Comment www.thelancet.com Vol 367 February 4, 2006 377 Around 30 American physician assistants are already working in the UK, in both primary and secondary care, enabling senior doctors in the community to con- centrate on patients with more complex needs and releasing junior doctors from routine tasks to facilitate training. 6,7 In addition to the increased service capacity and supporting flexibility in workforce planning, the benefits to patients include the provision of a broadly based professional who can contribute holistic patient- centred care in a range of settings. At a time when continuity of care is under strain with changes in working practice and training, the medical care prac- titioner will be a more permanent member of the medical team, providing continuity both for patients and senior doctors. Royal Colleges set the standards for training and clinical services, and therefore have a legitimate interest in the skill mix needed to deliver the highest quality of patients care. 8 Mary Armitage Royal College of Physicians, Regent’s Park, London NW1 4LE, UK mary.armitage@rcplondon.ac.uk I was co-chair of the Competence and Curriculum Framework Steering Group, for which I received no fees. 1 Department of Health. The curriculum framework for the surgical care practitioner: consultation document. London: Department of Health, 2005. 2 Department of Health. Anaesthetic practitioner curriculum framework. London: Department of Health, 2005. 3 Department of Health. The competence and curriculum framework for the medical care practitioner: consultation document. London: Department of Health, 2005. 4 Cawley JF, Hooker RS. Physician assistants: does the US experience have anything to offer other countries? J Health Serv Res Policy 2003; 8: 65–66. 5 General Medical Council. Good medical practice, 3rd edn. London: General Medical Council, 2001. 6 Stewart A, Catanzaro R. Can physician assistants be effective in the UK? Clin Med 2005; 5: 344–48. 7 Health Services Management Centre. Evaluation of US trained Physician Assistants working in the NHS in England. Birmingham: Birmingham University, 2005. 8 Royal College of Physicians. Skillmix and the hospital doctor: new roles for the healthcare workforce. Report of a working party. London: Royal College of Physicians, 2003. Recently, Darcy Reed and colleagues provided information about costs and funding for published medical education research. 1 Their paper highlights the lack of formal— external rather than institutional—funding for medical education research, and substantial underfunding because of underestimation of costs by researchers: “If authors cannot accurately estimate the costs of their studies after the fact, they will probably not be able to appropriately budget for proposed future studies.” 1 Reed and colleague might imply a new area of research, with inexperienced researchers on a steep learning curve. Medical education research, however, is not a new discipline. The Association for the Study of Medical Education was established in the UK in 1957, and the Research in Medical Education group of the Association of American Medical Colleges held its 44th annual conference in 2005. Although longstanding, medical education research still struggles for recognition. A debate is ongoing in the literature about whether universities should include medical education research in their submissions for the UK 2008 Research Assessment Exercise, a periodic national peer-review process done by the UK Higher Education Funding Councils “to provide a stimulus to the improvement of research quality overall”. 2 If institutions do not include it, there is the possibility of a “loss of morale among researchers and eventual problems with continued funding for medical education research posts and units”. 3 If they do decide to include it, which subpanel should judge the submissions? “Choosing placement within the education sub-panel, rather than the panel containing epidemiology, public health, public-health services research, and primary care, needs careful thought.” 4 Similar concerns exist in Australia about allocation of National Health and Medical Research Council funding. 4 There are many reasons for medical education research’s struggle for recognition. Internal factors include lack of rigour of medical education research. 5–7 There are claims that much medical education research is “not programmatic, in that individual studies do not inform each other”. 8 “We must build multicentre collaborations where research is informed by others’ work, and which will provide the critical mass of core research and higher degree students necessary for competitiveness.” 4 The autonomy of medical schools . . . is an impediment to the development and co-ordination of a national R&D programme for medical education.” 9 It is likely that medical education research will have to introduce new methods to show improved outcomes in Medical education research at the crossroads