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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Foundations of Health Professions Education Research Understand the principles, perspectives, and practices for researching health professions education with this accessible introduction Educating healthcare students and professionals is critical to the long-term improvement of human health. Health professions education research (HPER) is a growing field with enormous potential to enrich the education of medical, nursing, and allied health students and professionals. There is still, however, an urgent need for a textbook focusing on the foundations of HPER that will help new and existing HPE researchers ground their work in research philosophies, evidence-based methodologies, and proven best practices. Foundations of Health Professions Education Research meets this need with a broad-based and accessible introduction to the foundations of HPER. Rooted in the latest theoretical and methodological advances, this book takes a global and interdisciplinary approach, designed to provide the widest possible range of backgrounds with a working knowledge of HPER. It promises to become an indispensable contribution to this growing field of increasingly rigorous research. Foundations of Health Professions Education Research readers will also find: * An authorial team with decades of combined HPER experience on multiple continents * Educational features such as learning outcomes, illustrative case studies, discussion points, and exercises to facilitate understanding and retention * Detailed discussion of different approaches to HPER including scientific, realist, interpretivist, critical, and pragmatic approaches alongside a range of topics taking you through your entire research journey Foundations of Health Professions Education Research is a useful reference for both new and experienced HPE researchers, including postgraduate students studying HPER.
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Foundations of Health Professions Education Research
Principles, Perspectives and Practices
Edited by
Charlotte E. ReesThe University of Newcastle, Callaghan, New South Wales, Australia
Lynn V. MonrouxeThe University of Sydney, Camperdown, New South Wales, Australia
Bridget C. O’BrienUniversity of California San Francisco, San Francisco, California, USA
Lisi J. GordonThe University of Dundee, Dundee, Scotland, UK
Claire PalermoMonash University, Clayton, Victoria, Australia
This edition first published 2023
© 2023 John Wiley & Sons Ltd
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The right of Charlotte E. Rees, Lynn V. Monrouxe, Bridget C. O’Brien, Lisi J. Gordon and Claire Palermo to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
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A catalogue record for this book is available from the Library of Congress
Paperback ISBN: 9781119839484; ePub ISBN: 9781119839507; ePDF ISBN: 9781119839491
Cover Design: Wiley
Cover Image: Courtesy of Lynn Monrouxe
Set in 10.5/13pt STIXTwoText by Integra Software Services Pvt. Ltd, Pondicherry, India
We dedicate this book to our current and past research students, research assistants and fellows, as well as the early and mid-career researchers we have collaborated with, supervised, and mentored. We have truly learnt so much about research (and ourselves as researchers) from working with you and your projects. It has been a privilege to share the research journey with you.
Contents
Cover
Title Page
Copyright Page
Dedication
Foreword: Foundations?
About the Editors
Author Contributions
Acknowledgements
CHAPTER 1 Introducing Foundations of Health Professions Education Research
PART I Principles
CHAPTER 2 Theory in Health Professions Education Research
CHAPTER 3 Ethics in Health Professions Education Research
CHAPTER 4 Quality in Health Professions Education Research
PART II Perspectives
CHAPTER 5 Introducing Scientific Approaches in Health Professions Education Research
CHAPTER 6 Introducing Realist Approaches in Health Professions Education Research
CHAPTER 7 Introducing Interpretivist Approaches in Health Professions Education Research
CHAPTER 8 Introducing Critical Approaches in Health Professions Education Research
CHAPTER 9 Introducing Pragmatic Approaches in Health Professions Education Research
PART III Practices
CHAPTER 10 Proposals in Health Professions Education Research
CHAPTER 11 Publishing in Health Professions Education Research
CHAPTER 12 Impact in Health Professions Education Research
CHAPTER 13 Concluding Foundations of Health Professions Education Research
Afterword: Inspiring Early Career Researcher-led Developments in Health Professions Education Research into the Future
Book Glossary
Index
End User License Agreement
List of Tables
CHAPTER 02
TABLE 2.1 Summary of grand...
List of Illustrations
CHAPTER 08
FIGURE 8.1 Description of examples...
CHAPTER 09
FIGURE 9.1 A brief overview...
CHAPTER 11
FIGURE 11.1 Pathway from submission...
FIGURE 11.2 Infographic for the...
Guide
Cover
Title Page
Copyright Page
Dedication
Table of Contents
Foreword: Foundations?
About the Editors
Author Contributions
Acknowledgements
Begin Reading
Afterword: Inspiring Early Career Researcher-led Developments in Health Professions Education Research into the Future
Book Glossary
Index
End User License Agreement
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Foreword: Foundations?
This book is about foundations; the foundations of a field that many scholars have built up over the years to the point that a volume reassessing and outlining those foundations has become necessary. But what does it mean for something to have foundations? I ask you to pause and reflect before diving deeper into this book as thinking about the significances and meanings of foundations will help make your exploration of this volume all the more rewarding.
The term ‘foundation’ can refer to whatever a structure, whether physical, social, or cultural, has been built upon. Foundations may be deliberately constructed as a basis for what follows, or they may simply be what was there before. There is a temporality to this sense of foundation. Foundations precede, they imply something historical, something archaeological, something focused on the contexts that gave rise to something else and within which those later things need to be understood. The foundations of health professions education research (HPER) from this perspective imply therefore that there was a ‘before’ on which HPER was built. And yet, although the history of health professions education (HPE) can be linked to the founding of schools and programmes, and to system-wide reforms, HPER did not start at one point in time; it coalesced out of many threads and actions over an extended period of time. In terms of education, we might think back to the influence of Hippocrates or Galen, William Harvey or Thomas Sydenham, or to the traditions of medical training developed at Padua or Edinburgh, all of which have contributed to the foundations of HPE.
Foundations in this sense are akin to the tributaries of a great river. Some are long and deep like sociology, psychology, economics, and organisational science, while others are more obscure such as the epidemiological philosophies of science, or the emergent practices of action research and design research implied in the work of innovators and inventors. These foundations are often philosophies of science, scientific disciplines, or paradigms, each with their own histories and narratives, which beyond historical curiosity, may have limited relevance to HPER today. Who today worries much about the contested threads of ‘continental’ philosophy and how Kant and later Nietzsche shaped the thinking of Husserl, whose work in turn shaped phenomenology and much of the hermeneutic aspects of the qualitative sciences that HPE researchers employ? The foundations of HPER are primarily the foundations of the social sciences in general, albeit infused with beliefs and values from medicine and from the basic sciences.
