These words of wisdom fell from the lips of Lambert Schuwirth, a dear colleague who guided me through the assessment module on the Maastricht Health Professional Education Master’s programme many moons ago. Yet how much attention do we pay to this? Much effort goes into capturing and standardising responses in medical education. Yet do we train our educators to ask the right questions? If we phrased our challenges better could we stimulate deeper learning and more appropriate formative and summative assessment? This issue of the journal recaptures the dilemma for me; interestingly across a wide range of educational topics.
With his characteristic educational wisdom, Peter Cantillon explores through the ‘Three Papers’ the skill of questioning. He highlights the evidence in the literature that ‘teachers’ use of questions is often limited to assessing students’ knowledge’. The true potential of questions to arouse curiosity, challenge assumptions and develop clinical reasoning tends to be ignored. Important food for thought when training our educators. I suspect that improvement in questioning would also enhance patient care and communication with colleagues.
Are we asking the right questions of our educational paradigms? Celia Brown et al introduce new challenges for selection into primary care training. They compare the driving forces of recruitment in a seller’s market (insufficient applicants) with selection in a buyer’s market (sufficient applicants). They question the tensions within these two human resource management decisions. Food for thought as they analyse the recruitment dilemma facing the Western World and the selection processes for community health care workers in Sub-Saharan Africa; a contrasting difficulty the authors’ research has identified.
This issue also questions current training and assessment practices. Binczyk et al from the University of Alberta question the competency based two-year Canadian residency training programme, the shortest among high-income countries. Their research suggests that residents are subsequently less inclined to then take up opportunities to enhance their training. From Denmark, Prins et al conclude that further research to question the trainees’ perception of workplace-based assessment (WPBA) is needed. Adequate preparation by supervisors may be as problematic as assigning the time.
Finally, should licensing assessments ensure they ask questions aligned with the realities of training? A Scottish study from Cunningham et al, supported by a commentary from Blane, shows that training in deprived practices in Glasgow offers great learning opportunities. It is worrying that these trainees then feel disadvantaged when taking the Royal College of General Practitioners licensing examination. The question scenarios used do not reflect the reality of their training environment. This disparity may be even more profound for International Medical Graduates who fail the examination multiple times. The paper from Hawkridge and Molyneux, describing how they support them by questioning and addressing their individual learning needs, is most welcome.
Much food for thought here! ‘It is not the answer that enlightens, but the question.Footnote1’ I thank all the authors for asking these enlightening questions and strongly encourage more to do so. Not only will it help us build an evidence base for medical education but ultimately enrich how we approach patient care.
Notes
1. Eugène Ionesco Découvertes” 1970 in Wells S 1997 Choosing the Future: The Power of Strategic Thinking p15 Butterworth -Heinemann.