Secondary Logo

Journal Logo

Letters to the Editor

In Reply

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

Author Information
doi: 10.1097/ACM.0b013e3182a5d082
  • Free

In Reply to Wayne, Barsuk, and McGaghie: We thank Wayne and colleagues for their comment on our recent Perspective.1 We agree with them that education research plays an important role in advancing patient safety and health care quality. We also agree that now is a time for bold action. However, we believe that bold action does not require us to set aside caution, and we reiterate our suggestion that “deliberately weighing the available options will facilitate informed choices.”1

Those who conduct research must evaluate the cost and potential gains. This is true for any research, but perhaps particularly true for those considering research involving patient outcomes. Confounded, inconclusive, or potentially misleading studies will not help – and may hurt – our cause. Yet “outcomes research” that is poorly conceived, executed, or interpreted is susceptible to precisely these limitations.

We need research that is bold in answering important questions with clarity and certainty, bold in thoughtful planning and rigorous execution, bold in critical interpretation, bold in systematically building on prior work, and bold in challenging preconceived notions and expanding our vision. Sometimes this will entail the use of patient outcomes, but we believe such studies should generally be the capstone—the apex in a progression of sustained, programmatic2 work. Proximate measures of knowledge, reasoning, skill in a simulated setting, and behaviors at the bedside will often represent more efficient, less confounded, and perhaps even more definitive solutions to the education-related problem at hand. Clinical trials are typically preceded by bench research and phase 1 and 2 preliminary studies. The same paradigm seems apt for education research as well.

Now is indeed the time for bold action – preceded by cautious consideration of all of the options available. As P.T. Barnum stated, “You must exercise your caution in laying your plans, but be bold in carrying them out.”3(p178)

David A. Cook, MD, MHPE

Professor of medicine and medical education, and director, Office of Education Research, College of Medicine, Mayo Clinic, Rochester, MN;[email protected]

Colin P. West, MD, PhD

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


1. Cook DA, West CP. Perspective: Reconsidering the focus on “outcomes research” in medical education: A cautionary note. Acad Med. 2013;88:162–167
2. McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Med Educ. 2010;44:50–63
3. Barnum PT Struggles and Triumphs: Or, Forty Years’ Recollections of P. T. Barnum. 1880 Buffalo, NY The Courier Company
© 2013 by the Association of American Medical Colleges