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Academic Medicine:
doi: 10.1097/ACM.0b013e31829f33f9
Letters to the Editor

In Reply to Archer and to Lim

Cook, David A. MD, MHPE; West, Colin P. MD, PhD

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Professor of medicine and medical education; director, Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota; cook.david33@mayo.edu.

Associate professor of medicine and biostatistics, College of Medicine, Mayo Clinic, Rochester, Minnesota.

The letters from Dr. Archer and Dr. Lim highlight clearly the tension surrounding the topic of patient-related outcomes. As Dr. Archer suggests, academics are often accused of living in an ivory tower, distant from the realities faced by those on the front lines. Education researchers are not immune to this threat. An educator who has developed a program of sustained research in a theme such as clinical reasoning, Web-based learning, physician well-being, or cultural competence—a laudable goal, since programmatic research is typically required for scientific advances1,2 —may lose sight of the big picture or shifting priorities in a field. Research is most useful when it both deepens our understanding and responds to current needs.3 Focusing on patient impact helps to keep education scholars grounded in what matters most to patients and society.4

Yet if we set measurement of patient effects on a pedestal as the most desirable outcome, we encourage aspiration to an objective that may consume precious resources unnecessarily, distract from key intermediary questions and studies, and discourage some educators from engaging at all. Clearly, this endeavor requires a balanced approach, as advocated by Dr. Lim.

Indeed, we carefully crafted the title of our essay.4 We hope to encourage all stakeholders—including educators, researchers, administrators, policymakers, and funding agencies—to step back and reconsider the role of patient outcomes in health professions education research. We do not believe that we should retreat nor halt but, instead, proceed with caution—selectively, reflectively, and prudently employing the outcomes (patient-related or not) that are most appropriate to the research question and instructional objectives.

David A. Cook, MD, MHPE

Professor of medicine and medical education;

director, Office of Education Research, College of

Medicine, Mayo Clinic, Rochester, Minnesota;

cook.david33@mayo.edu.

Colin P. West, MD, PhD

Associate professor of medicine and biostatistics,

College of Medicine, Mayo Clinic, Rochester,

Minnesota.

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References

1. Eva KW, Lingard L. What’s next? A guiding question for educators engaged in educational research. Med Educ. 2008;42:752–754

2. Cook DA, Bordage G, Schmidt HG. Description, justification and clarification: a framework for classifying the purposes of research in medical education. Med Educ. 2008;42:128–133

3. Stokes DE Pasteur’s Quadrant: Basic Science and Technological Innovation. 1997 Washington DC Brookings Institution Press

4. Cook DA, West CP. Perspective: Reconsidering the focus on “outcomes research” in medical education: a cautionary note. Acad Med. 2013;88:162–167

© 2013 by the Association of American Medical Colleges

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