Understanding Medical Education

Evidence, Theory, and Practice

Tim Swanwick, Kirsty Forrest, Bridget C. O'Brien, Tim Swanwick, Kirsty Forrest, Bridget C. O'Brien, Bridget C. O'Brien

• Publisher: Wiley-Blackwell
• Year: 2018
• Print ISBN: 9781119373827
• eBook ISBN: 9781119373834
• Edition: 3
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Created in partnership with the Association for the Study of Medical Education (ASME), this completely revised and updated new edition of Understanding Medical Education synthesizes the latest knowledge, evidence and best practice across the continuum of medical education.

Written and edited by an international team, this latest edition continues to cover a wide range of subject matter within five broad areas – Foundations, Teaching and Learning, Assessment and Selection, Research and Evaluation, and Faculty and Learners – as well as featuring a wealth of new material, including new chapters on the science of learning, knowledge synthesis, and learner support and well-being.

The third edition of Understanding Medical Education:

• Provides a comprehensive and authoritative resource summarizing the theoretical and academic bases to modern medical education practice
• Meets the needs of all newcomers to medical education whether undergraduate or postgraduate, including those studying at certificate, diploma or masters level
• Offers a global perspective on medical education from leading experts from across the world

Providing practical guidance and exploring medical education in all its diversity, Understanding Medical Education continues to be an essential resource for both established educators and all those new to the field.

Part 1
Foundations

1
Understanding Medical Education

Tim Swanwick

Dean of Education and Leadership Development, NHS Leadership Academy, Health Education England, London, UK

It was the nuclear physicist and father of the hydrogen bomb, Edmund Teller, who wrote (perhaps rather alarmingly) ‘Confusion is no bad thing; it is the first step towards understanding’ [1, p. 79]. Newcomers to the field of medical education could be forgiven for being confused. Medical education is a busy, clamorous place, where a host of pedagogical practices, educational philosophies, and conceptual frameworks collide. It is a place where academic journals vie for attention, institutions and professional bodies compete for political leverage, and the wheel of reform and ‘improvement’ revolves faster than, and often independently of, the cycle of evaluation and research. And it is a place of increasing accountability and regulation because of its proximity to one of the prime socio‐political concerns of government, that of the health of its people.

It was the desire to develop evidence‐based policy and practice in this complex arena that led to the establishment of the Association for the Study of Medical Education (ASME) in 1957. The past 60 years have seen a burgeoning of literature in the field. This is both a help and a challenge to the clinician taking on responsibilities for teaching, assessment, and educational supervision. The range and diversity of relevant theory and research are now almost overwhelming, and in 2006 ASME recognised the need for a succinct yet comprehensive guide to the vast literature now underpinning best practice in medical education. Understanding Medical Education aims to be that guide.

What is Medical Education?

Medical education as we know it today spans three sectors: undergraduate, postgraduate, and the continuing professional development of established clinicians. However, it has not always been that way, and Abraham Flexner – the centenary of whose seminal report on the transformation of the American medical school system was celebrated earlier this decade [2] – would not have recognised the attention currently given to the design, management, and quality assurance of structured training in the postgraduate years, still less the need to instigate regulatory systems to ensure the ongoing personal and professional development of practising clinicians.

Medical education's ultimate aim is to supply society with a knowledgeable, skilled, and up‐to‐date cadre of health care professionals who put patient care above self‐interest, and who undertake to maintain and develop their expertise over the course of a lifelong career. Medicine has a privileged position in society and, as a result, medical education is itself set apart from the main body of higher education. In many countries it luxuriates in separate funding streams and higher rates of remuneration for its clinical teachers; it is the beneficiary of status and patronage through its colleges, academies, and professional institutions; and it is a formidably powerful, and predominantly conservative, political lobby, more than occasionally a source of frustration for those who seek to modernise health services.

Within the confines of this academic and political preserve lies the discipline of medical education; although one could question whether medical education is a discipline in its own right, or an idiosyncratic collection of concepts appropriated from other educational fields and perfused with a technical rationality borne out of the dominance of bioscience within medicine [3, 4]. There are certainly a number of predominant educational assumptions, such as experiential learning and reflective practice, and favoured curricular approaches borrowed from other fields – witness the enthusiastic transplantation of competency‐based education from vocational training [5]. But medical education is not just a ‘magpie’, taking ideas wherever they can be found, but has made, and continues to make, its own significant advances and contributions to the wider educational literature. Many of these unique and major developments are expounded within this book: problem‐based learning, simulation, structured assessments of clinical competence, supervision, and the use of technology to enhance learning, to name but a few.

Challenges and Preoccupations

Another characteristic of medical education is that it is, as Cooke and her colleagues note, ‘in a perpetual state of unrest’ [6, p. 1339]. A constant stream of reports issues from regulators, commissions, inquiries, and task forces – all urging reform. This may just reflect the sluggish response to change and innate conservatism of the profession and its educational institutions. This is not, as it happens, a new phenomenon. In the UK, George Pickering, writing as far back as 1956, offers us the wry observation that ‘no country has produced so many excellent analyses of the present defects of medical education as has Britain, and no country has done less to implement them’ [7]. Britain is not alone in this regard and from the other side of the Atlantic, Warren Anderson – in a special centenary ‘Flexner’ edition of Medical Education – questions ‘whether the current proliferation of literature about reforms in medical education can lead to real change, or whether it constitutes a self‐referential agitation that, in the aggregate, holds little promise’ [8, p. 29]. Despite such reservations, the frequency of such reports increases, and the clarion calls to action grow ever louder. So what are the current preoccupations of medical education and society's expectations of it?

To ‘begin at the beginning’; getting the right students and later on the right trainees training in the right specialty is crucial. In a competitive and litigious environment, the importance of having demonstrably fair selection processes is unarguable. A good person/job fit is essential to productivity, quality, and job satisfaction. In Chapter 26, Fiona Patterson and her colleagues identify just how difficult getting all this right can be. Predicting who will make a good doctor is critically dependent on what the role of the doctor will be 10–15 years into the future, something that is increasingly uncertain. So are there generic attributes that we can select for? What selection methods should we use? And to encourage the recruitment of well‐rounded practitioners, should entry to medical school be graduate only?

Having selected the right students and, with luck, matched the right trainees to the most suitable postgraduate training programme, how and what are they to learn, and how can the quality of their education and training be ensured? An array of approaches to teaching and learning are described in the central section of this book framed by a discussion by Janet Grant on approaches to curriculum (Chapter 5) and Linda Snell and colleagues on the importance of good instructional design (Chapter 6). A concise summary of relevant, and guiding, educational theory is provided by David Kaufman in Chapter 4, preceded by a summary of the emerging insights, for medical education, of the relatively recent field of cognitive neuroscience (Chapter 3). And in Chapter 7,...

Table of contents

• Cover
• Table of Contents
• Foreword to the Third Edition
• Preface
• Part 1: Foundations
• Part 2: Teaching and Learning
• Part 3: Assessment and Selection
• Part 4: Research and Evaluation
• Part 5: Faculty and Learners
• Index
• End User License Agreement