Foundations can also refer to the deliberate creation of something new, such as the founding of a school or university, or the functions of a foundry where things of substance are forged and cast. In this case, although historicity is implied, the focus is more on the intent and the acts of the founders. Indeed, this is the sense invoked whenever the emphasis is on the foundational person or people, or on their intentions, vision, hopes, or values. This is often a normative perspective that considers how things should have been according to some definitive source, and how reality has diverged from this founding vision ever since.
Foundations can also refer to that which underlies something in the present moment. From this perspective, foundations focus instead on the here and now and surveying and appraising the reasons for the current form and function of things; warts and all. This usually means unravelling the peculiar entanglements of different elements, traditions, structures, and practices that may never have been designed to interact. Foundations from this point of view can therefore be understood as a palimpsest of earlier things inscribing those that follow them. Examining foundations in this light can tell us much about the morphogenesis of contemporary HPE and HPER. For instance, in HPER we can think of the idiosyncrasies of professional identity formation with its jumble of service, vocation, agency, hierarchy, status, and other principles. Some of this foundational thinking comes from ancient tradition, some from current social realities. Some comes from guild-like collectivism, some from entrepreneurial competitiveness. As another example, we might consider Norman’s generational model [1], starting with a coalescence of scholars from very different backgrounds moving in and out of the, as yet undefined, spaces of HPER. These pioneers were followed by those who trained in other disciplines but pursued careers in HPER and established it as a distinct field, and they were followed in turn by scholars who trained in HPER, who knew little else, and who thought of it as a discipline as much as a field [1]. Each generation reinvented (and will reinvent) the foundations they encountered such that foundations become a standing wave defined both by tradition and the changing perspectives of the scholars in the field over time. For instance, that the historical figures I mentioned earlier were all men reflects a male-dominated past that is not reflected in the present or (I hope) in the future of our field.
Finally, foundations can mean covering over things or erasing them altogether. Indeed, although concealment and elision are not what one may first consider in thinking about foundations, they are important concerns. Foundations may simply just cover over what preceded, forming another stratum of change and development, such as the widespread adoption of Internet technologies over the past three decades. Foundations may also deliberately erase what went before, creating a terra nullius on which something new and better might be built. This sense of foundations is reflected in the episodic paradigm changes in scientific fields and disciplines that are often as much about what is rejected as they are about what replaces such ejecta. For example, some examples of historical people and places I gave earlier were drawn from Western and Anglophone perspectives, but what about others? The elision of non-Western traditions’ influence on the foundations of Western medicine and healthcare is a long-standing concern, reflected, for instance, in the extent to which Hippocrates and Galen are celebrated while the influence of Ibn Sina, Ibn Rushd, and Confucius (among many others) is rarely acknowledged.
Whether we focus on the unintended or deliberately shaped bases on which other things were built, or on the simple facts and consequences of precedence, or on acts of founding, or even on the underlying assumptions and idiosyncrasies of origins and their consequences, a consideration of foundations may tell us many things. Exploring foundations can help us to remember that science is not itself an objective or natural phenomenon; it was created by many people, working both together and in parallel, as well as cumulatively over time. Not one of them laid the foundations for science alone; they all contributed to them. We do not stand only on the shoulders of giants; we stand on the shoulders of everyone who has preceded us – giants and lesser mortals alike.
Although we talk about foundations as single entities, the foundations of HPER are made of many parts, as this book outlines. Chapter 1 argues the foundational purposes of HPER are both ‘to generate new knowledge and to improve education’. Chapter 2 explores theoretical and philosophical foundations of HPER with a particular focus on the purposes and bases of scientific disciplines in the context of HPER. Chapter 3 outlines the ethical and moral foundations of HPER. Chapter 4 considers different methodological foundations and their meaning in designing and appraising quality in HPER. These foundations are then expanded on in exploring different approaches to HPER with their differing foundational ideas. Chapter 5 illustrates scientific foundations, Chapter 6 outlines realist foundations, Chapter 7 outlines interpretivist foundations, Chapter 8 explores critical foundations, and finally, Chapter 9 outlines pragmatic approaches and their associated foundations. The book closes by describing the foundations of participation in HPER communities and discourses, with Chapter 10 outlining the foundations of expressing and communicating HPER in putting studies together, Chapter 11 describing the foundations of disseminating HPER once a study has been completed, and Chapter 12 outlining the foundations of translating HPER into practice and the potential impacts thereof.
There are clearly many dimensions to the foundations of a field like HPER. However, when we speak of foundations, we imply coherence and contiguity among their constituent parts. As much as this book outlines where this contiguity can or might be found, like any area of human activity, there are also gaps and conflicts. Indeed, if HPER had been deliberately designed, it would not resemble the HPER we have today, which has evolved organically and haphazardly over time. A study of foundations can tell us how we got to where we are. To that end, we might employ concepts of morphogenesis or poststructuralist discourse analyses. A study of foundations can also tell us why it is we do what we do when we know it is not ideal. From this perspective, we might draw on bounded rationality theory to consider the symbolic orders within which we practice [2]. A study of foundations can get us to reappraise and deepen our understanding and commitment to what we do in terms of moral agency and paradigm (ideology). A study of foundations can help us to be more selective and critical of why we do what we do; many scholars change track mid-career once they develop deeper understandings of the foundations of their chosen field or paradigm. A study of foundations can also help us to better appraise the evidence base we draw on, all of which is inevitably made up of past events and historical thinking.
This book may, in your hands, do some, many, or all of these things. It may also take you to other places or lead you to question the foundations of why this book was written, how it was written, and what influence it might have. These are all good things. I encourage you to think about why it is you are reading this, and what it is you seek or hope to find in this book or through it. You should also think about the various worlds of HPER in which you live or that you hope to explore, not just in terms of how they are right now but where they came from and where they are going. To do that you must attend to foundations.
