Once a year, our residency program holds a two week Medical Education Theory Elective. The residents quickly notice a jumble of new words as they enter this space.
We use inclusive language with patients (nosebleed instead of epistaxis), but we sometimes forget this in academic settings. Epistemology? Ontology? Reflexivity? It can be off-putting to not understand the language.
I have created a glossary of seven selected interrelated medical education terms that we covered in the elective. This list is not meant to be exhaustive, but a starter set of words (let us know if we should make this a recurring set of posts!). For each word, I’ve linked references and added quotes that I hope add depth and clarity.
If you feel I got a definition wrong, or have suggestions for additional words that you think should be included in future posts, let us know in the comments section! Happy reading!
Constructivism – is “based on the premise that the act of learning is based on a process which connects new knowledge to pre-existing knowledge.”1 In constructivism, “multiple truths are constructed by and between people”.2 Per Dennick: “We know that we do learn and that we have knowledge but there is no consensus on the relationship between the mechanism by which our brains learn and the optimal way in which we should be taught. In other words there is no necessary connection between epistemology and pedagogy.”1
Critical Theory – an “ontological position in which reality is shaped over time by structures such as social, political, cultural, economic, ethnic, and gender constructs.”3 In critical theory, “multiple truths exist and they are influenced by power relations among people.”2 Per Paradis et al.: ”Critical theory today represents a space that embraces vast social concerns and other conflict theories—that is, theories that stress intergroup struggles and anchor their analyses in people’s everyday lives, often as they are determined by their ascribed characteristics, defined as individual traits over which one has no control, such as race, ethnicity, gender, sexual orientation, age, etc.”3
Epistemology – the “theory of knowledge, especially with regard to its methods, validity, and scope. Epistemology is the investigation of what distinguishes justified belief from opinion.” Per Evans et al.: “At an individual or personal level, an epistemology is a belief system about knowledge that determines how one organizes, interprets, and abstracts meaning from information or stimuli. In a medical context, an epistemology determines how a physician organizes and prioritizes the biological and psychosocial data of a patient presentation.”4 Per Kuper et al.: “epistemology questions what knowledge is and how it can be acquired, and the extent to which any given subject or entity can be known.”5
Ontology – refers to the “study of being and nature of existence.”6 Per Ng et al. ”Ontology can be thought of as questions of ‘what is’ and epistemology as questions of ‘what it means to know.”6 Per Zouri et al.: “Ontology can be either lightweight or heavyweight, depending on the degree of formalization and the level of expressiveness. Lightweight ontologies describe concepts and the relationships among them, enabling focus on communications. Heavyweight ontologies add axioms and rules with a focus on reasoning about the knowledge.”7
Positivism – a paradigm of research that “seeks to discover laws of nature, expressing them through descriptions of theory.”8 In positivism, “there is one truth and it can be observed.”2 Per Park et al. “The development of positivism is characterized by a move away from social elites (e.g., royalty) defined by truth via decree, and toward scholars discovering objective, evidence-based truth through well-described experimentation.”8
Post-positivism – “an epistemology committed to the pursuit of truth while at the same time acknowledging the difficulty of ever getting there.”9 Post-positivists believe “there is one truth, but it can never be truly realized.”2 Per McMurtry: “The world may be ‘out there’, but our knowledge is not. Knowing is a relationship that we continually negotiate and re-negotiate with our world, including other objects, organisms, ecosystems, people and professional or social norms. Such knowledge is incredibly valuable; we don’t need dreams of eternal truths to justify our pursuit of it.”9
Reflexivity – “the conscious revelation of the underlying beliefs and values held by the researcher in selecting and justifying their methodological approach.”10 Per Balmer et al: “Much has been written about reflexivity in medical education, raising issues about the balance between authentic representation and confidentiality, potential power dynamics and more. But another dimension of reflexivity has not been addressed: the dynamic, lived experiences of investigators and their own change through time. Epiphanies and evolution in investigators’ understanding (i.e., their karios moments) should be acknowledged and accommodated—not viewed as bias or messy research design. For instance, longitudinal qualitative research investigators may start with a theory that positions individuals as agents of constructing their own identity. But these same investigators may shift to use critical theory as they are sensitized to gender inequity by the #MeToo movement and come to recognize that participants who identify as female consistently push back on constraining, gendered and social structures.”11 (Bonus definition from Karios: “a propitious moment for decision or action” or “a time when conditions are right for the accomplishment of a crucial action: the opportune and decisive moment” or “a rhetorical strategy that considers the timeliness of an argument or message, and its place in the zeitgeist.”)
References
1. Dennick R. Constructivism: reflections on twenty five years teaching the constructivist approach in medical education. Int J Med Educ. Jun 25 2016;7:200-5. doi:10.5116/ijme.5763.de11
2. Bergman E, de Feijter J, Frambach J, et al. AM last page: A guide to research paradigms relevant to medical education. Acad Med. Apr 2012;87(4):545. doi:10.1097/ACM.0b013e31824fbc8a
3. Paradis E, Nimmon L, Wondimagegn D, Whitehead CR. Critical Theory: Broadening Our Thinking to Explore the Structural Factors at Play in Health Professions Education. Acad Med. Jun 2020;95(6):842-845.
4. Evans L, Trotter DR, Jones BG, et al. Epistemology and uncertainty: a follow-up study with third-year medical students. Fam Med. Jan 2012;44(1):14-21.
5. Kuper A, Veinot P, Leavitt J, et al. Epistemology, culture, justice and power: non-bioscientific knowledge for medical training. Med Educ. Feb 2017;51(2):158-173.
6. Ng SL, Baker L, Cristancho S, Kennedy TJ, Lingard L. Qualitative research in medical education: methodologies and methods. Understanding Medical Education: Evidence, Theory, and Practice. 2018:427-441.
7. Zouri M, Ferworn A. An Ontology-Based Approach for Curriculum Mapping in Higher Education. 2021:0141-0147.
8. Park YS, Konge L, Artino AR, Jr. The Positivism Paradigm of Research. Acad Med. May 2020;95(5):690-694.
9. McMurtry A. Relief for the exhausted post-positivist: New epistemological choices transcend positivism, relativism, and even post-positivism. Can Med Educ J. Dec 2020;11(6):e197-e198. doi:10.36834/cmej.71217
10. Reid AM, Brown JM, Smith JM, Cope AC, Jamieson S. Ethical dilemmas and reflexivity in qualitative research. Perspect Med Educ. Apr 2018;7(2):69-75. doi:10.1007/s40037-018-0412-2
11. Balmer DF, Varpio L, Bennett D, Teunissen PW. Longitudinal qualitative research in medical education: Time to conceptualise time. Medical education. 2021;55(11):1253-1260.