What counts as quality in health professions education?

Two papers in this issue of Medical Education critique the state of research in health professions education (HPE).1, 2 Although these critiques focus on specific domains—team-based learning and rural professional identity—their concerns will be familiar to many in the field. Indeed, I recognise echoes of my own review comments in their conclusions. Yet encountering these papers together gave me pause. After nearly two decades working in HPE, I found myself asking: How has the quality of research in our field improved over time? And beyond assessing individual papers or programmes of work, by what criteria should a field such as ours be judged? Before addressing these questions, it is necessary to revisit a long-standing and consequential issue: whether HPE is best understood as a field or a discipline. This distinction matters because it shapes how we conceptualise quality, legitimacy, and progress. Van Enk and Regehr3 argue that HPE can be a knowledge-producing field, characterised by contributions from academics across multiple disciplines and from collaborators beyond the academy, integrating theory and practice. Kuhn4 positions a field as a ‘not-yet paradigm’, organised around problems rather than shared theoretical commitments, and defined by debate, exploration and provisional stability. In such a space, legitimacy is often pragmatic—gained because the work is useful and endures—yet continually fragile. It must be justified to schools, departments, universities and health services and repeatedly explained to those who respond with a perplexed look when one says they work in HPE. The looseness inherent to a field—its pluralism and inefficiency—also means that knowledge production may be slower and less cumulative. By contrast, Blouin5 contends that HPE meets Krishnan's criteria for a discipline: a socially and institutionally organised body of knowledge defined by shared concepts, methods, standards and power relations that regulate what counts as legitimate inquiry. Disciplines are anchored by unifying principles, canonical knowledge and a community of knowers who share a common interlanguage.6 In this view, a discipline embodies not only what is known but also a distinctive way of being, thinking and doing that is tightly aligned and self-reinforcing. While both arguments are persuasive, I am currently swayed by the characterisation of HPE as a field—albeit a hybrid one, situated at the intersection of health care and education. Historically, new scientific specialties often emerge at disciplinary margins before solidifying into disciplines.4 At the same time, contemporary disciplines themselves are increasingly plural6 and cross-disciplinary in practice.7 What I value most about HPE is its openness: its potential for interdisciplinary and transdisciplinary collaboration. While there is evidence that HPE research is becoming more interdisciplinary, reflected in increasing citation of work beyond medical education, there is scope for more.8 Those of us working in HPE are intellectual nomads, bringing with us disciplinary traditions—psychology, sociology and physics—as well as vocational and practice-based knowledge from medicine, allied health, and education. As Klein6 argues, interdisciplinarity is not simply a matter of borrowing methods or theories. Rather, it involves integrative work: developing conceptual frameworks that synthesise insights across disciplines to address problems that cannot be adequately understood from a single perspective. However, framing HPE as an interdisciplinary (or even cross-disciplinary) research field complicates any attempt to judge its quality. Interdisciplinary research cannot be evaluated using the criteria of a single discipline. National research quality exercises in the United Kingdom, Hong Kong and Australia gesture towards possible qualitative metrics, such as coherence, cumulative knowledge building, impact on policy and practice, plurality of knowledge and method and contribution to broader intellectual debates. These criteria point towards a different understanding of quality—one that values integration, relevance and intellectual ambition over methodological orthodoxy. None of these observations are new, and many have been articulated more eloquently elsewhere. Yet they lead to a pressing and unresolved question: How might we be more systematic and deliberate in sustaining the quality and future of HPE as a field? This is not a question that can be answered by individual researchers or single institutions. They require collective reflection, shared infrastructure, and an explicit willingness to debate what we value—and why—in the work we produce. But where, with whom and how should these conversations take place? HPE could become a discipline or an interdisciplinary field. In either case, legitimacy will not come from convergence around a single paradigm, method or canon. Instead, it will come from our capacity to sustain shared conversations about what matters, how we know and why our work is worth doing. The very features that make HPE harder to judge (plurality, interdisciplinarity, integration of practice and theory) could shape how we define and govern quality. Quality, in this sense, is less about standardisation and more about deliberateness—about being explicit in our theoretical commitments, ambitious in our integration of perspectives and accountable to both scholarship and practice. The challenge ahead is not whether HPE can become a discipline, but whether we can build the intellectual and social infrastructures that allow a plural field to become coherent, cumulative and consequential over time. Rola Ajjawi: Conceptualization; writing—original draft; writing—review and editing. With thanks to Drs. Meredith Young and Rabia Khan for thoughtful discussions on this topic. The author has no conflict of interest to disclose. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.