Upload
k-raman-sethuraman
View
103
Download
0
Embed Size (px)
Citation preview
Emerging Areas of Educational Research in Health Professions
Prof KR Sethuraman. Sri Balaji Vidyapeeth,
Puducherry www.sbvu.ac.in
ERICON-2017 2
20th Century
21st Century
ERICON-2017 3
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
ERICON-2017 4
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
ERICON-2017 6
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
ERICON-2017 7
Research Methods• Two general categories used in educational
research– Quantitative; – Qualitative
ERICON-2017 8
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
ERICON-2017 9
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
ERICON-2017 10
Qualitative Methods (eg.Learning in Rounds)
Obj. 3.9
ERICON-2017 11
ERICON-2017 12
A mixed-mode research combines the complementary strengths of the qualitative & quantitative approaches
Purpose guides Approach
ERICON-2017 13
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
ERICON-2017 14
Research Outcomes: Knowledge – Utility
Donald Stokes in his book, Pasteur's Quadrant, 1997.
“me-too” or Junk
ERICON-2017 15
The Recent Past:UNESCO on
Educational Research 26 Years Ago
ERICON-2017 16
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.
ERICON-2017 17
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
ERICON-2017 18
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
ERICON-2017 19
Research in Medical Education:
The Current Scene
ERICON-2017 20
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.
ERICON-2017 21
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
ERICON-2017 22
Top Authors 1988-2010
-- Adv in Health Sci Educ DOI 10.1007/s10459-011-9328-x
ERICON-2017 23
Top Cited Authors (Role-models)1988-2010
-- Adv in Health Sci Educ DOI 10.1007/s10459-011-9328-x
ERICON-2017 24
Top 4 Topics of Research 1988-2010
ERICON-2017 25
Topics of Research, Rank 5 – 10
ERICON-2017 26
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
ERICON-2017 27
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.
ERICON-2017 28
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
ERICON-2017 29
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.
ERICON-2017 30
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
ERICON-2017 31
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
ERICON-2017 32
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.
ERICON-2017 33
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
ERICON-2017 34
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
ERICON-2017 35
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.
ERICON-2017 36
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
ERICON-2017 37
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
ERICON-2017 38
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
ERICON-2017 39
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
ERICON-2017 40
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.
ERICON-2017 41
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.
ERICON-2017 42
5. Financial Barriers
• Lack of adequate and equitable distribution of funds and resources.
• Inadequate funding of scientific-research work.
• The lack of research incentives .
ERICON-2017 43
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
ERICON-2017 44
Numbers
Game
Pressure to Publish
Quantity versus Quality Issues
ERICON-2017 45
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
ERICON-2017 46
Proliferation of the Predatory Publishers
A current Scam in the making!
ERICON-2017 47
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.”
ERICON-2017 48
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
ERICON-2017 49
Research in Medical Education: Future Directions
ERICON-2017 50
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
ERICON-2017 51
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.
ERICON-2017 52
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
ERICON-2017 53
Does 70/20/10 Model Suit 21st Century Learning? Where are Indian Studies to Validate and
operationalize this Model ?
ERICON-2017 54
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
ERICON-2017 55
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
ERICON-2017 56
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
ERICON-2017 57
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
ERICON-2017 58
Planning a Comprehensive Health Professions Education Research
in 7 Clusters
A Quick Scan…
ERICON-2017 59
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.
ERICON-2017 60
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.
ERICON-2017 61
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.
ERICON-2017 62
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.
ERICON-2017 63
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.
ERICON-2017 64
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.
ERICON-2017 65
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.
ERICON-2017 66
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)
ERICON-2017 67
Fostering Education Research: Roles and Responsibilities
ERICON-2017 68
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
ERICON-2017 69
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
ERICON-2017 70
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
ERICON-2017 71
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
ERICON-2017 72
“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.
ERICON-2017 73
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 …