Understanding Medical Education

Reviews / Votes

This is the second edition of the popular, well-read and well-recognised volume which aims to provide an introduction to the ever important business of medical education. Its brief is ambitious. It aims to be a synopsis of educational theory and practice, of use both to scholarly medical educators and educational scholars all within an acknowledged context of complexity, contestation and political dialogue. This ambitious brief is largely accomplished. For the reader wishing to access ready and organised ideas there are boxes with key messages and important principles, but there are also opportunities for the reader with more substantive concerns to access and engage in competing discourses. The latter is nowhere more evident than in the chapter on Quality in medical education by Alan Bleakley, Julie Browne and Kate Ellis where it is recognised that quality has competing managerial, economic, scientific, aesthetic, ethical, professional, social and political discourses. Familiar and traditional areas of study are seen through the lens of contemporary theory. Clare Morris and David Blaney s account of Work-based learning, the very nub of medical education, provides a re-interpretation of traditional concepts like the clinical apprenticeship through the application of theories drawn from the cognitive and social sciences. The coverage of the volume is comprehensive. The authors are a truly international group representing the best writers and thinkers in the discipline. All the major areas of medical education are covered through the five sections of the book: Foundations, Educational Strategies, Assessment, Research and Evaluation and Staff and Students. There are some omissions. The increasing adoption of longitudinal integrated clinical clerkships and the evidence about their efficacy probably deserves a chapter on its own. Similarly the current concern for medical education to drive the social accountability imperatives of medical schools deserves consideration. Fiona Patterson, Eamonn Ferguson and Alec Knight list political validity as one of the multiple validities to be considered in Selection into medical education and training. This required stakeholders and stakeholding groups to be decision-makers in selection. Antony Americano and Dinesh Bhugra give well-constructed account of Dealing with diversity. What is missing is the synthesing of ideas such as these and application to the responsibilities of medical schools to their communities in their selection processes, student population and educational programs. The coverage within each section is also comprehensive. The section on Assessment can serve as an example. It opens with a chapter on How to design a useful test: the principles of assessment by Lambert Schuwirth and Cess van der Vleuten. Chapters on Written assessment by Brian Jolly and Work-place assessment by John Norcini follow. Structured assessments of clinical competence are carefully explained by Katharine Boursicot, Trudie Roberts and William Burdick while Andre De Champlain takes up the important question of Standard setting methods in medical education. Diana Wood rounds off the section with a consideration of Formative assessment. Both the scholarly medical educators and the educational scholars have much to gain from reading this section. There is plenty of contemporary theory, lots of sound advice and practical tips, tables and examples. There is not much on assessment that has escaped the collective authors attention and those planning assessment programs would benefit from a close reading. The section could be improved by some conceptual and theoretical linking of the chapters. For example formative assessment, as discussed in the last chapter, has a particular function in programmatic approaches to assessment which is the basis of the first chapter on the principles of assessment. Some clearer linking would be of benefit. In sum this second edition of Understanding Medical Education will prove to be every bit as popular as it predecessor. It retains the coverage of the field but updates it expands it and gives it more contemporary justification. It does what its title claims; promote understanding of the major ideas in this important field. Such an understanding is essential for all those who work as medical educators whether they be practitioners, clinicians, theorists and academics or those with the good fortune to perform a combination of these roles. (David Prideaux, Emeritus Professor of Medical Education, School of Medicine, Flinders University, South Australia)