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

CONTEXT: A fundamental premise of medical education is that faculty should educate trainees, that is, students and residents, to provide high quality patient care. Yet, there is little research on the effect of medical education on patient outcomes. OBJECTIVE: A content analysis of leading medical education journals was performed to determine the primary foci of medical education research, using a three- dimensional outcomes research framework based on the paradigm of health services outcomes research. DATA SOURCES: All articles in three medical education journals (Academic Medicine, Medical Education, and Teaching and Learning in Medicine) from 1996 to 1998 were reviewed. Papers presented at the Research in Medical Education conference at the Association of American Medical Colleges annual meeting during the same period, and published as Academic Medicine supplements, were 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 participant (i.e. trainee, faculty, provider and patient), outcome (performance, satisfaction, professionalism and cost), and level of analysis (geographic, system, institution and individual(s)). DATA SYNTHESIS: A total of 599 articles were analysed. Trainees were the most frequent participants studied (68.9%), followed by faculty (19.4%), providers (8.1%) and patients (3.5%). Performance was the most common outcome measured (49.4%), followed by satisfaction (34.1%). Cost was the focus of only 2.3% of articles and patient outcomes accounted for only 0.7% of articles. CONCLUSIONS: Medical education research is dominated by assessment of trainee performance followed by trainee satisfaction. Leading journals in medical education contain little information concerning the cost and products of medical education, that is, provider performance and patient outcomes. The study of these medical education outcomes represents an important challenge to medical education researchers.