Addressing deficiencies in American healthcare education: A call for informed instructional design

IN A DRIVE toward improved quality and safety in medicine, educators have emphasized the importance of lifelong learning and improved pedagogical models to effective continuing education. Scholarly understanding of disciplinary knowledge and expert thought has progressed rapidly in the past 40 years. Lessons from adult learning theory can and should be systematically applied to the design of effective, learner- centered, collaborative, and conceptually driven continuing education for physicians and surgeons. One example of this pedagogical approach is Integrated Medical Learning (IML), an instructional theory that is based on dynamic interaction between each element of the learning process, is learner centered, incorporates self-assessment, uses various formats and media to facilitate learning, and seeks to apply scientific method to educational process development. This article discusses advances in learning, instructional theory, and practice relevant to medical continuing education and outlines the conceptual basis for IML. The first iteration of IML, which took place in part at the General Scientific Sessions of the 2007 Annual Meeting of the Congress of Neurological Surgeons, will be described elsewhere. In addition to advancing goals related to educational effectiveness, IML produces novel and otherwise not easily obtainable data about current clinical knowledge, attitudes, and actual practice patterns that are relevant to clinical equipoise, study design, and medical evidence.