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 Table of Contents  
MEDICAL EDUCATION
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 132-135

Defining medical education scholarship: Its evolution and its importance


1 Higher Education, OISE/University of Toronto, Canada, North America, Canada
2 Professor of Surgery, University of Toronto, Canada, North America, Canada
3 Vice-President of Diversity, Inclusion & Education, The Ottawa Hospital; Associate Professor of Medicine, University of Ottawa, Canada, North America, Canada

Date of Submission11-May-2021
Date of Decision15-May-2021
Date of Acceptance16-May-2021
Date of Web Publication26-Jun-2021

Correspondence Address:
Dr. Elizabeth M Wooster
3101 Bloor St W, Ste 306, Toronto, ON M8X 2W2
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_111_21

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  Abstract 


Understanding the definition of medical education scholarship and its underlying theoretical constructs is essential to constructing medical education and supporting learning across the continuum. There continues to exist uncertainty surrounding defining and enacting medical education scholarship. This uncertainty results in an inability for educators to conduct medical education and scholarship and may result in missed opportunities for educators and learners across the continuum. For this paper, the authors define medical education scholarship as endeavours that are purposefully undertaken and may surpass the borders of those traditionally defined as research or innovation. Medical education may take place in areas of discovery, integration, application, teaching, and engagement. This definition is based on works by Boyer, Glassick and Shulman. This paper describes the contribution that each of these seminal works has made to advance the definition of medical education scholarship. The differences between medical education scholarship and creative professional activities as well as daily work are explored throughout the paper. The paper concludes with a call to develop, demonstrate, promote and support medical education scholarship and the faculty who are focused on undertaking related activities.

Keywords: Education scholarship, Education theory, Medical education scholarship


How to cite this article:
Wooster EM, Wooster DL, Maniate JM. Defining medical education scholarship: Its evolution and its importance. Arch Med Health Sci 2021;9:132-5

How to cite this URL:
Wooster EM, Wooster DL, Maniate JM. Defining medical education scholarship: Its evolution and its importance. Arch Med Health Sci [serial online] 2021 [cited 2021 Sep 18];9:132-5. Available from: https://www.amhsjournal.org/text.asp?2021/9/1/132/319371




  Introduction Top


The concept of scholarship in medical education is important and should be understood, applied to, and deliberately constructed into work being conducted by medical educators across the continuum (undergraduate medical education to continuing professional development). However, medical educators often have difficulty defining medical education as a whole and articulating the concepts underlying it. Without a thorough understanding of medical education scholarship, educators will be unable to incorporate it into their projects. This inability results in tremendous, missed opportunities for both educators and learners alike.

The concepts of medical education scholarship have been fundamentally informed by and drawn from seminal works by Boyer,[1],[2] Glassick,[3] and Shulman.[4],[5],[6] In this paper, the authors discuss these works, their influence on the evolution of the definition of medical education scholarship, and the importance of understanding the definition and role of medical education scholarship. As the continuum of medical education continues to evolve and react to changing internal and external pressures, a sound comprehension of the concepts and definitions of medical education scholarship is essential.


  Definition of Medical Education Scholarship Top


The concept of educational scholarship, and more specifically medical education scholarship, has been a source of discussion and debate for many years. Traditionally, scholarship has been understood as research and in the case of medicine, either basic science or clinical research. However, in the past 30 years, a shift has begun to occur. In 1990, Ernest Boyer published one of his seminal works, a book entitled “Scholarship Reconsidered: Priorities of the Professoriate.”[1] This work posited that there were multiple types of scholarship priorities that existed within academia. Specifically, in this work, Boyer stated that there were four main types of educational scholarship and that each of these types should be valued on its own and for the contributions it makes to a specific field.[1] The four types of scholarship described by Boyer were as follows: (1) the scholarship of discovery, (2) the scholarship of integration, (3) the scholarship of teaching, and (4) the scholarship of application.[1]

