Researching Medical Education E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
RESEARCHING MEDICAL EDUCATION Researching Medical Education is an authoritative guide to excellence in educational research within the healthcare professions presented by the Association for the Study of Medical Education and AMEE. This text provides readers with key foundational knowledge, while introducing a range of theories and how to use them, illustrating a diversity of methods and their use, and giving guidance on practical researcher development. By linking theory, design, and methods across the spectrum of health professions education research, the text supports the improvement of quality, capacity building, and knowledge generation. Researching Medical Education includes contributions from experts and emerging researchers from five continents. The text includes information on: * Developing yourself and your practice as a health professions education researcher * Methods and methodologies including ethnography/digital ethnography, visual methods, critical discourse analysis, functional and corpus linguistics, critical pedagogy, critical race theory and participatory action research, and educational neuroscience methods * Theories including those where relationships between context, environment, people and things matter (e.g., complexity theory, activity theory, sociomateriality, social cognitive theories and participatory practice) and those which are more individually focused (e.g., health behaviour theories, emotions in learning, instructional design, cognitive load theory and deliberate practice) * Includes 10 brand new chapters Researching Medical Education is the ideal resource for anyone researching health professions education, from medical school to postgraduate training to continuing professional development. "This is an extraordinary text that combines theory and practice in medical education research. The authors represent the who's who of medical education research, and their wisdom and insights will help guide novice and experienced researchers alike." --David M. Irby, Professor Emeritus of Medicine, University of California, San Francisco, USA "Research in health professions education is maturing. This is clearly evidenced by the second edition of Researching Medical Education. In 30 chapters this book takes you on an exciting voyage on research theories and research methodologies. This book is a comprehensive resource for anyone engaging in research in health professions education." -- Cees van der Vleuten, former Director of the School of Health Professions Education, Maastricht University, The Netherlands
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Veröffentlichungsjahr: 2022
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Table of Contents
Cover
Title Page
Copyright Page
List of contributors
Foreword
Foreword from ASME
Foreword from AMEE
Preface
Words of Recommendation
PART I: Developing your practice as a health professions education researcher
1 Exploring, measuring or both: considering the differences between qualitative, quantitative and mixed methods research
Philosophical differences
Comparing research design in quantitative, qualitative and mixed methods research
Data collection methods
Data management
Data analysis
Judging the quality of research
Conclusion
Recommended reading
References
2 Theory in health professions education research: the importance of worldview
The purpose of education research
The importance of worldview to study design
Personal assumptions and worldview
The relationship between theory and research
Conclusion
References
3 Constructivism: learning theories and approaches to research
Distinguishing constructivism from positivism: a review of important terminology
Constructivist theories of learning
Constructivist approaches to research
Five research examples of constructivist research traditions
Methods commonly used within constructivist research approaches
The role of the researcher within the constructivist paradigm
Approaches to ensure quality and rigour of research
Important points and common pitfalls
Conclusion
References
4 Widening access to medicine: using mid‐range theory to extend knowledge and understanding
Increasing diversity in medical schools
There is nothing as practical as a good theory
43
Theoretical trends in widening access research
Wave 4: Looking ahead
Conclusion
References
5 Developing the research question: setting the course for your research travels
Why a research question?
The research question under the microscope
The ‘good’ research question
Developing the research question
Refining the research question
Conclusion
Recommended reading
References
6 Researching technology use in health professions education: questions, theories, approaches
What?
Who?
Where, when, how?
Why?
Theorising technology use
Methodologies
Study designs and methods
Conclusion
Recommended reading
References
7 Power analyses: planning, conducting and evaluating education research
Compute and report effect sizes with confidence intervals
Practicalities and pitfalls
Conclusion
References and resources
8 Navigating health professions education research: exploring your researcher identity, research area and community
Why are
you
doing research?
Why are you doing
this
research?
Where
are you doing research?
