Virtual Issue for Researching Medical Education

Featured

Researching Medical Education – Virtual Issue

On November 19th, 2014, the Education Research Group of Association for the Study of Medical Education (ASME) will host the meeting entitled Researching Medical Education. The meeting is organized into six strands.

The table of contents of this Virtual Issue pulls together and hyperlinks to articles from both Medical Education and The Clinical Teacher. There are two articles related to each of the six strands of the meeting. The publisher, Wiley-Blackwell, has made these articles free for viewing, to facilitate the dialog around the meeting strands. You are encouraged to read the articles and post your comments to this blog post to engage in discussion with your fellow readers. Regardless of whether you can attend the meeting or not, you can discuss the articles and the meeting strands here.

Strand 1: How to write a research question

Making sense of work-based assessment: ask the right questions, in the right way, about the right things, of the right people

Lost in translation: why medical education research must embrace real-world complexities

Strand 2: Theory driven research – where do I begin

Educational impact of an assessment of medical students’ collaboration in health care teams

New consultants mastering the role of on-call supervisor: a longitudinal qualitative study

Strand 3: Using observation in research

Video-based cases disrupt deep critical thinking in problem-based learning

The construction of power in family medicine bedside teaching: a video observation study

Strand 4: Researching consequential transitions in healthcare

Describing clinical teachers’ characteristics and behaviours using critical incidents and repertory grids

Entering medical practice for the very first time: emotional talk, meaning and identity development

Strand 5: Symbolic interactionism

Group processes in medical education: learning from social identity theory

Virtual patient design: exploring what works and why. A grounded theory study

Strand 6: Researchers in Residence – embedding research expertise in the workplace

Encouraging new doctors to do medical education research

Teaching and learning in morbidity and mortality rounds: an ethnographic study

Shifts in the interpretation of health advocacy: a textual analysis

To read on journal website, click here.

By Maria Hubinette, Sarah Dobson, Angela Towle and Cynthia Whitehead

Context

Health advocacy is widely accepted as a key element of competency-based education. We examined shifts in the language and description of the role of the health advocate and what these reveal about its interpretation and enactment within the context of medical education.

Methods

We conducted a textual analysis of three key documents that provide sequential depictions of the role of the health advocate in medical education frameworks: Educating Future Physicians for Ontario (1993), CanMEDS 2000 and CanMEDS 2005. We used a series of questions to examine shifts in the emphasis, focus and application of the role between documents. Theoretically, we drew upon Carlisle’s conceptual framework to identify different approaches to advocacy.

Results

We identified three major shifts in the language associated with the role of health advocate across our textual documents. Firstly, activities and behaviours that were initially positioned as being the responsibility of the profession as a whole came to be described instead as competencies required of every physician. Secondly, the initial focus on health advocacy as representing collective action towards public policy and systems-level change was altered to a primary focus on individual patients and doctors. Thirdly, we observed a progression away from descriptions of concrete actions and behaviours.

Conclusions

This study uncovers shifts in the language of physician advocacy that affect the discourse of health advocacy and expectations placed on physicians and trainees. Being explicit about expectations of the medical profession and individual practitioners may require renewed examination of societal needs. Although this study uses the CanMEDS role of Health Advocate as a specific example, it has implications for the conceptualisation of health advocacy in medicine and medical education globally.

Discuss this article below by adding a comment.

DOI: 10.1111/medu.12584

Resident experiences of informal education: how often, from whom, about what and how

To read on journal website, click here.

By Lara Varpio, Erin Bidlake, Lynn Casimiro, Pippa Hall, Craig Kuziemsky, Susan Brajtman and Susan Humphrey-Murto

Context

The merits of informal learning have been widely reported and embraced by medical educators. However, research has yet to describe in detail the extent to which informal intraprofessional or informal interprofessional education is part of graduate medical education (GME), and the nature of those informal education experiences. This study seeks to describe: (i) who delivers informal education to residents; (ii) how often they do so; (iii) the content they share; and (iv) the teaching techniques they use.