In closing, let me return to the idea of foundations as an investment in the future, as a way of protecting and nurturing that which is good (as in Isaac Asimov’s Foundation novels). Laying down a solid foundation is not just to react to the present but to protect against and to embrace whatever the future may bring. To that end, foundations are a form of stewardship, and they are a form of defence against attack and decay. They are also the basis of hope and continuity from which better things might be built. Either way, foundations are an investment in the future, and they are the investments one makes in those who will follow. Your foundations are your ancestors, but you put down foundations for those who will follow you. Your successors will stand on your shoulders, as you have stood on the shoulders of those who came before you. The foundations of science serve us, and they are us.
Rachel H. Ellaway
University of Calgary, Alberta,
REFERENCES
1. Norman G. Fifty years of medical education research: waves of migration.
Med Educ
. 2011;45(8):785–791.
2. Gigerenzer G. What is bounded rationality? In Viale R, ed.
Routledge Handbook of Bounded Rationality
. London and New York: Routledge; 2021:55–70.
About the Editors
Charlotte E. Rees BSc (Hons), GradCertTerEd (Mgt), MEd, PhD, PFHEA, FRCP (Edin)
Charlotte is Head of School, School of Health Sciences, The University of Newcastle, New South Wales, and Adjunct Professor, Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia. With over 20 years’ postdoctoral experience in health professions education and research, Charlotte has expertise in workplace learning, healthcare professionalism, identities, and transitions. She employs realist and interpretivist approaches including longitudinal qualitative research, narrative enquiry, and realist evaluation methods.
@charlreessidhu
Lynn V. Monrouxe BSc (Hons), PGDip, PhD, FAcadMEd
Lynn is Professor and Academic Lead for Healthcare Professions Education Research, and Convenor of Waranara (Healthcare Professions Education Research Network), The University of Sydney, New South Wales, Australia. After completing her PhD in cognitive linguistics using experimental methods, she has 20 years’ experience in health professions education and research. With expertise in professional identities, healthcare professionalism, and workplace learning, she employs realist, interpretivist, and pragmatic approaches including qualitative and quantitative methodologies. She is especially interested in interactional analyses (narrative, conversation, and discourse) using audio and video data.
@lynnmonrouxe
Bridget C. O’Brien BSc, MSc, PhD
Bridget is Professor of Medicine and Education Scientist, Center for Faculty Educators, University of California. San Francisco, San Francisco, USA. She has more than 15 years’ postdoctoral experience as a researcher and educator in health professions. Bridget’s research focuses largely on understanding and improving workplace learning among health professionals using interpretivist and pragmatic approaches that employ a variety of qualitative and mixed methodologies. She has also studied various aspects of publishing including authorship and peer review.
@bobrien_15
Lisi J. Gordon BSc, MSc, PhD, FHEA
Lisi is Senior Lecturer in the Centre for Medical Education, School of Medicine, University of Dundee, Scotland, UK. Lisi has 10 years’ experience as a physiotherapist, and 20 years as an educator including 10 years’ doctoral and postdoctoral experience in health professions education research. Her expertise focuses on transitions, leadership, diversity and inclusion, and identities. She employs interpretivist and critical approaches including longitudinal qualitative research, narrative enquiry, diary-based, and visual methods.
@lisigordon
Claire Palermo BSc, MNutDiet, MPH, GradCertHthProfEd, PhD, PFHEA, Fellow DA
Claire is Associate Dean (Teaching and Learning), Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia. With 10 years’ experience as a dietitian and 15 years each as a teacher and education researcher, Claire has expertise in competency-based education and assessment, and workforce development employing critical and pragmatic approaches (using qualitative methodologies especially).
@ClairePalermo
Author Contributions
This book represents the culmination of editors’ individual and collective efforts over many years; including years of conducting health professions education research (HPER), supervising others’ HPER, and teaching research philosophies, methodologies, and methods through workshops, short courses, and award-bearing courses like Masters and Doctorates in Health Professions Education.
Charlotte led the development of this book proposal in January 2020; based on work done in 2017 with Claire at Monash University to develop a five-day intensive course introducing learners to HPER. This initial book proposal was substantially improved through discussions with, and suggestions from, Lynn, Bridget, Lisi, and Claire, who helped shape the final book proposal submitted to, and accepted by, Wiley Blackwell.
At the start of this book-writing project, we agreed that this would be an edited textbook, but that Chapters 2–12 would be written and edited by at least one editor (often two), including one to three external contributors as co-authors, mostly early career researchers (ECRs). This was especially important to us because we wanted the book to be developed with and for those relatively new to HPER. And the more senior you get, the harder it is to put yourself in the shoes of an ECR. Indeed, our external contributors have been priceless in reminding us what is understandable, and what is not, throughout the process of writing this book.
In terms of the editors, we decided on editor order based on contribution (rather than alphabetical), but with Claire’s position as last author akin to senior author given the Monash-based genesis of the book. Charlotte led the overall book project, managing regular editorial meetings, progress, and timelines, and liaising with the publisher. She led the writing of five chapters (Chapters 1, 2, 5, 6, and 12), edited Chapters 3 and 13, and gave extensive feedback on the remaining chapters. She, along with Lynn, also edited the whole book. Lynn led the writing of three chapters (Chapters 3, 7, and 13), edited three others (Chapters 1, 6, and 12), gave feedback on additional chapters, took the book photographs, and worked with Anique on the book cover. Bridget led the writing of two chapters (Chapters 4 and 9), contributed to the writing and editing of one chapter (Chapter 11), edited another chapter (Chapter 3), gave extensive feedback on other chapters, and section-edited Part I of the book. Together with Charlotte and Lynn, Bridget managed our half-yearly webinars with external contributors. Lisi led the writing of Chapter 11, contributed to the writing and editing of another three chapters (Chapters 2, 7, and 8), and section-edited Part III of the book. Finally, Claire led the writing of two chapters (Chapters 8 and 10), edited another three chapters (Chapters 4, 5, and 9), gave extensive feedback on other chapters, and section-edited the largest part of the book (Part II). Claire also managed our book’s data repository and contributor email communications. All editors were involved in pulling together the Book Glossary, with involvement of all chapter authors. From an editorial perspective, we largely stuck to guidelines about writing style, tone, and level, as well as chapter formatting, in order to maintain consistency across the chapters and parts, thereby benefiting learners reading the whole book in chronological order. However, you will note some differences between chapters due to variations in writing style and chapter content: some chapters are more philosophical/theoretical; others are more practical.