Interrelated questions and intentional answers
Recommended reading
References
9 How to tell compelling scientific stories: tips for artful use of the research manuscript and presentation genres
Writing up
Presenting your work
Presenting virtually
Communicating science on social media
Conclusion
Recommended reading
References
PART II: Methodologies and methods for health professions education research
10 What is known already: reviewing evidence in health professions education
Introduction
Evidence‐based and best evidence
‘Systematic review’ vs reviews that are ‘systematic’
The methodological pillars of ‘systematic’ reviews in health professions education
Specific review traditions
Conclusion
References
11 Qualitative research methodologies: embracing methodological borrowing, shifting and importing
Methodological borrowing
Qualitative description
Methodological shifting
Grounded theory
Methodological importing
Discourse analysis
Conclusion
Recommended reading
References
12 Attuning to the social world: ethnography in health professions education research
History and context of ethnography
Focused ethnography
Autoethnography
Going online: digital ethnography
Conclusion
Recommended reading
Acknowledgements
References
13 Visual methods in health professions research: purpose, challenges and opportunities
Using visuals in health professions education research
When to use visual methods and why
What do visual methods look like? Epistemological roots and key features
How to use visual methods
Challenges of using visual methods
Conclusion – and new frontiers
Recommended reading
References
14 Critical discourse analysis: questioning what we believe to be ‘true’
What is a discourse
Why is discourse important?
Discourse analysis
Opening the can of worms
Limitations of and alternatives to foucauldian discourse analysis
A return to the curriculum problem
Conclusion
Recommended reading
References
15 Functional and corpus linguistics in health professions education research: the study of language in use
Functional linguistics in health professions education research: making choices to make meaning
Corpus linguistics in HPE research: a pragmatic, accommodating approach to language in use
Conclusion
Recommended reading
References
16 Challenging epistemological hegemonies: researching inequity and discrimination in health professions education
Moving from numbers to words: a plea for theory–praxis linkage
Equity seeking versus sovereignty seeking groups: indigeneity and decolonising health professions education research
Critical pedagogy – researching praxis towards social justice
Critical reflexivity and inclusive anti‐racist research in health professions education
Transformational methodologies for greater social justice in medical education
Conclusion
References
17 Educational neuroscience: current status and future opportunities
Research methods in educational neuroscience
Educational neuroscience in practice
Conclusion
References
PART III: Theory informing health professions education research
18 Sticking with messy realities: how ‘thinking with complexity’ can inform health professions education research
Part I: Introduction and deliberations
Part II: Application
Part III: Considerations
References
19 Getting active: using activity theory to manage change
Philosophical position
Theoretical concepts
Expansive learning
Case study 1: pandemic‐induced change in primary healthcare activity
Getting practical: change laboratory
Case study 2: OSCEs as activity system
Where AT fits with other theories
Strengths and limitations of AT
Conclusion
Recommended reading
References
20 Attuning to materiality: sociomaterial research in health professions education
Why researching matter matters
Examples of research and synthesis of underpinning principles
Sociomaterial theories
Research approaches
Post‐qualitative research
Sociomaterial ethnography
What is the role of interviews?
