Medical education is a confusing field at times. Whilst I value its role in cementing training, there seems to be an often all too common course of contrast among educators as to what is classified as valuable academic research into teaching methods.

It seems that post intervention evaluation studies are of low ranking, pre and post studies may rank slightly higher, but the golden gem comes in the form of the randomised controlled trial, which is often difficult to undertake. Splitting student cohorts and randomising them to a novel intervention compared with a standard comparison measure can be fraught with educational unease among learners. Continuing on the rank scale, assessing a candidate’s perception of an intervention also seems to rank minimally. Academics however seem to place strong promise in the testing method to see whether an intervention has made actual impact from a practical setting, in other words is the intervention translatable to a real life setting and is the test reliable and valid? In other words do scores improve?

In actual practice however, as teachers we seem slightly guilty of the opposite. Many students often ask me whether a particular aspect of the curriculum that I am teaching will be tested come exam time. And many seniors often lament the fact that students are simply not keen on self-directed learning. They miss the high school silver spoon feeding. Problem based learning and team based learning are pushed to encourage ownership of learning and students are forced to accept.

I wonder therefore what the most suitable approach is. Assessment drives learning. And even though we shouldn’t spoon feed our juniors, there should be some form of direction to ensure an end outcome of adequate patient safety. When it comes to education based research we are already biasing our outcomes by providing an intervention designed to enhance learning and furthermore work well in a testing sense. The saga continues…

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.