Methods

This study describes instances of informal learning in GME captured through non-participant observations in two contexts: a palliative care hospice and a paediatric hospital. Analysis of 60 hours of observation data involved a process of collaborative team consensus to: (i) identify instances of informal intraprofessional and informal interprofessional education, and (ii) categorise these instances by CanMEDS Role and teaching technique.

Results

Findings indicate that 84.8% of GME-level informal education that takes place in these two settings is physician-led and 15.2% is nurse-led. Organised by CanMEDS Role, findings reveal that, although all Roles are addressed by both physicians and nurses, those most commonly addressed are Medical Expert (physicians: 35.7%; nurses: 27.5%) and Communicator (physicians: 22.3%; nurses: 25.0%). Organised by teaching technique, findings reveal that physicians and nurses favour similar techniques.

Conclusions

Although it is not surprising that informal interprofessional education plays a lesser role than informal intraprofessional education in GME, these findings suggest that the role of informal interprofessional education is worthy of support. Echoing the calls of others, we posit that medical education should recognise and capitalise on the contributions of informal learning, whether it occurs intra- or interprofessionally.

Discuss this article below by adding a comment.

DOI: 10.1111/medu.12549

 

Long-term culture change related to rapid response system implementation

To read on journal website, click here.

By Jennifer Stevens, Anna Johansson, Inga Lennes, Douglas Hsu, Anjala Tess and Michael Howell

Objectives

Increasing attention to patient safety in training hospitals may come at the expense of trainee autonomy and professional growth. This study sought to examine changes in medical trainees’ self-reported behaviour after the institution-wide implementation of a rapid response system.

Methods

We conducted a two-point cross-sectional survey of medical trainees in 2006, during the implementation of a rapid response system, and in 2010, in a single academic medical centre. A novel instrument was used to measure trainee likelihood of calling for supervisory assistance, perception of autonomy, and comfort in managing decompensating patients. Non-parametric tests to assess for change were used and year of training was evaluated as an effect modifier.

Results

Response rates were 38% in 2006 and 70% in 2010. After 5 years of the full implementation of the rapid response system, residents were significantly more likely to report calling their attending physicians for assistance (rising from 40% to 65% of relevant situations; p < 0.0001). Year of training was a significant effect modifier. Interns felt significantly more comfortable in managing acutely ill patients; juniors and seniors felt significantly less concerned about their autonomy at 5 years after the implementation of the rapid response system. These changes were mirrored in the actual use of the rapid response system, which increased by 41% during the 5-year period after adjustment for patient volume (p < 0.0001).

Conclusions

A primary team-focused implementation of a rapid response system was associated with durable changes in resident physicians’ reported behaviour, including increased comfort with involving more experienced physicians and managing unstable patients.

Discuss this article below by adding a comment.

DOI: 10.1111/medu.12538

Selection and study performance: comparing three admission processes within one medical school

To read on journal website, click here.

By Nienke R Schripsema, Anke M van Trigt, Jan C C Borleffs and Janke Cohen-Schotanus

Objectives

This study was conducted to: (i) analyse whether students admitted to one medical school based on top pre-university grades, a voluntary multifaceted selection process, or lottery, respectively, differed in study performance; (ii) examine whether students who were accepted in the multifaceted selection process outperformed their rejected peers, and (iii) analyse whether participation in the multifaceted selection procedure was related to performance.

Methods

We examined knowledge test and professionalism scores, study progress and dropout in three cohorts of medical students admitted to the University of Groningen, the Netherlands in 2009, 2010 and 2011 (n = 1055). We divided the lottery-admitted group into, respectively, students who had not participated and students who had been rejected in the multifaceted selection process. We used ancova modelling, logistic regression and Bonferroni post hoc multiple-comparison tests and controlled for gender and cohort.

Results

The top pre-university grade group achieved higher knowledge test scores and more Year 1 course credits than all other groups (p < 0.05). This group received the highest possible professionalism score more often than the lottery-admitted group that had not participated in the multifaceted selection process (p < 0.05). The group of students accepted in the multifaceted selection process obtained higher written test scores than the lottery-admitted group that had not participated (p < 0.05) and achieved the highest possible professionalism score more often than both lottery-admitted groups. The lottery-admitted group that had not participated in the multifaceted selection process earned fewer Year 1 and 2 course credits than all other groups (p < 0.05). Dropout rates differed among the groups (p < 0.05), but correction for multiple comparisons rendered all pairwise differences non-significant.

