Medical education research: being strategic

It is well overdue for medical education researchers to become more strategic in the way we wish to promote our discipline – and a very worthy one it is, at least as seen through the eyes of the converted. Medical education is not alone in this critique. The same frustrations about funding and recognition can be heard from primary care researchers or social scientists trying valiantly to promote the causes of poverty alleviation or mental health care. How often do we hear the cry: ‘They just don’t understand – if they did they would fund us appropriately'? Well, this may be true, but it is time we got smarter at understanding ‘them’ and telling ‘them’. That means knowing our environment and what targets we have to hit to get support, including finance. Australia is currently at a major turning point in terms of its publicly funded research. In May 2004, the prime minister announced the start of an 18-month process to establish quality and accessibility frameworks for publicly funded research.1 This process has been heavily informed by the current research assessment guidelines for the UK, RAE 2008,2,3 with Professor Sir Gareth Roberts leading the education minister's expert advisory group.4 Australians who have worked in the UK system can take some heart in knowing that both advisory papers underpinning the review stress the need for processes to appropriately measure ‘research impact generation’.5,6 This implies innovation in the development of measures of knowledge transfer, adoption, adaptation and application, rather than the application of a narrow focus on research quality indicators.6 Both discussion papers also call for diversity of measurement of research outputs across different types and fields of research and the need to move away from a ‘one size fits all’ strategy.5,6 For Australian medical education researchers, this means entering the debate early and modelling ways of assessing that diversity. But it also means forecasting the likely primary framework of assessment, including the things that may be valued more highly despite the call for diversity. The results of the RAE inform the distribution of public research funds from the 4 UK higher education funding bodies.2 How medical education places itself in this exercise is discussed elsewhere in this journal, but it will need to make strategic decisions about the panel and subpanels within which it chooses to be included. Choosing placement within the education subpanel, rather than the panel containing epidemiology, public health, health services research and primary care, needs careful thought.3 To be successful, we suggest medical educational research needs to understand these fields and, therefore, its competitors, well, and present its research, in particular its methodologies and outcomes, in a manner that fits the common context. Can medical education research demonstrate relevant health-related outcomes? Are its study methods understandable in this context? For Australia, the exercise is similar. National Health and Medical Research Council (NHMRC) funding, especially the prestigious programme grants, reward not only individual track records but focused research programmes with a core research team and high levels of higher degree students.7 Could any medical education unit in Australia currently pitch itself at this level? The most likely research areas for ‘best fit’ for medical education research and NHMRC project grants are health services research and public health, which are very similar to those in panel B in the RAE. The common methodologies and outcomes used in these disciplines are translatable to medical education. The other major Australian public funder is the Australian Research Council (ARC).8 In 2005, 23% of its linkage project funds (Aus$13m) went to the social, behavioural and economic sciences, the disciplines most likely to accommodate medical education research. Are medical education projects understandable in this discipline context? Opportunities also exist for projects with quality of care and health workforce outcomes to seek funding under the NHMRC or ARC.7 Are Australian medical education researchers seizing this opportunity? One of the reasons that medical education units in Australia and elsewhere have not traditionally competed well at these levels is that most are small and have been established comparatively recently. This is reflected in the kind of medical education research undertaken since 2000, which Regehr has described as falling into 4 categories: applied curriculum and teaching; skills and attitudes related to the structure of the profession; student characteristics, and assessment.9 Importantly, Regehr makes the claim that much medical education research is not programmatic in that individual studies do not ‘inform each other’.9 To be competitive our research must be programmatic. We must build multicentre collaborations where research is informed by others' work and which will provide the critical mass of core research staff and higher degree students necessary for competitiveness. But it must also be research that matters and can demonstrate relevant health system outcomes. Regehr illustrates this in his critique of Prideaux and Bligh's10 claim that locating research in a theoretical tradition will give it coherence and, by implication, make it programmatic. He points out that practically based objective structured clinical examination (OSCE) research approaches programmatic status, but theoretically rich research on experts' cognitive knowledge structures remains individualised.9 Programmatic research is not necessarily theory-driven, nor oriented to significant system outcomes. Medical educators need, therefore, to find common ground on research that will produce significant outcomes. One potential area concerns studies that demonstrate the workforce and career outcomes of medical courses and their relations to student characteristics, selection procedures, curriculum, teaching and learning and clinical placements. This is something of vital interest to governments, health system administrators, communities and funders. The Australian medical schools have made a start on this through a project initiated by the Committee of Deans of Australian Medical Schools (CDAMS) to establish a national graduate tracking database. This has already attracted significant government funds. Just as we know informed consumers can make appropriate choices about priorities in health care, informed funders will do the same.11 Responding to government discussion papers, positioning researchers on review panels and committees and collaborating with researchers outside the discipline are all key steps in this education process. Using Albert's model to describe the current debate in medical education research, the above critique is clearly a pragmatic one placed solidly at the ‘production for non producer’ pole.12 It suggests we promote collaboration outside medical education and respond to practical needs in seeking access to recognition and resources. There are enormous opportunities today for our discipline to contribute to quality health care delivery through rigorous research and scholarship. The challenge lies in recognising them and seizing them.