Document analysis and interview‐adjacent methods
Analytic methods
The role of the researcher in sociomaterial research
Conclusion
Recommended reading
References
21 Social cognitive theory: thinking and learning in social settings
Theoretical foundations of SCT
Situated cognition, distributed cognition, ecological psychology, situated learning and landscapes of practice: theory and principles
Examples of applying SCT in healthcare professions education
Conclusion
References
22 Learning and participatory practices at work: understanding and appraising learning through workplace experiences
Key conceps, definitions and distinctions
Learning through clinical practice
Investigating participatory practices in healthcare
Advances, cautions and limitations
Conclusion
Recommended reading
References
23 Health behaviour theories: a conceptual lens to explore behaviour change
What health behaviour theories offer to HPE research
The origins of health behaviour theories
How HBT has informed HPE research
Theory of reasoned action (TRA), theory of planned behaviour (TPB), integrated behavioural model (IBM) and reasoned action approach (RAA)
Transtheoretical model (TTM)
PRECEDE‐PROCEED model
Theoretical domains framework
Eclectic approaches
Practical and research implications of using HBTs
Conclusion
Recommended reading
References
24 Self‐regulated learning in health profession education: theoretical perspectives and research methods
Defining self‐regulation and self‐regulated learning
Core assumptions and common features of SRL theories
Related concepts in HPE
Two influential SRL perspectives
Methods for studying SRL in HPE
Future directions in SRL theory, research and practice
Conclusion
References
25 Emotions and learning: cognitive theoretical and methodological approaches to studying the influence of emotions on learning
Defining the terms
Conceptual foundations
Theoretical approaches
Mechanisms of action
Inducing and measuring emotions
Recent explorations of, and future directions for, emotion in medical education
Conclusion
References
26 Research on instructional design in the health professions: from taxonomies of learning to whole‐task models
The ADDIE model
The analysis phase
The design and development phases
The implementation and evaluation phases
Conclusion
References
27 Cognitive load theory: researching and planning teaching to maximise learning
Introduction
Cognitive architecture
Cognitive load: the basics
Cognitive load: recent developments
On the measurement of cognitive load
Cognitive load effects
Conclusion
Acknowledgement
References
28 Deliberate practice and mastery learning: origins of expert medical performance
Powerful medical education
Deliberate practice and mastery learning
Deliberate practice
Mastery learning
Medical education examples
The road ahead
Conclusion
Acknowledgement
References
29 Closing comments: building and sustaining capacity
The initial steps
Building a sustainable research programme
Conclusion
References
30 Conclusion
References
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 The hypothesis
Table 1.2 Types of quantitative design
Table 1.3 Independent and dependent variables in quantitative research
Table 1.4 Criteria for judging research
Table 1.5 Key characteristics of quantitative, qualitative and mixed method...
Chapter 2
Table 2.1 Summary of three worldviews. Adapted from
7–11
Chapter 3
Table 3.1 Dimensions for comparing five research traditions in qualitative ...
Table 3.2 Four elements of constructivist reflexive research practice (from
Table 3.3 A summary of quality and authenticity criteria in constructivist ...
Chapter 5
Table 5.1 The guises and objectives of research questions: in relation to a ...
Chapter 7
Table 7.1 An example of reporting effect sizes with 95% confidence intervals...
Chapter 10
Table 10.1 Comparing traditional reviews, ‘systematic reviews’and ‘systemati...
Table 10.2 The four major paradigms (see also chapters by MacLeod, Burm and ...
Table 10.3 Types of information which may be reported to describe primary st...
Table 10.4 Quality assessment tools
Table 10.5 When is a scoping review appropriate, or not
Chapter 13
Table 13.1 Data collection process
Table 13.2 Ethical considerations
Chapter 14
Table 14.1 Critical approaches
Table 14.2 Critical discourse analysis process
Table 14.3 Discourse analysis of ‘diabetes care’
Chapter 15
Table 15.1 The systemic functional approach to meaning making
Table 15.2 Health professions education studies and the three metafunctions...
Chapter 17
Table 17.1 Different methods, typical outcome variables and examples of outc...
Chapter 18
Table 18.1 Simple linear, complicated linear and complex problems
Table 18.2 The main features of complex systems, introducing new terms that ...
Table 18.3 Use of ‘bottom line’ complexity concepts
Chapter 23
Table 23.1 Theoretical domains framework, applied to adoption of WBA as beh...
Chapter 24
Table 24.1 Four core features of SRL theories
Table 24.2 Strengths and limitations of four individual methods and one mult...
Chapter 25
Table 25.1 Definitions of affect, mood and emotion
Table 25.2 Commonly used self‐report measures of emotions
Chapter 26
Table 26.1 Cognitive task analysis
Table 26.2 Research on learning tasks: five themes
Chapter 27
Table 27.1 Examples of shock organised by category
Chapter 28
Table 28.1 Twelve features of powerful medical education
List of Illustrations
Chapter 1
Figure 1.1 Word clouds of quantitative and qualitative language.
