Researchers lack the rich evidence base and benchmark patient outcomes needed to evaluate the effectiveness of medical education practice and guide policy. The authors offer a framework for medical education research that focuses on physician-influenced patient outcomes that are potentially sensitive to medical education. Adapting the concept of ambulatory care sensitive conditions, which provided traction to health services research by defining benchmark patient outcomes to measure health system performance, the authors introduce the concept and propose the adoption of educationally sensitive patient outcomes and suggest two measures: patient activation and clinical microsystem activation. They assert that the ultimate goal of medical education is to ensure that measurement of future physicians' competence and skills is based not only on biomedical knowledge and critical clinical skills but also on the ability to translate these competencies into effective patient- and systems-level outcomes. The authors consider methodological approaches and challenges to measuring such outcomes and argue for large, multiinstitutional, prospective cohort studies and the development of a national Database for Research in Education in Academic Medicine to provide the needed infrastructure. They advocate taking the next steps to establish an educational evidence base to guide the academic medical centers of the 21st century in aligning medical education practice with health care delivery that meets the needs of individuals and populations.
Purpose To prepare to develop a medical school curriculum on substance abuse disorders (SAD), the authors conducted a review of the quality of the sparse published literature. Method The authors searched MEDLINE (1950–December 2008), Web of Science, PsycINFO, and PubMed to identify all studies of SAD interventions targeted toward undergraduate medical students. Of the 1,084 studies identified initially, 31 reported sufficient data to allow the authors to evaluate quality using Medical Education Research Study Quality Instrument (MERSQI) scores. The authors also determined the impact of the studies by considering three-year citation rate and journal impact factor. A detailed review of the literature provided data on contact hours and intervention content. Results The three-rater intra-class correlation coefficient (ICC) for total MERSQI score was 0.82 (95% confidence interval: 0.70–0.90). The mean MERSQI score was 10.42 of a possible 18 (SD 2.59; range: 6.33–14.83). MERSQI scores were higher for more recently published studies and correlated with three-year citation rate but not impact factor. The mean contact time for 26 studies was 29.25 hours (range: 0.83–200 hours). Conclusions The literature provides a variety of educational methods to train medical students in SAD detection and intervention skills. This literature is of variable quality and provides limited guidance for development of curricula and medical education policy. Better methods of curriculum evaluation and publication guidelines would help ensure this literature has a positive impact on educational practice and public health.
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