Evidence, or the lack of, in health professions education
Dr Neel Sharma
The rise in health professions education (HPE) has been rapid. Yet despite this, there now needs to be a pause for reflection. Whilst various headliners are appearing under the domains of teaching, learning and assessment, it is important to assess the evidence for these avenues before adopting them en masse.
In terms of teaching and learning, we are aware of various methodologies, namely problem based, team based and the current flipped classroom movement. Yet we often ignore the limitations of these approaches and often adopt a one size fits all policy. Evidence highlights issues with regards to the above named avenues including an excessive student workload and limited improvement in knowledge scores.
Technology enhanced learning through high fidelity simulation is often praised at many global centres for its ability to allow learners to undertake patient case scenarios in a safe learning environment with feedback yet we often ignore the excessive cost and limited evidence to suggest it proves superior to more low fidelity methods. The WHO have in fact advised for the use of low fidelity platforms in resource limited environments
Assessment is also changing with now a desire to assess professional attributes such as the ability to lead or work in teams. Such situational judgement testing is in fact not without issues and evidence has indicated a need to evaluate the extent to which performance can be predicted as an independent practitioner based on such tests.
Competencies have been the backbone of health professions education but are now being revolutionised to the domain of entrustment, where faculty determine whether a learner can be entrusted to perform a skill unsupervised. Again no evidence exists for such in terms of long term performance.
Often interventions are adopted on weak evidence but rather consensus. And it was Margaret Thatcher who once said:
“Consensus: “The process of abandoning all beliefs, principles, values, and policies in search of something in which no one believes, but to which no one objects; the process of avoiding the very issues that have to be solved, merely because you cannot get agreement on the way ahead. What great cause would have been fought and won under the banner: ‘I stand for consensus?”
Concerns regarding HPE have been centred on the lack of strong leadership, underlying tribalism, issues regarding whether it delivers value for money and lack of social accountability. Further issues have been related to HP shortage, quality of training, selection and distribution.
Davis, M.H., AMEE Medical Education Guide No. 15: Problem-based learning: a practical guide. Medical Teacher, 1999. 21(2): p. 130-140.
Parmelee, D., et al., Team-based learning: a practical guide: AMEE guide no. 65. Med Teach, 2012. 34(5): p. e275-87.
Fatmi, M., et al., The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No. 30. Med Teach, 2013. 35(12): p. e1608-24
Jensen, J.L., T.A. Kummer, and M.G.P.D. d, Improvements from a flipped classroom may simply be the fruits of active learning. CBE Life Sci Educ, 2015. 14(1): p. ar5.
Whillier, S. and R.P. Lystad, No differences in grades or level of satisfaction in a flipped classroom for neuroanatomy. J Chiropr Educ, 2015
Cook, D.A., et al., Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA, 2011. 306(9): 978-88
Patterson F et al. Situational judgement tests in medical education and training: Research, theory and practice: AMEE Guide No. 100. Med Teach. 2016. 38 (1): 3-17
ten Cate, O., et al., Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99. Medical Teacher. 0(0): p. 1-20.
Horton R. A new epoch for health professionals’ education. The Lancet. 375. 9756. 1875-1877