Medical Education Research Research Articles

The Hazards of Using ChatGPT: A Call to Action for Medical Education Researchers.

The Hazards of Using ChatGPT: A Call to Action for Medical Education Researchers.

Barriers and Solutions to Successful Problem-Based Learning Delivery in Developing Countries - A Literature Review.

Problem-based learning (PBL) was introduced in the 1960s as an alternative to traditional teacher-centered and discipline-based preclinical medical education. A literature review was conducted to explore the barriers and solutions to successful PBL uptake and delivery in developing countries. The review involved the search of articles and scientific studies on PubMed, The Lancet, and Scielo. The review focused on the medical education literature, using as a primary search criterion "problem-based learning" in combination with "developing countries" and "education". The search was limited to articles in Spanish and English published between 2011 and November 2021, except for three articles due to their relevance to the subject. Faculty development programs are the cornerstone when implementing a new methodology in developing countries. Early career development, PBL methodology, and the available assessment options should be the primary learning objectives of these programs. Stakeholders will need to plan using available resources following the experience of other countries and institutions encouraging collaborative development. Evaluation and assessment will be crucial to understand the impact of PBL, and considerations should be taken to implement an integrated curriculum. Medical Education Research should be encouraged, appraised, and disseminated to improve evidence-based decision-making, creating a constant development cycle. PBL is innovative and represents many unanswered questions that will develop in the following decade as more schools implement new methodologies and Research on PBL.

We Need to Do Better: A Scoping Review of Wellness Programs In Surgery Residency

Burnout, depression, and fatigue are common among surgical residents. Most published wellness studies in surgery only focus on a cross-sectional view of attitudes and perceptions around wellness in training. While much of this literature calls for interventions and presents strategies for improving resident well-being, there is a paucity of published wellness initiatives, and even fewer with programmatic evaluation. A scoping review was designed to address: (1) What wellness initiatives are used in surgery residency programs? (2) Which wellness domains do these programs address? and (3) How are program outcomes evaluated? A formal literature search was conducted using PubMed, Embase, and Scopus databases to identify English-language studies conducted in the United States that described wellness-focused initiatives for surgery residents. Two authors independently screened all abstracts and full texts for inclusion. Data were extracted including wellness domain(s) and outcomes evaluation methods with associated Kirkpatrick level(s) (1-reaction, 2-learning, 3-behavior, 4-results). Study quality was examined using the medical education research study quality index (MERSQI) score. A total of 2237 abstracts were screened with 115 full texts reviewed for eligibility. Fifty-one studies were included in the final analysis, representing 39 distinct wellness programs. The most common domains of wellness addressed were emotional (19/39, 48.7%), occupational (17/39, 43.6%), and physical (16/39, 41.0%). Of the 51 studies reviewed, 8 (15.7%) did not conduct any program evaluation, 27 (52.9%) evaluated level 1, 30 (58.8%) evaluated level 2, 3 (5.9%) evaluated level 3, and none evaluated level 4 outcomes. The mean MERSQI score was 9.16 (SD 1.8). Wellness is an established problem in surgical training. This review reveals a small number of published wellness interventions and even fewer that incorporate programmatic evaluation at the level of behavior and results change. Effective change will require rigorous and deliberate programming that addresses multiple domains and evaluation levels.

Assessing clinical competence: a multitrait-multimethod matrix construct validity study.

Education in Doctor of Medicine programs has moved towards an emphasis on clinical competency, with entrustable professional activities providing a framework of learning objectives and outcomes to be assessed within the clinical environment. While the identification and structured definition of objectives and outcomes have evolved, many methods employed to assess clerkship students' clinical skills remain relatively unchanged. There is a paucity of medical education research applying advanced statistical design and analytic techniques to investigate the validity of clinical skills assessment. One robust statistical method, multitrait-multimethod matrix analysis, can be applied to investigate construct validity across multiple assessment instruments and settings. Four traits were operationalized to represent the construct of critical clinical skills (professionalism, data gathering, data synthesis, and data delivery). The traits were assessed using three methods (direct observations by faculty coaches, clinical workplace-based evaluations, and objective structured clinical examination type clinical practice examinations). The four traits and three methods were intercorrelated for the multitrait-multimethod matrix analysis. The results indicated reliability values in the adequate to good range across the three methods with the majority of the validity coefficients demonstrating statistical significance. The clearest evidence for convergent and divergent validity was with the professionalism trait. The correlations on the same method/different traits analyses indicated substantial method effect; particularly on clinical workplace-based assessments. The multitrait-multimethod matrix approach, currently underutilized in medical education, could be employed to explore validity evidence of complex constructs such as clinical skills. These results can inform faculty development programs to improve the reliability and validity of assessments within the clinical environment.

