January 31, 2023

What knowledge matters in health professions education?

SOUTH AFRICA

Knowledge matters in education, but some kinds of knowledge matter more. And knowledge that really matters is powerful. Powerful knowledge defines a field of study and determines what is taught within that field.

If one is hoping to influence the thinking and practice within a particular field, we believe one needs to start with the knowledge within that field that holds the power.

In this article, we ask questions about the nature of the knowledge that matters in one specific field, namely that of health professions education.

In the context of health professions education, it is probably fair to say that ‘biomedical’ knowledge holds pride of place. Curricula are often jam-packed with biomedical information that the graduating professional is expected to have at their fingertips when they leave the academic institution.

However, there has been a murmuring from the wings in health professions education circles suggesting that, perhaps, this focus on biomedical knowledge is not enough, considering global health concerns and the absence of health equity that has led to huge disparities in terms of access to meaningful health care.

There can be no doubt that health care across the world needs to become more responsive, and more attuned to the lived realities of the patient. In our recent paper, ‘What knowledge matters in health professions education?’ published in Teaching in Higher Education we, therefore, argue that health professions graduates need to be more than just competent clinicians.

They also need to be critically conscious of the social contexts within which they will work, and such awareness should manifest in how they practise within inequitable health care systems.

Not only knowing ‘what’, but also ‘how’ and ‘why’

Our argument is well-aligned with calls emanating from elsewhere across the globe. Students need to be guided into, not only knowing the ‘what’ of healthcare, but also the ‘how’ and ‘why’, which should be informed by principles that seek to enhance health care for all.

It is then up to the teacher – both clinician educator and biomedical scientist – to teach not only the ‘what’ of healthcare, but also the ‘how’ and ‘why’.

Teaching, however, is seldom neutral and is informed, not only by disciplinary knowledge, but also by teachers’ positions and world views. In our study, we explored the views of 34 health professions educators at a South African university, to discern what knowledge they believed mattered for their teaching and for their students.

There were differing views about what knowledge mattered in the development of future healthcare professionals. While all participants agreed that future healthcare professionals needed biomedical knowledge and clinical competence, as well as knowing how to be socially responsive and critically conscious, they differed about which of these knowledge domains mattered more.

While most of our participants agreed that modern-day healthcare professionals need ‘something more’ than just biomedical knowledge, the extent of that agreement could be mapped on a continuum that privileged biomedical knowledge above all: ‘We’re hard-core knowledge in our module. This is pathology, this is what a sick liver looks like, this is what causes stroke.’

This dominant view of what knowledge matters was closely followed by a view that valued the need for the skilled practical application of that knowledge: ‘If you take it purely as the doctor who heals, the clinician, just the clinician part of a doctor is already overwhelming. I know that we must prepare the doctor for the other roles as well, but it should not impede or take away from the clinician.’

The view that valued the sort of attributes, awareness and behaviours that could foster a more socially just healthcare system, were evident, but significantly less so: ‘We consciously create an awareness that students can act as change agents for patients … that they can, both at that micro level, but also at higher levels, effect change and bring an improvement to patient care.’

The findings show that, while some participants were consciously developing their students as change agents, others felt that this was an unfair expectation, claiming that: ‘You need the politicians and finance and engineers and other people to actually change the system.’

So, although all participants agreed that we needed both biomedical knowledge and social responsiveness in the development of future healthcare professionals, some (particularly the clinicians) felt that more emphasis needed to be placed on the biomedical knowledge and clinical competence: ‘… it’s already such a big feat … if you take it purely as the doctor who heals, the clinician. Just the clinician part of a doctor is already overwhelming. I know that we must prepare the doctor for the other roles as well, but it should not impede or take away from the clinician. From the primary function. So, the social determinants of health, fixing those social determinants, is not the general practitioner’s role.’

In contrast, other respondents saw the development of knowing how to be socially responsive and critically conscious as vitally important:

‘We should understand what are the needs of society, the health system, so then understand what does it need to do, to respond to the needs of society. The way that we train doctors should then be aligned with what is it that they need to do in that health system, in order to respond to the needs of society.’

Implications for training

Overall, it was the biomedical knowledge that mattered more; and the attributes, informing the being and becoming of a socially responsive healthcare practitioner, were less valued.

This has implications for how future healthcare practitioners are taught, and, by implication, for how they will practice.

So, the issue of what knowledge matters in health professions education is something the field of practice needs to consider. We argue that the development of both biomedical knowledge and social responsiveness in future healthcare practitioners are equally important.

If we are aiming to develop future healthcare professionals who are both clinically competent and socially responsive, then we need curricula that are designed to develop such graduates. We call for ongoing curriculum renewal that foregrounds debates about what knowledge matters in health professions education.

Professors Cecilia Jacobs and Susan van Schalkwyk are affiliated with the Centre for Health Professions Education in the faculty of medicine and health sciences at Stellenbosch University, South Africa. This article is based, in part, on their academic paper ‘What knowledge matters in health professions education?’ published in Teaching in Higher Education.