Emerging Areas of Educational Research in Health Professions

Prof KR Sethuraman. Sri Balaji Vidyapeeth,

Puducherry www.sbvu.ac.in

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20th Century

21st Century

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My objective is to share ideas on…• The characteristics of Educational Research • Current issues in Health-Professions Education

Research– The Asian Scenario in comparison to the Global

scene• Trends in Health-Professions Education

Research• The way forward & Challenges ahead

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Ways of Knowing• Five ways we can know something– Personal experience– Tradition– Experts and authorities– Logic• Inductive (Bottom-Up)• Deductive (top-down)

– The Scientific Method• Educational Research utilizes all these ways

to generate knowledge

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Purposes of Educational Research Four purposes are, to

• explore – generate ideas about educational phenomenon,

• describe – the characteristics of educational phenomenon,

• predict – forecast an educational phenomenon

• explain – to show why and how an educational phenomenon

operates

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Research Methods• Two general categories used in educational

research– Quantitative; – Qualitative

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Quantitative Methods

• Characteristics– Numerical data– Use of formally stated hypotheses and procedures– Use of controls to minimize the effects of confounders– Large numbers of participating subjects– An objective, detached researcher– Use of pencil and paper tests, questionnaires, etc.

Obj. 3.6 & 5.1

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Qualitative Methods

• Characteristics– There are no hypotheses guiding the researcher – Phenomena are studied in a natural context, and they are

viewed from the participants’ perspectives– There are only a few participants involved in the study– The researcher interacts extensively with the participants – Problems and methods tend to evolve over the course of

the study – Data analysis is interpretative in nature

Qualitative

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Qualitative Methods (eg.Learning in Rounds)

Obj. 3.9

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A mixed-mode research combines the complementary strengths of the qualitative & quantitative approaches

Purpose guides Approach

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Production for

Promotion!

Research for Whom? Peers or End-users? – a continuum

Production for Producers (PFP)

Researchers advocate for:• Knowledge Production aimed at

Peer Researchers• Autonomy of the Field; research

focus defined internally by researchers

• Research for Knowledge building

• Peer-review procedures for evaluation

• Exclusion of non-scientific criteria (“Silo mode”) -- Bourdieu P. in Soc Sci Inf. 1975;6:19–47.

Production for Users (PU Pole)

Researchers advocate for:• Knowledge Production for end-

users (non-Producers) • Opening the field to educator-

practitioners to define the research focus

• Research for problem solving or service improvement

• Participation of non-academics in evaluation process

• Inclusion of non-scientific criteria such as social relevance and societal values

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Research Outcomes: Knowledge – Utility

Donald Stokes in his book, Pasteur's Quadrant, 1997.

“me-too” or Junk

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The Recent Past:UNESCO on

Educational Research 26 Years Ago

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A Felt Need even then (1991) Five Issues prioritized: 1. Social, cultural & economic adjustments.2. Education & the environmental issues.3. Women/gender issues.4. Minority & marginal groups (equity of access).5. Ecology of educational research.

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Problems identified… • The position of educational research– Low priority in national agendas– Policies are seldom based on robust research

• The coordination of educational research– no definite research strategy; – vulnerable to conflicting demands from different agencies

• The development & maintenance of research capacity– Educators unable to conduct robust Educational research.

• The framework for the dissemination of educational research. – serious language barriers that hinder the international

exchange and mutual understanding

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Recommended Actions in 1991• Improve research quality• Improve institutional capacity for research• Facilitate dissemination and utilization of

research • Enhance the value of educational research;• Foster innovative research on problems of

education and development.• Set up an international commission to promote

collaborative researchStrengthening educational research in developing countries. Unesco - 1991

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Research in Medical Education:

The Current Scene

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Best Evidence Medical Education (BEME)

• “the nature of profession today demands that educators provide evidence of effectiveness and efficiency of their programs“

• BEME is an extension of the Evidence Based Medicine initiative to Medical Education

– Acad Med. 2004;79:925—930.

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Medical Education Research:High Fliers and Role Models

Samy A. Azer, The Top-Cited Articles in Medical Education: A Bibliometric Analysis. Academic Medicine, 2015; 90.8:1-15

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Top Authors 1988-2010

-- Adv in Health Sci Educ DOI 10.1007/s10459-011-9328-x

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Top Cited Authors (Role-models)1988-2010

-- Adv in Health Sci Educ DOI 10.1007/s10459-011-9328-x

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Top 4 Topics of Research 1988-2010

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Topics of Research, Rank 5 – 10

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Med Edu Research: Concerns• Not designing systematic research and,

therefore, missing out on the “big questions”• Piece meal studies: difficulty of aggregating

findings into generalisable themes • “Potpourri approach.” (Med Educ. 2002;36:1114–5)

• Weak Theoretical Basis: the theories we are too weak to be productive (Acad Med. 2002;77:1217–20)

Regehr G. Trends in Medical Education Research. Acad Med. 2004;79:939 –947

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Med Education – the Asian Scene• “Medical education in Asia is– colonial-biased, – subject-oriented, – teacher-centred, – discipline-based, – lecture-focused,– hospital-based traditions, & – Fails to ‘train medical students appropriately for

national health needs’.”Majumdar MAA, Issues and Priorities in Medical Education Research in Asia. Ann Acad Singapore 2004; 33:257-63.