Engaging Premedical Students in Medical Education Research: Benefits of Clinical Skills Observation Studies.

Observations requiring evaluation and critical thinking can be powerful learning experiences. Video-recorded standardized patient encounters are underused resources for evaluation and research. The authors engaged premedical students in medical education research reviewing standardized patient encounters. This study aims to explore participant perceptions of the research experience and how they gained clinical skills. This mixed-method study was completed between 2019 and 2022. Premedical participants coded medical students' clinical skills in video-recorded standardized patient encounters. Each participant also completed their own new patient history in a standardized patient encounter at both the beginning and end of their research project. Participants then completed an end-of-program debrief to discuss their experiences coding the clinical skills encounters. The authors coded communication skills implemented in the pre/postencounters and completed a thematic analysis of the debrief transcripts. All 21 participants demonstrated significant clinical skills gain after their research project, which included spending more time with the patient (pre-M=5 minutes, post-M=19 minutes, t=13.2, P<.001) and asking more questions (pre-M=13, post-M=40, t=9.3, P<.001). Prior clinical experience did not influence pre- or postoutcomes, but the number of videos coded was associated with asking more questions in the postencounter. Participants described learning actively and reflected that their clinical skills research project gave them greater insight into patient-care aspects of medical school and how medical students learn. These data demonstrate that observational studies in which premedical students evaluate standardized patient encounters gave the students context to medical education while enabling them to develop and transfer their own clinical skills. Studies observing standardized patient encounters provide rich insight into clinical skills development, and this work generates both research outcomes and actionable program evaluation data for medical educators. Purposefully engaging premedical students in such experiential learning opportunities benefits the students and helps cultivate early medical education pathways for these learners.

"A Look Under the Hood": Reflections on the Inaugural RIME Mentorship Program.

In 2021, Research in Medical Education (RIME) celebrated 60 years of advancing scholarship in health professions education (HPE). At that time, the nation's educational institutions faced a public reckoning on the long-standing pandemic of racism that sweltered in their practices and policies, laid bare by COVID-19 and the Black Lives Matters movement. RIME responded with a mentorship program for minoritized early career HPE faculty, which aims to amplify their voices in settings where their experiences and contributions are frequently dampened. The program fosters professional development through structured activities, participation as RIME committee interns, and formal mentorship channels to support career growth and offer experiences with scholarly publishing. This commentary was written by the first cohort of RIME mentees who are HPE scholars from various professions and diverse backgrounds with struggles traversing professional landscapes as immigrants and as individuals with minoritized identities and hopes for belonging in medical and educational institutions. In this commentary, the mentees describe the merits of the RIME mentorship program and what it meant to them and their unique marginalities. They also examine opportunities for improvements within the program to further reduce barriers faced by minoritized early career HPE faculty who often face limited support with scholarly activities.

Picking Up Where the Authors Left Off: Reading Research in Medical Education.

Picking Up Where the Authors Left Off: Reading Research in Medical Education.

Mentoring & support practices for final year medical students during a pandemic – ‘The covid doctors’

BackgroundTransition from final-year medical student to newly graduated doctor is challenging with evidence of associated increased patient mortality and medical errors. Previous work suggests tackling preparedness alone does not ‘solve’ this transition. The current focus on mentoring and support provision during this period and is an under-researched area. The COVID-19 pandemic represents a unique disruptive critical incident in which to examine mentoring and support practices, exposing strengths and weaknesses. The perspectives of this cohort and their implications remains an under-researched area.MethodsIndividual semi-structured interviews were conducted with nine graduate-entry final-year medical students. An inductive latent phenomenological approach explored individual experiences of mentoring and support practices during final-year and transition to professional practice.ResultsThree major themes emerged: 1) Mentoring & Support; 2) Clinical Exposure; 3) Graduation & Transition. A journey metaphor was used to aid the description of participants’ lived experience of mentoring and support practices during their final year. Final year medical students (FYMs) felt under-supported and found practices inadequate. Reduced clinical exposure yielded unpreparedness and regression, potentially impacting future careers. Positive experiences were variable and unstructured. ‘The COVID Doctors’, subtheme provided rich insights into shared narratives and identities amongst participants.ConclusionsThis study provides qualitative evidence for perceived inadequate mentoring and support provision for final year medical students at transition during a critical incident (the COVID-19 pandemic). Several themes using the metaphor of a journey explore the lived experience of this unique cohort determining their perceptions on the delivery of their medical education and their identity as ‘covid doctors’. There are several implications for this study in a post-pandemic era and for pandemic-preparedness, both rapidly growing areas of research in medical education. Recommendations include updating contingency plans, balancing clinical exposure with patient safety issues, and providing support to ‘bottom-up’ mentoring practices.