Chapter 3
Figure 3.1 Constructivist outlooks on learning and development
Chapter 4
Figure 4.1 Bridging role of mid‐range theory in the circle of enquiry
Chapter 5
Figure 5.1 The purpose of distillation is to separate a specific liquid, the...
Figure 5.2 A graphic representation of a conceptual framework affords the re...
Chapter 6
Figure 6.1 A logical flow of designing a study. Taking this approach, you st...
Figure 6.2 Three axioms of using theory in research. Left: Theory and empiri...
Figure 6.3 The METRICS model of domains and purposes of inquiry.
27
/ PD CC BY...
Chapter 7
Figure 7.1 Smallest effect size detectable with 80% power for sample sizes u...
Chapter 9
Figure 9.1 Signalling the journal’s values
Figure 9.2 Literature review as a portrayal of conversational turns
Figure 9.3 Laying out the problem, the gap and the hook
Figure 9.4 Establishing the gap in a well‐studied field
Figure 9.5 Keywords as characters in your story
Figure 9.6 Storytelling during presentations
Chapter 13
Figure 13.1 Superman installation using rich pictures
Figure 13.2 Glegg proposed typology of the purposes of visuals from
21
/SAGE P...
Figure 13.3 Example of a rich picture' On one edge, I've written “the patien...
Figure 13.4 Patient photograph of research articles she brought to her clini...
Figure 13.5 Physician photograph metaphorically (a deer in the snow) illustr...
Chapter 15
Figure 15.1 Worked example of study design from Konopasky and colleagues’
‘I
...
Figure 15.2 Example conversion mixed methods study using corpus linguistics ...
Chapter 16
Figure 16.1 The formal curriculum, the informal curriculum and the hidden cu...
Chapter 19
Figure 19.1 Activity system
Figure 19.2 Interacting activity systems
Chapter 20
Figure 20.1 The materiality of distributed medical education
Figure 20.2 The mannikin – technical, physical and human
Chapter 21
Figure 21.1 The schematisation of the reciprocal interactions among the thre...
Figure 21.2 Individual and identity formation in a community of practice and...
Chapter 23
Figure 23.1 Framework for organising the relationship between factors at var...
Figure 23.2 Health belief model.
Figure 23.3 Theory of planned behaviour. Dashed lines illustrate some additi...
Figure 23.4 Transtheoretical model
Figure 23.5 The PRECEDE model. Adapted from
62,
,
63
,
Figure 23.6 The mechanism factors mediating the relationship between assessm...
Chapter 24
Figure 24.1 A three‐phase, cyclical model of SRL. This model is adapted from...
Chapter 26
Figure 26.1 The ADDIE model
Figure 26.2 Part of a skills hierarchy for performing a nephrostomy (recurre...
Chapter 27
Figure 27.1 The relationship of cognitive load types and working memory reso...
Figure 27.2 The working memory depletion effect and the contribution of affe...
Chapter 28
Figure 28.1 Improvement to mastery level on checklist completion percentage ...
Guide
Cover Page
Title Page
Copyright Page
List of contributors
Foreword
Foreword from ASME
Foreword from AMEE
Preface
Words of Recommendation
Table of Contents
Begin Reading
Index
WILEY END USER LICENSE AGREEMENT
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Researching Medical Education
Second Edition
EDITED BY
Jennifer Cleland
Professor of Medical Education
Lee Kong Chian School of Medicine
Nanyang Technological University
Singapore
Steven J. Durning
Professor of Medicine and Health Professions Education
Uniformed Services University
Bethesda, Maryland, USA
This second edition first published 2023© 2023 The Association for the Study of Medical Education (ASME). Published byJohn Wiley & Sons Ltd.