In this framework, the scholarship of discovery, more commonly referred to as original research, involved finding new knowledge or new ways of doing things.[1] Original research was the traditionally accepted form of scholarship within academic professions. The scholarship of integration was defined as the process of incorporating knowledge and ideas into a larger context. This form of scholarship involved consideration of an interdisciplinary context.[1],[2] According to Boyer, the scholarship of teaching was different from a scholarly approach to teaching. A scholarly approach to teaching involved applying the current and most appropriate research, theories, and methods to teaching.[1] The scholarship of teaching moved beyond a scholarly approach to teaching and involved actively engaging students and encouraging them to be active participants both within the classroom and their own learning.[1] This involved consideration of the role and impact of their learning beyond the classroom. The scholarship of application was the extension of knowledge from a theoretical sense to a practical or real-world sense.[1]

Since Boyer's descriptions of these four areas of scholarship, there have been many papers discussing, applying, and extending these definitions.[3],[4],[5],[6],[7],[8],[9],[10],[11] The most influential of these works were a second publication by Boyer in 1996 “Scholarship of Engagement,”[2] a paper by Glassick in 2000 “Boyer's Expanded Definitions of Scholarship, the Standards for Assessing Scholarship, and the Elusiveness of the Scholarship of Teaching”[3] and Shulman's publications regarding the scholarship of teaching.[4],[5],[6]

In “Scholarship of Engagement,” Boyer expanded on his previous work, providing real-world examples and discussions of each area.[2] The Scholarship of Engagement helped to clarify confusion and debate that had emerged since the publication of the 1990 Scholarship Reconsidered.

In addition, in his 1996 publication, Boyer introduced the concept of “scholarship of engagement.”[2] By “scholarship of engagement,” Boyer described an environment that allowed higher education involvement in social issues for the purpose of serving the public good and providing a significant investment in future.[2] In his own words, Boyer stated that “the scholarship of engagement means creating a special climate in which the academic and civic cultures communicate more continuously and more creatively with each other, enlarging what anthropologist Clifford Geertz describes as the universe of human discourse and enriching the quality of life for us all.”[2] While Boyer was discussing the scholarship of engagement as it relates to higher education as a whole, this is a concept that resonates within medicine and medical education and should be actively considered by medical educators as they pursue their work.

In “Boyer's Expanded Definitions of Scholarship, the Standards for Assessing Scholarship, and the Elusiveness of the Scholarship of Teaching,” Glassick addressed the question of how scholarship should be assessed and by which criteria.[3] He summarizes the criteria that he had proposed in his book “Scholarship Assessed.”[3] According to Glassick for scholarship to “be praised, it must be characterized by clear goals, adequate preparation, appropriate methods, outstanding results, effective communication and a reflective critique.”[3] It is possible to envision how these criteria could be applied to all five priorities proposed by Boyer. In addition, Glassick touches on the question of the scholarship of teaching. This is a question that had been in debate since Boyer first released “Scholarship Reconsidered” and has been the focus of much of the work of Lee Shulman.

Shulman has published extensively on teaching and learning and the scholarship involved in each. After the release of “Scholarship Reconsidered,” much of Shulman's publications focused on differentiating between scholarly teaching and the scholarship of teaching.[4] Shulman describes scholarly teaching as the process of transferring knowledge known to the teacher and, based on scholarship, to students to assist them in their discovering the world.[5] According to Shulman, scholarship of teaching is quite different and requires three essential features. These features are: “it (scholarship of teaching) should be public, subject to peer review and evaluation, and accessible for exchange and use by members of one's disciplinary community.”[5]

Prior to 2014, no formal definition of medical education scholarship had been advanced in published manuscripts. Usually, when medical education scholarship is examined, the categories proposed by Boyer are those most discussed.[2],[7],[8],[9],[10],[11] In 2014, the Canadian Association for Medical Education released a white paper “Toward a Common Understanding” containing one of the first formally proposed definitions of medical education scholarship.[11] It defined scholarship as “an umbrella term which can encompass both research and innovation in health professions education. Quality in education scholarship is attained through work that is: peer-reviewed, publicly disseminated and provides a platform that others can build on.”[11] The aim of the Canadian Association for Medical Education (CAME) white paper was to define scholarship for the purpose of academic promotion; as such, the definition was kept broad. While this definition is broad, it provides guidance for medical educators who wish to undertake educational scholarship.

