Review of research paper on medical education
A brief report was publish in the Canadian Medical Education Journal titled Re-thinking clinical research training in residency. The authors were struggling with the same questions we have in our department. Perhaps the two most important points relate to the need for specialists to critically appraise research and to fulfil accreditation requirements.
In medicine we have well and truly departed from the era of eminence-based medicine. It is of utmost importance for specialist to be able to evaluate research evidence to inform their practice. This requirement extends well beyond simply browsing the introduction and conclusion sections in abstracts.
Furthermore, it has become necessary for postgraduate trainees in South Africa to complete a mini-dissertation towards a Masters degree in order to qualify to sit the final Colleges of Medicine exams.
The authors then asks three questions. Firstly, is mandating original research the answer? Secondly, what ought to be the central purpose of research training? Lastly, what are the alternatives to original clinical research? They quite correctly point out that there is much more to the development of a clinician-scientist than research training and bring up the necessity to focus trainee research on local patient needs as opposed the emphasis on conducting original research.
The main section of the paper attempts to answer the three question mentioned above. I’ll leave you to read the authors’ response to their first question, most of the suggested programs in aid of producing clinician-scientists are not available in this country.
On the question of the central purpose of research training, the authors focus on the (in my opinion) commendable CANMEDS initiative of placing the patient at the centre of medical education. It might be true that there exists tremendous personal fulfilment in a career in medicine, but by its nature, it is a pursuit aimed at helping patients and not a pursuit of personal gain. As in the South African academic setting, education takes place in institutions that are publicly funded and the authors express the opinion that time, effort, and resources in research education be spent on producing work aimed squarely at direct benefit to the local patient population, as opposed to original research.
As to the alternatives to original clinical research the authors once again explore pathways which they feel might benefit the patient more. They argue for the formation of teams by PhD-trained researches and feel that trainees are in a much better position to come up with relevant clinical questions which should lead to projects managed by these teams. They feel that trainees could learn much more about research in such groups.
Lastly, they raise the important issue of time available for research during training. Their situation certainly mimics our constrained environment, where it is almost impossible to release trainees for sustained periods during which they do not provide service delivery.
Certainly some food for though. Alas, it is my humble opinion that the Canadian Medical Education System, through CANMEDS, far exceeds our local effort. At this time, our dire need lies in establishing proper education in conducting research and statistical analysis. No formal education exists in this regard.