Edition History© John Wiley & Sons Ltd (1e, 2015)
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Jennifer Cleland and Steven J. Durning to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
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List of contributors
Abigail KonopaskyAssociate ProfessorGeisel School of MedicineDartmouth CollegeHanover, New Hampshire, USA
Adam GavarkovsInstructional DesignerInstitute of Health Policy, Management and EvaluationUniversity of TorontoOntario, Canada
Adam SzulewskiAssociate ProfessorDepartments of Emergency Medicine and PsychologyQueen's University, KingstonOntario, Canada
Alan BleakleyLife Emeritus Professor of Medical EducationUniversity of PlymouthPlymouth, UK
Andrea McKivettLecturerAdelaide Rural Clinical SchoolThe University of AdelaideAdelaide, South Australia, Australia
Anique de BruinProfessorDepartment of Educational Development and ResearchSchool of Health Professions EducationMaastricht UniversityMaastricht, The Netherlands
Anke SambethAssistant ProfessorDepartment of Neuropsychology and PsychopharmacologyMaastricht UniversityMaastricht, The Netherlands
Anna MacLeodProfessor and Director of Education ResearchFaculty of MedicineDalhousie UniversityHalifax, Nova Scotia, Canada
Anthony R. Artino Jr.Professor and Associate Dean for Evaluation and Educational ResearchSchool of Medicine and Health SciencesGeorge Washington UniversityWashington DC, USA
Ayelet KuperAssociate Director, The Wilson Centre, University Health NetworkAssociate Professor, Department of MedicineUniversity of TorontoToronto, Canada
Brett A. DiazResearch Fellow, The Wilson CentrePost‐Doctoral Researcher, Centre for Faculty DevelopmentUniversity of TorontoToronto, Ontario, Canada
Cees van der VleutenProfessorSchool of Health Professions EducationMaastricht UniversityMaastricht, The Netherlands
Champion N. NyoniSenior LecturerSchool of NursingUniversity of the Free StateBloemfontein, South Africa
Christina St‐OngeProfessorDepartment of MedicineCentre for Health Sciences EducationFaculty of Medicine and Health Sciences EducationUniversité de SherbrookeSherbrooke, Quebec, Canada
Christy NobleClinical Learning and Assessment LeadAcademy for Medical EducationFaculty of MedicineThe University of QueenslandHerston, Queensland, Australia
Cynthia WhiteheadDirector, The Wilson Centre, University Health NetworkProfessor, Department of Family and Community MedicineUniversity of TorontoToronto, Canada
Dario TorreProfessor of MedicineDrexel University College of MedicinePhiladelphia, USA
David TaylorProfessor of Medical Education and PhysiologyGulf Medical UniversityAjman, United Arab Emirates
Diana H.J.M. DolmansProfessorSchool of Health Professions EducationMaastricht UniversityMaastricht, The Netherlands
Emily FieldResearch AssociateCentre for Education Research and InnovationSchulich School of Medicine and DentistryWestern University, LondonOntario, Canada
Erik DriessenProfessor of Medical EducationMaastricht UniversityMaastricht, The Netherlands
Francois CilliersProfessorDepartment of Health Sciences EducationUniversity of Cape TownCape Town, South Africa
Fred PaasProfessor of Educational PsychologyInstitute of PsychologyErasmus UniversityRotterdam, The Netherlands
Helen ReidClinical Senior LecturerCentre for Medical EducationQueen’s University BelfastBelfast, Northern Ireland
Janet AlexanianSenior Research AssociateSt. Michael’s HospitalToronto, Ontario, Canada
Janneke M. FrambachAssistant ProfessorSchool of Health Professions Education (SHE)Maastricht UniversityMaastricht, The Netherlands
Jennifer ClelandProfessor and Vice‐Dean of Medical EducationLee Kong Chian School of MedicineNanyang Technological University SingaporeSingapore
Jenny JohnstonClinical ReaderSchool of Medicine, Dentistry and Biomedical SciencesQueen’s University BelfastBelfast, UK
Jeroen J.G. van MerrienboerProfessorSchool of Health Professions EducationMaastricht UniversityMaastricht, The Netherlands
Jimmy FrerejeanAssistant ProfessorSchool of Health Professions EducationMaastricht UniversityMaastricht, The Netherlands