For this paper, we consider medical education scholarship to include the five types of scholarship proposed by Boyer over his two seminal works: discovery, integration, application, teaching, and engagement. To Boyer's definition, we expand on Shulman's work with the following statement: medical education scholarship is an endeavor that is purposefully undertaken and may surpass the borders of endeavors that are traditionally defined as research or innovation. By this, we mean that, for projects to be considered scholarship, the underlying constructs must be deliberately integrated into the undertaking. In our minds, this is what differentiates work from scholarship. When you do medical education work, it is a regular activity or task that is undertaken as part of your daily (weekly and monthly) activities. This is what the Royal College of Physicians and Surgeons of Canada considers to be part of the “job” of being a physician. In fact, the CanMEDS Role of Scholar is defined as “physicians demonstrate a lifelong commitment to excellence in practice through continuous learning and by teaching others, evaluating evidence, and contributing to scholarship.”[12] The deliberate separation of contribution to scholarship from the roles of teaching and evaluating evidence demonstrates the importance and nuances related to these types of endeavors. Engaging in medical education scholarship involves the deliberate incorporation and integration of an aspect of curiosity, reflection, and inquiry into that daily process and the intention of disseminating the results of these inquiries.[12]


  Importance of Understanding Medical Education Scholarship Difference between Scholarship and Creative Professional Activities Top


There are many reasons and implications for the importance of understanding medical education scholarship and being able to undertake it. First, there is a direct link back into the communities we serve. There is a need to demonstrate the societal importance of the activities undertaken by the medical community. With the changing medical and medical education environment including increased financial pressures, changing demographics, and increasing burden of illness, there is a growing appreciation that the status quo of most health-care systems is inadequate to address their community needs or expectations. Medical education scholarship can contribute to bridging the gaps and preparing the health-care system to meet the growing challenges through progressive and innovative ideas, greater efficiency and effectiveness, and a positive impact on cost-effectiveness on the investments already being made.

The second importance of understanding the definition of the medical education scholarship relates to the ability of faculty to undertake these activities. Having a working definition firmly in mind allows medical educators in embed medical education scholarship throughout their projects, from naissance to completion. Without a thorough understanding of medical education, and its current working definition, it would be impossible for faculty to participate in relevant endeavors. In addition, building support systems to enable and encourage the further development of medical education scholarship would be impossible. Increasing this support system is of utmost importance, if faculty are to succeed in undertaking true medical education scholarship.

While some progress has been made to create a culture that allows medical education scholarship to flourish, additional advancement is still needed. To build and sustain an environment that enables and encourages medical education scholarship, the following questions should be considered: how do we build an environment that encourages medical educators and faculty to explore and push the boundaries of the current field without fear (or a lessened fear) of failure? Where we learn from the things that do not work rather than hiding them for fear of scrutiny?. Further to encourage the continued its continued growth, we may wish to build on lessons learned from other fields and other priorities within Boyer's schema. These include the development of formal training in medical education scholarship, faculty development opportunities in medical education scholarship, provision of infrastructure that parallels other research (support staff, protected time, financial support, etc.), and other crossovers from clinical and basic science research.

Finally, the ability to demonstrate scholarship, in any of the four priorities discussed above, assists with the individual medical educator gaining traction in the following areas. Among others, these include academic success and recognition. Success is defined differently for each individual; however, academic success is often defined by external, institutional forces and includes recognition, support, and promotion. In order to gain support, recognition and promotion are often needed. In order to gain recognition and promotion, it is necessary to fulfill institutional requirements.

