Promises and delivery—a research imperative for new approaches to medical education

Howe et al describe the approaches to medical education in the four new medical schools in the United Kingdom.¹ The new programmes embrace wider selection procedures, spiral curriculums, fitness to practise, integrated clinical experiences, and comprehensive assessment processes. The reforms are part of wider changes throughout British medical education, and Britain is not alone in this endeavour. In Australia there have been similar changes in existing and new medical schools.² Indeed, the past 20 years have seen worldwide reforms if measures such as adopting problem based learning and creating medical education units are to be taken as key indicators.

Several external factors have been driving the reforms, and their importance was apparent in my study of four international medical schools that were changing their education programmes or creating new ones (unpublished data). In both Britain and Australia the external forces have come through funding from governments with clear agendas to change both the quality and quantity of future entrants to the medical workforce.

External support does not come without obligations. External sponsors want to know if the programmes they support have the desired impacts on the healthcare system. Providing the answer to this type of question is not easy, as some writers on medical education reforms in North America have shown.³ Determining which attributes of graduates from innovative medical schools are important and how long they are retained as careers progress are complex problems. But therein lies an opportunity for staff in the new or changed medical schools.

Funding for workforce reforms frequently targets teaching initiatives without investing in research. Howe et al outline some of the difficulties of conducting medical education research at the same time as establishing new education programmes and the implications of this for the scholarship of medical education where programmes are located in otherwise research-rich environments.

There is at least one profitable direction for research in new or changed medical schools. Impact or outcome research may provide external sponsors with the information they need, but, if rigorously conducted, it will also provide generalisable findings for the wider medical education community. It will require the construction of tracking databases and associated research designs. Such work is not necessarily new and has been successfully applied at single institutions.⁴ However, it has the potential to provide more powerful findings if conducted collaboratively, with medical schools combining data on different approaches and their outcomes. The Australian medical schools have laid the foundations for such an approach though the Committee of Deans Medical School Outcomes Database Project. It remains to be seen whether it and future projects involving other innovative schools can provide the research evidence that Murray, for example, suggests can be generated in this time of change in medical education.⁵