An outcomes research perspective on medical education: the predominance oftrainee assessment and satisfaction

Context A fundamental premise of medical education is that faculty should e ducate trainees, that is, students and residents, to provide high quality p atient care. Yet, there is little research on the effect of medical educati on on patient outcomes. Objective A content analysis of leading medical education journals was perf ormed to determine the primary foci of medical education research, using a three-dimensional outcomes research framework based on the paradigm of heal th services outcomes research. Data sources All articles in three medical education journals (Academic Med icine, Medical Education, and Teaching and Learning in Medicine) from 1996 to 1998 were reviewed. Pagers presented at the Research in Medical Educatio n conference at the Association of American Medical Colleges annual meeting during the same period, and published as Academic Medicine supplements, we re also analysed. Study selection Only data-driven articles were selected for analysis; thus editorials and abstracts were excluded. Data Extraction Each article was categorized according to primary participa nt (i.e. trainee, faculty, provider and patient), outcome (performance, sat isfaction, professionalism and cost), and level of analysis (geographic, sy stem, institution and individual(s)). Data synthesis A total of 599 articles were analysed. Trainees were the mos t frequent participants studied (68.9%), followed by faculty (19.4%), provi ders (8.1%) and patients (3.5%). Performance was the most common outcome me asured (49.4%), followed by satisfaction (34.1%). Cost was the focus of onl y 2.3% of articles and patient outcomes accounted for only 0.7% of articles . Conclusions Medical education research is dominated by assessment of traine e performance followed by trainee satisfaction. Leading journals in medical education contain little information concerning the cost and products of m edical education, that is, provider performance and patient outcomes. The s tudy of these medical education outcomes represents an important challenge to medical education researchers.