Centre for Public Education and Pedagogy, Maynooth University, Co Kildare, Ireland.
Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK.
Teach Learn Med. 2020 Aug-Sep;32(4):449-456. doi: 10.1080/10401334.2020.1798240. Epub 2020 Aug 15.
In medical education, teaching is currently viewed as an intervention that causes learning. The task of medical education research is seen as establishing which educational interventions produce the desired learning outcomes. This 'medical model' of education does not do justice to the dynamics of education as an open, semiotic, recursive system rather than a closed, causal system. Empirical 'evidence' of 'what works' - that is, what is supposed to affect 'learning' - has become the norm for medical educational improvements, where generalized summary outcomes of research are often presented as must-follow guidelines for myriad future educational situations. Such investigations of educational processes tend to lack an explicit engagement with the purposes of medical education, which we suggest to understand in terms of qualification (the acquisition of knowledge, skills, and understanding), socialization (becoming a member of the professional group) and subjectification (becoming a thoughtful, independent, responsible professional). In addition, investigations of educational processes tend to rely on causal assumptions that are inadequate for capturing the dynamics of educational communication and interaction. Although we see an increasing acknowledgement of the context-dependency of teaching practices toward educational aims, the currently prevailing view in medical education and educational research limits understanding of what is actually going on when educators teach and students participate in medical education - a situation which seriously hinders advancements in the field. In this paper, we hope to inform discussion about the practice of medical education by proposing to view medical education in terms of three domains of purpose (professional qualification, professional socialization, and professional subjectification) and with full acknowledgement of the dynamics of educational interaction and communication. Such a view implies that curriculum design, pedagogy, assessment, and evaluation should be reoriented to include and integrate all three purposes in educational practice. It also means that medical education research findings cannot be applied in just any teaching context without carefully considering the value of the suggested courses of actions toward the particular educational aims and teaching setting. In addition, medical educational research would need to investigate all three purposes and recognize the openness, semiotic nature, and recursivity of education in offering implications for teaching practice.
在医学教育中，教学目前被视为一种引发学习的干预措施。医学教育研究的任务被视为确定哪些教育干预措施产生了预期的学习成果。这种“医学模式”的教育并没有公正对待教育作为一个开放、符号学、递归系统的动态，而不是一个封闭、因果系统。“实证”的“有效证据”——即被认为影响“学习”的证据——已经成为医学教育改进的规范，其中研究的概括性综合结果通常被作为无数未来教育情境下必须遵循的指导方针。这种对教育过程的调查往往缺乏对医学教育目的的明确参与，我们建议从资格（知识、技能和理解的获得）、社会化（成为专业群体的一员）和主体化（成为一个深思熟虑、独立、负责的专业人员）的角度来理解医学教育的目的。此外，对教育过程的调查往往依赖于因果假设，这些假设不足以捕捉教育沟通和互动的动态。尽管我们看到越来越多的人认识到教学实践对教育目标的背景依赖性，但医学教育和教育研究中目前流行的观点限制了对教育者教学和学生参与医学教育时实际情况的理解——这种情况严重阻碍了该领域的发展。在本文中，我们希望通过提出从三个目的领域（专业资格、专业社会化和专业主体化）来看待医学教育，并充分认识到教育互动和沟通的动态，为医学教育的实践提供信息。这种观点意味着课程设计、教学法、评估和评价应该重新定位，在教育实践中纳入并整合所有三个目的。这也意味着，如果不仔细考虑所建议的行动方案对特定教育目标和教学环境的价值，医学教育研究结果就不能在任何教学环境中随意应用。此外，医学教育研究需要调查所有三个目的，并认识到教育的开放性、符号性和递归性，为教学实践提供启示。
