Virtual Issue for Researching Medical Education

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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

#MedEdJ Conversation Start with Ellie Hothersall

Hello everyone!

This is Teresa Chan (@TChanMD) the e-editor intern for the journals Medical Education & Clinical Teacher. This month we are delighted to bring you more reflections via the Conversations in Medical Education blog.

I am happy to present to you a featured blog post from Ellie Hothersall, a member of our blog’s e-council.  She has written a thought-provoking piece to get the conversation started here on the blog about one of the recent articles in Medical Education‘s most recent issue.

Keep reading below to see what Ellie has to say about the article, and then join in the conversation via the blog comments below!  Also feel free to tweet me using the hashtag #MedEdJ.

– Teresa (@TChanMD)

***

How do we get medical students and medical trainees to understand the effect poverty has on health? I can’t believe that there’s anyone in the medical sphere who hasn’t grasped that poverty is bad for you (and again, and again), but how do we get people to act on that, to actually behave in a way that takes this into account when they deal with patients? Better yet, how could we get medical students and trainees to be advocates for this vitally important issue?

Photovoice may be part of the answer to those questions. By getting students to take a video diary and reflect on issues relating to poverty, a small number of students in a primary care setting in Quebec found new insights into poverty and felt that it became easier to discuss issues of poverty with each other, and (the authors write) “opened up the possibility of exploring the resources available instead of avoiding the patient’s problem.” It sounds like it has had a reasonable impact. But also, it sounds time-consuming, and although the authors mention at the end of the paper that they have now developed a resource to teach others about poverty, there’s no detail about that. So great: lots of photos, discussion and thus reflection, and you might feel better able to talk about poverty, and try to help patients find ways to improve their situation.

I do find myself wondering how this exercise would work if rolled out to a whole cohort of medical students. Perhaps I’m being cynical, but it has been observed previously that students can “game” reflective exercises. How do we get over that hump? Is it realistic to expect students to develop a profound understanding of so many complex aspects of human existence? After all, if we want students to reflect upon the effect of poverty, why not also literacy, chronic disease, loneliness? It seems like we pick a couple of big topics, and hope that they act as proxies for all other mature insights into the human condition. Of course we do, the curriculum it too long for anything else.

So do we need to go to such lengths to get insight into poverty? I’d argue we probably do. Poverty is normally filed away as “too hard”, or beyond our ability to have any impact. Most medical schools teach very little specifically about poverty, reinforcing the hidden curriculum message that it’s not our problem (although there have been calls to include screening for poverty in the medical curriculum). We (clinicians, including students) switch off from thinking about problems such as poverty because we teach ourselves not to be distracted by issues we feel we can’t control. Furthermore poverty is far from the experience of most clinicians, making it easier for us to overlook. Perhaps this is the way to counter that. I’d like to see how these students respond over time – perhaps it’s a candidate for the “you’ll thank me when your older” category of teaching. After all, if the outcome is that patients who are suffering due to poverty have that suffering alleviated, then we will all be better off.

Interviewing in situ: employing the guided walk as a dynamic form of qualitative inquiry

To read on journal website, click here.

Timothy V Dubé, Robert J Schinke, Roger Strasser and Nancy Lightfoot

Context

The purpose of this paper is to provide a critical analysis of a mobile research method, the guided walk, and its potential suitability in medical education research.

Methods

The Northern Ontario School of Medicine’s (NOSM) longitudinal integrated clerkship served as the research context in which the guided walk method was used to explore the lived experiences of 12 Year 3 medical students undertaking their clerkship in one of eight different communities across Northern Ontario, Canada. Informed by the social constructivist research paradigm, the guided walk method was employed to answer the research question: how do Year 3 medical students at NOSM describe their clerkship experiences as encountered in their placement and living contexts? Through an inductive thematic analysis of the data, the findings provided a rich description of the guided walk from the participants’ and the researcher’s perspectives.

Results

There were significant advantages to using the guided walk rather than other types of qualitative research approaches. The guided walk made it easier for participants to take part in the study, provided context-rich research interactions, and led to serendipitous encounters for both participants and the first author. There were also challenges and limitations associated with the guided walk method. For example, this method carries inherent challenges with reference to the safeguarding of confidentiality and anonymity for both participants and those encountered during the walk.

Conclusions

The guided walk method is promising within medical education, particularly for researchers seeking to gain participants’ stories in the contexts to which they refer. This method may be appropriate for use in medical education research in areas such as the evaluation and assessment of a student’s clinical decision-making skills and competency development, as well as the consolidation of strategies to manage ethical and professional dilemmas.

DOI: 10.1111/medu.12532

Exploring stakeholders’ views of medical education research priorities: a national survey

To read on journal website, click here.

