Lawrence Stenhouse, a wonderful British educationalist, is my role model. He believed that teachers should be leaders in educational practice, development, and research. And that people like me, who have studied education, should be there as their supporters and servants, to enable them to become the ‘extended professionals’ that they should be, thinking critically and developing the quality of education that they want to develop.

Often, we want to rely on ‘experts’ to solve our problems, establish proper systems and implement reforms, advise us, and provide templates. But who is an expert? Everybody knows something and has some relevant experience, and everybody is capable of thinking. I have got a lot of experience doing my thing in medical education, observing, analyzing, and contributing. But there is a lot that I cannot do, and there is a lot that somebody who has no training in medical education can do. It is all about what you think, what you see as a problem, how you are going to solve it, and what you can bring with this solution. So, to gain expertise, you need to allow people to obtain experience and think.

I admire the MED project because it does not bring ready answers. I have worked with people who often want to push their ideas, especially some trendy things. The MED project does not do that. The project can see things that need help, identify a problem, and make a reasonable, effective, and relevant response to it. That takes an awful lot of expertise. Being empathetic, providing a range of possibilities, and getting those solutions into place in a collaborative way — that is what the project is doing and what the real expertise from my perspective is.

The key thing is that the project, running across a wide variety of important issues, works with people in a collaborative manner. So, in the end, it is not important to look at the things you have done but to look at the team you have got. I think the MED team has developmental and collaborative perspectives. And that is used to address real issues, and real problems, leaving people with greater expertise. The effect of that collaboration is that the project has made a real difference wherever it has been.

I have had a lot of students on our master’s course, who are from war-torn or unstable areas, such as Iraq, Afghanistan, Yemen, and Myanmar. I have noticed the determination of these people to continue. I've been amazed at our students whose hospitals were falling down around them, whose life was fundamentally unsafe as a doctor, and these people have continued. Students from Yemen whose hospital was destroyed still wanted to develop postgraduate training standards. And what strikes me the most is that they had strategic expectations. So, the answer is that wars go on, and they are awful. But people who are going through them, have a wider perspective. And whilst dealing with the conditions that they are in, they also deal with the strategic view of what is going to happen afterwards.

The one thing that I find worrying is that when countries start to rebuild, they might do this based on someone’s else conditions, on models from another country and culture, often from the US or UK, and often with no evidence. And this is the danger. It might seem that one could rebuild quickly by adopting models from other places or by joining other systems. But that is not going to be the case because, in the end, your strength comes from your context. Slow down, and design for you.

We have this, so-called, ‘new normal’ now, which is a technology-based thing, as lots of people turned hugely to e-learning. But I think this is controversial. People keep saying: ‘Oh, we will convert all our courses, they are going to be modern and IT-based. We will not have lectures anymore’. And that worries me because people have forgotten the strengths of what they had before, the strengths of having students together. To me, the pandemic should not have any effects on medical education at all. It was a thing that happened. People dealt with it brilliantly. The teachers turned their hands to technology, and it was impressive. But it is over. Go back to what you had before. And start to undertake a proper analysis, review, and identification of problems, rather than imagining that some solutions that were forced on you can now be applied to anything when they cannot. I hope people will go back and start thinking properly about how to develop, review and quality assure a curriculum, rather than imagining that IT is a great thing and the only one answer to anything, because it is not.

Not really. I think this is the sphere where medical education and politics meet. Medical education is always in every country subject to political influence or political interference. And if we are talking about regulations as the way forward, you can turn to standards, like the World Federation of Medical Education Standards the development of which I lead, and examples of other countries. I think that the way we do things in the UK is really good. The General Medical Council (GMC) is one of the best regulators in the world. It is integrated with medicine and medical schools a lot. It has well-written standards and guidance, is very open and transparent, and is well-organized. But just because I think that the GMC works well in the UK, I cannot say you could transpose it to any other country. You can come and look at what the GMC does, and how it works, and think about how to adapt that for your context.

Also, it is worth mentioning that medical education is a social science, maybe with a business layer now. So medical education is not something that you can deal with and plan for in the way in which you can plan healthcare services. There is no policy document that describes the setting up of medical education because what you need depends on your context and culture. I would say that the best thing you can do to improve medical education is to have a national healthcare service (NHS) and design your medical education to funnel people into that service. In the UK, medical education is planned from the beginning to the end. The numbers, the places, the postgraduate seats, everything is there to serve our NHS. And then you must stop medical migration. This can be done by improving the working conditions, and postgraduate training of medical professionals. Because as long as people will find better training and conditions anywhere, they will leave.

The European Union is a bureaucratic entity. There are some written documents. The basic one that is still in place is Directive 93/16/EEC as of 1993, which sets out conditions for medical education (https://www.legislation.gov.uk/eudr/1993/16/contents). This document says you should have adequate knowledge of sciences, clinical disciplines, a sufficient understanding of the structure, function, and behavior of healthy and sick people, and obtain suitable clinical experience to become a doctor. A complete period of medical training should comprise at least a six-year course or 5500 hours of study. The Bologna declaration, unfortunately, is completely unsuitable for medicine. So that is as specific as European Directives go. And they rightly leave countries to make their own decisions.