Joanne GoldmanAssistant ProfessorCentre for Quality Improvement and Patient SafetyTemerty Faculty of MedicineUniversity of TorontoToronto, Ontario, Canada
John SwellerProfessor Emeritus of EducationUniversity of New South WalesSydney, New South Wales, Australia
Juanita BezuidenhoutProfessor and former Deputy DirectorCentre for Health Professions EducationStellenbosch UniversityCape Town, South Africa
Karen MannProfessor EmeritusMedical EducationDalhousie UniversityHalifax, Nova Scotia, Canada
Kevin W. EvaDirector and Professor of Educational Research and ScholarshipDepartment of MedicineUniversity of British ColumbiaVancouver, Canada
Kirsty AlexanderLecturer in Medical EducationSchool of MedicineUniversity of DundeeScotland, UK
Kori LaDonnaAssociate ProfessorDepartments of Innovation in Medical EducationFaculty of MedicineUniversity of Ottawa, OttawaOntario, Canada
Lara VarpioProfessorUniversity of PennsylvaniaPhiladelphiaPennsylvania, USA
Larry D. GruppenProfessorDepartment of Learning Health SciencesUniversity of Michigan Medical SchoolAnn Arbor, Michigan, USA
Linda SweetChair of MidwiferyDeakin University and Western HealthVictoria, Australia
Lorelei LingardDirector and ProfessorCentre for Education Research and InnovationSchulich School of Medicine and DentistryWestern University, LondonOntario, Canada
Maeve CoyleResearch AssociateBristol Medical SchoolUniversity of BristolBristol, UK
Marco Antonio de Carvalho FilhoProfessor of Research in Health Profession Education and TrainingUniversity Medical Center GroningenUniversity of GroningenGroningen, The Netherlands
Margaret BearmanProfessorCentre for Research in Assessment and Digital LearningDeakin University, MelbourneVictoria, Australia
Maria Athina Martimianakis (Tina)Professor and Director of Medical Education Scholarship,Department of PaediatricsUniversity of TorontoToronto, Canada
Maria MylopoulosAssistant ProfessorDepartment of PaediatricsUniversity of TorontoToronto, Canada
Meghan McConnellAssociate ProfessorDepartment of Innovation in Medical EducationFaculty of Medicine, University of OttowaOttowa, Canada
Minna HuotilainenProfessorDepartment of EducationUniversity of HelsinkiHelsinki, Finland
Morag PatonCPD Education Research CoordinatorTemerty Faculty of MedicineUniversity of TorontoToronto, Ontario, Canada
Morris GordonProfessorSchool of MedicineUniversity of Central LancashirePreston, UK
Muhammad Zafar IqbalResearch ScientistAltus AssessmentsToronto, Ontario, Canada
Pim W. TeunissenProfessorSchool of Health Professions EducationMaastricht UniversityMaastricht, The Netherlands
Rachel H. EllawayProfessor, Department of Community Health SciencesDirector, Office of Health and Medical Education ScholarshipCumming School of MedicineUniversity of CalgaryCalgary, Alberta, Canada
R. Brent StansfieldDirector of Education (Graduate Medical Education)Wayne State University School of MedicineMichigan, USA
René WongResearch FellowDepartment of Medicine & The Wilson CentreTemerty Faculty of MedicineUniversity of TorontoToronto, Ontario, CanadaRhoda Meyer Centre for Health Professions EducationStellenbosch UniversitySouth Africa
Rola AjjawiAssociate ProfessorCentre for Research in Assessment and Digital LearningDeakin University, MelbourneVictoria, Australia
Ryan BrydgesAssistant ProfessorDepartment of MedicineUniversity of TorontoToronto, Ontario, Canada
Saleem RazackProfessor of Pediatrics and Health Sciences EducationMcGill UniversityMontréal, Quebec, Canada
Sandra NicholsonProfessor and DeanThe Three Counties Medical SchoolUniversity of WorchesterWorchester, UK
Sarah BurmAssistant ProfessorFaculty of MedicineDalhousie UniversityHalifax, Nova Scotia, Canada
Sayra CristanchoAssociate ProfessorCentre for Education Research and InnovationSchulich School of Medicine and DentistryWestern University, LondonOntario, Canada
Simon KittoProfessorDepartment of Innovation in Medical Education (DIME)Faculty of MedicineUniversity of Ottawa, OttawaOntario, Canada