All nineteen contributors to Chapters 2–12, provided illustrative cases for their selected chapters (thirty cases in total across the book representing diverse topics, approaches, methodologies/methods/theories, study participants, healthcare professions, and countries/regions). All contributors also commented on and/or edited their chapter, plus all bar one provided peer-review feedback for another chapter. Additionally, some contributors were more involved in the writing process, for example, about half wrote the first draft of a chapter section. Six of our chapter contributors (all early career researchers from Monash University) also peer-reviewed one of the three book parts: Part I (Dr Van Nguyen and Dr Mahbub Sarkar), Part II (Dr Jonathan Foo and Dr Olivia King) and Part III (Dr Louise Allen and Dr Ella Ottrey). They also worked together to co-author the Afterword for our book. Furthermore, as mentioned above, Dr Anique Atherley worked tirelessly on book cover designs. We include brief biographies for our contributors here (in alphabetical order):
Louise Allen BNutDiet (Hons), GradCertEdDes, PhD
Louise is Lecturer, Monash Centre for Professional Development and Monash Online Education, Monash University, Australia. She is a dietitian by background and an early career researcher having completed her PhD in 2020. Her PhD used a pragmatic approach to explore the broad impacts of continuing professional development in the health professions. She completed a Fulbright Postdoctoral Scholarship 2022/2023 furthering her research in continuing professional development and her qualitative research skills.
@Louise_Allen3
Lulu Alwazzan MD, MMEd, PhD
Lulu is Assistant Professor of Medical Education and Head of the Assessment and Examination Unit, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Saudi Arabia. With a medical degree and postgraduate medical education training, she is currently the chairperson of the Department of Medical Education. Having received her Medical Education PhD in 2019, her scholarly work examines leadership/leadership development and professional development using qualitative methods.
@Alwazzan_L
Anique Atherley MBBS, MPH, PGCUTL, PhD
Anique is Assistant Professor, Academy for Teaching and Learning, Ross University School of Medicine, Barbados. She is an early career researcher who received her PhD in Medical Education in 2021 through dual candidature with Maastricht University, Netherlands and Western Sydney University, Australia. Anique has been working in medical education research since 2012 and has interests in transitions, academic and research coaching, and using qualitative social network analysis, longitudinal qualitative research, and review methodology.
@aniqueatherley
Maria A. Blanco EdM, EdD
Maria is Associate Dean for Faculty Development and Associate Professor, Department of Psychiatry, School of Medicine, Tufts University, USA. In 2002, she earned her Masters in Education at Harvard Graduate School of Education, followed by a Doctor of Education in 2007. Maria has been an educator and researcher in health professions for more than 24 years. Her scholarly work covers various topics (e.g., mentoring, faculty development, diversity, equity, and inclusion) and involves qualitative and mixed methodologies.
@MariaABlanco1
Gabrielle BrandBN, MN (Research), PhD
Gabrielle is Associate Professor, Monash Nursing & Midwifery, Monash University, Australia. After gaining her PhD in 2013, Gabrielle focuses on narrative medicine, health humanities, and creative and critical pedagogy including co-design. She leads a health humanities research programme called Depth of Field, drawing on healthcare consumers’ voice (narrative) and art (narrative artefacts and visual methodologies) to co-design strengths-based, consumer-driven health professions workforce education resources.
@GabbyBrand6
Megan E.L. Brown MBBS(H), PGCHPE, PGCRT, PhD, FHEA
Megan is Senior Lecturer in Medical Education and Programme Lead for the Postgraduate Certificate in Medical Education, University of Buckingham, UK. She is also Teaching Fellow in Medical Education Research, Imperial College London, UK. With a medical background, she is now a full-time medical educator and researcher since her PhD completion in 2022. Her research interests include the philosophy of medical education, longitudinal learning, and professional identity, and using creative approaches to qualitative research.
@Megan_EL_Brown
Jeffrey J.H. Cheung HBSc, MSc, PhD
Jeffrey is Assistant Professor, Department of Medical Education, University of Illinois College of Medicine at Chicago, USA. He received his PhD in 2019 from The University of Toronto, Canada where he also completed his research fellowship at The Wilson Centre. Drawing on scientific approaches, his research primarily applies theories from cognitive psychology to clarify how educators can design learning experiences that better prepare learners for clinical practice, and how to assess learners’ capacity to be flexible with their knowledge/skills.
@CheungJJH
Anna T. Cianciolo BA, MA, PhD
Anna is Associate Professor of Medical Education, Southern Illinois University School of Medicine, USA and Editor-in-Chief of Teaching and Learning in Medicine. She ‘emigrated’ to medical education in 2011 after 10 years conducting performance-based training research/development for the US Army (PhD, 2001). Her research interests include small-group collaborative and peer-assisted learning, clinical teaching, learning and assessment, clinical reasoning, and scholarly professional development. She draws on diverse approaches/methodologies to investigate practical problems.
@cianciolo_anna
Paul E.S. Crampton BSc (Hons), MSc, PhD, SFHEA, FAcadMEd
Paul is lead for the Health Professions Education Unit (HPEU), Lecturer in Medical Education, and Programme Director for the MSc in Health Professions Education at Hull York Medical School, University of York, UK. Paul has been working in medical education since 2008 and gained his PhD in 2015. He has expertise in subjects such as interprofessional learning, professionalism, quality assurance, longitudinal placements, workplace learning, fitness to practice, and continuing professional development, drawing on diverse methodologies.
@pes_crampton
Jonathan Foo BPhysiotherapy (Hons), PhD
Jon is a Physiotherapist and Lecturer, Department of Physiotherapy, Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia. He is an early career researcher (PhD 2021) with a passion for optimising resource allocation – promoting research, education, and healthcare that makes best use of available resources. His quantitative work has primarily focused on the application of economic theory and methodologies, including within the context of health professions education research.
