a review of methods of developing resilience in ... protocol 2015... · 3 research aims a review of...
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A Review of Methods of Developing Resilience in Undergraduate, Postgraduate and
Continuing Medical Education
BEME PROTOCOL 2015
Lead Reviewer
Dr Vimmi Passi
Warwick Medical School
Director, Masters in Medical Education
Tel: 0771-385-2078.
Mrs Samantha Johnson
Warwick Medical School
Academic Medical Librarian
Lead Academic Medical Librarian
Professor Neil Johnson
Dean
Faculty of Health and Medicine
Lancaster University
Additional Author
To be confirmed
Warwick Medical School
Coventry
CV4 5AL
www.warwick.ac.uk
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BACKGROUND
Resilience is emerging as an important phenomenon in medical education.1 The importance
of developing resilience in the wellbeing of students has been reported worldwide.1-2
Tempski et al emphasised that resilience is an important construct which should be explored
in more detail in medical education practice and research.2
There are many descriptions of resilience within the psychological and sociological
literature.3-6 One review highlighted that it can be constructed as ‘a trajectory, a continuum, a
system, a trait, a process, a cycle and a qualitative category.3’ Resilience has also been
described as an emotional competence and can be considered as behaviour to be acquired
during training.4 Resilience consists of cognitive processes that encompass at least four
dimensions: self-efficacy; planning; self-control; commitment and perseverance.5 As there is
no consensus definition of resilience, but in medical education we are focusing on resilience
as a trait that can be acquired and so the definition chosen to be used for this review is that of
‘ resilience as an emotional competence and can be considered as a behaviour to be acquired
during training.4’
Developing resilience is particularly important in medicine because of the demanding
workloads, societal expectations and political issues.7 The relationship between developing
resilience and student wellbeing has been illustrated in the literature.8-10 Also, there have been
studies illustrating the need to develop resilience to avoid physician burnout.11-14 Measures
of resilience are reported in the literature and are noted to be effective predictors of how good
adults are at using positive emotions to prevent adverse impacts of stressful events.15-16
An initial scoping study has been conducted and the search strategies are illustrated in
Appendix 1. The initial search identified 1857 relevant titles. A review of the abstracts
identified 110 potential papers on resilience and these references are provided in Appendix 2.
This scoping study has revealed that there is a broad range of different methods of developing
resilience including firstly, methods at a personal level such as mindfulness therapy;
secondly, faculty development initiatives and thirdly, teaching methods/ models incorporated
within the medical curriculum. There is currently no systematic review that has synthesised
all the different methods of developing resilience across the continuum of medical education.
Therefore, it is anticipated that this review will be of importance to medical educators
worldwide in developing methods to enhance resilience within their own institutions.
In summary, although there is a growing body of literature on the importance of resilience,
there has been no systematic review of the methods and strategies to develop resilience across
the continuum of medical education. Therefore, the aim of this review is to synthesise the
evidence of methods available to develop resilience in undergraduate, postgraduate and
continuing medical education.
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Research Aims
A review of the methods of developing resilience in undergraduate, postgraduate and
continuing medical education.
Research Objectives
The objectives for this review are as follows: -
1. Identifying methods of developing resilience
2. Synthesise the evidence on the different methods of developing resilience.
3. Develop recommendations for developing resilience in medical education.
4. Develop recommendations for future research in developing resilience.
SEARCH STRATEGY
The databases to be searched include: Medline; PsychInfo; Education Research Complete,
Web of Science and Embase. The literature search will be conducted from 2005 -2015, as the
scoping study revealed that most the literature in medical education is from the last ten years.
The medical subject headings (MeSH) and keywords to be used are resilience, resilient,
medical education (includes undergraduate, postgraduate and continuing medical
education); medical students; medical school; physicians and doctors.
STUDY SELECTION CRITERIA
The focus of the review is on developing resilience in undergraduate, postgraduate and
continuing medical education. All primary research studies will be included. Descriptive
studies without evaluative methodology will be excluded. Only English Language studies
will be included in the review. The search strategy will exclude resilience studies in other
healthcare professionals. Hand searching of the journals, Medical Teacher, Academic
Medicine and Medical Education will be undertaken.
INITIAL APPRAISAL OF LITERATURE SEARCH
Two authors (VP, SJ) will use the exclusion/ inclusion to assess all electronic citations
generated by the search and decide on the basis of the title and abstract, whether the citation
is relevant to the topic. Clearly irrelevant items will be identified and eliminated, before the
full text articles for all potentially relevant citations will be obtained. A second stage will
involve the lead reviewer excluding any full text articles which did not meet the inclusion
criteria. To ensure that all key studies were included, the reference lists of the final review
studies identified through the primary search will be searched by two reviewers for any
additional references. All references identified through searching will be entered into an
Endnote Online Version 3.12 and duplicate references will be removed, first automatically
and then manually.
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QUALITY ASSESSMENT OF STUDIES
The methodological quality of each included study will be assessed using the tool validated
by the BEME Review on Education Portfolios.17 This tool will be included within our data
extraction sheet. This tool includes eleven quality indicators relating to the appropriateness of
the study design, results, analysis and conclusions. Higher quality studies are considered to be
those which meet a minimum of eight of these quality indicators, medium quality studies
were those that meet six or seven criteria, and low scoring papers are those meeting five or
fewer of the criteria. The data extraction sheet to be used is shown in Appendix 3.
