His research interests center around the development of expertise, knowledge and performance assessment, self-regulated learning, evidence-based medicine, and educational leadership development. He has held the offices of president of the Society of Directors of Research in Medical Education and chair of the Association of American Medical College’s Central Group on Educational Affairs. He was also the founding chair of the AAMC’s Medical Education Research Certificate (MERC) program.
How did you first become interested in medical education?
I started graduate school intending to teach psychology in a liberal arts college, but I got a job evaluating an innovative program for training physicians starting right out of high school. That job turned into a career as I found how complex and fascinating medicine was as a domain for studying clinical reasoning, the development of expertise, and many other phenomena. The more work I did in medical education, the more intriguing were the opportunities and the richer the network of extremely intelligent, innovative colleagues.
Can you share your background on how you got to where you are right now?
I am a psychologist by training and an educator by practice. I have always had an interest in individual differences and how people in the same situation can respond in such very different ways. This recognition that people are not the same has pervaded much of my subsequent work and research. I also enjoy the intellectual challenge of complex problems and can get lost in the fascinating relationships a good research study reveals. I’ve also found considerable satisfaction in teaching and helping others discover solutions to their educational problems, both individual and institutional.
The network of colleagues that I’ve been able to join has been a tremendous influence and a powerful source of stimulation. The professional conferences in medical education are both intellectually stimulating and personally enjoyable – educators are fun people! It has been particularly valuable to be able to expand this network internationally and recognize that the same problems exist for us all around the globe.
How do you think competency based education will impact medical education at both the undergraduate and graduate medical education levels?
Competency based education (CBE) has enormous potential for fundamentally changing medical education at both undergraduate and graduate levels. Although for many, CBE is more of a fad than a fundamental framework for education, the fact that it is being adopted by so many institutions, so quickly, is evidence for its potential. The immediate impact of CBE is probably on defining what we mean by a “competent” practitioner and what stages of development (milestones) learners need to pass through at the undergraduate and graduate levels. Too often, however, defining the competencies is largely rearranging previous goals and objectives of a curriculum into new categories. When taken seriously, however, thinking in terms of competencies can be a significant change in perspective.
Another key implication of CBE is that we need to be able to measure the competencies that we define. Assessment in CBE needs to be more extensive and more flexible in form and format. This assessment needs to provide formative feedback for learners to guide their progress towards competence. It also needs to provide summative information on the success of the learners and the curriculum and producing competent graduates. Assessment is changing rapidly in medicine, going beyond just tests of knowledge to assessments of performance in workplace settings. These new forms of assessment are rich fields of creative opportunity and innovation for educators.
The most dramatic impact of CBE is the shift from time to outcomes. It is frequently said that traditional education holds time stable and lets the outcomes vary, whereas competency-based education holds outcomes as fixed and let’s time vary. In other words, CBE recognizes that different learners acquire competence at different rates and need different experiences to do so. Traditional education is much more a ‘one-size-fits-all’ framework: a four year undergraduate program, a three-year residency, a two-year fellowship. Competence in such programs is as much a matter of trust that this is enough time as it is an evidence-based conclusion that graduates ARE competent. Transforming from a time-based to a competency-based framework requires foundational changes in the organization and structure of curricula – changes that very few programs (and faculty) are comfortable with.
Based on your work, what are 2-3 changes you would like to see in the current medical education system?
Because so much of assessment in medicine is based on faculty judgments of learners, there is a tangled relationship between feedback, evaluation and student willingness to ask questions. Knowing that asking a question can be enormously educational but that asking that question exposes one’s ignorance leaves many learners in a dilemma – will their exposure of ignorance result in a lower rating by the faculty member or will they get valuable, individualized instruction as a result? I would like to see evaluation (grades) clearly separated from feedback by having faculty do one of these roles or the other, but not both.
Another change I think is critical is for faculty to recognize that being an expert in their specialty is not sufficient for being a good teacher. Educational skills are distinct from content-expertise and every faculty member will benefit from developing these skills.
Do you have any final tips for medical students on best practices to learning and comprehending medicine?
Your education is your responsibility. Don’t depend on your school or program to teach you all you need to know – they will try but you know your goals and gaps better than they do. Ask questions, even though you feel vulnerable. Questions are among the best methods for learning because they operate at the boundary of knowledge and ignorance – right where we all learn best.