Rethinking Research in Health Education

 

 

 

 

 

 

 

 

 

 

 

It’s not rocket science

In a recent article in the journal Medical Education, Dr. Glenn Regehr champions a radical rethink of education research. Drawing on insights and advances in subatomic and macro physics, he argues against the imperatives of proof, generalizable solutions and simplicity (all drawn from the prevalent theoretical and methodological approaches in medical research broadly). Instead, Regehr suggests that we embrace the construct of uncertainty (“elegant messiness”) in unique education settings (“context is the irreducible covariate”).

Does a narrow focus on the success of medical education initiatives diminish the utility of education research? Here is Regehr’s thinking, with which I’m inclined to agree:

“Rather than dwelling on the questions of what is going on, we jump straight to the issue of whether it worked. We keep tweaking when the answer is ‘No’, but are satisfied as soon as the answer is ‘Yes’. We celebrate and publish our positive results as proof of our rightness and treat the negative results as ‘failures’ to be ignored or even buried. As a result, the information we share with the larger education research community through the talks we give and the studies we publish tends to feel more like a ‘show-and-tell’ exercise than an engaging and challenging contribution to the community’s understanding of learning processes and education practices.”

These are brave words, especially in a field that has historically privileged positivist epistemology over interpretivist approaches (a debate for another day). Yet the parallels between dynamic systems described in chaos theory, and its application to learning contexts and communities, are striking.

Both are highly context-sensitive and characterized by an “exponential growth in perturbation.” In other words, while all education settings have broad similarities, it is their unique and particular differences that matter with respect to learning outcomes and applications. Small contextual variations (perturbation) can lead to massively divergent results (that’s the exponential growth part).

Take-home messages and food for thought:

Competence isn’t contained within an individual practitioner – it emerges via interaction with an always-changing context.

Education research should focus on sharing new and better ways of thinking about clinical teaching/learning problems, issues and assumptions.

We need a shift from showing what we did right, to articulating what we learned along the way.