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Med Edu Research – the Asian Scene• Papers published from Asia in Academic

Medicine (1%) and Medical Education (8%) are negligible.

• Efforts are needed – to bridge the information gap between the

developed and developing countries – to minimise "information poverty" in this

"resource-poor" region – to improve the quality of medical education and

healthcare services

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Med Edu Research in Asia: Law of Diminishing Non-returns !

i. Poor socio-economic condition - Lack of funds - Donor-funded projects: "commissioned research" ii. Conservatism and passive "Follow the Rest" mind iii. Lack of relevance - Medical training ignores community health needs - Research has different purposes, scopes and outcomes

Majumdar MAA, Issues and Priorities in Medical Education Research in Asia. Ann Acad Singapore 2004; 33:257-63.

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Med Edu Research in Asia:iv. Leadership crisis - No effort to undertake large-scale medical education

experiments - No "culturally relevant" policy and guidelines - Half-hearted commitments of regional & international

agencies- 'Brain drain' of academics due to poor working environment v. Faculty development - Low availability of training on qualitative research methodology - Educational research reaps no professional reward - Weak collaboration among departments and institutes

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Med Edu Research in Asia:vi. Information poverty - Lack of up-to-date books and journals - High subscription costs of journals - No regional medical education journal - Scanty publication: language barrier, editorial bias,

uncertainty about appropriate journal options - Poor Information Technology facilities and training - Information gap between developed and developing

countries vii. Unforeseeable research outcome - Impact on healthcare is difficult to assess as it needs long-

term studies

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Strengthen Research Capabilitiesi. Leadership and commitment - "culturally

appropriate" (Think Global – Act Local)ii. Relevance = - Community needs assessment;

setting of priorities for educational research iii. Establish an education research centre iv. Availability of financial resources v. Research methodology – capacity buildingvi. Access to information Majumdar MAA, Issues and Priorities in Medical Education Research in Asia. Ann Acad Singapore 2004; 33:257-63.

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Open access: Sad state of Indian repositories• 69 Indian repositories listed in the Directory of

Open Access Repositories (DOAR) • Only 12 added “at least one item during a

month” during July 2015 to June 2016. • 17 repositories did not add even a single item• 40 were “irregular” in adding items to the

repositories, http://www.thehindu.com/sci-tech/science/Open-access-The-sorry-state-of-Indian-repositories/article17108642.ece?homepage=true

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Challenges and Barriers to Medical Education Research

Barriers that prevent implementation of research in medical education. Journal of Advances in Medical Education, 2015; 1.1:10-21Barriers that prevent implementation of research in medical education. Journal of Advances in Medical Education, 2015; 1.1:10-21

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Lament From USA – Applies to India too !

• “Medical education has a history of reports by prestigious bodies calling for reforms.

• Yet the reform has been slow to come. • - there is still no consensus, national policy, or

unified body of research on health professions education and its relationship to areas such as practice-needs...”

Traxler HG. Proceedings of the BHPr–AAMC Conference, “Research in Medical Education: Policies for the Future.” Introduction. Acad Med. 1994;69:601–3.

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Intrinsic Difficulties in Educational Research

– Involves human beings and the complexities associated with them

– Difficulties generalizing from specific studies– Problems in imposing sufficient controls to

conduct research in educational settings– Complications when observing in educational

settings (Hawthorne Effect, biases, etc)– Indirect measurement of the variables being

studied

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Barriers to Education Research• Lack of protected time for educational project • Fragmentation – opportunities for education projects are sporadic

• Prioritisation: – service-teaching-research dilemma

• Motivation – limited recognition and support for education

research

Zibrowski et al, issues of fragmentation, prioritisation and motivation for education scholarship among medical faculty. Med Edu 2008: 42: 872–878

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1. Personal barriers

• Lack of knowledge of issues worthy of study• Lack of sufficient incentives to carry out

research priorities at the university.• Inadequate skills and knowledge of statistics

and research methodology.• There was No need to do research at the

university for career progression.

