The shoulders of giants

‘Bernard of Chartres used to say that we are like dwarfs on the shoulders of giants, so that we can see more than they, and things at a greater distance, not by virtue of any sharpness of sight on our part, or any physical distinction, but because we are carried high and raised up by their giant size.’ The sentiment expressed by John of Salisbury (and later popularised by Newton) has become a tad clichéd, I know, but sometimes ideas become clichéd because the words that describe them are just too perfect. They fit so well in health professional education research that one-third of this issue of Medical Education has been allotted to three individuals who personify Bernard of Chartres’ giants: Ronald Harden,2 Geoffrey Norman3 and Henk Schmidt.4 We put this issue together in part to celebrate their many accomplishments, in part to thank them for providing the shoulders onto which many of us try to climb, and in part because, while Harden, Norman and Schmidt personify giants as individuals, their collective also provides a worthy metaphor representative of the field of health professional education itself. These three were called upon because, among their many accolades, they were the first three winners of the Karolinska Institute Prize for Research in Medical Education. To quote the Institute’s website, ‘This international prize is awarded for outstanding research in medical education… to recognise and stimulate high-quality research in the field, and to promote long-term improvements in educational practice.’ Each individual was charged simply (and vaguely, I must confess) with offering his perspective on the evolving field of medical education and medical education research. Although the literal texts they have provided offer a fascinating history and glimpses into the future, equally intriguing to me are the more implicit messages that can be drawn from the juxtaposition of the three articles.2-4 Health professional education as a field is comprised of educators, innovators, researchers, administrators, clinicians, academics and contributors of countless other identities. They are clearly not mutually exclusive, but nor should they be deemed mutually inclusive. Just as in clinical practice, there are specialisations within health professional education that overlap with one another in important ways, but need to be nurtured, supported and rewarded in their own rights if we are to maintain the strengths provided by complementary expertise. Diversity is an essential condition for the field’s current success and continued maturation, yet no one person can be expected to embody the entirety of that diversity. The first three Karolinska Institute award winners come as close to doing so as anyone, yet when I reflect on the articles submitted to this issue by Harden,2 Norman3 and Schmidt et al.4 and consider the exceptional careers of these three men, the words that most readily come to mind are, respectively, innovation, research and education. Each author is an innovator, researcher and educator and all three clearly practise their craft from a position of deep and impressive scholarship. However, there are palpable differences in the dominant focus each of these contributors puts forward when asked to reflect on the past, present and future. That each has been broadly recognised for his substantial contributions to health professional education speaks well of the capacity of the field to recognise and value various vantage points, albeit that these three individuals represent the tip of the iceberg in each respect. That a physician, a physicist and a psychologist combine to collectively represent the best the field has to offer (rather than being the start of a joke that continues with ‘walk into a bar’) further underlines the success health professional education has had in managing the tension between practical needs and theoretical advances. As health professional education continues to evolve, it appears to be nestling itself nicely within Pasteur’s quadrant of scientific research that seek to meet both basic and applied ends.5 Finally, although it is self-evident that career achievement awards like the Karolinska Institute prize recognise long-term success, the decades’ worth of contributions to the field made by the first three prize winners and the evolution of their thinking and careers over that time raises another theme of relevance to the field as a whole. Harden’s, Norman’s and Schmidt’s dynamic scholarship typifies the programmatic efforts used by Lakatos6 to define scientific study and the sustained innovation called for by Bereiter7 as the mechanism through which progress is achieved. In doing so, their scholarship serves as a model of how the field itself must continue to evolve. Bereiter speaks of each innovation (and here I refer to innovations in health professional education research) as representing only the most recent imperfect iteration and teaches us that it is only through continuous efforts at quality improvement that we will reach our full potential.7 Harden’s, Norman’s and Schmidt et al.’s articles2-4 offer complementary and insightful guidance regarding the directions in which the field might continue to strengthen and particular ways in which we might achieve our goals, thereby truly raising us up ‘by their giant size’.