THIRD EDITION
EDITED BY
Tim Swanwick
Dean of Education and Leadership Development
NHS Leadership Academy
Health Education England, London, UK
Kirsty Forrest
Dean of Medicine
Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
Bridget C. O’Brien
Associate Professor, Department of Medicine
Education Researcher, Center for Faculty Educators
School of Medicine, University of California, San Francisco, CA, USA
This edition first published 2019
© 2019 The Association for the Study of Medical Education (ASME)
Edition History
(1e, 2010), (2e 2014).
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The rights of Tim Swanwick, Kirsty Forrest, and Bridget C. O’Brien to be identified as the author(s) of the editorial material in this work has been asserted in accordance with law.
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Library of Congress Cataloging‐in‐Publication Data
Names: Swanwick, Tim, editor. | Forrest, Kirsty, editor. | O’Brien, Bridget C., editor. | Association for the Study of Medical Education, sponsoring body.
Title: Understanding medical education : evidence, theory, and practice / edited by Tim Swanwick, Kirsty Forrest, Bridget C. O’Brien.
Description: 3rd edition. | Hoboken, NJ : Wiley‐Blackwell, 2018. | Includes bibliographical references and index. |
Identifiers: LCCN 2018027439 (print) | LCCN 2018027968 (ebook) | ISBN 9781119373858 (Adobe PDF) | ISBN 9781119373834 (ePub) | ISBN 9781119373827 (pbk.)
Subjects: | MESH: Education, Medical–methods | Education, Medical–organization & administration
Classification: LCC R845 (ebook) | LCC R845 (print) | NLM W 18 | DDC 610.76–dc23
LC record available at https://lccn.loc.gov/2018027439
Cover Design: Wiley
Cover Image: ©Steve Debenport/E+/Getty Images
Lindsay Baker
Scientist
Li K Shing Knowledge Institute
Researcher
Centre for Faculty Development
St. Michael’s Hospital
Assistant Professor
Faculty of Medicine
University of Toronto
Toronto, Ontario, Canada
Alexis Battista
Assistant Professor of Medicine
Department of Medicine & F. Edward Hébert School of Medicine
Uniformed Services University of the Health Sciences
Bethesda, MD, USA
Jo Bishop
Associate Dean
Student Affairs and Service Quality
Faculty of Health Sciences and Medicine
Bond University
Gold Coast, Queensland, Australia
Nicole J. Borges
Professor of Neurobiology and Anatomical Sciences
University of Mississippi Medical Center
Jackson, MS, USA
Katharine A. M. Boursicot
Director
Health Professional Assessment Consultancy, Singapore
Singapore
William P. Burdick
Associate Vice President for Education
Foundation for Advancement of International Medical Education and Research (FAIMER)
Clinical Professor of Department of Emergency Medicine
Drexel University College of Medicine
Philadelphia, PA, USA
Craig Campbell
Principal Senior Advisor, Competency‐based Continuing Professional Development
Office of Specialty Education
Royal College of Physicians and Surgeons of Canada
Ottawa, Ontario, Canada
Madeline Carter
Senior Lecturer
Department of Psychology, Faculty of Health and Life Sciences
Northumbria University
Newcastle, UK
Olivia Carter‐Pokras
Professor of Epidemiology and Associate Dean for Diversity and Inclusion
Department of Epidemiology and Biostatistics
School of Public Health
University of Maryland, College Park
College Park, MD, USA
Neville Chiavaroli
Senior Lecturer
Department of Medical Education
Melbourne Medical School
University of Melbourne
Melbourne, Australia
Jennifer Cleland
Professor of Medical Education Research
Centre for Health care Education Research and Innovation
University of Aberdeen
King’s College
Aberdeen, UK
Deborah Cohen
Professor and Director
Student Support
Centre for Psychosocial Research, Occupational and Physician Health
School of Medicine
Cardiff University
Cardiff, UK
Ian Cooper
Language and Communications Specialist
School of Medicine
Cardiff University
Cardiff, UK
Sayra Cristancho
Scientist
Centre for Education Research & Innovation
Assistant Professor
Departments of Surgery and Faculty of Education
Schulich School of Medicine & Dentistry
Western University,
London, Ontario, Canada
Richard L. Cruess
Professor of Surgery
The Centre for Medical Education
McGill University
Montreal, Quebec, Canada
Sylvia R. Cruess
