Rigor in Medical Education
I congratulate Wright and colleagues for their timely article from the February issue of the Journal of Graduate Medical Education.1 Research design is fundamental in helping to draw the right conclusions in medical education. The community has moved from little innovation in medical education to new approaches in the domains of teaching, learning, and assessment. Examples include team-based learning, “flipped classrooms,” massive open online courses, entrustment, and situational judgement testing, to name a few.
Despite these innovative approaches, it is consensus rather than evidence that often dictates approaches in medical education, with expert bias possibly playing a major role. Methodology and reporting currently used in medical education research may not be suited for its purpose. We rarely see long-term outcomes. There is also a lack of negative reporting, as well as use of non-intervention comparison groups in medical education studies. Research in medical education also lacks demographic analysis. Innovations tested in Western settings snowball globally, and this often neglects the notable cultural educational differences that exist. The literature notes the important concepts of individualism and collectivism.2 The former is typically a Western-based approach, focusing on students speaking out, large group discussion, confrontation in learning, and impartial teacher input. The collectivist culture that exists in many Eastern nations may mean that students speak out when called on to do so, favor small group interaction, and avoid situations in which they may not be perceived as knowledgeable, due to concerns about “loss of face.”2
To achieve rigor in medical education, we need greater dialogue between educators and clinicians, and across different nations and context. For education methods to be fit for purpose they must be relevant to their target learner population. This suggests a need for added testing of interventions across different cultural settings and contexts.
