Health Professions Education Research Research Articles

Discussion Paper: Improving the participation of students in health professional education research

Health professional education (HPE) has grown as a field of research, with an increasing number of publications since the 1990s. Interprofessional education is a specific area of growth with ongoing debate in the literature, at least in part due to the challenges that exist in implementation, and further research is needed to inform ongoing practice. Participant recruitment is a major challenge, and poor participation rates lead to bias and a failure to demonstrate outcomes. There is a lack of information about why students decline to participate in research to inform and improve education. Motivation for volunteerism in other contexts and recruitment of human participants in other types of research are examined as a way to understand the likely motivations of student participants. Disincentives to participate include time commitment, survey fatigue and a poor understanding of the value of HPE research and the processes involved. The ethical considerations for teacher-researchers add another layer of complexity to recruitment. A multifaceted approach, involving all stakeholders and targeting known influences, is needed to improve recruitment in health professional education research, and clear communication of the research rationale and its potential impact on curriculum design is essential. Explicit communication and adequate information to allow informed student choice are also required, while improved literacy in HPE research may provide students with a better basis for decision making when considering participation. In addition, partnership and student co-design could be a mechanism for more meaningful engagement.

The Distinctions Between Theory, Theoretical Framework, and Conceptual Framework.

Health professions education (HPE) researchers are regularly asked to articulate their use of theory, theoretical frameworks, and conceptual frameworks in their research. However, all too often, these words are used interchangeably or without a clear understanding of the differences between these concepts. Further problematizing this situation is the fact that theory, theoretical framework, and conceptual framework are terms that are used in different ways in different research approaches. In this article, the authors set out to clarify the meaning of these terms and to describe how they are used in 2 approaches to research commonly used in HPE: the objectivist deductive approach (from theory to data) and the subjectivist inductive approach (from data to theory). In addition to this, given that within subjectivist inductive research theory, theoretical framework, and conceptual framework can be used in different ways, they describe 3 uses that HPE researchers frequently rely on: fully inductive theory development, fully theory-informed inductive, and theory-informing inductive data analysis.

Foreword: The Moment of Discovery: How Do You Know When You Hit a Question That's Pure Gold?

Foreword: The Moment of Discovery: How Do You Know When You Hit a Question That's Pure Gold?

Focal Length Fluidity: Research Questions in Medical Education Research and Scholarship

Research and scholarship in health professions education has been shaped by intended audience (i.e., producers vs users) and the purpose of research questions (i.e., curiosity driven or service oriented), but these archetypal dichotomies do not represent the breadth of scholarship in the field. Akin to an array of lenses required by scientists to capture images of a black hole, the authors propose the analogy of lenses with different focal lengths to consider how different kinds of research questions can offer insight into health professions research-a microscope, a magnifying glass, binoculars, and telescopes allow us to ask and answer different kinds of research questions. They argue for the relevance of all of the different kinds of research questions (or focal lengths); each provides important insight into a particular phenomenon and contributes to understanding that phenomenon in a different way. The authors propose that research questions can move fluidly across focal lengths. For example, a theoretical question can be made more pragmatic through asking "how" questions ("How can we observe and measure a phenomenon?"), whereas a pragmatic question can be made more theoretic by asking a series of "why" questions ("Why are these findings relevant to larger issues?"). In summary, only through the combination of lenses with different focal lengths, brought to bear through interdisciplinary work, can we fully comprehend important phenomena in health professions education and scholarship-the same way scientists managed to image a black hole.

Strategic Planning in Health Professions Education: Scholarship or Management?

Strategic planning, in its various forms, is an evaluation practice that is ubiquitous in academic medicine. However, published reports of strategic planning at academic health centers usually ignore theory. In a 2017 strategic planning exercise at the Wilson Centre, a scholarly model evolved using a theoretical framework and a research approach rather than a conventional management model, which typically identifies outcomes and how to achieve them. After completing this exercise, the authors considered the larger questions of the assumptions underpinning different models of strategic planning and strategic planning's value to academic medicine. To elaborate on these questions, the authors examine relevant literature and set out the Wilson Centre's emergent scholarly model. They describe the main features of the scholarly model, including ways it differs from a management approach and from the typical approach to strategic planning in the authors' experience and in the field of health professions education research. The authors also share lessons learned as a means to encourage consideration by other academic organizations.