DATA EXTRACTION
An initial pilot of the devised data extraction sheet will be conducted by two authors (VP, SJ)
each reviewing the same paper. The two authors (VP, SJ) will then independently extract the
data from all full text articles selected and the extracted information will be systematically
collated onto the data extraction forms. Discrepancies in the total scores will be resolved by
discussion and consensus between the two authors.
DATA SYNTHESIS
A thematic analysis will be conducted on methods and strategies of developing resilience
across the continuum of medical education. No statistical integration of data findings will be
possible due to the predominantly descriptive nature of the results. The findings will be
integrated into a narrative structure and a table will illustrate the main emergent themes.
POTENTIAL IMPACT OF THE REVIEW
The aim of this review is to synthesise the evidence currently available on methods of
developing resilience across the continuum of medical education. The review will synthesise
the evidence for the importance of developing and maintaining resilience in medical
education. This review will summarise the evidence of the teaching methods and strategies
for developing resilience at an institutional and individual level.
The impact of the review will be to inform educational practice with regard to the
development of resilience in undergraduate, postgraduate and continuing medical education.
By synthesising the evidence on methods of developing resilience, this review will consider
innovative methods to developing resilience. Based on the evidence synthesised in this
review, recommendations for best practice in developing resilience in 21st century medical
education will be described. Finally, this systematic review will also highlight areas for future
educational research on developing and maintaining resilience. It is anticipated that this
review will be of importance to medical educators worldwide.
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PROJECT TIMETABLE
Systematic Literature Search : November 2015 – December 2015
Full papers reviewed and completion of coding : January 2016 – March 2016
Synthesis of findings : April 2016
Writing of full review : May 2016 – July 2016
Submission of full review : July 2016
CONFLICT OF INTEREST
The review group members declare no conflict of interests in conducting this study.
PLANS FOR UPDATING REVIEW
The systematic review will be updated annually after completion so to include any new
emerging evidence on the development of resilience in medical education.
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APPENDICES
Appendix 1 : Scoping Study – Search Strategies and Initial Summary
Appendix 2 : Scoping Study – List of Papers
Appendix 3 : Data Extraction Sheet
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Scoping Study - Search Summary Results
Initial search results De-duplicated results
Medline 606 468
Embase 670 345
Web of Science 739 371
PsycInfo 641 439
Education Research Complete 379 234
TOTAL 3035 1857
Medline search strategy:
Appendix 1: Scoping Study – Search Strategies and Initial Summary
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Embase search strategy:
Web of Science search strategy: (resilien*) AND TOPIC: ("medical student*" or "medical school*" or "medical education" or physician or doctor* or
resident or residency)
PsycInfo Search Strategy:
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Education Research Complete Search Strategy:
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Appendix 2: Scoping Study – List of Papers
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students. Medical Education. 2010;44(10):1016-1026.
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16
Appendix 3: Data Extraction Sheet
Section 1: Administrative
Reviewer
Authors
Title
Year
University, Country
Section 2: Summary of Papers according to Quality Indicators (details below).
Quality Indicator Score= 0 or 1
Summary
1. Research Question
2. Study Subjects
3. Data Collection Methods
4. Completeness of Data
5. Control of Confounding
6. Analysis of Results
7. Conclusions
8. Reproducibility
9. Prospective
10. Ethical Issues
11. Triangulation
Total Score = / 11
Section 3: Detail of Method of Developing Resilience
…………………………………………………………………………………………………
………………………………………………………………………………………………...
Section 4: Any other comments regarding the article
…………………………………………………………………………………………………
…………………………………………………………………………………………………
17
BEME Scoring taken from BEME Review on E-Portfolios17
Quality indicators for all studies. Quality indicators against which all studies were assessed are given, together with
clarification of
meaning in each case.
Quality assessment of studies
To assess the quality of included studies, a series of 11 quality ‘indicators’ was developed.
These related to the appropriateness of the study design, conduct, results analysis and
conclusions. Higher quality studies were considered to be those which met a minimum of 8 of
these 11 indicators.
Quality Indicator Detail
1. Research question : Is the research question(s) or hypothesis clearly stated?
2. Study subjects : Is the subject group appropriate for the study being carried out (number, characteristics, selection, and homogeneity)?
3. ‘Data’ collection methods : Are the methods used (qualitative or quantitative) reliable and valid for the research question and context?
4. Completeness of ‘data’: Have subjects dropped out? Is the attrition rate less than 50%? For questionnaire based studies, is the response rate acceptable (60% or above)?
5. Control for confounding: Have multiple factors/variables been removed or accounted for
where possible?
6. Analysis of results: Are the statistical or other methods of results analysis used appropriate?
7. Conclusions: Is it clear that the data justify the conclusions drawn?
8. Reproducibility: Could the study be repeated by other researchers?
9. Prospective: Does the study look forwards in time (prospective) rather than backwards
(retrospective)?
10. Ethical issues: Were all relevant ethical issues addressed?
11. Triangulation : Were results supported by data from more than one so