The cross‐cutting edge: striving for symbiosis between medical education research and related disciplines

During my first term of university as an undergraduate studying natural sciences, I found myself in numerous arguments with friends about the value of experimental psychology as a discipline. I was not particularly passionate about the subject at the time and had no idea how central the discipline would become in my life, but I had difficulty understanding how little credibility the field held for some of my classmates. In terms that are much more erudite than those we would have used then, the argument repeatedly presented to me was one of frustration that no laws had been established within psychology – it seemed as though every thesis we studied had an equally plausible antithesis and each theorist seemed capable of empirically falsifying the theories of opposing scholars. Few to no explanations of behaviour in psychology could compete with those of the chemical reactions we studied, or of germ theory or the theory of relativity, in terms of how broadly and accurately they could account for known data, let alone how they could successfully make precise predictions about phenomena that had not yet been witnessed. Later I came to appreciate the beauty of both thinking about the world in probabilistic terms rather than deterministic ones and of the robust influence context plays on behaviour (both of which make it unlikely that psychological – or educational – laws will ever be established in absolutes that are comparable with the laws of thermodynamics). At the time, however, my most common (albeit not necessarily influential) rejoinder was something along the lines of: ‘It’s not a fair comparison – you need to give the field time to mature.’ Depending on the context I may have spewed out some other words that cannot be reproduced here, but the gist of the argument was that experimental psychology as a field was only a century old, and that it was completely unreasonable to expect it to have accomplished what had been achieved through multiple centuries of careful and scholarly study in chemistry, biology or physics. Little did I know that I would go on to work predominantly in a field that was even younger than that of experimental psychology. Medical Education, one of the more established journals in the field of research that goes by the same name, is currently publishing its 42nd volume, meaning that, in academic years, the field of research in health professional education is just entering adolescence. As the community grapples with the growing pains of puberty, the global village that is raising this child must be sure to continue to nurture it into an adult that will make us proud. What distinguishes medical education from psychology at equal points in their maturation is, in part, the fact that medical education research has a much broader array of relevant topics, a much larger number of people (with variable training) interested in and positioned to research those topics, and a larger population that addresses its research questions between and around the time constraints of other substantial commitments. Whereas many individuals working in traditional academic environments complain about their teaching ‘load’, the majority of those interested in medical education research consider themselves first and foremost to be educators and clinicians. Despite these challenges, I dare say that the community of individuals engaged in medical education research is growing at a rate that far surpasses that of most other academic areas at equal points in their histories (computer science being one likely exception). Medical Education now receives over 1000 submissions per year from a truly international community of educators and researchers who are working towards improving educational practices in the health professions. In a previous editorial Lorelei Lingard and I noted some (and sympathised with all) of the numerous challenges facing many medical education researchers with respect to ways in which the current system makes it difficult to track where the gaps exist in the literature, let alone to appreciate how one’s own research efforts can be tailored to fill those gaps.1 I have also stated my belief that medical education, as a field, has benefited from the influence of countless disciplines of study, ranging from anthropology to physics.2 Albeit tremendously valuable, such diversity makes it even more difficult for individuals to understand the moorings of all studies and to appreciate the extent to which work carried out in other disciplines might contribute usefully to one’s own struggle with practical problems. Although there is no easy or single solution to this challenge, this editorial is written to elaborate on a new initiative Medical Education is introducing to help overcome these trials. This issue contains the first article commissioned to provide our readership with a look at the cross-cutting edge. Mark Albanese provided the pun. The general idea from which the pun arose is to intermittently publish thoughtful, empirically based and theory-oriented papers that present cutting edge research from another discipline of study that cuts across the field of medical education. The papers themselves will predominantly be devoted to synopses of research programmes (and an overview of the theory and findings that contribute to those programmes) that are relevant to the health professions education community, but have predominantly been published elsewhere. In this issue, Larsen, Butler and Roediger present an article entitled ‘Test-enhanced learning in medical education’, which will hopefully serve as a model for others to follow.3 Henry Roediger III, the senior author on the paper, is past president of the American Psychological Association and a tremendously successful cognitive psychologist by every measure. A relatively recent interest of his is the careful study of the direct pedagogical benefit gained from being tested on material one is trying to learn relative to repeated study. The phenomenon, known as test-enhanced learning, has been studied sporadically since the early 1900s, but was only recently re-discovered and subjected to careful empirical study. To write about this area of study, Roediger teamed up with Andrew Butler, another cognitive psychologist, and Douglas Larsen, a neurologist who is engaging in research in this area while practising medicine in St Louis, Missouri, USA. I think you will find that the three of them have teamed up to provide a very thoughtful summary of the test-enhanced learning phenomenon that is readily interpretable by psychologists and non-psychologists alike and which has practical implications across all levels of health professional training and practice. As a general rule, we will strive to enhance knowledge translation of papers that address the cross-cutting edge by publishing them along with a pair of commentaries from individuals working directly within the medical education research community. The paper by Larsen et al. has been read and commented upon in this issue by both Peter Cantillon, a family practice doctor from the University of Galway, in Ireland,4 and Jack Boulet, a psychometrician working with the Foundation for the Advancement of Innovation in Medical Education Research, in Philadelphia, PA, USA.5 You will undoubtedly have your own opinions on the value of this article, others that follow in the series, and other topics that you would find useful to have represented in this series. Please feel free to share those thoughts, as always, by writing to med@mededuc.com. Returning to the notion of knowledge translation, it is worth noting that a secondary goal of this initiative involves sharing the work conducted by medical education researchers with others outside the field who stand to benefit from consideration of this practice-oriented and important domain. Many areas of study within medical education have begun to be fed back productively to the home disciplines from which the basic ideas arose, at the same time as they impact upon practice and theory within medical education itself. Through the strategy outlined in this editorial, it is my sincere hope that we, as a community, will be better positioned not only to take advantage of the strongest work being performed in other domains, but to make the relationship symbiotic in that we might better position ourselves to complete work that will fill gaps and advance understanding of the ideas and phenomena currently constrained in those domains.