Joanna Bates1, Brett Schrewe2, Rachel H Ellaway3, Pim W Teunissen4, Christopher Watling5. 1. Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 2. Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 3. Department of Community Health Sciences and Director of the Office of Health and Medical Education Scholarship (OHMES), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 4. School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands. 5. Departments of Clinical Neurological Sciences and Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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.
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.
Authors: Natan Cramer; Lauren Cantwell; Hilary Ong; Shyam M Sivasankar; Danielle Graff; Simone L Lawson; Paria M Wilson; Kathleen A Noorbakhsh; Megan Mickley; Noel S Zuckerbraun; Brad Sobolewski; Jane K Soung; Devora B Azhdam; Desiree N Wagner Neville; Mark R Hincapie; Jennifer R Marin Journal: AEM Educ Train Date: 2021-08-01
Authors: Clare Guilding; Paul Khoo Li Zhi; Sailesh Mohana Krishnan; Paul Stephen Hubbard; Kenneth Scott McKeegan Journal: Med Sci Educ Date: 2021-09-16