A welcome and healthy debate has been opened up by the recent contrasting opinions articulated in the commentaries by Bligh and Brice1 and Montrouxe and Rees2 in this journal. Bligh and Brice argue that if we are to compete in the world of biomedical research, we need to produce more robust, understandable and measurable outcomes to appease funders, readers and practitioners. Montrouxe and Rees, on the other hand, suggest that, rather than perceiving our work as a variant of biomedical research, medical education researchers and funders need to accept that the purpose of much of what we research and study is less about clearly advising practice and more about understanding processes and theory building.
The application of social science frameworks within our empirical setting is, arguably, an emergent field
Medical education research is now a well-established field; the number of medical education journals is testament to that. However, the application of social science frameworks within our empirical setting is, arguably, an emergent field. A growing body of medical education practitioner-researchers, both doctors and allied health professionals, are embarking on medical education research and have chosen to adopt social sciences methodologies in the realisation that education and research in education are fundamentally humanistic endeavours. Their previous scientific training and often solely positivistic research experience mean this is a journey into uncommon territory. Many are lucky to work with, and gain support from, the outstanding body of medical education researchers who are not clinicians who enrich our understanding of both learning and teaching and of how to carry out meaningful research in this arena. Others are working in more isolated environments and look to the literature, including the medical education journals, for help and guidance.
High-impact biomedical journals which publish education research privilege large-scale quantitative studies that suppress the local context in favour of the general
It remains true in medicine, and even to some extent in medical education, that we still privilege a consensus approach where the randomised control trial is given precedence over sophisticated observation and hermeneutic possibilities. Medical education research practised in this environment tends to lead to research techniques that favour hard measurables and that treat narrative as numbers, fragmenting stories, ignoring the unconscious and controlled by a technical metaphysical framework, in order to produce answers, thereby privileging one meaning over another. High-impact biomedical journals which publish education research privilege large-scale quantitative studies that suppress the local context in favour of the general in a misguided notion about the metrics of quality in educational research. This uni-dimensional view of the value of research methodologies has been supported in a recent clarion call to education researchers by Todres et al.3 Such editorial policy has the potential to make a powerful impact on the types of research undertaken, and published, by the medical education community.4
Medical education research should aspire to inform theory and policy, as well as practice, and should contribute to ‘knowledge building conversations’
We agree wholeheartedly with Montrouxe and Rees2 that we need to think about who we are publishing for and for what purpose, and that we should recognise that medical education research should aspire to inform theory and policy, as well as practice, and should contribute to ‘knowledge building conversation[s]’5 with the wider education community. Moreover, we suggest that the time has come not just to think about recasting medical education as a social science, but to refocus on what is publishable and published to support this; what, in other words, constitutes the legitimate scholarly outputs of the study of medical education. Given that the significance of publication as a metric of academic success and its importance in disseminating new ideas remain unquestioned, it is vital that we consider how traditional publication practices may impact on the development of medical education research and what we might do to nurture progress.
We need to reconsider the traditional canons currently used to judge quality in medical education research
So what may be the ways forward? An examination of the quality of publications remains essential, but we also need to reconsider the traditional canons currently used to judge quality in medical education research.4,6 Medical education is a multidisciplinary field and therefore includes research outputs from a range of different standpoints, including social and educational psychologists, anthropologists, statisticians, sociologists, educationalists and doctors. There needs to be space in medical education journals to accommodate research outputs from this wide range of disciplines. This will require a fundamental shift in our concept of validity and reliability so that we can recalibrate where these concepts sit within social science viewpoints, establish their parameters and features, and balance validity and reliability against ethical consideration. This will be partially achieved by legitimising the publication of negative results and findings: this work is valuable in enriching our understanding of education.
‘We murder to dissect’ (Wordsworth, 1798)
If our interest lies in meanings, we need to question the established doctrine and its rules about how we work with cases, narratives and stories. Even in qualitative medical education research, we tend to dissect the narratives of others, coding, counting and re-categorising. This may be a consequence of earlier immersion in a medical world where the treatment of narrative in medical training has been described as an ‘institutional autism’ where the re-telling is a mis-representation in which stories are turned into mechanical, automated information that loses their richness and ‘conceals the reality’.7
The medical education literature needs to allow space for increasing scholarship and theory building: this is difficult to do in articles that are limited to 3000 words in length. Supplementary online publication and discussion fora means journal articles can be longer at little extra expense, and the publication of full appendices can allow the documentation of thought processes and analyses, as well as detailed explanations of methodology, thus helping the reader-researcher and the reader-practitioner to decide on the evidence put before them.
Longer articles also permit scope for authors to declare their theoretical perspective: if we acknowledge that all research is to some degree shaped by the researcher, then clear declarations of the researcher’s perspectives are needed to enable the reader to interpret the research approach and findings. We need to provide a clear declaration of orienting concepts and world views: our epistemologies and ontologies should be a mandatory aspect of all submitted manuscripts.
We need to provide a clear declaration of orienting concepts and world views: our epistemologies and ontologies should be a mandatory aspect of all submitted manuscripts
Medical education researchers also need a forum in which to publish and discuss methodologies: methodological literacy is key to moving forward within the field of medical education. But in a multi-professional discipline such as medical education, there needs to be recognition that some methodologies and approaches may be unfamiliar to a practitioner audience. Papers with more methodological details will help, but papers from social science perspectives may need commentaries to help practitioners and early researchers make sense of the purpose, methodologies and findings and to assist them to become more familiar with the theories currently underpinning much of what is researched in medical education and education in general.
A reconceptualisation of the meaning of ‘evidence’ is an important next step for potential authors, funders and publishers
To conclude, a reconceptualisation of the meaning of ‘evidence’ is an important next step for potential authors, funders and publishers.6 We, as a research community, need to ensure that what is published in journals of medical education embraces a strong social science orientation that privileges the unique, the local and the story, and that allows for uncertainty. We need to accept that ‘soft’ methodologies do not equate with soft outcomes: just richer, more complex and perhaps less instantly practical ones, which permit debate, building consensus through collaborative practice and advancing understanding. In a world in which publication output holds hegemonic status as a measure of scholarship, a further imperative as we move forward in the field is a publishing forum that welcomes research from a broad church of world views, that promotes detailed presentation of methodologies and provides opportunities to theory build and thus to make conclusions that are useful and accessible.