimately it is patients that are on the receiving end. Therefore more needs to be done to include patients in medical education based research and funding should be allocated accordingly.
I shall continue on in my journey, reflecting and gathering insight as best I can.
I second the authors’ closing comment.
1. Goldacre, B. and C. Heneghan, How medicine is broken, and how we can fix it. Vol. 350. 2015.
2. Hally, E. and K. Walsh, Competing interests and medical education. Medical Teacher, 2014. 36(9): p. 825-825.
3. GMC. Record number of complaints against doctors - GMC report. 2012; Available from: http://www.gmc-uk.org/news/13895.asp.
Competing interests: No competing interests