Dialogue in Medical Education: enabling the academic voyeur that lurks inside us all


‘If the structure does not permit dialogue the structure must be changed.’Paolo Freire

I can recall countless moments when my thinking as a young graduate student was advanced in giant leaps by opportunities to listen in on conversations held by individuals who were deeply embedded in problems I had just begun to appreciate. Little did I know that I was engaging in a form of legitimate peripheral participation,1 which, with the growing prevalence of online communities of practice, has come to be termed ‘lurking’.2 Lurking brought with it a sense of angst (‘What can I possibly say to contribute to this conversation?’), excitement (‘This is so cutting-edge!’), astonishment (‘How did they learn all of this?’) and fear (‘How will I ever get to this point?’). Only with hindsight have those experiences also brought a sense of good fortune (it seems such a shame that more people didn’t get to listen with me) and jealousy (for every conversation I enjoyed, there must have been many others that would have been equally enlightening). In this editorial, I am announcing a new strategy through which Medical Education will strive to make those conversations readily available to a greater number of individuals.

Presenting at conferences and publishing in journals are great ways to disseminate ideas to a large audience, but there is just something different about hearing and discussing ideas that are presented in a more casual, free-flowing and interactive voice relative to the crafted discussion promoted by the podium. In more formal settings, the presenter very deliberately scripts his or her remarks in a manner that tells the audience what the authors think to be most important. Rarely can the conversation grow organically to take into account what the audience finds most intriguing. Even the question-and-answer period is usually driven by responses to things the presenter has said, rather than by its evolution into a genuine dialogue. By the term ‘dialogue’, I do not mean dialogue such as that of Socrates, in which the wizened teacher focused on asking questions of students in order to lead them to the understanding he possessed. Rather, I mean dialogue such as that of Freire, in which two individuals work with and challenge one another to collaboratively alter and deepen the understanding of both parties.

In this issue of Medical Education, we publish the first article in a new series entitled ‘Dialogue’. In this series we will identify pairs of people who do not regularly publish together and ask them to engage in e-mail correspondence over the course of a month. They will be encouraged not to type lengthy opuses, but, rather, to engage in a pithy dialogue in which the pair share their current perspectives on a timely topic of mutual interest.

Although Bohm et al.3 state that ‘no firm rules can be laid down for conducting a Dialogue because its essence is learning’, they do suggest that the basic conditions for an effective Dialogue include the participation of individuals who view and treat one another as peers engaged in a mutually beneficial quest for insight that requires both partners to be willing to question their assumptions. To that end, we established the following ground rules for the series.

  • 1 Correspondents should avoid turning the conversation into a debate in which each person tries to beat the other by proving his or her perspective to be the right one. Doing so is unnecessarily polarising and risks focusing the conversation on less important issues. Rather, participants in a Dialogue should aim to conduct a cooperative exploration to establish the areas in which their perspectives are similar and those in which they differ in interesting ways.
  • 2 As in improvisational acting, each person must commit to ‘going with the flow’ by responding to his or her partner’s most recent correspondence rather than trying to force the conversation in one direction or another.
  • 3 Claims made should be empirically defensible (and backed up with citations) or labelled as speculation to make the derivation or source of statements clear to readers and to give them the opportunity to track the argument backwards if they so choose. Although references are not essential during the act of corresponding, they should be added before the document is submitted.
  • 4 Both authors should take the opportunity to review and revise the entirety of their correspondence for the sake of clarity/flow/wordsmithing prior to submitting, but they must make an effort to remain true to the original conversation.
  • 5 There should be some effort to keep the total dialogue under 4000 words and to work together to create a smooth introduction, body and end that will be interpretable by readers who will not have full knowledge of the authors’ backgrounds.

As a result of the latter three ground rules, these articles will diverge from the natural instances of lurking that were used to introduce this editorial. This was thought to be necessary in developing this new genre for the sake of ensuring accessibility and clarity, and optimising pedagogical value.

As with any innovation, some pilot testing is required. I must convey my sincere gratitude to Brian Hodges for agreeing to engage in the experimentation represented by the first article in this series.4 Brian and I have both been exploring the limitations that are placed on health professional education when the field fully adopts any one perspective (or discourse) on assessment. We set ourselves a rule that we each had to respond within 48 hours of receiving an e-mail. That made the task challenging, but it was thought-provoking and enjoyable. That experience yields hope that this series will fulfil two purposes: (i) to expand the authors’ thinking through engagement in dialogue, and (ii) to offer readers access to eclectic and high-level conversations that traditionally occur in contexts in which they cannot be lurked upon. In publishing the first in the series, Brian and I hope you find our deliberations useful in pushing your own thinking forward and we invite those of you who are not satisfied with simply lurking to add to the conversation we started by using the ‘discuss’ link at http://www.mededuc.com. Readers who are interested in completing a Dialogue of their own should contact the Editor with a proposal.


Acknowledgements:  the author would like to thank Lorelei Lingard (London, ON, Canada), for her encouragement and thoughtful reflections on how this series might be developed most effectively.