There was an effort to develop European standards, but it did not work out, as within the European Union individual countries still quite rightly maintain their own character and way of doing things. And that is absolutely as it should be. As there is no evidence to say that one way of doing things is better than another. There are no curricula, no directives, nothing that will tell you exactly what to do. The European way to do things is a way where you are free to do your own things. You need to feel that freedom to do what you want. To do things that suit your country, your resources, and your purposes within these broad conditions, which are set, for example, in Article 23 of Directive 93/16/EEC.

Also, there is the European Association for Quality Assurance in Higher Education (ENQA, http://www.ehea.info/page-enqa) which applies general, not specifically medical, European standards and guidelines (ESG issued in 2015). So, what you can do, is to get your regulatory body to become an ENQA member and if you do that, you have done everything that you should do to regulate medical education. Then you take your own approach to the curriculum.

A regulatory body sets the standards and inspects documentary evidence, makes site visits, and so on. They make recommendations that a university has to comply with. So, the highest, national, level is what your regulatory body does and the standards it sets, and the regulatory process which is in place. But then you come down to the local level, wondering how we can make sure that what is going on here is good. And there are lots of ways. But there are no templates and no best practices. Institutions need to consider how best to design their own quality assurance system. They have to design that for their own purposes and integrate it with the management of the school. It should be in the hands of teachers and students. The system should be something that helps to identify and solve problems, something that enables the school to gather records of progress, and of what is happening there. There are plenty of different ways to develop the system, as well as purposes you need to look at to assure quality. I would focus on what teachers need, but that is just my view.

I would look at the business model, the regulatory system, and medical migration and the reasons for it. I would look at the variability between medical schools. I would look at the politics and purposes of medical education, and who decides whether and how you can set up a medical school. I would ask those questions at the national level and look at the speed with which medical schools are set up. I would look at where they get their ideas from, and how well they respect their own culture and context.

No, here we are talking about the country. The country should know why it has medical schools, and what are the effects. Medical schools in a lot of countries are income generators, as they are in your country. Medical schools have a lot of foreign students, who pay money and go back to wherever they came from. And if you look nationally, you must see the perspective. You must look at the way the business of medical education is managed. Because in the end, it affects the quality of medical education itself.

Depends on the medical school. You can look at different things. Usually, when medical schools ask for external evaluation, they know the reason. I can give you an example of the review process I undertook recently. I took the new WFME standards (https://wfme.org/) and invited people who were experienced in each of these areas to join the review team. Then, knowing the purpose of the review, we visited that school, studied documentation, talked with more than 100 people, and got a lot of history. Being a team of three, we spent a week there. Then we spent a week discussing, asking, and looking at things that were done. Finally, we had a complete view from the management, the teachers, and the students, as well as the perspective of the hospitals around. We had this huge perspective within a framework of all the things that you would look at in a medical school: its aims, management, curriculum, assessment system, and quality assurance system. We found that the WFME standards were not all applicable. As a result, we wrote a detailed report with recommendations. So, you can use the framework of the latest WFME standards, and they will tell you what you need to take into account and what you need to look at and plan for. They enable you to find local answers to local questions. We are just completing the same type of principles-based standards for postgraduate training to guide you on what to think about and come to your own design decisions. Also, look at the General Medical Council standards. They are absolutely excellent.

If you want to go down the medical education route you must have basic technical skills: knowing the technical issues around assessment, how to manage curriculum, resources, people, and changes, how research works, and what you need to do for quality assurance. You need to do some kind of qualification degree to learn technical things. Or you can learn those things in another way. It depends on your own context whether or not people require a qualification. But you should acquire the knowledge base: theoretical as well as practical. There are many learning theories about all these new teaching methods nowadays, most of which are nonsense. You need to know what people are saying. But the most important thing is to develop the ability to critique and not to believe, or blindly adopt. You should remain sceptical and critical, asking for evidence.

Whenever you read about globalization, there should be a big question mark coming up in front of your eyes. Globalization in medical education is something you read about all the time. But often globalization means the imposing of Western ideas which, very often have no evidence base and no generalisability outside their own culture and context. I never saw any Western country take up ideas from India or Indonesia or China. So, when you know all that and have a sceptical attitude, you'll be a pretty good educational developer.

Being an educational psychologist means a special way you look at the world. The way that psychologists look at the world is informed by the theories they believe in and the values they have, and their ability to critique and argue. It enables you to look at the world and the way people behave in that world. It gives you an analytical framework. I like the social science dimension of it and the fact that as a psychologist, I have theories, knowledge, and frameworks. But I also know there is no truth. My entire profession is driven by critique, and reflection on the nature of society and how it affects individuals, practices, and policy.

And also, it is essential to empower teachers. I think teachers today are disempowered. And they are the center of any educational institution. I would stop medical education ‘experts’ from telling people what to do, and I would find out from the teachers what they want to do. So, if you are a manager, empower teachers in your university, and show respect and interest in their work. Use the medical education experts you might have in your institution to serve and support teachers. And always apply the social science skills of criticism. As a doctor you have come from a positivist, maybe a bit of post-positivist environment, where you believe in natural sciences or truth, you believe in research. And now you should become also a social scientist. And social scientists know that truth is socially constructed.

I'm too old to be inspired but I have some recommendations. If you think you know enough about medical education, you can read Seven Myths about Education by Daisy Christodoulou. It's an old book, but totally the best. The other book you may be interested in is What if Everything You Knew About Education Was Wrong? by David Didau. These two books are about being critical, which I mention often. And if you want to learn about medical education from the beginning, you could probably read a collection edited by Swanwick Understanding Medical Education.