Blind spots in medical education – International perspectives

Abstract

Background

All individuals and groups have blind spots that can create problems if unaddressed. The goal of this study was to examine blind spots in medical education from international perspectives.

Methods

From December 2022 to March 2023, we distributed an electronic survey through international networks of medical students, postgraduate trainees, and medical educators. Respondents named blind spots affecting their medical education system and then rated nine blind spot domains from a study of U.S. medical education along five-point Likert-type scales (1 = much less attention needed; 5 = much more attention needed). We tested for differences between blind spot ratings by respondent groups. We also analyzed the blind spots that respondents identified to determine those not previously described and performed content analysis on open-ended responses about blind spot domains.

Results

There were 356 respondents from 88 countries, including 127 (44%) educators, 80 (28%) medical students, and 33 (11%) postgraduate trainees. At least 80% of respondents rated each blind spot domain as needing ‘more’ or ‘much more’ attention; the highest was 88% for ‘Patient perspectives and voices that are not heard, valued, or understood.’ In analyses by gender, role in medical education, World Bank country income level, and region, a mean difference of 0.5 was seen in only five of the possible 279 statistical comparisons. Of 885 blind spots documented, new blind spot areas related to issues that crossed national boundaries (e.g. international standards) and the sufficiency of resources to support medical education. Comments about the nine blind spot domains illustrated that cultural, health system, and governmental elements influenced how blind spots are manifested across different settings.

Discussion

There may be general agreement throughout the world about blind spots in medical education that deserve more attention. This could establish a basis for coordinated international effort to allocate resources and tailor interventions that advance medical education.

Keywords:

• Biases
• blind spots
• medical education reform
• innovation

Acknowledgements

Authors would like to thank all those who supported this study through access to the international networks, including Balkiss Abdelmoula, Siobhan Fitzpatrick, Kosha Gala, Michelle Che Yan Lam, Justin Seeling, and Rannia Shehrish.

Disclosure statement

This work was developed with support from the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education Grant for Medical Education Transformation Collaboratories. Dr. Wright is the Anne Gaines and G. Thomas Miller Professor of Medicine supported through the Johns Hopkins Center for Innovative Medicine, and he is the Mary & David Gallo Scholar for Hopkins’ Initiative to Humanize Medicine. Dr. Whitehead is the BMO Financial Group Chair in Health Professions Education Research, University Health Network. The authors declare no conflicts of interest.

Additional information

Notes on contributors

Sean Tackett

Sean Tackett, MD, MPH, is an associate professor of Medicine and International Medical Education Director for Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.

Yvonne Steinert

Yvonne Steinert, PhD, is a professor of Family Medicine and Health Sciences Education, former director of the Institute of Health Sciences Education, and the Richard and Sylvia Cruess Chair in Medical Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.

Susan Mirabal

Susan Mirabal, MD, MS, is an assistant professor of medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Darcy A. Reed

Darcy A. Reed, MD, MPH, is a professor of medicine, Mayo Clinic College of Medicine and Science, and consultant, Division of Community Internal Medicine, Geriatrics and Palliative Care, Mayo Clinic, Rochester, MN, USA.

Cynthia R. Whitehead

Cynthia R. Whitehead, MD, PhD, is a professor of family and community medicine, Wilson Centre for Research in Education, University Health Network & University of Toronto, Toronto, Ontario, Canada, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Scott M. Wright

Scott M. Wright, MD, is a professor of medicine, Johns Hopkins University School of Medicine, and chief, General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.