Professor of Medicine
The Centre for Medical Education
McGill University
Montreal, Quebec, Canada
Mary Jane Dalton
Senior Lecturer
School of Medicine and Public Health
University of Newcastle
Callaghan, New South Wales, Australia
Anique B. H. de Bruin
Associate Professor
School of Health Professions Education
Maastricht University
Maastricht, The Netherlands
André F. De Champlain
Chief Research Psychometrician
Research and Development, Medical Council of Canada
Ottawa, Ontario, Canada
Nisha Dogra
Emeritus Professor of Psychiatry Education
Greenwood Institute of Child Health, Department of Neuroscience, Psychology and Behaviour, College of Life Sciences
University of Leicester
Leicester, UK
Erik Driessen
Associate Professor of Medical Education
Department of Educational Development and Research
Faculty of Health, Medicine and Life Sciences
Maastricht University
Maastricht, The Netherlands
Steven J. Durning
Professor and Director
Division of Health Professions Education, Department of Medicine
Uniformed Services University of the Health Sciences
Bethesda, MD, USA
Rachel H. Ellaway
Professor of Medical Education
Department of Community Health Sciences
Co‐DirectorOffice of Health and Medical Education Scholarship
Cumming School of Medicine
University of Calgary
Calgary, Alberta, Canada
Caroline Elton
Director
Career Planning for Doctors and Dentists
London, UK
Kevin W. Eva
Senior Scientist
Centre for Health Education Scholarship
Professor
Director of Education Research & Scholarship
Department of Medicine
University of British Columbia
Vancouver, British Columbia, Canada
Eamonn Ferguson
Professor of Health Psychology
University of Nottingham
Nottingham, UK
Kirsty Forrest
Dean of Medicine
Faculty of Health Sciences and Medicine
Bond University
Gold Coast, QLD, Australia
Della Freeth
Executive Director of Education
Royal College of Physicians
London, UK
Janet Grant
Emerita Professor
The Open University
Honorary Professor
University College London Medical School
Director
CenMEDIC (Centre for Medical Education in Context)
London, UK
Special adviser to the President, World Federation for Medical Education
Ferney‐Voltaire, France
Matthew C. E. Gwee
Medical Educationalist and Chairman
International and Education Programs
Centre for Medical Education, Yong Lo Lin School of Medicine
National University of Singapore, Singapore
Singapore
Graeme Horton
Senior Lecturer
School of Medicine and Public Health
University of Newcastle
Newcastle, New South Wales, Australia
Wendy Hu
Associate Dean
Academic (learning & innovation)
Chair of Medical Education
School of Medicine
Western Sydney University
Penrith, New South Wales, Australia
Chien‐Da Huang
Physician Educator
Chang Gung Medical Education Research Centre (CG‐MERC)
Chang Gung Memorial Hospital
Linkou, Taiwan (ROC)
Deputy Director
Department of Internal Medicine
Associate Professor
Department of Thoracic Medicine and Medical Education
Chang Gung Memorial Hospital
Chang Gung University College of Medicine
Taipei, Taiwan (ROC)
Jan Illing
Professor of Medical Education Research
School of Medical Education
Newcastle University, Newcastle, UK
Dahn Jeong
Research Associate
Office of Continuing Professional Development
Department of Innovation in Medical Education
Faculty of Medicine, University of Ottawa
Ottawa, Ontario, Canada
Brian Jolly
Professor
School of Medicine and Public Health
University of Newcastle
Callaghan, New South Wales, Australia
School of Rural Medicine
University of New England
Armidale, Australia
David M. Kaufman
Professor
Faculty of Education
Associate Member
Faculty of Health Sciences
Associate Member
Department of Gerontology
Simon Fraser University
Burnaby, British Columbia, Canada
Tara J. Kennedy
Developmental Pediatrician and Clinical Leader
Pediatric Autism Rehabilitation Services
Stan Cassidy Centre for Rehabilitation
Fredericton, New Brunswick, Canada
Diane N. Kenwright
Head of Department
Department of Pathology and Molecular Medicine,
University of Otago
Wellington, New Zealand
Simon Kitto
Full Professor
Department of Innovation in Medical Education
Director of Research
Office of Continuing Professional Development
Faculty of Medicine, University of Ottawa
Ottawa, Ontario, Canada
Assistant Professor
