Medical education research: is there virtue in eclecticism?

A great deal has been written about research in medical education recently, as even a short perusal of the major journals in the field shows. Partly this has been stimulated by the Best-Evidence Medical Education (BEME) movement. It also represents the coming of age of the discipline of medical education and the increased participation in medical education at both the practical implementation and scholarly engagement levels. Along the way important critiques have emerged of research approaches and research methods particularly in the process of harnessing methods from the clinical and basic sciences to address educational questions. Issues concerned with complexity, randomisation and control, effect size and choice of outcome measures have all been the subject of recent comments. Much of the debate about research in medical education has been centred around the choice between quantitative or qualitative designs and defending the latter against what has been referred to as the biomedical elitism of quantitative designs. However, as Pirrie points out, the fundamental issues in research in medical education are not solely about the dominance of one research method over another . There are more searching questions about short-term or long-term focus, the depth and significance of research questions and conceptual clarity and theoretical directions of research. These fundamental questions in medical education are being brought into increasing focus by the ever widening diversity of medical education endeavour. Bligh and Parsell have indicated that clinicians and basic scientists have been joined by educators, psychologists and social scientists in pursuing medical education matters. With a greater range of disciplines there has come a greater range of research methodologies, including the variants of qualitative designs. There are signs that the field of endeavour is widening further still. For example, in this journal there is an interest in the arts and humanities in medical education. We may well soon see literary criticism and philosophical analysis added to an expanding repertoire of medical education research designs. This increasing diversity goes to the very heart of the discipline of medical education itself. It probably never was a tightly defined discipline, but while increased participation is to be applauded, it renders a tight definition of modes of inquiry, an even more difficult undertaking in medical education. This begs another fundamental question: should medical educators attempt to define generic standards and criteria to somehow include all research undertakings or should a virtue be made of diversity and should eclecticism be embraced? One way to do the latter is to take up Irby’s notion of the medical educator as a generalizer . In this role medical educators take concepts and ideas from a range of disciplines and research paradigms and apply them to the pursuit of educational problems and investigations. This, however, requires a degree of sophistication in thinking and understanding across a range of research traditions. Will it be feasible to maintain this as the spectrum of disciplines involved in medical education is broadened? A second way of embracing a diversity of research traditions is to consider the scale of research. It has been argued, for example, that a large increase in medical student numbers in the United Kingdom and the fostering of innovation in course design provides a large natural experiment and a fertile context for researching significant and deep questions about the outcomes of the new arrangements. It could be claimed that there is a similar natural experiment in Australia with the allocation of funds and programmes for innovative rural and community-based medical education. No doubt there are other national examples of movements of this order. Research into the efficacy of large scale reforms will need to be multifaceted if it is to provide the answers to the deep and significant questions posed by the programmes. Research on this scale will be well-served by involvement of medical educators from different disciplinary backgrounds pursuing research that is rigorous and defensible. Its rigour, however, is best judged by the standards and criteria of the discipline itself and its arbiters should be those that are steeped in the discipline. It does not mean that those outside the discipline should take it all on trust. If medical education is to be marked by diversity it should also be marked by explicitness, of research design, by the linking of research design to quality standards in the field and by clear explanation of the procedures undertaken to ensure rigour and credibility. The absence of an embracing theory in medical education has been noted. If medical education research is to be aimed at answering questions about large scale reforms, is there a virtue in embracing eclecticism as one of the platforms on which the theory can be built?