Barriers that prevent implementation of research in medical education. Journal of Advances in Medical Education, 2015; 1.1:10-21

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2. Organizational barriers• Lack of appropriate equipment and facilities.• The long process of research projects approval.• Demands of Clinical/Laboratory work-load.• Failure to allocate credits for research

activities.• Unwillingness of organizations to implement

the study results in a sustained manner.• Lack of monitoring and evaluation of the

impact by the Research wing

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3. Strategic and Policy Barriers

• Lack of the comprehensive and transparent planning.

• Lack of a comprehensive database.• Low budget allocations.• The absence of active core-groups to perform

parts of a large-scale research.• Constant changes in programs and research

projects.

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4. Educational Barriers

• Low research morale in the educational system.

• Lack of coordination and coherence of activities in the field.

• Insufficient communication and cooperation between teachers and students in research projects and dissertations.

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5. Financial Barriers

• Lack of adequate and equitable distribution of funds and resources.

• Inadequate funding of scientific-research work.

• The lack of research incentives .

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6. Cultural Barriers• Poor Research etiquette and lack of

motivation to work in teams.• The organizational culture ignores the

importance of research efforts and impact.• “Crab mentality” of pulling other researchers

down

Barriers that prevent implementation of research in medical education. Journal of Advances in Medical Education, 2015; 1.1:10-21

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Numbers

Game

Pressure to Publish

Quantity versus Quality Issues

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Major Driving Forces for HealthProfessions Education Research

• Requirements for Recognition/accreditation • Institutions making independent decisions

based on local needs and issues• Perceived need for scientifically directed

peer-reviewed research • Presently, the pressure from Councils to

publish for career advancement

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Proliferation of the Predatory Publishers

A current Scam in the making!

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Pressure to Publish

Peer-Review Fraud — Hacking the Scientific Publication ProcessCharlotte J. Haug, NEJM. DOI: 10.1056/NEJMp1512330In August 2015, the publisher Springer retracted 64 articles from 10 different subscription journals “after editorial checks spotted fake email addresses, and subsequent internal investigations uncovered fabricated peer review reports.”

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Why Researchers of Developing Nations Avoid International Journals

• English as a language barrier constitutes a huge problem.

• Incapability to select the right journal • Unfamiliar with the range of journals open to

them• A false perception of an editorial bias against

work submitted from the developing world.Oktay Tutarel, Geographical distribution of publications in the field of medical education. BMC Medical Education 2002, 2:3

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Research in Medical Education: Future Directions

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IRB* for Educational Research• The context and methodology of educational

research are far different from biomedical studies

• The former is closer to soft-sciences like pedagogy, sociology and psychology

• A common IRB for both may be dismissive of non-randomized qualitative studies by educationists Acad Med. 2016;91:229–232.

* Institutional Review Board

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Discipline Based Educational Research • to understand how students learn the concepts,

practices, and ways of thinking in a discipline; • to understand the nature and development of

expertise in a discipline; • to contribute to the knowledge base to guide the

translation of DBER findings to classroom practice; • to identify approaches to make education in

specific disciplines broad and inclusive.

To achieve these goals, DBER scholars need to conduct studies in basic and applied research.

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Emerging Disruptor, MOOC • MOOC (Massive Open Online Course) has a

great potential to reach the rural and remote areas in India

• Regulatory bodies have effectively curbed the Power of MOOC to reach out to Millions– M (in MOOC) stands for “Miniscule”?!

• Operations Research is urgently needed to make use of MOOC to foster effective education using the 70:20:10 framework

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Does 70/20/10 Model Suit 21st Century Learning? Where are Indian Studies to Validate and

operationalize this Model ?

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Emerging area: CBME – Competency Based Medical Education

• The most promising area of study in Health Professions education in 21st Century lies in the assessment of individual competence

• Larger systematic studies to monitor CBME to support meaningful changes in Health Professions education.

• Clinical Medical Education (2014) Vol. 1, No. 1: 6-11

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Emerging Area: Simulation as an Effective Training Tool

• Many features contribute to its effectiveness:– feedback, – cognitive interactivity, – repetitive practice, and – exposure to range of difficulty in procedural tasks

• Research on the effects of simulation training on patient-related outcomes is just beginning– With immersive simulation (Virtual reality) this is a

field full of opportunities

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Emerging area: Use of Social Media • This represents a major paradigm shift in education.• Positive view: Web 2.0 fosters student learning,

i.e., engagement, encouragement of autonomy, reflection, and group learning as a “connected community”.

• Critical view: ‘Google retrieval is not learning’ and stress the need to promote critical thinking and literacy skills in today’s students.

• Piotrowski C. Emerging research on social media use in education: a study of 29 dissertations. Research in Higher Education Journal, 2015; 27:1-15

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The ‘Digital Generation’ has added Basements to Miller’s Pyramid!

