Intended for healthcare professionals

Analysis And Comment Medical education

Challenges for educationalists

BMJ 2006; 333 doi: (Published 07 September 2006) Cite this as: BMJ 2006;333:544
  1. Lambert W T Schuwirth, assistant professor of medical education (,
  2. Cees P M van der Vleuten, professor of medical education1
  1. 1 University of Maastricht, PO Box 616, Dokter Tanslaan 10, Maastricht, 6200 MD, Netherlands
  1. Correspondence to: L W T Schuwirth

    Medical education has to change to meet the shifts in public and professional attitudes. Experts gathering at the annual meeting of the Association for Medical Education in Europe next week have plenty to discuss

    Medical education is currently a hot topic. More and more people want to be involved in developing new educational and assessment methods and in conducting research in medical education. These developments have an increasing influence on the work of everybody in health care. Of course, it is nice that our discipline is high on the agenda, but some major challenges need to be tackled if the specialty wants to be taken seriously, as we outline below.

    Make practical training more effective

    Many of the developments and research in medical education have focused on the undergraduate curriculum, especially the theoretical parts. Clinical attachments and postgraduate training have not received nearly as much attention. This is unfortunate because not only are these practical aspects largely unstructured but they also waste too much time on non-educational activities and rely on learning by doing.12

    Changes in society have made this approach inadequate. Firstly, patients' growing awareness about quality of care makes them understandably reluctant to act as learning tools for medical students or registrars. Secondly, the European Working Time Directive, which limits the number of hours a registrar is allowed to work to 58 a week, has implications for training. The directive is a good thing for individual patient care, as working long hours increases the risk of medical errors,34 but there is a downside. The evidence from cognitive psychological research on expertise shows that to become an expert you need many hours of practice.5

    The challenges are thus to find ways to allow registrars to practise without using patients as learning objects and to optimise the educational effectiveness of …

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