Stephen BillettProfessor of Adult and Vocational EducationSchool of Education and Professional StudiesGriffith UniversityBrisbane, Queensland, Australia
Steven J. DurningProfessor of MedicineUniformed Services UniversityBethesda, Maryland, USA
Susan C. van SchalkwykProfessor and DirectorCentre for Health Professions EducationStellenbosch UniversityCape Town, South Africa
Tamara van GogProfessor of Educational PsychologyErasmus UniversityRotterdam, The Netherlands
Theresa KristopaitisAssociate ProfessorDepartments of Internal Medicine and PathologyStritch School of MedicineLoyola University ChicagoMaywood, IL, USA
Thirusha NaiduAssociate ProfessorSchool of Nursing and Public HealthUniversity of KwaZulu‐NatalKwaZulu‐Natal, South Africa
Trevor GibbsProfessor and Past PresidentAssociation for Medical Education in Europe (AMEE)Dundee, UK
Wendy McMillanAssociate Professor in Dental EducationUniversity of Western CapeCape Town, South Africa
William C. McGaghieProfessor of Medical EducationDepartment of Medical EducationFeinberg School of MedicineNorthwestern UniversityChicago, IL, USA
Foreword
The publication of the second edition of Researching Medical Education is welcome evidence that the field of health professions education research is thriving and maturing. It requires only a rapid survey of topics in the book to see the evolution – more diverse theoretical perspectives, a closer alignment of theory and methodology and increasing synergies with cognate disciplines that are themselves advancing. Social sciences such as sociology, anthropology and communication studies are refining constructivist and critical perspectives, while the sciences of measurement and experimental method are evolving post‐positivist approaches for a changing world. The authors of the chapters in this book are alive to these larger developments.
There could be no more urgent time to consider and debate questions of the value of research. Since the publication of the last edition, much has changed in the world. A global pandemic, a climate emergency, conflict on a scale not seen since the early twentieth century, and the rise of leaders who profit from discrediting science confront us. Questions about what is true, what is evidence and who has authority to claim either are more pointed now than at any time in my life. Today, it is insufficient to make a claim about anything, no matter how rigorously researched, without providing information about the worldview, theoretical perspective and methodology of the claimant. This puts tremendous pressure on researchers to articulate and effectively communicate what they understand to be ‘evidence’. And I write, ‘research teams’ deliberately, because it is more apparent than ever that knowledge advances through the work of teams and scholarly communities, not individuals working alone, no matter how brilliant.
The editors of this book state a desire to draw in a ‘wider circle’ of those active in health professions education research. This is a notable goal in an era when too few voices are given disproportionate opportunity to promulgate their views, including about scientific discovery, insight or truth. Research in the health professions will only realise its full potential when those caring for patients and families (and those educating them) in all parts of the world, regardless of language, culture or model of healthcare, participate in research. This book takes the field very much further in that direction.
As with the first edition, Cleland and Durning’s book is an indispensable resource for those new to the field of health professions education research but also those who have deep expertise. The book illustrates in equal measure the journey that our field has taken and the challenges that continue to lie ahead. Researching Medical Education owes its existence to The Association for the Study of Medical Education (ASME) which, through its journals and conferences, is an important voice for high‐quality research in health professions education.