By Ashley A Dennis, Jennifer A Cleland, Peter Johnston, Jean S Ker, Murray Lough and Charlotte E Rees

Context

Setting research priorities is important when exploring complex issues with limited resources. Only two countries (Canada and New Zealand) have previously conducted priority-setting exercises for medical education research (MER). This study aimed to identify the views of multiple stakeholders on MER priorities in Scotland.

Methods

This study utilised a two-stage design to explore the views of stakeholders across the medical education continuum using online questionnaires. In Stage 1, key informants outlined their top three MER priorities and justified their choices. In Stage 2, participants rated 21 topics generated in Stage 1 according to importance and identified or justified their top priorities. A combination of qualitative (i.e. framework analysis) and quantitative (e.g. exploratory factor analysis) data analyses were employed.

Results

Views were gathered from over 1300 stakeholders. A total of 21 subthemes (or priority areas) identified in Stage 1 were explored further in Stage 2. The 21 items loaded onto five factors: the culture of learning together in the workplace; enhancing and valuing the role of educators; curriculum integration and innovation; bridging the gap between assessment and feedback, and building a resilient workforce. Within Stage 2, the top priority subthemes were: balancing conflicts between service and training; providing useful feedback; promoting resiliency and well-being; creating an effective workplace learning culture; selecting and recruiting doctors to reflect need, and ensuring that curricula prepare trainees for practice. Participant characteristics were related to the perceived importance of the factors. Finally, five themes explaining why participants prioritised items were identified: patient safety; quality of care; investing for the future; policy and political agendas, and evidence-based education.

Conclusions

This study indicates that, across the spectrum of stakeholders and geography, certain MER priorities are consistently identified. These priority areas are in harmony with a range of current drivers in UK medical education. They provide a platform of evidence on which to base decisions about MER programmes in Scotland and beyond.

DOI: 10.1111/medu.12522

Seeing the ‘black box’ differently: assessor cognition from three research perspectives

To read on journal website, click here.

by Andrea Gingerich, Jennifer Kogan, Peter Yeates, Marjan Govaerts and Eric Holmboe

Context

Performance assessments, such as workplace-based assessments (WBAs), represent a crucial component of assessment strategy in medical education. Persistent concerns about rater variability in performance assessments have resulted in a new field of study focusing on the cognitive processes used by raters, or more inclusively, by assessors.

Methods

An international group of researchers met regularly to share and critique key findings in assessor cognition research. Through iterative discussions, they identified the prevailing approaches to assessor cognition research and noted that each of them were based on nearly disparate theoretical frameworks and literatures. This paper aims to provide a conceptual review of the different perspectives used by researchers in this field using the specific example of WBA.

Results

Three distinct, but not mutually exclusive, perspectives on the origins and possible solutions to variability in assessment judgements emerged from the discussions within the group of researchers: (i) the assessor as trainable: assessors vary because they do not apply assessment criteria correctly, use varied frames of reference and make unjustified inferences; (ii) the assessor as fallible: variations arise as a result of fundamental limitations in human cognition that mean assessors are readily and haphazardly influenced by their immediate context, and (iii) the assessor as meaningfully idiosyncratic: experts are capable of making sense of highly complex and nuanced scenarios through inference and contextual sensitivity, which suggests assessor differences may represent legitimate experience-based interpretations.

Conclusions

Although each of the perspectives discussed in this paper advances our understanding of assessor cognition and its impact on WBA, every perspective has its limitations. Following a discussion of areas of concordance and discordance across the perspectives, we propose a coexistent view in which researchers and practitioners utilise aspects of all three perspectives with the goal of advancing assessment quality and ultimately improving patient care.

DOI: 10.1111/medu.12546

Shame, guilt, and the medical learner: ignored connections and why we should care

To read on journal website, click here.

by William E Bynum IV, and Jeffrey L Goodie

Context

Shame and guilt are subjective emotional responses that occur in response to negative events such as the making of mistakes or an experience of mistreatment, and have been studied extensively in the field of psychology. Despite their potentially damaging effects and ubiquitous presence in everyday life, very little has been written about the impact of shame and guilt in medical education.

Methods

The authors reference the psychology literature to define shame and guilt and then focus on one area in medical education in which they manifest: the response of the learner and teacher to medical errors. Evidence is provided from the psychology literature to show associations between shame and negative coping mechanisms, decreased empathy and impaired self-forgiveness following a transgression. The authors link this evidence to existing findings in the medical literature that may be related to unrecognised shame and guilt, and propose novel ways of thinking about a learner’s ability to cope, remain empathetic and forgive him or herself following an error.