Conclusions

A top pre-university grade point average was the best predictor of performance. For so-called non-academic performance, the multifaceted selection process was efficient in identifying applicants with suitable skills. Participation in the multifaceted selection procedure seems to be predictive of higher performance. Further research is needed to assess whether our results are generalisable to other medical schools.

Discuss this article below by adding a comment.

DOI: 10.1111/medu.12537

Toward a common understanding: supporting and promoting education scholarship for medical school faculty

To read on journal website, click here.

by Elaine Van Melle, Jocelyn Lockyer, Vernon Curran, Susan Lieff, Christina St Onge and Mark Goldszmidt

Context

Education scholarship (ES) is integral to the transformation of medical education. Faculty members who engage in ES need encouragement and recognition of this work. Beginning with the definition of ES as ‘an umbrella term which can encompass both research and innovation in health professions education’, and which as such represents an activity that is separate and distinct from teaching and leadership, the purpose of our study was to explore how promotion policies and processes are used in Canadian medical schools to support and promote ES.

Methods

We conducted an analysis of the promotion policies of 17 Canadian medical schools and interviews with a key informant at each institution. We drew on an interpretive approach to policy analysis to analyse the data and to understand explicit messages about how ES was represented and supported.

Results

Of the 17 schools’ promotion documents, only nine contained specific reference to ES. There was wide variation in focus and level of detail. All key informants indicated that ES is recognised and considered for academic promotion. Barriers to the support and recognition of ES included a lack of understanding of ES and its relationship to teaching and leadership. This was manifest in the variability in promotion policies and processes, support systems, and career planning and pathways for ES.

Conclusions

This lack of clarity may make it challenging for medical school faculty members to make sense of how they might successfully align ES within an academic career. There is a need therefore to better articulate ES in promotion policies and support systems. Creating a common understanding of ES, developing guidelines to assess the impact of all forms of ES, developing an informed leadership and system of mentors, and creating explicit role descriptions and guidelines are identified as potential strategies to ensure that ES is appropriately valued.

Discuss this article below by adding a comment.

DOI: 10.1111/medu.12543

What is reflection? A conceptual analysis of major definitions and a proposal of a five-component model

To read on journal website, click here.

By Quoc Dinh Nguyen, Nicolas Fernandez, Thierry Karsenti and Bernard Charlin

Context

Although reflection is considered a significant component of medical education and practice, the literature does not provide a consensual definition or model for it. Because reflection has taken on multiple meanings, it remains difficult to operationalise. A standard definition and model are needed to improve the development of practical applications of reflection.

Objectives

This study was conducted in order to identify, explore and analyse the most influential conceptualisations of reflection, and to develop a new theory-informed and unified definition and model of reflection.

Methods

A systematic review was conducted to identify the 15 most cited authors in papers on reflection published during the period from 2008 to 2012. The authors’ definitions and models were extracted. An exploratory thematic analysis was carried out and identified seven initial categories. Categories were clustered and reworded to develop an integrative definition and model of reflection, which feature core components that define reflection and extrinsic elements that influence instances of reflection.

Results

Following our review and analysis, five core components of reflection and two extrinsic elements were identified as characteristics of the reflective thinking process. Reflection is defined as the process of engaging the self (S) in attentive, critical, exploratory and iterative (ACEI) interactions with one’s thoughts and actions (TA), and their underlying conceptual frame (CF), with a view to changing them and a view on thechange itself (VC). Our conceptual model consists of the defining core components, supplemented with the extrinsic elements that influence reflection.

Conclusions

This article presents a new theory-informed, five-component definition and model of reflection. We believe these have advantages over previous models in terms of helping to guide the further study, learning, assessment and teaching of reflection.

Discuss this article below by adding a comment.

