Medical Education Research methodology

The specialty of research in medical education began just over three decades ago with a small group of clinicians and educational researchers at the medical school in Buffalo, New York. Since that time it has expanded worldwide. This paper is a personal reflection on how this research has informed our understanding of learning, teaching, and assessment in medicine.

Summary points

Research in medical education has contributed substantially to understanding the learning process

The educational community is becoming aware of the importance of evidence in educational decision making

Areas of major development include basic research on the nature of medical expertise, problem based learning, performance assessment, and continuing education and assessment of practising physicians

Measuring progress

In medicine, indicators of scientific progress might be measured by objective indicators such as death from cardiovascular disease. In education such “hard” evidence may be lacking for several reasons. Firstly, paradoxically, real differences in educational strategies may not be reflected in outcomes, such as licensing examination performance, simply because students are highly motivated and are not blinded to the intervention, so will compensate for any defects in the curriculum.– Secondly, a curriculum is not like a drug, which can be given at standard doses, but instead contains many components, delivered with variable quality by different teachers. Finally, the time between learning and important outcomes may be so long that the effects of the curriculum are obscured—although not always.

Use of evidence in educational decision making

Perhaps the most important evidence of progress in the discipline is that we are now more likely than before to demand evidence to guide educational decision making. Before 1970 important educational advances were largely adopted by persuasion and politics; since that time changes are more likely to be initiated or accompanied by evidence. Although this may sound circular, it represents tangible recognition of the contributions that research can make to the practice of education.

Specific areas of progress

Beyond this cultural change, the following broad domains have seen real progress: basic research in the acquisition of expertise, problem based learning, advances in assessment methods, and continuing education, recertification, and relicensure.

Basic research in the acquisition of expertise

In the early 1970s basic research into the nature of clinical reasoning pursued the hypothesis that expert clinicians were distinguished by the possession of general “clinical problem solving” skills. This was wrong; what emerged was that expertise lay predominantly in the knowledge, both formal and experiential, that the expert brought to the problem.

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