Neel Sharma: Reforms in medical education—are we missing something?

Medical education has seen significant change over the past decade and more. Advances in teaching, learning, and assessment strategies are vast. The didactic lecture form of teaching is no longer the flavour of the month it seems with more and more emphasis on problem and team based learning. Classrooms are seeing the use of mobile devices to allow for rapid learner access to information and instructors are now tasked with the need not to simply disseminate information but to ensure understanding and provide appropriate feedback. Classes are being “flipped” and the MOOC movement has meant that attending face to face teaching is slowly becoming a non-existing entity.

Further use of technology has allowed for high fidelity and virtual simulation to be brought into play ensuring replication of clinical scenarios in a safe learning environment. And the movement towards learning analytics and adaptive learning has meant that teaching is becoming more and more learner orientated. Regarding assessment, the existent of defined competencies and now entrustable professional activities allows for on the job performance to be monitored and recorded, ensuring that assessment simply doesn’t rely on a final exam alone but rather a regular stepped wise approach.
As backing for all described, evidence has been delivered by the truckload. And the highly talked about role of the cognitive sciences with terms such as spaced learning and interleaving has added a certain futuristic sounding approach to the domain.

Interestingly, many of these interventions are introduced at a particular centre based on that particular learner cohort. The effects are then highlighted and the intervention snowballs with institutes following suit sometimes without sufficient evidence in doing so. Medical education in this regard contrasts completely to science where rigorous checks are in place, with randomization and sample size measures ensuring validation of a new drug or form of hospital based technology. Interestingly, science translated in this way ensures that patient outcomes are optimum. However in medical education, the major deficit is the lack of patient engagement. Educators may assess the value of an intervention on the learner but never the end goal, which is primarily the patient.

Earlier this year, Barack Obama highlighted plans for a Precision Medicine Initiative. A 215 million dollar investment aiming to pioneer a new model of patient powered research that promises to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients.

This intervention makes perfect sense. After all, patients differ in terms of their anatomy and physiology and ultimately their clinical presentation. In the field of medical education as alluded to earlier we tend however to ignore our patients completely.

In order for the academic field of medical education to be truly rigorous in its pursuits, there needs to be a greater interest on the patient and not just the learner. It goes without saying that there is a particular bias in assessing the learner on its own, particularly on the basis of what they feel they know or are capable of doing. Therefore by pursuing patients as a worthwhile intervention group, medical educators can truly ascertain whether a particular innovation has had valuable merits.

Neel Sharma graduated from the University of Manchester and did his internal medicine training at The Royal London Hospital and Guy’s and St Thomas’ NHS Foundation Trust. Currently he is a gastroenterology trainee based in Singapore.

Competing interests: None declared.

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