DOI: 10.1111/medu.12583

Multiple mini-interviews: same concept, different approaches

To read on journal website, click here.

By Mirjana Knorr and Johanna Hissbach

Objectives
Increasing numbers of educational institutions in the medical field choose to replace their conventional admissions interviews with a multiple mini-interview (MMI) format because the latter has superior reliability values and reduces interviewer bias. As the MMI format can be adapted to the conditions of each institution, the question of under which circumstances an MMI is most expedient remains unresolved. This article systematically reviews the existing MMI literature to identify the aspects of MMI design that have impact on the reliability, validity and cost-efficiency of the format.

Methods
Three electronic databases (OVID, PubMed, Web of Science) were searched for any publications in which MMIs and related approaches were discussed. Sixty-six publications were included in the analysis.

Results
Forty studies reported reliability values. Generally, raising the number of stations has more impact on reliability than raising the number of raters per station. Other factors with positive influence include the exclusion of stations that are too easy, and the use of normative anchored rating scales or skills-based rater training. Data on criterion-related validities and analyses of dimensionality were found in 31 studies. Irrespective of design differences, the relationship between MMI results and academic measures is small to zero. The McMaster University MMI predicts in-programme and licensing examination performance. Construct validity analyses are mostly exploratory and their results are inconclusive. Seven publications gave information on required resources or provided suggestions on how to save costs. The most relevant cost factors that are additional to those of conventional interviews are the costs of station development and actor payments.

Conclusions
The MMI literature provides useful recommendations for reliable and cost-efficient MMI designs, but some important aspects have not yet been fully explored. More theory-driven research is needed concerning dimensionality and construct validity, the predictive validity of MMIs other than those of McMaster University, the comparison of station types, and a cost-efficient station development process.

Discuss this article below by adding a comment.

DOI: 10.1111/medu.12535

Deciding ‘what to teach’ health professionals: a human-centred systems engineering perspective

To read on journal website, click here.  DOI: 10.1111/medu.12570

Deciding ‘what to teach’ health professionals: a human-centred systems engineering perspective

by Anna T Cianciolo

Context
Recent calls propose the conceptualisation of medical education research as ‘an improvement science for complex social interventions’. This involves developing principled, yet contextually grounded, descriptions of health care practice that increase the likelihood of successful intervention. Defining what health professionals should be taught using theoretical perspectives and analytical techniques borrowed from human-centred systems engineering (HCSE) may acknowledge this call by allowing learning objectives and performance assessment criteria to be aligned with the demands of actual work.

Discussion
Human-centred systems engineering is a multidisciplinary endeavour that seeks to promote the safe, efficient and productive performance of socio-technological systems. Systems theories in HCSE explain how environmental conditions constrain and afford human goal-directed behaviour and are modified by such. Many of the techniques used in HCSE research that are applicable to examining health care practice should be familiar to medical education researchers. This method differs from other empirical approaches that have been applied to the study of health care practice in its emphasis on practical problem solving via intervention design.

Conclusions
Learning objectives and performance assessment criteria derived from an HCSE perspective target people’s attunement to environmental conditions as they strive to enact goal-directed behaviour. Implementing educational interventions from an HCSE perspective should facilitate a sustained positive impact across contexts because theories of person–environment interaction enable principled adaptations of interventions to local circumstances.

Discuss this article below by adding a comment.

Guest post: Researching Medical Education – What’s the point of the term MFFD? What’s the point of medical education research?

This is the fourth of 4 related posts.

As noted in a previous post about a new Virtual Issue, ASME is hosting a daylong meeting on Researching Medical Education. The meeting is organized into six strands. The post below is from Rakesh Patel, a faculty member and medical education researcher based at University of Leicester in the United Kingdom.

You are encouraged to comment in response to this post, and to continue the conversation ‘live’ at the meeting if you plan to attend.

_____________________________________

By Rakesh Patel

What’s the point of the term MFFD? What’s the point of medical education research?

