Clinical medicine is fairly black and white as I'm sure many of you would agree. If I were to treat a patient diagnosed with a myocardial infarction in Asia, Europe or America I would certainly initiate aspirin (among other cardiac meds) in all cases. Why? Because the evidence for its benefit is global.
However when we look at the field of medical education I have battled with the thought of the need for evidence for some time and struggle to reach a firm conclusion. Reflecting on my journey in medicine, I was schooled via PBL, which was fairly novel at the time but was highlighted as the ultimate way forward because 'evidence' suggested for example that it encouraged a desire to learn, something essential for one's career as a doctor. However I can say with certainty that not all schools across the globe have adopted this approach. And in fact we are now being told that 'evidence' points firmly in the direction of TBL with the use of in group assessments and content experts enabling one's reinforcement of knowledge and application. It seems that the 'Do it Yourself' approach is now no longer the gold standard.
Then we come to assessment. In the UK, we now see the introduction of two new assessments - the situational judgement test - based on the desire to assess aptitude for employment and the professional attributes expected of a newly qualified doctor coupled with the prescribing safety assessment, born on the premise of 'evidence' suggesting that prescribing skills among new starters are not up to scratch. Surely I would like to pose the question then that why were these facets not an issue previously? For I do recall being told that 'evidence' existed to support the reliability of the assessments I undertook as an undergraduate prior to the arrival of these new contenders. Should I view my registration to practice as incomplete on the basis of not being assessed according to current standards?
I am now being told that the multiple mini interview is essential in the process of medical school selection and even postgraduate employment as the 'evidence' highlights its worth for example in determining those doctors who are likely to score well in their future assessments. As clinicians I'm sure we have all had the pleasure of working with book worms, capable of reciting countless medical facts, but incapable of applying these facts to the patient in front of them. Yes syndrome Mumbo Jumbo may be the 50th differential for those patient's symptoms, but this isn't exactly House I'm afraid.
And now I am informed of 'evidence' highlighting the benefits of simulation, interprofessional learning, portfolios and so on.
So what is my take? Well education isn't an exact science - yet we are trying to make it so. I wasn't a fan of PBL because I was forced to learn medicine for myself and if I dared ask for help from my instructors who were themselves non clinicians I was met with pursed lips. Yet I graduated from a PBL school. I am a fan of the use of technology in medical training yet many instructors, presumably those tech illiterate, critique my interests. The reality is, there is no right or wrong. All methods have merits and downsides. We need to appreciate that people learn in different ways and that will never change.
Having only recently stepped foot in the domain of education I will always think what is best for my students. How do they prefer to learn and what will ensure they are safe and effective doctors. We can battle to our wit's end in over assessing our undergrads but we know for the most part doctors will always do what's best for their patients - and if they don't, well they are in the wrong profession to start with. And only with actual patient experience will things become clearer. To force particular pedagogy on students that fit the box is simply disadvantaging those who don't. In fact from my personal observation as 'evidence' it is often the latter who are the forward thinkers, the more innovative and the more likely to advance in the long run.
For now I shall continue to observe the constant changes in apparent 'evidence'. Of course I can't prevent the existence of a top-down approach. However I can aim to lighten the burden through my teaching by choosing to ask what format my target audience would prefer first.