Qualitative content analysis of the highly cited articles in medical education: Trends and characteristics associated with citation of published studies in medical education research

Purpose To explore and describe the highly cited articles’ themes of research in medical education and to provide an insight into and reflection on which the elites of medical education society invested their energies from 2009 to 2018. Methods An in-depth content analysis as a research technique for the objective, systematic, and quantitative description of the manifest content of communication was used to quantitatively assess subject interests, methods, and other characteristics associated with citation of published studies in medical education research. Meaning units were compacted and coded with labels and categories in two phases. Results Among a variety of topics, methods, and strategies, 764 codes, 24 descriptive themes, and seven categories were extracted from the content analysis as the most prominent. Categories of medical education research were: modern technologies updating in medical education; learner performance improvement; sociological aspects of medical education; clinical reasoning; research methodology concerns of medical education; instructional design educational models; and professional aspects of medical education. Conclusions Commitment to continuous revision of educational emphasis and concerns on technological, sociological, and methodological concerns were the most repeated components of the highly cited articles that were ascertained through increased structure course designs and instructional strategies of the flipped classrooms to realize clinical reasoning and performance improvement. Practice points It becomes increasingly urgent to understand how various educational processes and technology-enhanced innovations affect each other and do or could influence learning outcomes, clinical reasoning, and performance improvement. Modern technologies as techniques to administer the changing educational and social environment, can supply and support the infrastructure and basis for operating many of the challenges in preparing the medical education community for the future. Research in the medical education context in the future should be focused on the inter-relationships of prominent and marginalized educational themes and categories.

Educator's blueprint: A primer on consensus methods in medical education research.

Consensus methods such as the Delphi and nominal group techniques are increasingly utilized within medical education research. This educator's blueprint paper provides practical strategies regarding five key steps for ensuring best practices when using consensus methods. These strategies include deciding which consensus method is best, developing the initial questionnaire, identifying the participants, determining the number of rounds and consensus threshold, and describing and justifying any modifications. These strategies will help guide education researchers on their next study using consensus methods.

Examining the nexus between medical education and complexity: a systematic review to inform practice and research

BackgroundMedical education is a multifarious endeavour integrating a range of pedagogies and philosophies. Complexity as a science or theory (‘complexity’) signals a move away from a reductionist paradigm to one which appreciates that interactions in multi-component systems, such as healthcare systems, can result in adaptive and emergent outcomes. This examination of the nexus between medical education and complexity theory aims to discover ways that complexity theory can inform medical education and medical education research.MethodsA structured literature review was conducted to examine the nexus between medical education and complexity; 5 databases were searched using relevant terms. Papers were included if they engaged fully with complexity as a science or theory and were significantly focused on medical education. All types of papers were included, including conceptual papers (e.g. opinion and theoretical discussions), case studies, program evaluations and empirical research. A narrative and thematic synthesis was undertaken to create a deep understanding of the use of complexity in medical education.ResultsEighty-three papers were included; the majority were conceptual papers. The context and theoretical underpinnings of complexity as a relevant theory for medical education were identified. Bibliographic and temporal observations were noted regarding the entry of complexity into medical education. Complexity was relied upon as a theoretical framework for empirical studies covering a variety of elements within medical education including: knowledge and learning theories; curricular, program and faculty development; program evaluation and medical education research; assessment and admissions; professionalism and leadership; and learning for systems, about systems and in systems.DiscussionThere is a call for greater use of theory by medical educators. Complexity within medical education is established, although not widespread. Individualistic cultures of medicine and comfort with reductionist epistemologies challenges its introduction. However, complexity was found to be a useful theory across a range of areas by a limited number of authors and is increasingly used by medical educators and medical education researchers. This review has further conceptualized how complexity is being used to support medical education and medical education research.ConclusionThis literature review can assist in understanding how complexity can be useful in medical educationalists' practice.

