Changing education, changing assessment, changing research?


L W T Schuwirth, PO Box 616m 6200 MD Maastricht, The Netherlands. Tel: 00 31 43 388 1129; E-mail:


Background  In medical education, assessment of medical competence and performance, important changes have taken place in the last 5 decades. These changes have affected the basic concepts in all 3 domains.

Developments in education and assessment  In education constructivism has provided a completely new view on how students learn best. In assessment the change from trait-orientated to competency- or role-orientated thinking has given rise to a whole range of new approaches. Certain methods of education, such as problem-based learning (PBL), and assessment, however, are often seen as almost synonymous with the underlying concepts, and one tends to forget that it is the concept that is important and that a particular method is but 1 way of using a concept. When doing this, one runs the risk of confusing means and ends, which may hamper or slow down new developments.

Lessons for research  A similar problem seems to occur often in research of medical education. Here too, methods – or, rather, methodologies – are confused with research questions. This may lead to an overemphasis on research that fits well known methodologies (e.g. the randomised controlled trial) and neglect of what are sometimes even more important research questions because they do not fit well known methodologies.

Conclusion  In this paper we advocate a return to the underlying concepts and a careful reflection of their use in various situations.