Results

The authors combine the discussion of shame, guilt and learner error with findings from the medical education literature and outline three specific ways in which teachers might lead learners to a shame-free response to errors: by acknowledging the presence of shame and guilt in the learner; by avoiding humiliation, and by leveraging effective feedback.

Conclusions

The authors conclude with recommendations for research on shame and guilt and their influence on the experience of the medical learner. This critical research plus enhanced recognition of shame and guilt will allow teachers and institutions to further cultivate the engaged, empathetic and shame-resilient learners they strive to create.

DOI: 10.1111/medu.12521

Getting your journal article noticed

If you have published or are considering publishing in Medical Education or The Clinical Teacher, you now have a tool to help measure its impact. Wiley, the publisher of the journals Medical Education and The Clinical Teacher, have incorporated Altimetric, a function that reflects the impact of a particular article. This may help authors to promote their article and get involved with the conversations around their article, including this blog. There is also a section of the Wiley Exchanges site which hosts an author promotional toolkit (http://exchanges.wiley.com/authors/promo). A link to the announcement and description of Alimetric is here:

Wiley Exchanges blog: http://exchanges.wiley.com/blog/2014/09/18/5-tips-for-improving-your-articles-altmetric-score/

#MedEdJ Conversation Starter with Karen Scott

Hello everyone!

This is Teresa Chan (@TChanMD) the new e-editor intern for the journals Medical Education & Clinical Teacher.  I am very excited to be working with Dr. Joshua Jacobs to help with the Conversations in Medical Education blog.

This month, I am delighted to bring you a featured blog post from Karen Scott, a member of our blog’s e-council.  She has written a thought-provoking piece to get the conversation started here on the blog about one of the recent articles in Medical Education‘s most recent issue.

Keep reading below to see what Karen has to say about the article, and then join in the conversation via the blog comments below!  Also feel free to tweet me using the hashtag #MedEdJ

Teresa Chan

Continue reading

Clinical Teacher Online Discussion | October 2014

Hey Folks,

It’s Teresa Chan your intern e-Editor this year for the Conversations in Medical Education blog.  I’m hoping our audience for the Clinical Teacher journal might be interested in joining us online for discussions about our latest issue (October 2014), so I’m creating this blog post to get things started.

How to participate:

Please participate in our online conversation by writing your comment below.  When responding, please denote the article your are referring to:

e.g.

Re: Nelson et al. Developing cross-specialty endovascular simulation training (pages 411–415)
<Then write your note>

Looking forward to chatting with you online about this exciting new issue!

The mini-clinical evaluation exercise during medical clerkships: are learning needs and learning goals aligned?

To read on journal website, click here.

Stephanie Montagne, Anja Rogausch, Armin Gemperli, Christoph Berendonk, Patrick Jucker-Kupper, and Christine Beyeler

Objectives

The generation of learning goals (LGs) that are aligned with learning needs (LNs) is one of the main purposes of formative workplace-based assessment. In this study, we aimed to analyse how often trainer–student pairs identified corresponding LNs in mini-clinical evaluation exercise (mini-CEX) encounters and to what degree these LNs aligned with recorded LGs, taking into account the social environment (e.g. clinic size) in which the mini-CEX was conducted.

Methods

Retrospective analyses of adapted mini-CEX forms (trainers’ and students’ assessments) completed by all Year 4 medical students during clerkships were performed. Learning needs were defined by the lowest score(s) assigned to one or more of the mini-CEX domains. Learning goals were categorised qualitatively according to their correspondence with the six mini-CEX domains (e.g. history taking, professionalism). Following descriptive analyses of LNs and LGs, multi-level logistic regression models were used to predict LGs by identified LNs and social context variables.

Results

A total of 512 trainers and 165 students conducted 1783 mini-CEXs (98% completion rate). Concordantly, trainer–student pairs most often identified LNs in the domains of ‘clinical reasoning’ (23% of 1167 complete forms), ‘organisation/efficiency’ (20%) and ‘physical examination’ (20%). At least one ‘defined’ LG was noted on 313 student forms (18% of 1710). Of the 446 LGs noted in total, the most frequently noted were ‘physical examination’ (49%) and ‘history taking’ (21%). Corresponding LNs as well as social context factors (e.g. clinic size) were found to be predictors of these LGs.

Conclusions

Although trainer–student pairs often agreed in the LNs they identified, many assessments did not result in aligned LGs. The sparseness of LGs, their dependency on social context and their partial non-alignment with students’ LNs raise questions about how the full potential of the mini-CEX as not only a ‘diagnostic’ but also an ‘educational’ tool can be exploited.

Article DOI: 10.1111/medu.12513