Traditionally, research scholarship has been the most widely recognized area of scholarship and this also holds true in medical education, with medical education research being the most recognized and valued form of scholarship. Since the publication of the Boyer's Scholarship Reconsidered, there has been a push to recognize the other three scholarship priorities (teaching, application, and integration) at the same level as research.[9] Progress in this area has been more successful in North America and Europe but slow overall.[12],[11]

To facilitate the integration of the other three priorities into the academic process, there have been attempts to describe and create assessment metrics for specific activity areas within scholarship priorities, usually within the scholarship of teaching. The rationale for doing this is two-fold: first, developing these metrics would provide a roadmap for faculty as they navigate the academic recognition and promotion process, and second, it facilitates the process of standardization of recognition across institutions. This is the rationale that has received the most focus in academic literature (CITE).


  Conclusion Top


The concept of scholarship in medical education is important and should be understood, applied to, and deliberately constructed into work being conducted by medical educators. The work of Boyer, Glassick, Shulman, and others has helped define this understanding with elements of discovery, integration, application, teaching, and engagement. Medical education scholarship is an endeavor that is purposefully undertaken and surpasses what is traditionally defined as research or innovation. Although an integral part of professional activity and grounded in that activity, scholarly activity is separate from the “work” of being a physician. The Scholarship of Engagement provides a direct link back into the communities we serve; there is a societal importance. To fully leverage the scholarship of medical education, we must demonstrate and promote such scholarship, develop and support the ability of faculty to undertake these activities, and create a culture that recognizes and rewards it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Boyer EL. Scholarship Reconsidered: Priorities of the Professoriate. Princeton, NJ: Carnegie Foundation for the Advancement of Teaching; 1990. Retrieved from https://eric.ed.gov/?id=ED442420. [Last accessed on 2020 Dec 09].  Back to cited text no. 1
    
2.
Boyer EL. The scholarship of engagement. J Public Serv Outreach 1996;1:11-20.  Back to cited text no. 2
    
3.
Glassick CE. Boyer's expanded definitions of scholarship, the standards for assessing scholarship and the elusiveness of the scholarship of teaching. Acad Med 2000;75:877-80.  Back to cited text no. 3
    
4.
Shulman LS. The scholarship of teaching and learning: A personal account and reflection. Int J Scholarsh Teach Learn 2011;5:doi. 10.20429/ijsotl.2011.050130.  Back to cited text no. 4
    
5.
Shulman LS. Fostering a Scholarship of Teaching and Learning. Athens GA: Publisher is the University of Georgia and its locations is Athens Georgia; Retrieved from https://eric.ed.gov/?id=ED442420 [Last accessed on 2021 May 09].  Back to cited text no. 5
    
6.
Shulman LS. From Minsk to Pink: Why a Scholarship of Teaching and Learning? Anaheim, CA: Remarks to Carnegie Academy for the Scholarship of Teaching and Learning (CASTL); 2000.  Back to cited text no. 6
    
7.
McGaghie WC. Varieties of integrative scholarship: Why rules of evidence, criteria, and standards matter. Acad Med 2015;90:294-302.  Back to cited text no. 7
    
8.
Cook DA. Getting started in medical education scholarship. Keio J Med 2010;59:96-103.  Back to cited text no. 8
    
9.
Boudreau JD, Cassell EJ. Abraham Flexner's “mooted question” and the story of integration. Acad Med 2010;85:378-83.  Back to cited text no. 9
    
10.
Simpson D, Fincher RM, Hafler JP, Irby DM, Richards BF, Rosenfeld GC, et al. Advancing educators and education by defining the components and evidence associated with educational scholarship. Med Educ 2007;41:1002-9.  Back to cited text no. 10
    
11.
Van Melle E, Lockyer J, Curran V, Lieff S, St Onge C, Goldszmidt M. Toward a common understanding: Supporting and promoting education scholarship for medical school faculty. Med Educ 2014;48:1190-200.  Back to cited text no. 11
    
12.
Richardson D, Oswald A, Chan MK, Lang ES, Harvey BJ, editors. Scholar. In: Frank JR, Snell L, Sherbino J, editors. Can Meds 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. Retrieved from https://eric.ed.gov/?id=ED442420 [Last accessed on 2021 Mar 15].  Back to cited text no. 12
    




 

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