Ethics approval for health professions education research: are we going too far down the barrel?

Ethics review is important, but can be overly onerous for it purpose. The authors propose that adoption of a utilitarian view, aligning purpose and goal, can enable a leaner process.

Problematizing assumptions about interdisciplinary research: implications for health professions education research

This article critically examines three assumptions underlying recent efforts to advance interdisciplinary research—defined in this article as communication and collaboration between researchers across academic disciplines (e.g. Sociology, Psychology, Biology)—and examines these assumptions’ implications for health professions education research (HPER). These assumptions are: (1) disciplines are silos that inhibit the free flowing of knowledge across fields and stifle innovative thinking; (2) interdisciplinary research generates a better understanding of the world as it brings together researchers from various fields of expertise capable of tackling complex problems; and (3) interdisciplinary research reduces fragmentation across groups of researchers by eliminating boundaries. These assumptions are among the new beliefs shaping the contemporary academic arena; they orient academics’ and university administrators’ decisions toward expanding interdisciplinary research and training, but without solid empirical evidence. This article argues that the field of HPER has largely adopted the premises of interdisciplinary research but has not yet debated the potential effects of organizing around these premises. The authors hope to inspire members of the HPER community to critically examine the ubiquitous discourse promoting interdisciplinarity, and engage in reflection about the future of the field informed by evidence rather than by unsubstantiated assumptions. For example: Should research centres and graduate programs in HPER encourage the development of interdisciplinary or disciplinary-trained researchers? Should training predominantly focus on methods and methodologies or draw more on disciplinary-based knowledge? What is the best route toward increasing the field’s profile within academia and attracting the best students and researchers to engage in HPER? These are questions that merit attention at the current juncture as the future of the HPER field relies on decisions made in the present time.

Cost evaluations in health professions education: a systematic review of methods and reporting quality.

High-quality research into education costs can inform better decision making. Improvements to cost research can be guided by information about the research questions, methods and reporting of studies evaluating costs in health professions education (HPE). Our objective was to appraise the overall state of the field and evaluate temporal trends in the methods and reporting quality of cost evaluations in HPE research. We searched the MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, Business Source Complete and ERIC (Education Resources Information Centre) databases on 31 July 2017. To evaluate trends over time, we sampled research reports at 5-year intervals (2001, 2006, 2011 and 2016). All original research studies in HPE that reported a cost outcome were included. The Medical Education Research Study Quality Instrument (MERSQI) and the BMJ economic checklist were used to appraise methodological and reporting quality, respectively. Trends in quality over time were analysed. A total of 78 studies were included, of which 16 were published in 2001, 15 in 2006, 20 in 2011 and 27 in 2016. The region most commonly represented was the USA (n=43). The profession most commonly referred to was that of the physician (n=46). The mean±standard deviation (SD) MERSQI score was 10.9±2.6 out of 18, with no significant change over time (p=0.55). The mean±SD BMJ score was 13.5±7.1 out of 35, with no significant change over time (p=0.39). A total of 49 (63%) studies stated a cost-related research question, 23 (29%) stated the type of cost evaluation used, and 31 (40%) described the method of estimating resource quantities and unit costs. A total of 16 studies compared two or more interventions and reported both cost and learning outcomes. The absolute number of cost evaluations in HPE is increasing. However, there are shortcomings in the quality of methodology and reporting, and these are not improving over time.

Situated learning theory in health professions education research: a scoping review.