@JonFromAus
Ghufran Jassim BSc (Hons), MD (Hons), HPEC Diploma, MSc, PhD, ABMS, ICGP, Advance HE Fellowship Cert
Ghufran is Associate Professor and Head of Department of Family Medicine, Royal College of Surgeons in Ireland (RCSI), Bahrain. With a medical background, she received her PhD in 2014, and has recently completed the RCSI health education profession diploma programme and fellowship in advanced higher education. Her research interests include women’s health and medical education and her expertise is primarily with bioethics research including quantitative, qualitative, and review methodologies.
@Ghufranprof
Olivia A. King BPod (Hons), Grad Cert Diabetes Education, PhD
Olivia is Manager, Research Capability Building, Western Alliance and Adjunct Research Associate, Monash University, Australia. She is an early career researcher (PhD 2018) and is passionate about developing research capability in rural and regional health workforces. Her research interests include health professions education, allied health workforce, and sociology of the professions. Her expertise is primarily with qualitative methodologies.
@Oliviaaking
Van N.B. Nguyen BN, MN, PhD
Van is Lecturer, Monash Nursing & Midwifery, Monash University, Australia. For her PhD (conferred 2017), Van developed and validated the Clinical Nurse Educator Skill Acquisition Assessment (CNESAA) tool and is passionate about using this to explore factors contributing to nurse educators’ clinical teaching confidence. As an early career researcher, Van is interested in health professions education and workforce capacity building research, as well as expanding her expertise in diverse research methodologies.
@VanNBNguyen
Ella Ottrey BNutrDietet, BNut (Hons), PhD
Ella is Senior Research Fellow, Monash Centre for Scholarship in Health Education, Monash University, Australia. She has 10 years’ experience as a dietitian and three years’ postdoctoral experience in health professions education research, having completed her PhD in 2019. Ella has research expertise and interest in preparedness for practice, transitions into practice, and healthcare workforce development using interpretivist approaches.
@ellaottrey
Nicole Redvers BSc, ND, MPH
Nicole is a member of the Deninu K’ue First Nation in Denendeh (Northwest Territories, Canada) and has worked with Indigenous patients, scholars, and communities around the globe across her career. She is Associate Professor, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada. She is actively involved at regional, national, and international levels promoting the inclusion of Indigenous perspectives in both human and planetary health research and practice.
@DrNicoleRedvers
Eliot L. Rees MBChB, PGCert, MA, FHEA
Eliot is Lecturer in Medical Education, Keele University and National Institute for Health Research (NIHR) Academic Clinical Fellow in General Practice, University College London, UK. Eliot has been working in medical education research since 2012 and is submitting his PhD thesis in 2023. He has research expertise in selection, widening access, peer teaching, and primary care medical education using diverse approaches including quantitative, qualitative, and review methodologies.
@ELRees1
Mahbub Sarkar BEd (Hons), MEd, PhD, SFHEA
Mahbub is Senior Lecturer of Educational Research, Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia. Having gained his PhD in STEM Education in 2012, he made the transition to health professions education research in 2018. He has over 15 years’ experience researching educational issues from early years to undergraduate levels. His current research interests include developing employability capital for healthcare students and improving professional learning for university educators. He primarily employs qualitative and mixed methods approaches.
@MahbubS
Ahsan Sethi BDS, MPH, MMEd, PhD, FDTFEd, FAIMER Fellow, FHEA
Ahsan is Associate Professor and Programme Coordinator for the MSc in Health Professions Education, Qatar University, Qatar. He is also faculty at institutions internationally (e.g., University of Dundee, UK; Khyber Medical University, Pakistan). He completed his PhD in Medical Education (2016) at the University of Dundee. With over 12 years’ experience as a dentist, educator, and researcher, his research focuses on curriculum, assessment/accreditation, blended learning, and professional development. He largely draws on pragmatic approaches employing mixed methods.
@drahsansethi
Marieke van der Schaaf PhD
Marieke is Professor of Research and Development of Health Professions Education. She is Director of the Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht and of the Life Sciences Education Research PhD programme, Graduate School of Life Sciences, Utrecht University, Netherlands. She earned her PhD in 2005 and has interests in health professionals’ expertise development, feedback, and educational innovations. She uses a pluralism of approaches and methods (e.g., mixed-methods).
@MariekevdSchaaf
Acknowledgements
It takes a community to pull together an edited textbook, so we have numerous people and organisations (plus the odd pet) to thank here; without whom the book would have been challenging at best, impossible at worst.
First, we would like to thank our contributors (most of whom are early career researchers) for your wonderful inputs into Chapters 2–12 – for your writing, editing, and peer-reviewing. Across these chapters, we share over thirty diverse case studies based on our contributors’ (and our own) research. These case studies are diverse in terms of the health professions education (HPE) topics covered (e.g., teaching, learning, assessment, simulation, professionalism, professional identities, faculty development, transitions, well-being), the research approaches taken (i.e., scientific, realist, interpretivist, critical, and pragmatic) and methodologies/methods/theories employed, the study participants included (learners, educators, patients), the health professions researched (medicine, nursing, allied health), and countries/regions included (Asia-Pacific, Australia, Canada, Europe, Middle East, UK, USA). We would also like to thank the co-authors of the papers featured in the case studies (noting that our interpretations of these cases are ours alone and may not represent those of our co-authors). Returning to our contributors, we would especially like to thank seven who went beyond the call of duty in either helping us design the book cover (Dr Anique Atherley, Ross University School of Medicine, Barbados) or peer-review entire book sections (as well as chapters) and writing our book’s afterword. All from Monash University, we thank (in alphabetical order): Dr Louise Allen, Dr Jonathan Foo, Dr Olivia King, Dr Van Nguyen, Dr Ella Ottrey, and Dr Mahbub Sarkar. Extra thanks go to Ella for her detailed proofreading of the whole book. We are also hugely appreciative to Professor Rachel Ellaway, University of Calgary, for writing the book’s thought-provoking foreword – thanks Rachel for taking the time and for sharing your wisdom so generously. Lastly, in terms of our contributors, we would like to thank Associate Professor Narelle Warren, Monash University, for her peer review of the ethics chapter.
