Book Review

Achieving Excellence in Medical Education

N Engl J Med 2006; 355:2381-2382November 30, 2006

Article

Achieving Excellence in Medical Education
By Richard B. Gunderman. 179 pp. London, Springer, 2006. $129. ISBN: 1-84628-296-9

In this unusual book, there are discussions of a very broad range of issues in medical education — from learning theory to educational technology, and from diversity in medicine to the economic challenges of academic practice and the relationships between medical schools and teaching hospitals. Such an attempt by a single author to be comprehensive often veers off into personal, sometimes idiosyncratic perspectives, but in this case I was pleasantly surprised. This book not only succeeds in what I doubted a single author could accomplish — the book is, in fact, a useful and balanced overview of the state of medical education — but also is exactly what the author promises in his preface: a book about “the pursuit of excellence in medical education, construed above all in ethical terms.” The discussion of specific issues and challenges is all in the service of an overall emphasis on what makes a great educator, a great resident, or a great educational institution.

Gunderman is an accomplished educator, well known as a thoughtful and provocative teacher at the University of Chicago and now at Indiana University. His work on educational matters has been published extensively in the radiology literature, but until now he has not been a central voice in debates within the broader medical education community. He enters this arena as the “everyman” among our faculties.

Achieving Excellence in Medical Education consists of a series of essays concerning basic educational theory, the characteristics of excellent educators, and the organizational features that promote excellence. Within this basic structural coherence, there is a good bit of heterogeneity. There are essays within essays, with the chapters divided by subsections related to the overall chapter topic but not necessarily to one another. The result is a smorgasbord of reflections on specific problems in medical education, joined by the overarching theme of the path to excellence. A slim book, it can be approached as a whole or enjoyed piece by piece. Either way, the theme is coherent — and unmistakable.

Chapter 5, “Educational Excellence,” can serve to illustrate the structure. In its first pages, Gunderman brings some of his prior writing into play with a discussion of the “tyranny of correctness” in our learning environments. This is an interesting take on the distinctions between the dominant information-intensive culture of medical knowledge and the sort of learning environment that might lead more quickly and reliably to the wisdom in practice that others, such as Kathryn Montgomery, have called phronesis. Later pages describe the essence of mentorship when everyone is both teacher and learner. The final portion of the chapter, under the heading “Developing Educators,” is a commonsensical analysis of the importance and potential impact of faculty development in education, well worth a read by those who still doubt the need for it.

Buried within chapter 6, “Educational Technique,” is another brief essay under the heading “Residency and Technical School.” Here Gunderman argues that although residents have spent many years at the top of “the food chain of higher learning,” during their residency they find themselves in an environment more akin to that of a technical school. I found this analogy a bit overdrawn — to imagine medical school faculty simultaneously working with medical students as professional students and residents as technical students is to imagine a wider gulf in the continuum than actually exists — but the author makes his point, as has Jordan Cohen, about the need to “put the E back into GME.”

The final chapter is about educational leadership. This book does speak most directly to those who hold or aspire to institutional leadership positions. Junior faculty seeking inspiration and new ideas for their work as teachers would probably find a more useful, approachable guide in a handbook such as the second edition of A Practical Guide for Medical Teachers (Philadelphia: Churchill Livingstone, 2005) by John Dent and Ronald Harden. I recommend Gunderman's book to department chairs, clerkship and residency program directors, and education professionals who are shaping the future of medical education. His “fondest hope,” as expressed in the preface, “is that these essays will serve as useful points of departure for lively discussion and innovation among dedicated learners and educators.” I do hope the Journal readership will take up this book and use it as Gunderman wishes.

Raymond H. Curry, M.D.
Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
rcurry@northwestern.edu