At a time when cognitive and behavioral theories dominated the landscape of learning theories, Lave and Wenger's situated learning theory (SLT) opened new territory by illuminating social and cultural learning processes. Many researchers and educators in the health professions embraced this theory, but few have considered how SLT has been used and what has been learned or improved through its use in health professions education (HPE). In this scoping review, the authors examine these questions and consider opportunities for future work with SLT in HPE. The authors followed Levac's modified scoping review framework. They conducted a search of CINAHL, ERIC, PubMed, Scopus, and Web of Science for articles referencing SLT or related concepts in HPE between 2006 and 2016. Two reviewers screened all titles and abstracts, then screened full text for inclusion based on substantive treatment of SLT. Two authors extracted, analyzed and synthesized data from the final set of 193 articles. The authors identified two patterns of theory use. One sought an understanding of social learning processes in a specific context. The other aimed to design and/or evaluate interventions associated with communities of practice. These patterns are similar to other literatures (e.g., general education, healthcare, and organizational development) and, according to Lave and Wenger, may reflect confusion about the purpose, stance, and terminology of SLT. The authors discuss their findings in relation to primary source literature and consider opportunities for HPE researchers to employ and contribute to SLT going forward.

"This Manuscript Was a Complete Waste of Time": Reviewer Etiquette Matters.

"This Manuscript Was a Complete Waste of Time": Reviewer Etiquette Matters.

Rich pictures: a companion method for qualitative research in medical education.

Within the social sciences, researchers increasingly build on visual methods to explore complex phenomena and understand how people experience and give meaning to this complexity. Amongst the variety of visual methods available, rich pictures are beginning to gain traction in health professions education (HPE) research. A rich picture is a pictorial representation of a particular situation, including what happened, who was involved, how people felt, how people acted, how people behaved, and what external pressures they acted upon. Rich pictures expand our perspective; they may highlight connections, illuminate the big picture and reveal unexpected emotions. Although new methods bring excitement to the field, it is our responsibility to also be cautious and insightful about their limitations. Rich pictures are a method in evolution in HPE research, with many unknowns about what is possible and what is optimal. In the current paper, we aim to map out the background, describe the process and share some reflective insights of using rich pictures as a data collection method.

Creating Educator Scholar Leaders—Curriculum Development of a New PhD Program in Anatomy Education

INTRODUCTIONAnatomy education is perhaps experiencing the best and the worst of times. It may be the best of times because so much hard work has been done by many anatomists over the past three decades to develop more effective and evidence‐based educational practices and technological tools to maximize student learning. The worst of times may be near as forces transform medical curricula and create a paucity of new anatomists as faculty retire and new schools are created/expanded.AIMUsing the arguments from both contexts, we sought to create a unique PhD program in Anatomy Education.METHODSApplying Kern's six step approach to curriculum development in medical education, we successfully merged the strengths and existing resources of two educational programs at LECOM to create a new PhD program in Anatomy Education.RESULTSThree critical components of this curricular endeavor include the educational preparation in transforming teaching and learning practices in anatomy; tight coherence and integration among anatomical and pedagogical knowledge, skills, and behaviors through clinical and educational supervision; and developing strategies for meeting challenges facing program approval at the institutional and accreditation levels. Several PhD students have marticulated and positively favor the new program.CONCLUSIONThis program has a strong commitment to producing a unique breed of new anatomists as education specialists who have the knowledge, skills and behaviors needed to lead health professions education development and research, thereby enhancing academic programs, improving health care outcomes, and strengthening the anatomical profession.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Factors associated with scientific misconduct and questionable research practices in health professions education.