Inter-institutional data-driven education research: consensus values, principles, and recommendations to guide the ethical sharing of administrative education data in the Canadian medical education research context.

Administrative data are generated when educating, licensing, and regulating future physicians but these data are rarely used beyond their pre-specified purposes. The capacity necessary for sensitive and responsive oversight that supports the sharing of administrative medical education data across institutions for research purposes needs to be developed. A pan-Canadian consensus-building project was undertaken to develop agreement on the goals, benefits, risks, values, and principles that should underpin inter-institutional data-driven medical education research in Canada. A survey of key literature, consultations with various stakeholders and five successive knowledge synthesis workshops informed this project. Propositions were developed, driving subsequent discussions until collective agreement was distilled. Consensus coalesced around six key principles: establishing clear purposes, rationale, and methodology for inter-institutional data-driven research a priori; informed consent from data generators in education systems is non-negotiable; multi-institutional data sharing requires special governance; data governance should be guided by data sovereignty; data use should be guided by an identified set of shared values; and best practices in research data-management should be applied. We recommend establishing a representative governance body, engaging trusted data facility, and adherence to extant data management policies when sharing administrative medical education data for research purposes in Canada.

Defining the Culture of Surgery.

Surgical culture is often referenced but not well defined. Recent research and changing policies in graduate medical education have influenced the training paradigm and expectations of surgical trainees. It is unclear how these changes impact surgeons' understanding of surgical culture today and how those views impact surgical training. We sought to understand surgical culture and its impact on training from the perspective of a diverse group of surgeons with varied amounts of experience. A series of semi-structured, qualitative interviews were conducted with 21 surgeons and trainees in a single academic institution. Interviews were transcribed, coded, and analyzed using directed content analysis. We identified 7 major themes that impact surgical culture. Cohorts were separated by those who had been promoted to at least associate professor (late-career surgeons) and assistant professors, fellows, residents, and students (early-career surgeons). Both cohorts similarly emphasized patient-centered care, hierarchy, high standards, and meaningful work. Late- and early-career surgeons highlighted themes differently: late-career surgeons' perceptions were informed by experience and focused on challenges, complications, humility, and work ethic, while perceptions of early-career surgeons were more individually focused and referenced being goal-oriented and self-sacrificing, and focus on education and work-life balance. Late- and early-career surgeons both emphasize that patient-centered care is core to surgical culture. Early-career surgeons expressed more themes related to personal well-being, while late-career surgeons emphasized themes related to professional accomplishment. Differences in the perceived culture can lead to strained interactions between generations of surgeons and trainees, and a better understanding of these differences would lead to improved communication and interactions between these groups, as well as better management of expectations for surgeons in their training and career.

Peer-Led Versus Conventional Teacher-Led Methodological Research Education Sessions: An Initiative to Improve Medical Education Research Teaching

IntroductionTo enhance doctors’ engagement with research, the National Medical Research Association (NMRA) developed a research teaching series, delivering peer-led (PL) sessions by medical students and conventional teacher-led (CL) sessions by licenced physicians/lecturers. We assessed the effectiveness of the series and compared the PL and CL approaches.MethodsThe teaching sessions were delivered virtually via Zoom weekly either PL or CL. Feedback was provided by participants on completion of every session using a 10-point Likert scale assessing their knowledge pre- and post-training.ResultsA total of 87 participants were included generating 782 feedback forms, 367 (47.1%) for PL and 412 for CL sessions. The median knowledge scores significantly increased following each session (p-value < 0.05) independent of teaching approach. An overall improvement in the median knowledge score from all sessions from 5/10 to 8/10 was reported. There was no significant difference between knowledge gained from the CL or PL teaching.ConclusionDidactic PL research training sessions are equally effective as CL sessions.

