Center for Health Professions Education, Adesh University, Bathinda, Punjab, India.
Department of Psychiatry, Smt. NHL Municipal Medical College and SVPIMSR, Ahmedabad, Gujarat, India.
J Postgrad Med. 2023 Jan-Mar;69(1):35-40. doi: 10.4103/jpgm.jpgm_337_22.
The McNamara fallacy refers to the tendency to focus on numbers, metrics, and quantifiable data while disregarding the meaningful qualitative aspects. The existence of such a fallacy in medical education is reviewed in this paper. Competency-based medical education (CBME) has been introduced in India with the goal of having Indian Medical Graduates competent in five different roles - Clinician, Communicator, Leader and member of the health care team, Professional, and Lifelong learner. If we only focus on numbers and structure to assess the competencies pertaining to these roles, we would be falling prey to the McNamara fallacy. To assess these roles in the real sense, we need to embrace the qualitative assessment methods and appreciate their value in competency-based education. This can be done by using various workplace-based assessments, choosing tools based on educational impact rather than psychometric properties, using narratives and descriptive evaluation, giving grades instead of marks, and improving the quality of the questions asked in various exams. There are challenges in adopting qualitative assessment starting with being able to move past the objective-subjective debate, to developing expertise in conducting and documenting such assessment, and adding the rigor of qualitative research methods to enhance its credibility. The perspective on assessment thus needs a paradigm shift - we need to assess the important rather than just making the assessed important; and this would be crucial for the success of the CBME curriculum.
麦克纳马拉谬误是指在关注数字、指标和可量化数据的同时，忽略有意义的定性方面的倾向。本文回顾了医学教育中存在的这种谬误。以培养印度医学生在五个不同角色（临床医生、沟通者、领导者和医疗团队成员、专业人员以及终身学习者）方面具备胜任力为目标，印度引入了以胜任力为基础的医学教育（CBME）。如果我们仅仅关注数字和结构来评估与这些角色相关的胜任力，我们就会陷入麦克纳马拉谬误。要从真正意义上评估这些角色，我们需要采用定性评估方法，并欣赏其在以胜任力为基础的教育中的价值。这可以通过使用各种基于工作场所的评估、根据教育影响而不是心理测量特性选择工具、使用叙述和描述性评估、给予等级而不是分数以及改进各种考试中问题的质量来实现。从能够超越客观-主观的争论，到发展进行和记录此类评估的专业知识，再到增加定性研究方法的严谨性以提高其可信度，采用定性评估都面临着挑战。因此，评估的视角需要转变——我们需要评估重要的内容，而不仅仅是使评估的内容显得重要；这对于 CBME 课程的成功至关重要。