“Got it in my Pen-Drive”

“Can Google”KRS

We need to study the effects of such beliefs on the outcomes

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Planning a Comprehensive Health Professions Education Research

in 7 Clusters

A Quick Scan…

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I. Contextual Issues :(Looking Back to the Future)

• Academic “Silos” and Their Impact on Medical Education

• Socio-Cultural Issues in Clinical Teaching• The Effect of Technology on Medical Education• Medical Sociology – Bioethics and Medical

Education• The History of Medical Education

Acad Emerg Med. 2012;19(12):1336–1343.

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II. Cognition & Educational Theory

• The Nature and Nurture of Medical Expertise• Transfer of Learning• Clinical Reasoning and Decision-Making• Motivation and Deliberate Learning• Self Assessment and Confidence • Principles of Adult Learning

Acad Emerg Med. 2012;19(12):1336–1343.

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III. Assessment of Individuals

• Selection of Medical Students and Residents• Individual Competency Assessment• Workplace-based Assessment• Simulation-Based High-Stakes Assessment• Assessment of Non-Cognitive Skills• Assessment of Teacher Effectiveness

Acad Emerg Med. 2012;19(12):1336–1343.

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IV. Teaching & Learning• Enhancing Effective Teaching in a Clinical Setting• Communication Skills• Designing a Curriculum for Continuity of Care

Training• Community-Oriented Medical Education• Residents as Teachers• The Hidden Curriculum• Simulation in Medical Education

Acad Emerg Med. 2012;19(12):1336–1343.

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V. Curriculum Development & Evaluation

• Approaches to Curriculum Development and Design

• Curriculum Mapping• Curriculum Evaluation• Effective Strategies to align Intended, Enacted,

Learnt and Assessed Curricular Outcomes

Acad Emerg Med. 2012;19(12):1336–1343.

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VI. Leadership & Career Development

• Organizational Change Management • Educational Scholarship in the Medical School• Educational Leadership Opportunities• Effective Mentorship• Personal and Professional Growth• Socialization into the Profession• Professional Identity Formation• Communication Skills

Acad Emerg Med. 2012;19(12):1336–1343.

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VII. Methodology and Research Principles

• Quality of Research in Medical Education• Best Evidence in Medical Education• The Influence of Social and Political Factors on

Funding in Medical Education Research• Best Practices for Mixed Methods Research

• Ref: Acad Emerg Med. 2012;19:1336–43.

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Recent Research in Medical Education (FAIMER Projects- 2012-'13; n=28)

1. Contextual issues (4)2. Cognition and educational theory (0)3. Assessment of individuals (5)4. Teaching and learning (9)5. Curriculum development and evaluation (6)6. Leadership and career development (4)7. Methodology and research principles (0)

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Fostering Education Research: Roles and Responsibilities

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Agency for Educational Research: Six pearls for effectiveness…

o Recruit Educationists with Leadership and Managerial skills to run the agency

o Create mechanisms to guide research agenda, grant funds and goad progress

o Insulate the Agency from Political interferenceo Adequately fund the agencyo Develop research agenda that covers short~, Medium~

and Long-term issues of importance to medical education

o Invest in research infrastructureScientific research in Education – at https://www.nap.edu/read/10236/chapter/1

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Roles for HPE Institutions…• Articulate and enable development of

research competencies in students• Ensure that student-researchers develop in-

depth knowledge and skills to undertake research

• Provide these students with variety of self-determined and meaningful research experiences

https://www.nap.edu/catalog/11112/advancing-scientific-research-in-education

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Roles for Professionals & Publishers

• Develop explicit standards for data sharing• Require authors of journal articles to make

data available to other researchers • Create infrastructure to facilitate data sharing

and knowledge accumulation • Develop manuscript review systems that

support professional development

https://www.nap.edu/catalog/11112/advancing-scientific-research-in-education

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To Sum Up…• There seems to be an absence of community

effort to build on our understanding of Medical Education in Global & Local contexts

• We need a community where data and ideas are – not merely described, but listened to, – not merely dismissed or ignored but addressed,

incorporated, and improved upon – by other members of the community of

educationist-researchers

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“Medical Education Is the Ugly Duckling” Challenges to Medical Educators’ Identity*

• a change in professional identity is needed

• for medical education, • medical education

research,• the practice of

medicine, and• patient care.

* Acad Med. 2014;89:1474–1480.

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Together We Can…

THANK YOU!

• We need to form an effective network to cooperate, coordinate and collaborate to create a robust evidence-informed education that results in quality healthcare delivery in the 21st Century.

• Let us forge ahead in earnest …