Department of Surgery, University of Toronto
Toronto, Ontario, Canada
John Launer
Programme Director for Educational Innovation in Primary Care
(North Central and East London)
Health Education England
London, UK
Lorelei Lingard
Director and Senior Scientist
Centre for Education Research & Innovation
Professor
Department of Medicine
Schulich School of Medicine & Dentistry
Faculty of Education
Western University
London, Ontario, Canada
Bridget Lock
Associate Director of Medical Education
South London Health care NHS Trust
London, UK
Andrew Long
Vice President (Education)
Royal College of Paediatrics and Child Health
Honorary Senior Lecturer
University College London
Consultant Paediatrician
Great Ormond Street Hospital
London, UK
Chris Lovato
Professor
School of Population & Public Health
Director
Evaluation Studies Unit, Faculty of Medicine
University of British Columbia
Vancouver, British Columbia, Canada
Lauren A. Maggio
Associate Professor and Associate Director
Division of Health Professions Education, Department of Medicine
Uniformed Services University of the Health Sciences
Bethesda, MD, USA
Peter McCrorie
Professor of Medical Education
Institute of Medical and Biomedical Education
St George’s University of London
London, UK
Founding Chair and Professor of Medical Education
Department of Medical Education,
University of Nicosia Medical School
Nicosia, Cyprus
Judy McKimm
Professor and Director of Strategic Educational Development
College of Medicine
Swansea University Medical School
Swansea, UK
Lynn Monrouxe
Director
Chang Gung Medical Education Research Centre (CG‐MERC)
Chang Gung Memorial Hospital
Linkou, Taiwan (ROC)
Sandra Monteiro
Assistant Professor
Department of Health Research Methods, Evidence and Impact
McMaster University
Hamilton, Ontario, Canada
Clare Morris
Reader in Medical Education Research and Development
Institute of Health Sciences Education,
Barts and the London School of Medicine and Dentistry
Queen Mary University of London
London, UK
Debra Nestel
Professor of Simulation Education in Health care
Monash University
Clayton, Victoria, Australia
Professor of Surgical Education
Department of Surgery
University of Melbourne
Melbourne, Victoria, Australia
Stella L. Ng
Scientist
The Wilson Centre
Director of Research
Centre for Faculty Development
Arrell Family Chair in Health Professions Teaching
St. Michael’s Hospital
Assistant Professor
Faculty of Medicine
University of Toronto
Toronto, Ontario, Canada
John J. Norcini
President and CEO
Foundation for Advancement of International Medical Education and Research (FAIMER)
Philadelphia, PA, USA
Geoff Norman
Professor Emeritus
Clinical Epidemiology and Biostatistics
McMaster University
Hamilton, Ontario, Canada
Bridget C. O'Brien
Associate Professor
Department of Medicine
Education Researcher
Center for Faculty Educators
University of California
San Francisco, CA, USA
Hirotaka Onishi
Assistant Professor
Department of International Cooperation for Medical Education
International Research Centre for Medical Education
University of Tokyo
Tokyo, Japan
Fiona Patterson
Founding Director
Work Psychology Group
London, UK
Principal Researcher
University of Cambridge
Cambridge, UK
Linda Peterson
Professor and Senior Evaluation Adviser
Retired, Faculty of Medicine
University of British Columbia
Vancouver, British Columbia, Canada
David Price
Senior Vice President
ABMS Research and Education Foundation
American Board of Medical Specialties
Chicago, IL, USA
Professor
Department of Family Medicine,
University of Colorado School of Medicine
Denver, CO, USA
Scott Reeves
Professor
Faculty of Health, Social Care and Education
Kingston University and St. George’s University of London
London, UK
Trudie E. Roberts
Director of Leeds Institute of Medical Education
University of Leeds
Leeds, UK
Melody Rhydderch
GP Training Academic Development Lead
Wales Deanery
Cardiff, UK
Dujeepa D. Samarasekera
Director
Centre for Medical Education, Yong Lo Lin School of Medicine
National University of Singapore, Singapore
Singapore
Maggi Savin‐Baden
Professor of Education
Institute of Education
University of Worcester
Worcester, UK
Lambert W.T. Schuwirth
Strategic Professor for Medical Education
Flinders University
Adelaide, Australia
