Demonstrating causality, bestowing honours, and contributing to the arms race: Threats to the sustainability of HPE research

As the field of health professions education (HPE) continues to evolve, it is necessary to occasionally pause and reflect on the potential effects and outcomes of our research practices. While future-casting does not guarantee that impending negative consequences will be evaded, the exercise can help us avoid pitfalls. In this paper, we reflect on two terms that have taken hold as powerful idols in HPE research that stand above questioning and apart from critique: patient outcomes and productivity. We argue that these terms, and the ways of thinking they uphold, threaten the sustainability of HPE research-one at the level of the community and one at the level of the scholar. First, we suggest that HPE research's history of endorsing a linear and causal association ethos has driven its quest to connect education to patient outcomes. To ensure the sustainability of HPE scholarship, we must deconstruct and disempower patient outcomes as one of HPE's god-terms, as the pinnacle goal of educational activities. To be sustained, HPE research needs to value all of its contributions equally. A second god-term is productivity; it impairs the sustainability of the careers of individual researchers. Problems of honorary authorship, research output expectations, and comparisons with other fields have constructed a space where only scholars with sufficient privilege can prevail. If productivity persists as a god-term, the field of HPE research could decay into a space where new scholars are silenced-not because they fail to make important contributions, but because access is restricted by existing research metrics. These are two of many god-terms threatening the sustainability of HPE research. By highlighting patient outcomes and productivity and by acknowledging our own participation in propagating them, we hope to encourage others to recognize how our collective choices threaten the sustainability of our field.