“Medically fit for discharge (MFFD)” is a phrase used in the workplace but what does it actually mean? I was receiving handover from the junior members of the team and after mentioning the name of the patient the phrase MFFD was occupying the space for diagnosis. When I questioned what was actually wrong with the patient or requested some more information about why the patient came into the hospital in the first place I was struck by the dumbfounded expressions on the faces of the individuals in question. I could of course now get on my soap box and show my age by saying “when I was an house officer, I knew all my patients and their blood results” so why don’t the doctors of today know this information. Taking a step back, perhaps I could reflect more about the factors that may have contributed to my perception that there was actually a problem with the phrase MFFD in the first place given it seems commonplace in the discourse of healthcare teams. Alternatively I could consider my observation from multiple perspectives to make better sense of the role that social structures and systems play in leading to people using this phrase in relation to the patient rather than the person. Either way, this example raises some important considerations for those interested in medical education.

Firstly from my perspective as a medical educator, understanding how best to educate those in training is key to achieving what I would like to see from a new doctor and that is the skills and appreciation to ‘know’ patients are more than just a label. Secondly, from my perspective as a medical education researcher, the example highlights the importance of stepping back and considering a problem from the multiple perspectives so greater insight is gained into a given problem or opportunity. Medicine and healthcare professions education face many challenges today however the transdisciplinary expertise possessed by researchers in this area can add significant value to advancing practice but also aspects related to teaching and learning. Finally, from my perspective as a trainee or a future patient, the example serves a reminder that the answer is rarely gained without discussion and reflection on what others, particular those whom were serve, have to say. The six papers chosen to stimulate discussion among those interested in the discipline will be used to consider their contribution to advancing the discipline of medical education as whole or advancing the understanding of research of learning in practice as is the theme of the conference.

Professional identity seems to be “new kid on the block” in terms of attracting attention from medical education researchers interested in the area of professionalism. Over the past few years, individuals have tried to increase our understanding of professionalism in our discipline through advancing research and scholarship. (Helmich et al. 2012) provided some empirical data from medical students in their early years about their lived experience of interactions with patients and the potential contribution of these experiences on their professional identity development. At the same time, (Burford 2012) published a paper recommending that consideration be given to the role of group membership in developing social identity in the health education context. For the novice clinical teacher these papers would both be retrieved following a search on ‘professionalism’ but how should readers make sense of the papers and apply the insights back into practice? Similarly, for the novice researcher, how should they make sense of the different approaches and develop methodologies and methods for researching the priorities areas in this theme?

Most recently, (Cruess et al. 2014) suggested better understanding of identity formation in medicine and of socialization in the medical environment could lend greater clarity to the educational activities used to support medical practitioners of the future develop the qualities of the “good physician.” A good physician in my opinion would not just write ‘MFFD’ in a set of medical notes as part of their daily review without some consideration to what this phrase actually means in the context of providing care out of hours or for patient safety in its widest sense.

When undertaking research in medical education, making explicit the underpinning research paradigms and perspectives on matters such as ontology, epistemology and axiology is important. This information is fundamental for understanding the perceptions, beliefs, assumptions and the nature of reality and truth (or knowledge of that reality) held by the individual or team undertaking the research. Furthermore, such matters also influence decisions about key aspects of the research such as study design and conclusions. These individual values are often not apparent to readers so appraising whether the approaches chosen by researchers are appropriate for the nature of the phenomenon under study or whether sufficient attention is given by the researcher to his/her world view, cannot be made at first glance.

(Chitsabesan et al. 2006) used semi-structured interviews using repertory grids and critical incidents to elicit preferred characteristics and behaviours of clinical teachers. In choosing this method, the authors attempted to justify their selection by suggesting items on surveys are constrained by preconceived ideas, potentially limiting the responses. Furthermore, the authors also propose that focus groups limit the expression of individual’s views since patients influence one another. The authors provide limited, or at times no supporting evidence for these assertions and ironically do not reflect on how their own values and beliefs are likely to influence the approach to the research. This creates uncertainty in the mind of the reader about the credibility of the findings and one could argue the process of traditional peer-review.

