In clinical research there is typically a transition from cell based analysis, animal work, and human involvement before any form of intervention, be it diagnostic or treatment based, is deemed valid in a clinical setting. One example I can relate to currently is the use of image enhanced endoscopy which my colleagues and I are working on at the human stage having cleared cellular and animal works.
The FDA is central to the drug and device approval process. And interestingly for the former, up to 3000 patients can be tested with the process taking several years. The latter also follows similar cautious settings.
In medical education I wonder what similar approvals are in place to draw parallels of bench to bedside. So taking PubMed as a reference point I decided to see how much evidence exists for the following areas related to teaching, learning and assessment:
1. Problem based learning AND medical education—4020 results
2. Team based learning AND medical education—921
3. Simulation AND medical education—6463
4. Interprofessional medical education—5355
1. OSCE AND medical education—918 hits
2. Progress testing AND medical education—172
3. Competency based assessment AND medical education—1089
4. Entrustable professional activities AND medical education—51
5. Situational judgement test AND medical education—18
6. Prescribing safety assessment AND medical education—41
7. Multiple mini interview AND medical education—71
Although a slightly rough and ready insight, the results above prove interesting. Current UK requirements advocate the use of the situational judgement test and prescribing safety assessment with little in the way of formal research prior to launch. The multiple mini interview is also employed globally as an admissions assessment tool yet formal evidence is lacking. Competency based assessment scores highly yet the much talked about entrustable professional activities which have been adopted as part of the core AAMC requirement for entering residency has less backing.
I can’t admit to having read each article in depth, but educationalists can probably agree with the point I am trying to make. It seems that in education there are situations of formal approaches coming to light without sufficient pre testing, unlike the case with clinical based research. I wonder therefore how stringent we should be before adopting new interventions and whether there should be a global consensus in place as is the case with the FDA. I personally would classify the training of the future generation with the same importance as the need for appropriately safe and effective new drugs and devices. In all cases, the safety of patients’ lives is at risk.
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.