Embracing standardisation and contextualisation in medical education

Abstract

Context The tensions that emerge between the universal and the local in a global world require continuous negotiation. However, in medical education, standardization and contextual diversity tend to operate as separate philosophies, with little attention to the interplay between them. Methods The authors synthesise the literature related to the intersections and resulting tensions between standardization and contextual diversity in medical education. In doing so, the authors analyze the interplay between these competing concepts in two domains of medical education (admissions and competency‐based medical education), and provide concrete examples drawn from the literature. Results Standardization offers many rewards: its common articulations and assumptions promote patient safety, foster continuous quality improvement, and enable the spread of best practices. Standardization may also contribute to greater fairness, equity, reliability and validity in high stakes processes, and can provide stakeholders, including the public, with tangible reassurance and a sense of the stable and timeless. At the same time, contextual variation in medical education can afford myriad learning opportunities, and it can improve alignment between training and local workforce needs. The inevitable diversity of contexts for learning and practice renders any absolute standardization of programs, experiences, or outcomes an impossibility. Conclusions The authors propose a number of ways to examine the interplay of contextual diversity and standardization and suggest three ways to move beyond an either/or stance. In reconciling the laudable goals of standardization and the realities of the innumerable contexts in which we train and deliver care, we are better positioned to design and deliver a medical education system that is globally responsible and locally engaged.

Time to CHAT about globalisation

“…In other words, we have an ethical duty as educators to shape our discourses and curricula to best meet the needs of the populations future workforces will serve. With this in mind, two papers that touch on these issues are published in the current State of the Science edition of Medical Education , both of which wrestle with the tensions that globalisation brings, whether this is between local and global or standardised and contextualised practices.…”

“…Using the example of competency‐based medical education, the authors illustrate the seductive appeal of standardisation, with its promises for meeting a patient safety agenda. They counter this by arguing for the need for contextual diversity in medical education in order to produce the kinds of physicians who can ‘adapt their practices to local concerns’ (perhaps the future physicians who can accept the ‘constancy of change’ foregrounded 60 years ago).…”

“…This is particularly true if educational approaches are divorced from the understanding that capabilities are ultimately locally negotiated and in part dependent on interprofessional situated pressures . The paper concludes that standardisation and contextualisation should be negotiated to encompass both approaches and calls for the adoption of realist approaches to elucidate what works, for whom, and in which contexts …”

“…There may be a third way to navigate the tensions articulated in the persuasive papers presented. With this in mind, we move beyond traditional and realist approaches to draw on the conceptual and research tools of cultural historical activity theory (CHAT) .…”

“…Both papers articulate tensions that arise when medical schools begin to interact across and beyond their historical, cultural and practice borders. If we understand medical schools as interacting activity systems, we have to consider the ‘object of their activity’ (their purpose) and examine the ways in which that object is being expanded, intentionally or otherwise, by a globalisation agenda.…”