Uncertainty in medical education research was a theme at AMEE 2014 and during one of the invited symposia focusing on research, Lorelei Lingard suggested uncertainty arises from researchers not asking themselves a series of questions stated below:

 

  1. What questions are you not going to ask?
  2. Who are not your participants?
  3. What is the area not of interest
  4. What are you not looking for?
  5. What story do you not tell?

 

Although the answers to these questions prior to publication, they are often debated face-to-face or online after publication afterwards, and a ‘blog’ provides an excellent platform upon which to engage in such a conversation.

 

The paper by (Chitsabesan et al. 2006) can also be used to discuss another anecdotal observation that is prevalent in most disciplines such as medical education and that is the issue of researchers ‘fitting a problem to a given study design’ rather than ‘fitting the study design to a given problem’. Methodology and methods are the hallmark of good research and where individuals have limited knowledge or skills in these aspects, they could and should turn to others for answers. Researchers in medical education could learn from counterparts in the social sciences, arts and humanities as well as business, engineering and physical sciences.

 

The Researching Medical Education conference is a showcase of talent from one of these disciplines as well as a magnet for researchers interested in medical education where these methods can be found. The impression one wants to avoid giving when writing a paper is the one that suggests as authors, a chosen method or study design was selected prior to any thought was given to a research question or the individual values and biases possessed by the research team.

 

Furthermore, justification for one research method over another is a fundamental part of academic training yet attracts little scrutiny from journal editors as part of the peer review process as in the case example above. For readers and new researchers alike, the tacit knowledge that goes into picking or justifying one method over another is really important for reducing uncertainty and increasing clarity. Access to source literature for readers is key to making the implicit more explicit and avoid the trap of performing ’sloppy science’ as suggested by Caes Van der Vleuten and colleagues at another AMEE 2014 research symposium.

 

One of the outputs from quality research activity is ideally a significant contribution to the existing body of knowledge or literature (The Lancet 2013). It follows that the responsibility of researchers should be to identify the gap in the literature and justify the rationale for performing research. Without a clear rationale, there risks the tendency for researchers to engage in inquiry just for the sake of it. Virtual patients are real-life clinical scenarios that enable learners to emulate the roles of health care providers to obtain a history, conduct a physical exam, and make diagnostic and therapeutic decisions (Cook, Erwin & Triola 2010) . However their role in the teaching and learning remains unclear. They are expensive and resource intensive (Saleh 2010) therefore priorities for research in this area should be set by stakeholders such as learners or patients, rather than faculty or industry. A critical literature review of VPs conducted by (Cook, Triola 2009) identified design variations for VPs were limitless but called for further research to explore design issues. Nevertheless a systematic review of computerised VPs in health professions education performed by (Cook, Erwin & Triola 2010)  suggested that VPs, irrespective of instructional design led to large positive effects interms of gains in learning.

 

Against this backdrop,(Bateman et al. 2013)  chose to explore which form of virtual patient (VP) design may be effective and why among undergraduate medical students using a ground theory approach. Now from the learner perspective, this work may have lower priority in comparison to questions of greater relevance to them such as ‘will VPs make medical students better or safer doctors?’. For patients and the public taxpayer, the question they want answered is ‘what is the added value of VPs compared to other training modalities (such as real patient contact)? Likewise, clinical teachers and medical educators first want answers to questions such ‘what is the effectiveness of VPs for increasing the transferability of diagnostic decision-making skills into the workplace?’ before others more granular or specialist interest questions like activity design.

 

(Bateman et al. 2013) suggest educational theory plays little or no role for informing how best to design VPs yet there was an entire symposium at AMEE 2014 devoted to the use of educational theory for developing new technology-enhanced learning approaches based on insights from cognitive load (Sweller J, van Merrienboer J, Paas F 1998) and multimedia learning (Mayer 2001) theories, the former of which was rubbished by the authors above in the context of VPs. These assumptions were made without sufficient reference to the published literature so risks leaving the novice clinical teacher or even experienced medical educator unclear how best to make sense of the research, especially in regards to the justification for performing the research and the choice of methodology used to explore the problem.

