Where <i>Medical Education</i> matters

Editor's note: This is the fourth editorial in a series that offers a retrospective look at the 50 volumes of Medical Education through the lens of each Editor's tenure. John Bligh served as Editor in Chief for Volumes 32-39. For the preceding editorials in the series click ‘read’ at www.mededuc.com. During my editorship of Medical Education, from 1998 to 2005, I was acutely – often painfully – conscious of the powerful responsibility of the journal and its editorial team in setting the agenda for medical education research and practice. During that time, if you had asked me, I would have said that my prime concern as editor was to ensure that medical education research remained focused on its core mission: to inform, advance and enhance our understanding of medical education for the benefit of students and doctors in training, and ultimately for the patients they serve. It was a deliberate influencing of the medical education research agenda for which I feel no need to apologise. So after 10 years, it is interesting to look back and to see that this relationship between the journal and its discipline was a two-way process of which I was perhaps less aware at the time. Medical Education certainly shaped the study and practice of medical education research, but it has always been a child of its time and has invariably reflected, in its own organisation and editorial mission, some of the key debates and cultural changes that were happening in the field around it. There were many of these, but I would like to select four main ways in which developments in medical education influenced developments within the journal itself. The first aspect of the prevailing zeitgeist to which the journal desperately needed to respond when I became editor in the late 1990s was the need for medical education organisations and their leaders to professionalise: to make themselves more available, more accountable, more consistent and more transparent to the communities they served. For the journal this meant that it was no longer enough just to administer a rigorous process for the selection of manuscripts; such a process had to be seen to be fair, and the principles and values on which it was based had to be transparent and defensible. One of my first tasks was to revise and publish clear guidelines for authors, standardise the review process, develop a clear set of quality principles on which publication decisions could be made and – most importantly – to tell readers and authors about this in editorials,1 inviting feedback and criticism in an enhanced letters and commentaries section. Just as standard setting and professionalism were key preoccupations within the field, defining, applying and assuring ethical conduct in medical education research and publication were also significant issues. Not long before my appointment as editor, JAMA: The Journal of the American Medical Association had published the Vancouver Guidelines for Biomedical Publication.2 At last editors and authors had ready access to authoritative standards that defined important concepts such as authorship and plagiarism, and, importantly, re-emphasised the centrality of assuring ethical standards in all research involving humans. Up to this point, medical students had occasionally been viewed as not quite human in terms of requirements for ethical approval, so we introduced a requirement for research committee approval or exemption as a necessary prerequisite for publication.3 Reflecting on its commitment to quality improvement, Medical Education undertook regular reviews of its handling of significant incidents and also established an independent ethical scrutiny committee which was charged with overseeing the journal's own performance; during my time as editor I was grateful for the guidance and assurance afforded by this expert committee. The second manifestation of the spirit of the age was the drive to make better use of technological advances. The impact of new technology was beginning to make itself felt all the way across medical education at the time, leading to an exciting flurry of papers on high-fidelity simulation, computer-based learning and assessment, the use of hand-held devices in clinical settings – does anyone still remember the PDA (personal digital assistant)? – online platforms, and so on. Medical Education itself became an early adopter of new technological facilities, accepting electronic submissions early in 1999 and then moving rapidly to online submission and review, producing its own web archive, radically altering its appearance to include colour covers, and publishing online collections and supplementary material. New technologies meant that we could internationalise our editorial operation in a way that had been impossible previously, and we took full advantage of e-mail, videoconferencing and file sharing to engage more fully with our community across the world. Time differences and physical distance became far less constraining, although I regret that these remained a significant issue for our Australian editors, who nevertheless cheerfully attended editorial teleconferences at (their) midnight. A third area in which the journal was heavily influenced by developments in the field of medical education was that of widening engagement. This was not driven solely by a desire to increase readership, but also sprang from a genuine wish to become more inclusive. One of my earliest preoccupations was possible publication bias and, in particular, the concern that the journal was not doing enough to engage authors and readers whose first language was not English and those who were not members of large prestigious Western institutions. It was with great delight that the journal team participated in the Ottawa in Africa Meeting in 2000 as an early demonstration of our support for broader representation within the journal.4 We broadened the international editorial board, instituted annual audits of our submission, publication and citation rates,5 undertook a deliberate policy of ensuring that all papers were reviewed by at least one reviewer from a country other than that of the authors, increased our technical support for accepted authors who were struggling with English, and instituted a vigorous campaign of commissioning work from international researchers. In addition to broadening the journal's international reach, we made efforts to include work from junior researchers and students. We carved out space for very short reports of smaller projects and pilot studies, and I am delighted that ‘Really Good Stuff’, which first appeared in Medical Education in November 2000,6 continues to go from strength to strength thanks to the wonderful work of Brownie Anderson and her growing team of reviewers. The fourth area in which Medical Education responded to the evolving discipline of medical education refers to the increasing scope of its fields of interest. We commissioned and published papers and commentaries that introduced, both in subject and method, a much wider range of relevant interdisciplinary studies than had previously been seen in the journal, including studies embracing social and cognitive psychology, humanities and cultural theory, philosophy, history, management and organisational disciplines, and sociology. There was a flowering of interest in developing and exploring some fundamental questions about medical education: whom does it really serve? What are the mechanisms by which it works? Why does it matter? How can we measure its effect? What is excellent medical education research? And so on. Although we were keen to encourage this new openness to intellectual curiosity and an increasingly rigorous and academically important theory-based debate, we were also acutely aware of the attendant risk of disengaging those whose interest in medical education was chiefly practical: jobbing clinical teachers. Translational medicine was in the air. It was clear that as the quality of research papers improved, we also required a new type of ‘translational medical education’. We needed to continue to reach out to those non-specialists who read Medical Education seeking short answers to practical problems and, as former deputy editor John Spencer memorably put it, were increasingly thinking: ‘So what? And who cares?’ In response to this need for a medical education journal that a busy clinician could pick up and put down during short breaks, and with the support of Medical Education's owners, the Association for the Study of Medical Education (ASME) and, at the time, Blackwell Publishing, we launched The Clinical Teacher in 2004.7 I was its first editor and its editorial board was composed entirely of clinicians. Its mission was to publish scholarly evidence in medical education in a stylish, accessible and unpatronising manner for clinicians and those new to the study of medical education – a role it continues to perform with energy and flair to this day. The secret of Medical Education's success over the years is no secret at all: for 50 years it has been engaged with and responsive to the needs of the community it serves, never losing sight of its vital role in improving the study and practice of medical education for the benefit of patients and society. This culture of service has been shared and supported by its professional staff, excellent editorial team, and a wonderfully committed and conscientious community of authors, readers and reviewers. I am confident it will continue to hold fast to these values and maintain its position as the pre-eminent international journal in the field. In a 1998 commentary I argued that for medical education to be effective, it must be responsive and open to change, and must never lose sight of its primary objective, which is to ‘develop and ensure the conditions in which students and doctors can learn to practise the highest quality medicine’.8 I wrote: ‘The quality of medical education matters most where its results are applied – at the bedside, in the consulting room, or in the wider community’.8 For medical education, read Medical Education.

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