Professor for Innovative Assessment
Maastricht University, Maastricht
The Netherlands
Professor of Medical Education
Chang Gung University
Taoyuan, Taiwan
Professor of Medicine (Education),
Uniformed Services University for the Health Professions
Bethesda, MD, USA
Matthew Sibbald
Assistant Professor
Department of Medicine
Director
Centre for Simulation‐Based Learning
McMaster University
Hamilton, Ontario, Canada
Linda Snell
Professor of Medicine
Centre for Medical Education and Department of Medicine
McGill University
Montréal, Quebec, Canada
Daisuke Son
Assistant Professor
Department of Medical Education Studies
International Research Centre for Medical Education,
University of Tokyo
Tokyo, Japan
John Spencer
Emeritus Professor of Primary Care and Clinical Education
Newcastle University
Newcastle, UK
Yvonne Steinert
Professor of Family Medicine
Richard and Sylvia Cruess Chair in Medical Education
Director
Centre for Medical Education
Faculty of Medicine
McGill University
Montreal, Quebec, Canada
Tim Swanwick
Dean of Education and Leadership Development
NHS Leadership Academy
Health Education England
London, UK
Jools Symons
Patient & Public Involvement Manager
Faculty of Medicine and Health
Leeds University
Leeds, UK
Olle ten Cate
Professor
Directorate of Education and Training
Utrecht University
Utrecht, The Netherlands
Adjunct Professor of Medicine
University of California
San Francisco, CA, USA
Jill Thistlethwaite
Adjunct Professor
School of Communication
University of Technology
Sydney, Australia
Aliki Thomas
Associate Professor and Research Scientist
Centre for Medical Education
School of Physical and Occupational Therapy
Faculty of Medicine,
McGill University
Montreal, Quebec, Canada
Cees P. M. van der Vleuten
Scientific Director
School of Health Professions Education
University of Maastricht
Maastricht, The Netherlands
Jan van Tartwijk
Professor of Education
Department of Education
Utrecht University
Utrecht, The Netherlands
Claire Vogan
Associate Professor
Swansea University Medical School
Swansea, Wales, UK
Marjo Wijnen‐Meijer
Associate Professor
TUM Medical Education Center
Technical University of Munich
Munich, Germany
Tim Wilkinson
Professor of Medicine and Director of the MB ChB programme
Otago Medical School
University of Otago
Christchurch, New Zealand
Diana F. Wood
Director of Medical Education and Clinical Dean
University of Cambridge School of Clinical Medicine
Cambridge, UK
Zareen Zaidi
Associate Professor
Department of Medicine
University of Florida College of Medicine
Gainesville, FL, USA
Lara Zibarras
Associate Director for Research, Development and Dissemination
Work Psychology Group
Senior Lecturer in Organisational Psychology
City, University of London
London, UK
What can one say about a book that within less than 10 years is its third edition? The need for this new edition reflects that Understanding Medical Education is the authoritative and comprehensive resource in modern medical education practice. To borrow from Parmenides, ‘nothing comes from nothing’ and so it is useful to reflect on both the origins of Understanding Medical Education and how it has evolved through its various iterations. During the early ‘noughties’, the Association for the Study of Medical Education (ASME) approached leading experts in the field of medical education to contribute to a series of standalone monographs on their topics of expertise. These monographs proved incredibly popular, so much so that it became clear that there was a need for a definitive guide to medical education presented, for the first time, in a single core textbook. Having commissioned and edited the original series, Tim Swanwick was invited to take on the gargantuan task of bringing everything together in one place, approaching authors to revise their contributions in light of new research evidence and emerging thinking, and sourcing other well‐known figures and rising stars as contributors. Understanding Medical Education was a cutting‐edge ‘one‐stop shop’ presented in simple language and applicable across the entire spectrum of health professions education. It was an instant ‘hit’, adopted rapidly by medical educators across five continents with translations available in a number of different languages.