 

Extending the notion that research which really matters should be taken conducted and progressed, (Darbyshire, Baker 2013) presents the experience of medical trainees as early career researchers in medical education. Without developing capacity in a new generation of medical trainees, the make up of researchers in medical education in the future may be similar to the situation facing health sciences now, where the dwindling numbers of medical academics is resulting in the reduced contribution from medical doctors within the discipline. Whilst it is encouraging to see medical education grow in terms of diversity, (Darbyshire, Baker 2013) remind us of the importance of ensuring part of the core contains medical doctors but with understanding about research methods and appreciation for the social sciences. Traditionally, medical doctors have entered medical education towards the end of their career or with an ‘interest in teaching’, however advancing an academic discipline requires more than just individuals with this motivation. Medical doctors wanting to be academic medical educators should have some understanding about scholarship in teaching and learning as well as knowledge of the various educational philosophies and research methods.

 

(Darbyshire, Baker 2013) only present data from six participants yet the usefulness of the findings for informing the current practice of supervisors of this sample population and the policies for supporting these trainees is potentially significant. Anecdotal conversations with colleagues suggest the problem of career development for medical trainees with an interest in medical education is growing. There are limited opportunities to harness the experience of those who have had previous success so this type of ‘evidence’, regardless of the ’n’ number is potentially invaluable for readers interested in creating similar opportunities in their local context.

 

The paper by (Kuper et al. 2010)  draws together all the key points made in this blog post into a paper that demonstrates how medical education can add value to the development of medical students, trainees, and health care professionals as well as the care of patients at the bedside. Morbidity and mortality rounds (MMRs) are opportunities for healthcare professionals to come together and discuss learning points from aspects of care, which demonstrate the healthcare team’s strengths and areas for improvement in the context of a significant incident. (Kuper et al. 2010) used ethnography to observe the interactions and behaviours of staff at MMRs, as well as conducted interviews with both staff doctors and residents and triangulated the resultant data.

 

The use of multiple methods can be undervalued by the novice researcher. Some of the papers referenced above describe single methods for exploring a complex phenomenon, whereas (Kuper et al. 2010)  demonstrate the value of using triangulating findings and developing a better understanding of reality or knowledge about the ‘truth’. (Kuper et al. 2010) identified that novices value content knowledge, yet these forums are ideally placed to provide opportunities for much more deeper learning around the values, beliefs and attitudes of healthcare professionals in the workplace.

 

Readers who have experience of these rounds will have first-hand accounts about the desire of healthcare professionals to seek detail about significant incidents, perhaps overlooking the very behaviours, which led to problems or adverse incidents in the first place. These meetings are also a barometer of a department’s workplace culture since meetings in which the focus is on learning lessons for the future are more likely to be associated with organisations in which there is a strong ethic for learning. The challenge as highlighted by (Kuper et al. 2010) remains re-framing the perceptions of trainees about what is important when in the professional role of a doctor – the patient and their safety.

 

I started this piece with a reflection about the work MFFD and I feel that my reticence about the term persists in terms of the usefulness of the phrase and the understanding about its use in the discourse among healthcare professionals. The challenge for clinical teachers, medical educators and medical education researchers is to ensure that content knowledge is not valued above the development of professional identity and patient safety. We have a responsibility to public and patients alike that we are advancing the discipline in the right ways and we are researching about things that actually matter. Patient care is not about the destination of discharge, its about the journey for the patient and ourselves. Medical students, doctors in training and doctors, let’s think of another term that doesn’t sound as though we only see the patient and not the person.

 

References

Bateman, J., Allen, M., Samani, D., Kidd, J. & Davies, D. 2013, “Virtual patient design: exploring what works and why. A grounded theory study”, Medical education, vol. 47, no. 6, pp. 595-606.

Burford, B. 2012, “Group processes in medical education: learning from social identity theory”, Medical education, vol. 46, no. 2, pp. 143-152.

Chitsabesan, P., Corbett, S., Walker, L., Spencer, J. & Barton, J.R. 2006, “Describing clinical teachers’ characteristics and behaviours using critical incidents and repertory grids”, Medical education, vol. 40, no. 7, pp. 645-653.