IntroductionEngaging in scientific misconduct and questionable research practices (QRPs) is a noted problem across fields, including health professions education (HPE). To mitigate these practices, other disciplines have enacted strategies based on researcher characteristics and practice factors. Thus, to inform HPE, this study seeks to determine which researcher characteristics and practice factors, if any, might explain the frequency of irresponsible research practices.MethodIn 2017, a cross-sectional survey of HPE researchers was conducted. The survey included 66 items adapted from three published surveys: two published QRP surveys and a publication pressure scale. The outcome variable was a self-reported misconduct score, which is a weighted mean score for each respondent on all misconduct and QRP items. Statistical analysis included descriptive statistics, reliability and correlation analysis, and multiple linear regression modelling.Results and DiscussionIn total, 590 researchers completed the survey. Results from the final regression model indicated that researcher age had a negative association with the misconduct score (b = -0.01, β = -0.22, t = -2.91, p <0.05), suggesting that older researchers tended to report less misconduct. On the other hand, those with more publications had higher misconduct scores (b = 0.001, β = 0.17, t = 3.27, p < 0.05) and, compared with researchers in the region of North America, researchers in Asia tended to have higher misconduct scores (b = 0.21, β = 0.12, t = 2.84, p < 0.01). In addition, compared with those who defined their work role as clinician, those who defined their role as researcher tended to have higher misconduct scores (b = 0.12, β = 0.13, t = 2.15, p < 0.05). Finally, publication pressure emerged as the strongest individual predictor of misconduct (b = 0.20, β = 0.34, t = 7.82, p < 0.01); the greater the publication pressure, the greater the reported misconduct. Overall, the explanatory variables accounted for 21% of the variance in the misconduct score, with publication pressure accounting for 10% of the variance in the outcome, above and beyond the other explanatory variables. Although correlational, these findings suggest several researcher characteristics and practice factors that could be targeted to address scientific misconduct and QRPs in HPE.Electronic supplementary materialThe online version of this article (10.1007/s40037-019-0501-x) contains supplementary material, which is available to authorized users.

Why institutional ethnography? Why now? Institutional ethnography in health professions education.

This ‘A Qualitative Space’ article takes a critical look at Dorothy Smith’s approach to inquiry known as institutional ethnography and its potentiality in contemporary health professions education research. We delve into institutional ethnography’s philosophical underpinnings, setting out the ontological shift that the researcher needs to make within this critical feminist approach. We use examples of research into frontline healthcare, into the health work of patients and into education to allow the reader to consider what an institutional ethnography research project might offer. We lay out our vision for potential growth for institutional ethnography research within the health professions education field and explain why we see this as the opportune moment to adopt institutional ethnography to meet some of the challenges facing health professions education in a way that offers informed change.

Translating health professional education research evidence into effective continuous professional development.

Translating health professional education research evidence into effective continuous professional development.

Ethical Shades of Gray: International Frequency of Scientific Misconduct and Questionable Research Practices in Health Professions Education.

To maintain scientific integrity and engender public confidence, research must be conducted responsibly. Whereas deliberate scientific misconduct such as data fabrication is clearly unethical, other behaviors-often referred to as questionable research practices (QRPs)-exploit the ethical shades of gray that color acceptable practice. This study aimed to measure the frequency of self-reported misconduct and QRPs in a diverse, international sample of health professions education (HPE) researchers. In 2017, the authors conducted an anonymous, cross-sectional survey study. The web-based survey contained 43 items that asked respondents to rate how often they had engaged in a variety of irresponsible research behaviors. The items were adapted from previously published surveys. In total, 590 HPE researchers took the survey. The mean age was 46 years (SD = 11.6), and the majority of participants were from the United States (26.4%), Europe (23.2%), and Canada (15.3%). The three most frequently reported irresponsible research behaviors were adding authors who did not qualify for authorship (60.6%), citing articles that were not read (49.5%), and selectively citing papers to please editors or reviewers (49.4%). Additionally, respondents reported misrepresenting a participant's words (6.7%), plagiarizing (5.5%), inappropriately modifying results (5.3%), deleting data without disclosure (3.4%), and fabricating data (2.4%). Overall, 533 (90.3%) respondents reported at least one irresponsible behavior. Notwithstanding the methodological limitations of survey research, these findings indicate that a substantial proportion of HPE researchers report a range of misconduct and QRPs. Consequently, reforms may be needed to improve the conduct of HPE research.