Ethical Principles for Medical Student Recruitment in Education Research in Pakistan: A Systematic Review

Objective: With the increasing publication in medical education research in Pakistan, this systematic review aims to identify both addressed and un-addressed ethical issues for student recruitment in medical education research.Methodology: After key search terms finalisation selection criteria were defined for the systematic review. The finalised keywords were put in data bases of Pub-Med, Pakmedinet, and ERIC, revealing a total of 12084 articles. Google Scholar was used as grey literature search leading to 2509 articles. 10056 out of 10087 were removed upon initial screening. A total of 31 met the eligibility criteria according to PRISMA guidelines, out of which 23 were excluded leaving a final count of 8 articles to be included in the study.Results: The ethical issues identified in the selected studies were, Distributive Justice, Autonomy, Rights to withdraw, Coercion into Study, Confidentiality, Informed Consent, Equity in participant selection, Awareness of research participation. Four out of eight studies failed to openly declare the rights of the students to participate voluntarily, while five out of eight studies failed to declare students having rights to withdraw. Three out of eight studies lacked distributive justice of educational content among different groups whereas two studies lacked methodological rigor on participant selection.Conclusion: During the recruitment of students for research, researchers need to be aware of ethical issues and devise a strategy to address them. These issues should be thoroughly addressed before Institutional Review Boards approve data collection. Institutes promoting such research can train and educate researchers by practicing ethical research protocols.

Translation, adaptation, and validation of the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale for use in Japan

BackgroundAmbiguity is inherent to the medical field; hence, assessing and educating medical trainees regarding ambiguity tolerance is essential. The Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale—a novel instrument that assesses ambiguity tolerance in clinical settings—has been widely used for medical education research in Western countries. However, a version of this scale applicable to the intricate clinical contexts of Japan has not yet been developed. In this study, we developed the Japanese version of the TAMSAD (J-TAMSAD) scale and tested its psychometric properties.MethodsIn this multicenter study, we collected data through a cross-sectional survey in two universities (medical students) and ten hospitals (residents) across Japan, and evaluated the structural validity, criterion-related validity, and internal consistency reliability of the J-TAMSAD scale.ResultsWe analyzed the data of 247 participants. The sample was randomly divided in half, with exploratory factor analysis (EFA) performed on one half and confirmatory factor analysis (CFA) on the other. EFA led to an 18-item J-TAMSAD scale comprising five factors. CFA showed acceptable fit for this five-factor model (comparative fit index = 0.900, root mean square error of approximation = 0.050, standardized root mean square residual = 0.069, goodness of fit index = 0.987). There was a positive correlation between the J-TAMSAD scale scores and total reverse scores on the Japanese version of the Short Intolerance of Uncertainty Scale (Pearson correlation coefficient 0.41). The internal consistency was found to be satisfactory (Cronbach’s alpha 0.70).ConclusionsThe J-TAMSAD scale was developed, and its psychometric properties were confirmed. The instrument can be useful for assessing tolerance of ambiguity among medical trainees in Japan. With further validation, it could be used to verify the educational effectiveness of curricula that foster ambiguity tolerance in medical trainees, or even in research assessing the relationship with other variables.

Faster, higher, stronger – together? A bibliometric analysis of author distribution in top medical education journals

IntroductionMedical education and medical education research are growing industries that have become increasingly globalised. Recognition of the colonial foundations of medical education has led to a growing focus on issues...

Interventions to support medical trainee well-being when dealing with patient death: a scoping review protocol

IntroductionExisting literature demonstrates that medical students and residents experience complex emotions and substantial grief after patient deaths. Over time, this can lead to burnout and depression and adversely impact patient...

Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review

There is a growing need for interventions to improve well-being in healthcare workers, particularly since the onset of COVID-19.ObjectivesTo synthesise evidence since 2015 on the impact of interventions designed to...

NATIONAL MEDICAL COMMISSION REGULATION 2020: IS THIS BOON OR EXECRATION FOR MEDICAL INSTITUTIONS IN INDIA?

Indian Medical Council Act, 1956 with section 61(2) of the National Medical Council Act, 2019 published notification as, Requirements for Annual M.B.B.S. Admissions Regulations, 2020 dated 20th October 2020, which replaced to replaces the Minimum Standard Requirements for Medical Colleges, 1999 of the erstwhile Medical Council of India (MCI). The objectives of the notification were to harness modern educational technology tools to facilitate quality education and healthcare. It was pictured that competency-based medical education to be taught by medical degree holders and non-medical degree holders are less competent. Whereas research and publications part in medical education is completely ignored that is the sole of medical innovations. The reduction in basic sciences non-medical qualified teachers will hamper basic research and its translation to medical research. Authors searched relevant literature from online PubMed, Scopes, Elsevier, Google Scholar database. In conclusion, a proportionate number of basic sciences and integration with clinical subject faculties will eliminate the scarcity of high impact medical publications.