#KeyLIMEPodcast 298: Not cause and effect, but why, how and who

Linda introduces a commentary paper that looks at to identify the best forms of research to inform #MedEd practice, beyond the medical model.

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KeyLIME Session 298

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Biesta & van Braak, Beyond the Medical Model: Thinking Differently about Medical Education and Medical Education Research. Teaching and Learning in Medicine. 2020 32:4, 449-456


Linda Snell (@LindaSMedEd)


The authors state that the concept of ‘the medical model’ for understanding the dynamics of education is ‘common’ – the idea that an education ‘intervention produces learning. As much medical research focuses on questions of effectiveness, there may be a pull for medical education research to emulate this. They feel this has spawned an approach to #MedEd Research (MER) focusing on ‘what works’ and that teachers should then base practice on this  evidence. The rationale is that ‘better teaching = better learning, leading to better patient care, = improves patient outcomes’. That means that MER values generalizability, RCTs, systematic reviews, meta-analyses etc.

The authors have 2 concerns:

  1. is ‘learning’ what #MedEd is to produce?
  2. is the task of MER to look for a cause/effect relationship between teaching and learning?


To ‘inform discussion about the practice of medical education by proposing to view medical education in terms of three domains of purpose  while acknowledging the dynamics of educational interaction and communication.’ What are the best forms of research to inform #MedEd practice…beyond the medical model?

Key Points on the Methods

This is a commentary paper – no methods.

Key Outcomes

What is education ‘for’? students learn something, for a reason, and from someone. So the the three ‘elements’ that constitute education are content, purpose, and relationships.

The authors suggest that purpose is the first thing to look at and that education, and  #MedEd has 3 purposes:

  1. professional qualification, providing students with knowledge, skills, and understanding that will qualify them to do ‘something.’
  2. professional socialization, initiating students into the norms and values of professional traditions, give them a sense of direction and also contributes to identity formation.
  3. professional subjectification, who can make up their mind, draw conclusions, and be responsible for their actions; educational ideas such as agency, autonomy, and responsibility

In #meded terms  we want competent doctors (qualification), with a professional identity (socialization) and with judgement and responsibility (subjectification). These all need to be integrated.

If we agree that the point of #MedEd is the 3 purposes we can then look at what they learn and how.

The medical model the causal relationship of teaching and learning does not make sense here as education is an open system with multiple inputs and outputs, iterative, and subject to interpretation. Educators reduce the range of these.

Key Conclusions

The authors conclude that these concepts allow us to think  in a more refined way about the ‘why’ of education, which affects curriculum design, assessment, evaluation, education / teaching practice.

It also shows the need to move from one dimensional research designs, focusing on one domain, to exploring  all purposes and how, through ‘arranging the openness, semiosis, and recursivity of educational practices, meaningful education can be established.’   This implies a need to  engage with teachers and students and their interpretation.

Spare Keys – other take home points for clinician educators

A new way of thinking about #MedEd research.

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