Second, we would like to thank our institutions for providing us with resources (e.g., time, IT, library) to develop, write, and edit this book: The University of Newcastle (Charlotte), Murdoch University (Charlotte), The University of Sydney (Lynn), University of California San Francisco (Bridget), University of Dundee (Lisi), and Monash University (Claire). We also thank our colleagues at these institutions for giving us the space to write, as well as allowing us to bounce our ideas off them. And we especially thank our colleagues in the Monash Centre for Scholarship in Health Education (Dr Olivia King, Dr Van Nguyen, and Dr Mahbub Sarkar), who helped two of us (Charlotte and Claire) co-create a five-day intensive course on health professions education research in 2017 on which this book proposal was based. We would also like to thank our research students, assistants, and fellows across our careers for putting our ideas on the spot – encouraging us to continuously think about and question research, how it ought to be done and why, and what that means for who we think we are (and ought to be) as researchers.
Third, we would like to thank the supportive and encouraging Wiley Blackwell team for commissioning the book, giving us feedback on the proposal, chapters, and book, and for helping us navigate (often COVID-related) challenges along the way. Thanks especially to James Watson (Commissioning Editor), Jenny Seward (Managing Editor), and Ella Elliot (Editorial Assistant).
Finally, we would like to thank our wonderful families and friends for their support and encouragement, and for reducing their expectations of our time and attention during two years of busy thinking, writing, and editing (often at unsociable hours). More specifically, our personal thanks go to:
Charlotte: Thanks to my chapter contributors (Lulu, Jeff, Paul, Jon, Olivia, and Van) – I have enjoyed learning with you and from you in the write-up of our chapters. Thanks as ever go to my enormously patient family – Sid and Kitty – who put up with considerable periods of inattention when I get into the zone of reading and writing. I love you both. And thanks to my Miniature Schnauzer Herbert whose twice-daily walks have kept me sane – during COVID and this book-writing project. Many of my best ideas happen on our shared walks and he is also good for cuddles. Finally, thanks to Lynn, Bridget, Lisi, and Claire; all of whom I have worked with previously but never all together before. You are formidable women – individually and collectively. Thanks for your insights, suggestions, advice, support, good humour, and your unwavering patience whenever I got my knickers in a knot about our book progress and timelines.
Lynn: First and foremost, I would like to thank you, Charlotte: for your strength in leadership for the team across the many months of work (intellectually and emotionally). It is never easy working with a team of strong-minded academics, and at times I am sure it felt like you were herding cats. But here we are, on time, within the word limit and more knowledgeable for it. I would also like to thank my other co-editors, and sometimes co-authors: Bridget, Claire, and Lisi. Always supportive, always communicative, always a pleasure to work with. Thanks too for my early-career co-authors: Ella, Megan, Olivia, Paul, and Van. Learning with you, and about your work, is a delight. For inspiring work on the book illustrations, I would like to thank Anique. Thanks also to my Waranara colleagues for stimulating conversations (and occasional references) to help my thinking. Finally, there is Foohey (my Greyhound), sitting beside me, always reminding me that five o’clock walkies are more important than writing (in his world, at least!).
Bridget: When I joined the team of editors and authors on this book, I broke my promise to decline any more book projects. I am so glad I did. Working with an international team of editors (Charlotte, Claire, Lisi, and Lynn) and co-authors (Anique, Anna, Eliot, Ghufran, Louise, and Marieke) has been an incredibly rewarding and enriching experience. It makes me truly excited for the future of health professions education research and I am grateful for the opportunity. I also wish to thank my partner Damian, my pup Maddie (who occasionally shares her perspective during our meetings), and my colleague and mentor at UCSF, Patricia O’Sullivan, who now knows almost as much about pragmatic approaches as I do. Finally, I thank the editors for converting my American English to British – ‘z’s’ are starting to look foreign to me and ‘u’s’ are popping up all over the place!
Lisi: I would like to start by thanking co-editors Charlotte, Bridget, Claire, and Lynn for inviting me to share this adventure – you are all such brilliant academics, I still feel a bit star struck! Thanks to my co-writers (Anique, Anna, Ella, Gabrielle, Lulu, Megan, and Nicole); I have learned so much from you all. There are so many colleagues who have supported my academic career; I thank you all. I want to especially mention Professors Charlotte Rees, Divya Jindal-Snape, and Martina Sliwa, whose encouragement and belief in me (even when I wobble) has led me to do things I did not think I could. Finally, my husband, Iain, my ‘little’ boys Dougie and Fergus (both of whom grew past six foot during the writing of this book), and my friends: the ‘Bookless Club’ ladies (Amy, Anna, Fiona, Heather, and Susie). Your love and laughter are the touchstones that have kept me grounded.
Claire: I would especially like to thank Charlotte for having the idea for this book and making it happen. Thanks also go to my chapter co-authors (Jeff, Jon, Eliot, Gabby, Nicole, Maria, and Mahbub). I would like to thank Wayne Hodgson and Michelle Leech for their continued belief in me and for encouraging me to take on the challenge of working at the Monash Centre for Scholarship in Health Education. A very special thanks to Charlotte who significantly advanced my 10 years’ postdoctoral experience as a health professions education researcher and developed my capabilities so much further. The time you invested in me, and your honest and timely feedback has developed me in more ways than you probably realise. Thanks to Carl, my husband, for being my biggest fan. To the rest of the editorial team, thank you for having me along this journey with you and for all your hard work and critique.