Experiences of Health Professions Educators Utilizing Multiple Institutional Review Boards for Collaborative Research

This study describes the experiences and perspectives of health professions educators around institutional review board (IRB) review of multi-institutional education research. This survey study gathered quantitative and qualitative data from members of three of the four geographic regions of the AAMC Group on Educational Affairs (GEA) as well as a snowball sample from the fourth region, where access to the listserv was not possible. Quantitative data is described and qualitative comments were coded and themed. Ninety-six percent of the 151 respondents considered multi-institutional incredibly or somewhat valuable to their educational research goals. Sixty-two percent had submitted at least one project to multiple institutions for review. Of 57 respondents, 21 identified disagreements in the type of IRB review required (exempt, expedited, or full-board review). Disagreements between IRBs are also reported, including changes in wording or informed consent procedures. Of the 36 participants who noted disagreement between IRBs for any changes, only three participants believed that the process significantly improved the research subject protections. Most health professions education researchers across the USA and Canada appreciated the value and role of IRB review and expressed frustration in the face of review that seemingly did not result in meaningful improvements. Final changes to the federal Common Rule call for a single-IRB review in multi-institutional research, particularly for low-risk studies. This change on the horizon could not only mitigate current concerns but also bolster the proliferation of multi-institutional research studies in health professions education.

Examining grounded theory through the lens of rationalist epistemology

The objective of scientific, or more broadly, academic knowledge is to provide an understanding of the social and natural world that lies beyond common sense and everyday thinking. Academics use an array of techniques, methods and conceptual apparatuses to achieve this goal. The question we explore in this essay is the following: Does the grounded theory approach, in the constructivist version developed by Kathy Charmaz, provide the necessary methodological tools for the creation of knowledge and theories beyond everyday thinking? To conduct our analysis, we have drawn on the rationalist epistemology originally developed by Gaston Bachelard and taken up a few decades later by Pierre Bourdieu and colleagues to look at the epistemological foundation of the CGT methods as defined by Charmaz. We focussed on two distinctive epistemological features characterising constructivist grounded theory (CGT): the use of inductive reasoning to generate interpretative theory; and the primacy of subjectivity over objectivity as the preferred path to knowledge making. While the usefulness of CGT for conducting qualitative research and understanding the perspective of social actors has been acknowledged by scholars in health professions education research and other research areas, the inductivist logic on which it draws raises questions concerning the nature of the knowledge yielded by this approach. As we argue in this article, it is still unclear in what way the interpretative theory generated by CGT is not a duplication of everyday thinking expressed through meta-narratives. It is also unclear how the understanding of social phenomena can be refined if the use of inductive procedures logically implies the creation of a new theory each time a study is conducted. We engage with these questions to broaden the epistemological conversation within the health professions education research community. It is our hope that scholars in the field will engage in this epistemological conversation and advance it in new directions.

Advancing Health Professions Education Research by Creating a Network of Networks.

Producing the best evidence to show educational outcomes, such as competency achievement and credentialing effectiveness, across the health professions education continuum will require large multisite research projects and longitudinal studies. Current limitations that must be overcome to reach this goal include the prevalence of single-institution study designs, assessments of a single curricular component, and cross-sectional study designs that provide only a snapshot in time of a program or initiative rather than a longitudinal perspective.One solution to overcoming these limitations is to develop a network of networks that collaborates, using longitudinal approaches, across health professions and regions of the United States. Currently, individual networks are advancing educational innovation toward understanding the effectiveness of educational and credentialing programs. Examples of such networks include (1) the American Medical Association's Accelerating Change in Medical Education initiative, (2) the National Center for Interprofessional Practice and Education, and (3) the Accreditation Council for Graduate Medical Education's Accreditation System. In this Invited Commentary, the authors briefly profile these existing networks, identify their progress and the challenges they have encountered, and propose a vigorous way forward toward creating a national network of networks designed to determine the effectiveness of health professions education and credentialing.

How to… get started with theory in education.

This paper, on using theory in health professions education research, is the second in a series that aims to support novice researchers within clinical education, particularly those undertaking their first qualitative study. Diving into the world of education theory can be challenging and uncomfortable for clinician-educators. Nonetheless, theory is an essential ingredient in high-quality research, shaping everything from research questions to study design, analysis and, ultimately, the interpretation of findings. We hope that this paper, introducing different levels of theory and examples of how to use theory, will shed light on how theory can be used in research, and that it will help you in getting to grips with using theory in your own work. It will help you in getting to grips with using theory in your own work.