Back to the future: Celebrating 40 years of academic achievement in medical education*

Welcome to this 40th anniversary celebratory issue of Medical Teacher featuring a series of invited papers on curriculum themes. In the changing world of academic journals, lasting forty years is no mean feat and going from strength to strength in that time is a real achievement and a testament to the high quality of the papers published within these covers over the years. As part of thinking about the introduction to this issue I decided to look back at the first few issues of the Journal and compare the content with that of the present day. It makes for interesting reading. Some areas such as the article on the use of the overhead projector by Essex-Lopresti (1979) would seem to be quaint now and some of our more junior colleagues might not even remember writing or printing on acetate sheets or rolls which were used with this technology.

Student selection into medical school however remains a very popular area for study. In his article in the first issue of Medical Teacher, Gough (1979) makes an analysis of the then current methods available for selection committees in medical schools and makes a plea for heterogeneity of medical students, concluding with the advice “The techniques of selection, in short, should not impose a new and artificial hierarchy of values of their own. On the contrary, they should be viewed as tools, by means of which rational and appropriately varied choices can be made”. A rough and ready search of the first 10 years of the journal revealed 36 articles on student selection into medical school. A similar search over the last 10 years listed over 400 articles in the same area so it would appear that we are still grappling to find the “right” tools.

Reflecting on the change in trends and emphasis in medical education, I would contend that in four decades we have become more professionalised in our approach to research in our discipline. My evidence for this statement comes from the observation that many of the submissions in the earliest years are observational studies good as far as they went but without any attempt at looking at underlying theory or developing theoretical frameworks. Again, using an analysis of the first 10 years of the journal the word “theory or theoretical framework” appears in only 36 articles whereas in the last 10 years over one thousand papers contain the word or phrase. Assessment is another area of growth for published articles and performing a similar search for the word “psychometric”, only eight articles were published in the first decade whereas in the last 10 years nearly 300 articles use this term. Given the movement towards authentic assessment, I wonder if we might see a reduction of publications about student and trainee assessment incorporating psychometrics.

Looking at this anniversary issue it is particularly gratifying to see a paper on students as partners in their education. For far too long it was considered that education was something “done” to students. Students were there to be stuffed with knowledge. Large numbers of facts were memorised, to be regurgitated in exams and then forgotten. The experience was almost Dickensian in nature:

Now, what I want is Facts. Teach these boys and girls nothing but Facts. Facts alone are wanted in life. Plant nothing else, and root out everything else. You can only form the minds of reasoning animals upon Facts; nothing else will ever be of any service to them.

– Charles Dickens, Hard Times.

How curricula change, adopt, and discard different modes of teaching is described by Benjamin et al. (2018) and it is interesting for the authors to reflect on the reasons for the path they have taken and for readers to compare this to their own experience.

Articles on team based learning and interprofessional learning reflect the change in the attitude from just training tomorrow’s doctors to training doctors who understand the importance of the healthcare team in patient care and who are comfortable with their role within the many different healthcare teams and environments they will encounter over the course of a professional lifetime.

Trust has always been an important work in the medical lexicon, particularly the trust between patient and doctor. More recently the concept has been revisited and used to exemplify the development of medical trainees in being allowed to undertake increasingly complex roles and procedures. The paper by Brenner et al. (2018) shows how the concept of entrustability can be used even with early learners.

It is interesting that in the first issue an article entitled “What is a teacher’s job” by Guilbert (1979), Chief Medical Officer for Educational Planning, Division of Health Manpower Development, World Health Organization, lists 12 roles of the teacher but does not mention leadership. The paper in this issue on “leadership” during a time of educational change by Pinder and Shabbits (2018) corrects this omission.

Perhaps not surprisingly newer technology adoption features in the final paper by Wakefield et al. (2018) on introducing point of care ultrasound (POCUS) into a medical curriculum. How medical curricula respond to a changing world of healthcare delivery will be one of the next big challenges for medical education.

Can we predict what will happen to the contents of the journal in the next 40 years or to the format of the journal itself for that matter? In the next decade, the impact of digital medicine and the use of artificial intelligence is likely to make a profound difference in the way that healthcare is delivered and consequently the effect on the way we prepare new doctors is likely to change dramatically. Virtual and augmented reality together with immersive experience is likely to become more commonplace and absorbed into routine simulation teaching. The “machine as part of the team” is already being talked about and therefore team based learning and working will need to accommodate this development. Interprofessional learning is likely to expand beyond the usual healthcare professionals to include computer programmers, engineers, and systems analysts. The effects of these radical changes in healthcare delivery and medical education mean that the area of bioethics will become even more important and so the inclusion of the paper by D'Souza et al. (2018) is timely and prophetic. Even the journal format itself may look very different – more publications are encompassing audio podcasts as part of their offering. In the future authors may read and discuss their own work – which could be challenging for multi-author papers! Predicting is often a misguided notion, except it is probably safe to say it is likely that an 80th anniversary issue on curricula themes will look very different from this 40th anniversary issue.

I do hope you enjoy reading this 40th anniversary issue of Medical Teacher and I am confident that the next 40 years will bring even richer content to one of the leading journals in the discipline.

Disclosure statement

The author reports no conflicts of interest. The author alone is responsible for the content and writing of this article.

Additional information

Notes on contributors

Trudie E. Roberts

Trudie E. Roberts is Director of Leeds Institute of Medical Education and AMEE President.