Research in medical education: finding its place

31 December 2000 will be an important date for medical education in the UK because it is the census date for the Research Assessment Exercise (RAE). The RAE is a quality assurance programme established and organized by the national UK funding body for higher education in order to examine whether its investment in university research has resulted in value for money. The performance of individuals and groups of researchers is assessed using their publication record, grant income and supervision of research as indicators of research activity. Previous exercises, held five-yearly, have had both positive and negative effects on research performance.1 One particularly negative effect has been the emergence of a biomedical `elitism' that values quantitative, `hard science' research over other formats. Another problem has been the division of medical research into hospital, community, and laboratory-based categories. These divisions have made it difficult to identify and confirm the valuable place medical education research has within the reporting process. Pressures on individuals to become academically respectable before the next round of the RAE are increasing the need to define the nature of medical education research and where the results of such research can be applied most effectively. This is now an urgent task in universities and medical schools in the United Kingdom. Although jobs may not be overtly threatened, especially in clinical posts, professional self-esteem and personal job satisfaction take a tumble when your head of department informs you that your published work in medical education is `non-returnable' or that it is rated as being of little importance. A recent review2 showed that medical education research is frequently small-scale, local, funded informally or internally, and aims to find answers to local problems. Natural, rather than controlled settings are typical with field-based action research techniques used more often than experimental designs.3 A study conducted for the Association for the Study of Medical Education (ASME)4 found considerable informal research activity being undertaken by individual teachers or departments. Formal research activity was largely clustered around groupings of expert researchers. Both these and other studies5 have suggested that although some high quality work has been reported, increased rigour and coherence, especially in relation to theory building, would strengthen the quality and reputation of research in medical education. This should result in a reduction of prejudice on behalf of funding bodies. Irby has divided research approaches in medical education into two areas.6 The first is the `biomedical' variety, that is heavily influenced by reductionism and incorporates experimental research designs. Studies that investigate, for example, problem-solving skills or different scoring methods in examinations, provide examples of this paradigm. The second approach, characterized by a holistic perspective, `seeks to illuminate the meanings of events and actions rather than to formulate guiding rules for professional practice'. This more recent approach draws on well-established qualitative research methods derived from, for example, anthropology, sociology, or linguistics.7 Howard Becker's well-known study of socialization amongst medical students is an example of work based on this paradigm.8 Medical education research is not undertaken solely by doctors. Researchers with backgrounds in education, psychology, the social sciences or other disciplines are occupying a larger role in a rapidly growing field. For example, both cognitive and educational psychology have made substantial contributions towards our understanding of student learning. The social sciences have provided frameworks that enable us to interpret students' experiences as they undergo medical training, and qualitative research methods are increasingly being used for the study of complex educational phenomena. Whilst this range of disciplines undoubtedly represents a major strength, it also increases the problem of defining medical education research. Research in medical education is the critical, systematic, study of teaching and learning in medicine and includes scholarly analysis of the context, processes and outcomes of all phases of medical education. The results of research into aspects of medical education, for example, new facts, concepts or ideas, and emerging issues, have an impact on how medical students and doctors learn, how they are taught, assessed, and selected, and how their courses are organized, funded and administered. Fundamentally, medical education is concerned with improving patient care. Ultimately, research into teaching and learning in medicine has its impact at the bedside, in the consulting room and in the wider community. Research in medical education matters.