Cook, D.A., Erwin, P.J. & Triola, M.M. 2010, “Computerized virtual patients in health professions education: a systematic review and meta-analysis”, Academic Medicine, vol. 85, no. 10, pp. 1589-1602.

Cook, D.A. & Triola, M.M. 2009, “Virtual patients: a critical literature review and proposed next steps”, Medical Education, vol. 43, pp. 303-311.

Cruess, R.L., Cruess, S.R., Boudreau, J.D., Snell, L. & Steinert, Y. 2014, “Reframing Medical Education to Support Professional Identity Formation”, Academic medicine : journal of the Association of American Medical Colleges, .

Darbyshire, D. & Baker, P. 2013, “Encouraging new doctors to do medical education research”, The Clinical Teacher, vol. 10, no. 6, pp. 358-361.

Helmich, E., Bolhuis, S., Dornan, T., Laan, R. & Koopmans, R. 2012, “Entering medical practice for the very first time: emotional talk, meaning and identity development”, Medical education, vol. 46, no. 11, pp. 1074-1086.

Kuper, A., Nedden, N.Z., Etchells, E., Shadowitz, S. & Reeves, S. 2010, “Teaching and learning in morbidity and mortality rounds: an ethnographic study”, Medical education, vol. 44, no. 6, pp. 559-569.

Mayer, R.E. 2001, Multimedia Learning. Second edn, Cambridge University Press, New York.

Saleh, N. 2010, “The value of virtual patient in medical education”, Annals of Behavioural Science and Medical Education, vol. 16, no. 2, pp. 29-31.

Sweller J, van Merrienboer J, Paas F 1998, “Cognitive architecture and instructional design”, Educ Psychol Rev, , no. 10, pp. 251-296.

The Lancet 2013, “What is the purpose of medical research?”, The Lancet, vol. 381, no. 9864, pp. 347.

Guest post: Researching Medical Education – Using observation in research

This is the third of 4 related posts.

As noted in a previous post about a new Virtual Issue, ASME is hosting a daylong meeting on Researching Medical Education. The meeting is organized into six strands. The post below is from Jeremy Brown, a faculty member and medical education researcher based at Edge Hill University in the United Kingdom.

You are encouraged to comment in response to this post, and to continue the conversation ‘live’ at the meeting if you plan to attend.

______________________

By Jeremy Brown

Strand 3:  Using Observation in Research

In Strands 1 and 2 we have considered the importance of the research question and the theory that underpins our work.  These discussions have asked how we can ‘up our game’ as medical education researchers.  Strand 3 focuses on Using Observation in Research.  When reading the two excellent papers below I began to reflect on the practical challenges researchers have to face when deciding upon the feasibility of using Observation in Research.

Roy RB, McMahon GT (2012) Video-based cases disrupt deep critical thinking in problem-based learning.   Medical Education.  46 (4), 426–435.

Roy and McMahon (2012) use a rigorous design to investigate the impacts of video and text based case presentation on the learning of students in PBL tutorials.   As well as making a significant contribution to the evidence base what hits home to me is the complexity of work undertaken by the researchers.  The setting up of the tutorials, the recruitment of participants, the power calculations, the recording of data and then the detailed analysis are practical challenge in themselves.   This paper makes us reflect on the choices of research methods and whether we on occasions rule out approaches, not based on methodological decisions but on circumstances?

Rees CE,Ajjawi1 R, Monrouxe LV (2013) The construction of power in family medicine bedside teaching: a video observation study.  Medical Education, 47: 154–165.

Rees et al (2013) used video-recorded observations as well as the more commonly used methods of audio-recording or qualitative interviews in order to analyse the interactions of participants in bedside teaching encounters.  This paper is a fascinating read not only because of its findings regarding the student–patient–doctor relationship and the power dynamics in bedside teaching but also how the research team designed and constructed the study.  As a non-clinician working in postgraduate medical education I have often been advised to steer away from using observation.  This has been based on both ethical and practical considerations of being the ‘other side of the curtain’.  After reading this paper should I be thinking again?