Yet nothing stands still. After many centuries of little change, medical education and medicine have shifted dramatically in recent years. Medical practice, society, health care systems, and expectations from patients are changing, and medical education has to also change to keep up. For example, ways of working with patients and colleagues are different. There are changes in how we deliver education and training linked to changing health care practices, particularly fewer opportunities to learn in the workplace because of system changes such as regulated hours for junior doctors. There have been major advances in research and treatments, and hence views of what is good clinical practice. These rapid changes mean that medical education must prepare today's medical students and doctors in training to work in very different ways from those of the past. Best practice in medical curricula, methods of instruction, assessment, and so on have to change and evolve in order to reflect the needs of contemporary medical practice. It is extremely challenging for educators to keep up with the literature, read journal articles and book chapters: the synthesis of the latest, most relevant, and essential material in medical education is if anything more necessary today than it was at the time of the first edition.
The second edition of Understanding Medical Education was published only four years after the first, reflecting the rapidity of change. This third edition, has kept pace with the continuing and hectic evolution of medical education. The content illustrates the journey that medical education has taken over recent years, and hints at the challenges that lie ahead. The content also reflects the responsiveness of the Understanding Medical Education project, a feature which will help those delivering medical education and training reflect on how things have changed since they were in the classroom and clinic, and help them break free of what Whitehead and colleagues have called the ‘carousel of ponies’. This colourful analogy suggests that there are returning themes in medical education, circling round and round in the continual rediscovery of discursive ‘truths’. Getting off this carousel requires both knowledge and reflection. Understanding Medical Education's five sections of Foundations, Teaching and Learning, Assessment and Selection, Research and Evaluation, and Faculty and Learners focus ostensibly on knowledge. Yet running throughout the book is also a strong acknowledgement of the necessity of considered and scholarly reflection on the process of medical education. By this I mean the need to think not just about the ‘what’ or ‘how’ (to assess in the workplace, to introduce portfolios, design a curriculum, etc.) but also the ‘why’ (are we introducing something new, what can we learn from pedagogic shifts, and so on). Understanding Medical Education provides a resource which will help educators reflect on the complexity of medical education, to question discourses and practices in a way which will help them develop as professionals and move medical education ever forwards.
Long‐term fans will also notice that Understanding Medical Education has extended its editorial team. As the current Chair of the Association for the Study of Medical Education (ASME), and the person responsible for commissioning the third edition of UME, I believed it was critically important to ensure that the book explicitly reflected ASME's explicit ‘UK‐based internationally facing’ mission. This mission is reflected in editors, contributors, and readers of ASME's journals, Medical Education and The Clinical Teacher, and our other indispensable resource, Researching Medical Education. In support of this aim, I was delighted to invite Bridget C. O'Brien from the US and Kirsty Forrest from Australia to join Tim Swanwick as co‐editors. Their international collaboration on this edition illustrates the great benefits of working together to share knowledge and networks.