CHAPTER1Introducing Foundations of Health Professions Education Research
Charlotte E. Rees1,2 and Lynn V. Monrouxe3
1 The University of Newcastle, Callaghan, New South Wales, Australia 2 Monash University, Clayton, Victoria, Australia 3 The University of Sydney, Camperdown, New South Wales, Australia
Health professions education research (HPER) matters: it involves the creation and sharing of new knowledge about healthcare students and professionals’ education and development. HPER considers a plethora of topics from student admission to healthcare professionals’ (HCPs’) retirement; with the aim of not only developing HCPs for their own benefit, but also for the benefit of others and organisations. Research priorities across HPER internationally, therefore, point towards diverse topics (e.g., preparedness for practice, transitions, assessment/feedback, workplace learning, educational methods) for the improvement of student learning and well-being, graduate employability, evidence-based education, organisational cultures, as well as addressing current challenges with education, policy, and political agendas [1–13]. Ultimately, HPER is about making better practitioners to improve patient health, safety, and well-being.
Based on the collective research supervision, teaching, and mentoring experiences of our interdisciplinary and international editorial team, we know that the number of individuals wanting to conduct HPER for the first time is increasing, and that existing HPE researchers want and need to improve the quality and impact of their HPER. Furthermore, our experience is backed up by evidence of: ‘a solid increase of publications, numbers of specialized journals, professional associations, national and international conferences, academies for medical educators, masters and doctoral courses, and the establishment of many units of HPE scholarship’ [14 p. 510]. Therefore, foundational guides such as this book serve to help novice and more experienced HPE researchers alike to build their understanding of the principles, perspectives, and practices of HPER. Using the latest evidence-based theoretical and methodological thinking, illustrated through our numerous case studies (including from early-career researchers), this down to earth guide will help build your capabilities in HPER; improving the quality and impact of your research.
In this introduction chapter, we clarify what we mean when we say research in section 1.1, and outline two key purposes of HPER in section 1.2. In section 1.3, we discuss past and future trends in HPER methods. In section 1.4, we discuss why you should read this book and how. Finally, in section 1.5, we outline what the book comprises. We hope this book will facilitate a smooth navigation of your HPER journey – helping you to choose your preferred route, as well as manage any inevitable detours (or potholes) along the way.
1.1 HEALTH PROFESSIONS EDUCATION RESEARCH (HPER)
Research is: ‘a process of investigation leading to new insights, effectively shared’ [15 p. 60]. But not all educational investigations offering insights are research [16]. It is therefore important that you understand what HPER is and what it is not. Educational research typically applies, tests, and/or builds theory (see Chapter 2). Educational research also involves systematic, rigorous, and peer-reviewed methodologies and methods with careful sampling, data collection, and analysis (see Chapters 5–9). We can contrast this with teaching evaluation activities that you might engage in for the purpose of developing your own practice. While an important activity, such work typically involves quick, non-systematic educational evaluations employing non-validated scales [17, 18]. We can also contrast education research with other published work such as commentaries, practical tips for educators, and education innovation dissemination [16]. The primary focus of educational research is the discovery of generalisable knowledge to benefit other researchers, with any resulting applications at the national and even international levels. This contrasts with teaching evaluations that focus on applying findings to your own local practice: making judgements about specific programmes within specific contexts [18–20]. This is not to say that HPER simply focuses on building new knowledge and theory for other researchers. HPER is a highly applied field continuously looking to make improvements to educational practice and policy (see Chapter 12).
1.2 WHAT ARE THE PURPOSES OF HPER?
Two key purposes of HPER can be seen as sitting at opposite ends of the same continuum: (1) to generate new knowledge; and (2) to improve education [19]. At the knowledge generation end of the continuum, research focuses on producing findings for other research producers (i.e., researchers). Consequently, research problems are defined by researchers (often due to gaps in knowledge). The focus here is on creating knowledge and theory, with other researchers evaluating research quality through peer review (see Chapter 4) [19, 21]. At the other end of the continuum, research centres on producing findings for research users (e.g., practitioners, policymakers, students) with research problems being typically defined by practitioners (often due to current problems with education). The focus here is on solving such educational problems through research, with users evaluating research quality through its uptake and use (see Chapter 12) [19, 21]. It is therefore important at the outset of your HPER that you understand the purpose(s) for conducting your project and where you sit on the continuum: is your primary purpose to generate new knowledge, is it to improve education, or is it to do both? Indeed, most HPE researchers nowadays (and we include ourselves in this camp) try to marry theory and practice in our HPER by making novel contributions to educational knowledge and/or theory and making a difference to education through improving educational practice and/or policy. It is not unusual for educational scholars to occupy multiple different roles: for example, as teachers, assessors, curriculum developers, educational leaders, educational policymakers, and educational researchers. Each of these roles we occupy might place us in various and changing positions on this producer–user continuum. It is therefore not uncommon that your position might shift on this continuum depending on context (e.g., different projects), the role you occupy (e.g., teacher in this project, leader in another project), or different time periods.
1.3 WHAT ARE THE TRENDS IN HPER METHODS?
In the UK and USA, the emergence of HPER occurred throughout the early- to mid-twentieth century triggered by multiple factors, not least policy-driven, including the: Atherlone, Goldmark, Wood, and Brown (UK/US nursing) [22], Flexner and Gies (US medicine and dentistry) [23], and Nuffield (UK pharmacy) reports [24]. Other contributing factors comprised the growing importance of scientific research, increased funding, journals, and publications for educational research, and calls for research accountability [25–31]. This has led the field to both retrospectively and prospectively consider trends in HPER topics and related approaches to develop strategic, forward-thinking HPER. And while research has tended to focus mainly on the whats of HPER (e.g., past topics under study and future needs), there is a select body of work that comments on trends in research approaches. Thus, commentaries and studies across a range of HPE disciplines, employing a variety of methods (e.g., bibliometrics, content analysis, critical discourse analysis, narrative review, scoping review, social network analysis, text network analysis), have examined HPER internationally across a time period of over fifty years (1963–2022) [29, 31–44]. Within this work, two key trends have been identified.
