When we review and ultimately select articles for publication in Academic Medicine, we always hope that they will influence how we think about an important issue and perhaps improve our thinking in a useful and meaningful way. One of the ways that we gauge the value of our articles is by the number of citations each receives in the medical literature. So, I was very interested in the review by Azer (1) that identifies the top-cited articles on topics related to medical education published since 1979. Azer looked both at articles published in medical education journals and at medical education articles published in general or specialty journals. While I was gratified to see how often Academic Medicine was the home for these top-cited articles, I was a bit surprised to see how many of the articles were reviews, opinions, or concept papers that did not contain original research. Perhaps this indicates the importance of such articles that integrate research from many sources in a way that helps to answer questions of importance to our communities. For example, the most-cited article published in the medical education literature, by Albanese and Mitchell (2), was a comparison of the features of problem-based learning and traditional medical education strategies, using a literature review. Problem-based learning was also the topic of other top-cited articles in medical education journals. Also in the top ten most-cited articles were two articles on the nature of expertise in medicine, one by Schmidt et al (3) and the other by Ericsson (4), which discuss the literature on expertise from a variety of areas and apply them to medicine. A third topic represented in the top ten most-cited articles was clinical competence and assessment (see the conceptual articles by Harden and Gleeson (5) and by Miller (6)). Other well represented topics were professionalism, simulation, and communications.

What can we learn from Azer’s article? First of all, I believe that the list of top-cited articles suggests that medical education scholarship draws on knowledge developed in a variety of social science areas, such as psychology, sociology, and philosophy, as well as the basic sciences, and that articles that can bridge these areas of knowledge can significantly influence medical education scholarship. Second, the area of cognition, expertise, and decision making has been a fertile area for investigation as it can influence curriculum design related to how students gain the skills in diagnostic decision making that they need to move from a novice to an expert. Of note, among Academic Medicine‘s top-cited articles in 2014 were two on diagnostic decision making processes, one by Norman et al (7) and another by Croskerry et al (8). Based on the central role of cognition and decision making in medical education, I would expect this area to continue to be well represented among top-cited articles. Similarly, assessment of competence will likely maintain its prominent place among our top-cited articles, particularly as outcomes-based medical education gains steam. An area that I would expect to show continued growth is simulation in medical education because of the technological advances in simulation models and the need to ensure patient safety in training for procedural competence.

I believe that the article by Azer can be a useful starting point for anyone wishing to develop a broad familiarity with the most influential articles in medical education published in the past 35 years. It also provides an opportunity to identify those areas with high potential for future scholarship to address current gaps in knowledge. We should congratulate those authors who made these important contributions and encourage our future scholars to learn from their success.

 

References

1. Azer SA.The top-cited articles in medical education: A bibliometirc analysis. Acad Med.2015;90.
2. Albanese MA, Mitchell S. Problem-based learning: A review of literature on its outcomes and implementation issues. Acad Med. 1993;68:52-81.
3. Schmidt HG, Norman GR, Boshuizen HP. A cognitive perspective on medical expertise: Theory and implication. Acad Med. 1990;65:611-621.
4. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79:S70-S81.
5. Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Med Educ. 1979;13:41-54.
6. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65:S63-S67.
7. Norman G, Sherbino J, Dore K, et al. The etiology of diagnostic errors: A controlled trial of system 1 versus system 2 reasoning. Acad Med. 2014;89:277-284.
8. Croskerry P, Petrie DA, Reilly JB, Tait G. Deciding about fast and slow decisions. Acad Med. 2014;89:197-200.