Learning throughout a continuum, an innovative and feasible educational agenda!

In this new special medical education issue of Military Medicine, we find a wide array of interesting and timely research about challenging topics in medical education. One of the themes that immediately emerge is the interest, the exploratory effort, and the curiosity to further investigate clinical reasoning and its multifaceted aspects from a variety of dimensions such as preclerkship assessment, neuroimaging, and various educational methods. The research performed in such an area certainly contributes to the current literature but more importantly, paves the way to new thinking in learning and assessing clinical reasoning skills. We can appreciate the longitudinality of the research presented in this special issue. In a time where the Association of American Medical Colleges 1 and the Accreditation Council for Graduate Medical Education are stressing the importance of developing a true medical educational continuum, the series of articles in this edition that link the educational journey before, during, and after medical school contribute a great deal to show how building knowledge on pre-existing knowledge, stemming from a constructivist approach, 2 is a key educational, effective yet feasible paradigm. Exploring premedical school measures and their association with board certification is a clear effort by Durning et al to investigate in depth new aspects of such educational continuum. The variety of educational methods that span from the use of CIP by Capaldi et al to the multistep examination by Hemmer et al applied to clinical reasoning to the innovative use of concept maps in TBL by Knollmann-Ritschel provides a quick yet rich view of a research agenda aiming at the investigation of new collaborative, active learning tools to foster learners’ growth. The innovation and the breadth of learning strategies utilized and described in this issue are testimony to the continuous exploration of active and new learning strategies. One key issue I wonder about is whether some of the results or learning methods described in this issue can be generalizable to other schools. We are all aware that learning is contextual and that context plays a major role in all aspects of learning. Research about learning tools such as CIP, multistep examination, or concept maps, under the guidance of experienced educators, can certainly be implemented in other institutional environments. It might be argued that the organizational structure of Uniformed Services University of the Health Sciences (USU) may facilitate the follow-up and longitudinality of these studies related to career outcomes; however, other institutions can certainly work on developing a robust system to follow the educational path of their graduates, perform rigorous studies, and obtain long-term career outcomes. Such outcomes can then be compared across institutions and may assist the educational community to make important curricular decisions. Furthermore, the USU experience can serve as a motivation and as an example for many other educational institutions to systematically design and accomplish more studies aimed at career development and outcomes. Finally, the continuous pursuit of innovation in the use of learning methods in crucial areas of medical education, for example, clinical reasoning, coupled with assessment of long-term career outcomes, is a core and integral part of this issue and is a testimonial to the commitments of USU educational researchers and leadership to pursue the road less traveled while furthering true discovery and growth.