Firstly, there appears to be a distinct shift from primarily empirical research conducted within a positivist framework (see Chapter 5), towards the inclusion and acceptance of a wider range of research approaches (see Chapters 6–9) [26, 34, 37, 42, 43]. Indeed, due to the influence of clinically or experimentally trained researchers, it has been commonplace to: ‘methodological[ly] transplant’ [34 p. 14] gold-standard research approaches from those clinical fields to educational research [45]. So, the early years of HPER were dominated by randomised control trials (RCTs) and experimental methodologies (see Chapter 5). Over this lengthy time period, HPER has been influenced by psychology, thereby focusing on individuals (i.e., learners or teachers) [31]. Indeed, a great deal of early research has employed scientific approaches (see Chapter 5) focusing on programme effectiveness (i.e., justification studies) [46], rather than studies exploring what works, how, and why (i.e., description or clarification studies) [31, 44, 46–48]. Although this culture continues in some geographical and disciplinary domains [32, 38, 44], over the years, researchers from a wider range of disciplines have joined the field. And this has triggered the discipline’s developing interest in wide-ranging topics: ‘there is now a stronger emphasis than ever before on the need for multifaceted approaches to the diverse issues’ [42 p. 31]. Indeed, it is clear to many of us with long-standing editorial and peer-reviewer roles that the last decade has seen a considerable rise in qualitative HPER, as well as non-experimental quantitative research [30, 49]. Furthermore, recent work (spanning 2000–2020) has identified the key role played by sociology in examining socialisation, professions, social control, knowledge production, and stratification, alongside examining the field of HPER itself [36]. Clearly, this trajectory of HPER approaches reflects a broader shift whereby: ‘educational researchers have moved into … systems, classrooms, and workplaces and have found a complex and multifaceted world that they feel is not well described by traditional research techniques’ [50 p. 35]. This shift has moved educational researchers to consider a wide range of research approaches enabling a greater understanding of the complexity of HPE systems. For example, promotion of realist approaches to evaluate complex interventions in areas such as simulation-based education (see Chapter 6) [35].
Secondly, responding to calls for greater evidence in HPE and the explosion of new HPER, there has been a growth in articles using a range of knowledge syntheses approaches (e.g., literature reviews, bibliometric reviews) [31, 33, 39, 40, 51, 52]. For example, in the largest study of its kind in HPER, Maggio et al. [39] conducted a bibliometric analysis to characterise the frequency, types, and patterns of knowledge synthesis publications in medical education across twenty years (1999–2019). From the 963 studies identified, they found a 2620% increase over that period in knowledge synthesis articles, compared to an overall increase of 204% for non-knowledge synthesis articles. Systematic and critical reviews were present at the beginning of the period, with realist and scoping reviews being published from 2010 and 2011 respectively.
1.4 WHY SHOULD YOU READ THIS BOOK AND HOW?
As mentioned above, this book serves to help you build your understanding of the fundamentals (i.e., principles, perspectives, and practices) of HPER. We have pitched this book at readers who are novice HPE researchers, as well as more experienced HPE researchers who want to better understand the fundamentals of less-familiar approaches. So, if you are studying postgraduate qualifications (e.g., Masters, PhD) in HPE, or if you are an experienced biomedical or clinical researcher wanting to conduct educational research for the first time, this book is for you. This book is also for you if you are an experienced HPE researcher with responsibilities for supervising students or teaching HPER methodology/method courses. Indeed, the original idea for this book was inspired by one of our own courses (based at the Monash Centre for Scholarship in Health Education, Monash University) and triggered by our desire to develop a foundational guide to recommend to our own students in degree-awarding programmes (e.g., Masters, PhD) and non-degree short courses (e.g., continuing professional development). Therefore, we set out to ensure that this book is broad in its scope, focusing on HPER (not just medical education research) with global relevance. With a multidisciplinary, international authorship team, the book draws on literature and case studies from diverse countries (including Western and non-Western cultures) and healthcare professions (including dentistry, dietetics, medicine, nursing, pharmacy, physiotherapy, and others).
We believe that this book is unique compared to other texts currently available. Firstly, our book focuses on the key foundations of HPER, so privileges principles, perspectives, and practices rather than providing a how-to methods textbook (we recommend that novice readers read our book as a prelude to how-to methods texts). The uniqueness of our approach, in terms of the scope of our book, means that you can use this as a guide as you design, develop, conduct, and publish your research. Furthermore, we have written this book for, and most importantly with, early-career HPE researchers across the globe, to ensure that each chapter is maximally appropriate and relevant to our primary audience. Additionally, aligned with others’ suggestions of broadening the scope of HPER to give more attention to interactional and organisational levels, and perspectives from sociology, economics and so on [31], we include some novel chapters not yet appearing in other texts (e.g., realist approaches, critical approaches, pragmatic approaches, research impact). Each chapter aims to facilitate your learning. While Chapters 1 and 13 do so by providing you with the necessary introductory material and discussing synergistic elements across the chapters, bringing together key recurring themes, the remaining chapters offer examples and exercises to stretch your mind. And while we cover significant foundational ground, we encourage you to make links and connections between that theory and your own and others’ HPER throughout.
Thus, Chapters 2–12 start with learning outcomes, and contain several case studies from our own research (including examples of Masters and PhD research), bringing concepts to life. These chapters also include ‘pause and reflect’ activities, ‘stop and do’ activities, and recommended reading. We therefore anticipate you engaging actively with each Chapter’s learning processes. Chapters can be read as stand-alone depending on what best suits your needs during your learning journey; however, we have written the book to be read chronologically with Part I (Principles) foundational to Part II (Perspectives), and Part II foundational to Part III (Practices). All chapters include links to earlier and later chapters to help you make connections between them, and to guide your decision-making around which chapter to read next should you not adopt a chronological reading approach.
1.5 OVERVIEW OF THE BOOK
Our book is organised in three parts, with Part I (Chapters 2–4) providing a synopsis of HPER principles, Part II (Chapters 5–9) giving an overview of key perspectives to HPER, and Part III (Chapters 10–12) presenting cross-cutting practices in HPER. Thus, our opening chapter in Part I, Chapter 2, will help you better understand what theory is, the different purposes of theory, and the challenges in applying theory in HPER. It will facilitate your appraisal of the different ways theory can be employed in HPER and reflect critically on theories relevant to your own research. Chapter 3 will help you understand why it is necessary to consider ethics in HPER, analyse key theoretical ethical perspectives in HPER, and summarise the practical elements of doing ethical research (including the role of institutional review boards, research ethics committees, and codes of conduct). It will also enable you to review key issues around research integrity in HPER. Chapter 4
