Thinking and acting scientifically: Indispensable basis of medical education.

Editorial

This issue of ZMA is dedicated to a variety of core topics of medical education research: The spectrum of contributions covers student selection in medicine [1] and dentistry [2] as well as the psychosocial effects of body donation in the anatomical dissection course [3]. The article of Gehlhar et al. looks at the impact of different curricula on critical clinical thinking [4]. The establishment of skills lab in veterinary medicine [5] is described as a project as well as a tutor training curriculum for students with a certificate [6] and the establishment of a postgraduate master program in dentistry [7]. Welbergen et al. describe and evaluate an innovative format for informing medical students about opportunities of postgraduate training – the so called battle of the specialties [8].

The broad variety of articles combining topics from the first day of undergraduate studies all the way along until postgraduate training in medicine, dentistry and veterinary medicine impressively underlines the scope of ZMA. This issue is enriched by a student commentary dedicated to a topic that is intensively debated right now, i.e. scholarship and scholarly competencies in medical education [9]. A number of important questions arise here:

Is there a discrepancy between the requirements, students should meet and the actual training they get to become critical scientific thinkers and decision makers?

How research-oriented is current medical training at our faculties really?

Do we motivate our students enough for doing research themselves?

How much cutting edge research is actually and consistently needed as the basis for quality medical education?

These questions are at the heart of medical education and gain importance in light of the debate on the quality of teaching at so called franchise medical faculties in Germany that are run under European law. The latest example is the medical faculty at Nürnberg Hospital run by the Private Medical University Salzburg (PMU) that was accredited via Austrian regulation.

Medicine is an applied science that uses and combines insights from natural, life and social sciences for the benefit of the patient. Scientific reasoning and argumentation as one of the key competencies should be acquired in medical education but also in other study programs. Scientific thinking can be described across disciplines as a limited number of epistemic modes and activities [10]. Essentially, two target dimensions of scientific thinking can be differentiated: Understanding and application. Pure basic research is characterized by its primary goal of advancing scientific understanding of natural and social phenomena, regardless of its usefulness in one or more fields of practice. In contrast, pure applied research emphasizes the use of scientific knowledge without the aim of advancing theory building and understanding [11].

Thus, on the one hand of the extremes there is scientific thinking that pursues pure advancement of understanding. Students must acquire this competency composed of knowledge, skills and attitudes that then allows participation in the scientific discourse of the respective subject domain. On the other hand of the extremes there is a second kind of scientific thinking that applies scientific concepts, methods and findings to achieve goals of problem solving in practice. Students must learn to make evidence-based decisions and solve problems on the basis of the scientific insights and findings in a field. Both epistemic modes must be understood with regard to their specific characteristics (e.g. in terms of how they approach their objects and with regard to their rationale and claim of validity) and acquired as competencies. Medicine comprises research and innovation in all facets between scientific basic understanding and application of scientific concepts. The decision making for each single patient should be an example for this. This is one of the many strengths of medicine that we should make more educational use of in the future with innovative scientific and research oriented teaching. Medical faculties with a strong research profile offer the ideal environment for this undertaking.

The current intense discussion of the scientific medical associations under the roof of AWMF together with all German medical faculties around the published draft of the National Competency-based Catalogue of Learning Objectives in Medicine (NKLM) and dentistry (NKLZ) show, how important it is, to identify the core competencies of scientific thinking and decision-making for each physician [http://www.nklm.de]. This clarification process is at the heart of medical education and a prerequisite for good medical care. We need more scientific and scholarly competencies and a better promotion of future scientists in medical education. Medicine needs sound knowledge and the ability to critically reflect. With the definition of scientific and scholarly competencies as a prerequisite for postgraduate training comprising life-long learning, teaching, critical appraisal of scientific evidence and innovation via research as goals for all students NKLM and NKLZ exceed the legal requirements in the ÄAppO by far. On the road to a broadly accepted agreement on the revised versions of NKLM and NKLZ there still is a lot of work to do. We want to finally get the first full official versions approved by summer 2015.

Competing interests

The authors declare that they have no competing interests.