Understanding Medical Education synthesises the latest knowledge, evidence, and best practices in the field. It provides a snapshot of how far we have come as a field. It is the essential resource for established educators and those new to the field. This extensively revised and extended third edition should be on the desk of every medical educator.
Understanding Medical Education was launched by the Association for the Study of Medical Education as a series of monographs in September 2006. In 2010 these monographs were brought together into a single textbook, providing a unique and comprehensive guide to the theoretical and academic bases to modern medical education practice.
As well as providing practical guidance for clinicians, teachers, and researchers, Understanding Medical Education is designed to meet the needs of all newcomers to medical education, including those studying at certificate, diploma, or masters level; Understanding Medical Education aims to be both accessible and useful to the reader. The intention is that after reading one of the chapters the reader will not only be better informed about their field of interest, but able to assimilate their new knowledge into their clinical teaching or academic activities.
Following a rigorous process of expert peer review, this third edition sees major updates of all existing chapters and some completely new ones, including contributions on the science of learning, knowledge synthesis, and learner support and well‐being. The third edition also comes with a brand new foreword from Professor Jennifer Cleland, Chair of Medical Education Research at the University of Aberdeen and Chair of Council for the Association for the Study of Medical Education.
Understanding Medical Education remains the first port of call for anyone engaged in medical education as an academic discipline. The book is a unique resource which should prove invaluable for anyone involved in the development of health care professionals, in whatever discipline, wherever they are in the world.
An online edition of the complete book together with individual chapter downloads is available at http://onlinelibrary.wiley.com.
Tim Swanwick, MA, FRCGP, MA(Ed), FAcadMEd, has a broad range of experience in health care education and is based in London (UK), where he is Dean of Education and Leadership Development for Health Education England and the NHS Leadership Academy. Tim has a variety of academic interests including work‐based learning, faculty development, professional support, academic careers and clinical leadership, and has taught, researched and published widely.
Kirsty Forrest, MBChB, BSc Hons, FRCA, MMEd, FAcadMEd, FANZCA, is based in Gold Coast, Queensland, Australia, as Dean of Medicine at Bond University. She is co‐author and editor of a number of medical textbooks. Kirsty has been involved in educational research and management for many years both at the undergraduate and postgraduate levels and she continues to work clinically as a consultant anaesthetist.
Bridget C. O’Brien, PhD, is an associate professor and education researcher at the University of California, San Francisco, where she supervises doctoral students in the UCSF‐University of Utrecht doctoral program and directs the San Francisco Veterans Affairs Fellowship in Health Professions Education Evaluation and Research. She co‐authored Educating Physicians: A Call for Reform of Medical School and Residency (2010) and has published numerous peer‐reviewed research papers and articles. Her research focuses on workplace learning across the continuum of health professions education.
The Association for the Study of Medical Education (ASME) was established in 1957 by the UK General Medical Council to promote and conduct research into medical education. ASME's goals are to:
ASME's mission is to meet the needs of teachers, trainers, and learners in medical education by supporting research‐informed best practice across the continuum of medical education.
Producing a textbook such as this is a team effort, and thanks must be extended to the ASME Executive and Understanding Medical Education editorial advisory board for their advice and guidance, to the ASME team for their administrative support, and to James Watson and the editorial team at Wiley for helping to make the third edition of Understanding Medical Education such an impressive and attractive volume.
Members of the Editorial Advisory Board include:
Jennifer Cleland
Steven J. Durning
Rachel H. Ellaway
Deborah Gill
Marjan Govaerts
Larry Gruppen
Brian Jolly
Karen Mattick
Lynn Monrouxe
John J. Norcini
William Reid
Charlotte Ringsted
Trudie E. Roberts
Jonathan Sherbino
Linda Snell
Olle ten Cate
Pim Teunissen
Steve Trumble
Sebastian Uijtdehaage
Tim Wilkinson