I recommend trying to approach this book with ‘cognitive flexibility’, that challenging frame of holding multiple perspectives in mind at the same time. It is not easy, as F. Scott Fitzgerald noted, to do so and still ‘retain the ability to function’. Yet it seems to me that in recognising that more and different lenses increase our understanding of the world, health professions researchers, teachers and students but also patients and communities benefit most. By contrast, clinging with narrow‐minded devotion to one theorist or one method is more likely to lead to impoverished understanding and the balkanisation of knowledge. Theorist Donna Harraway wrote that each of us can only ever aspire to a ‘partial perspective’ on the world. This book provides a blueprint to retain openness, to locate where each of our worldviews and expertise fit, and to help each of us to being something of importance to our exciting and evolving field.
Brian D. Hodges, Toronto
Foreword from ASME
I am delighted that this new version of Researching Medical Education (RME) was commissioned. The original genesis for the book, bringing together world experts in the field of health professions education to inform and educate in a wide range of relevant research theories and approaches, has been brought up to date with refreshed chapters alongside new ones. This reflects the rapidly changing and expanding world that is health professions education today.
The editors have once again produced a stimulating and inspiring book. The sections, ‘Developing your practice’, ‘Methodologies’ and ‘Theory’ are the three academic themes. These are complemented and reinforced by the individual chapters which provide the knowledge for the many scholarly topics which are important to consider at any stage of research. This book will provide a resource which any health professions education researcher will need to push the boundaries of research and extend knowledge in the field.
Researching Medical Education, alongside it’s sister publication Understanding Medical Education (now in its third edition), exemplifies the ASME vision of Advancing Scholarship in Medical Education. The book showcases essential qualities for research, including collaboration, working across contexts, aiming for excellence, enabling researchers and, importantly, focusing on the future of health professions education. This book should be a ‘must have’ for any healthcare researcher to progress their knowledge and understanding.
Dr Kim Walker
Director of Publications, ASME
Foreword from AMEE
Whilst some may consider that education, training and research are separate entities, there is increasing evidence that they are intrinsically connected; modern methods of education eventually lead to health improvement; research into newer approaches and methods of education and training lead to improved learning.
Introducing research into the undergraduate medical curriculum is becoming standard in many schools. Much of this research is what can be called scientific or clinical research, but students and early researchers are slowly becoming more involved in educational research; intercalated degrees in medical education, student publications in educational journals and graduates concentrating more on education than clinical research are becoming more prevalent. Activities in education move quickly, however, and this second revision of the book has come at a particularly interesting time when newer educational strategies are being put into place as a result of global challenge. AMEE congratulates the many authors who have contributed to this new edition, their contributions will not go unnoticed, and to the editors whose passion for medical education and vision for educational research led to this new edition, which will enhance the importance of the topic immensely.
Trevor Gibbs
President, Association for Medical Education in Europe
Preface
The intent of the first edition of Researching Medical Education (2015) was to provide an authoritative guide to promote excellence in health professions (which includes medicine, nursing, dentistry and other fields) education research. We believe we were successful in doing so. Researching Medical Education was adopted as a core text by many Masters and Doctoral programmes, and had clear international appeal as represented by healthy sales throughout Europe, North America, Africa, Asia and Australasia. It is clear that Researching Medical Education (2015) ‘hit the spot’ and is highly valued.
We are delighted to have received feedback over the years about what learners and colleagues would like to see more of in the next edition. With this in mind, our aim for the second edition of Researching Medical Education was to have a balance of established and new areas of research and ideas, increasingly popular theories and methodologies, and draw in more people who are active in the field of health professions education research. We had to make some hard decisions. Three chapters from the original edition are not present in the second edition, because their focus was no longer highly topical or because the topic is well covered in other books, particularly Understanding Medical Education. An additional eight chapters provide more content and a broader representation of authors.
Although seven years have passed since the original publication, our position remains the same: rigorous and original educational research in the health professions is critical to the future of health professions education and hence, ultimately, patient care. By encouraging thinking, discovery, evaluation, innovation, teaching, learning and improvement via research, the gaps between best practice and what actually happens in medical (and other health professions) education can be addressed. In this way, knowledge can inform and advance education and practice, while education and practice can, in turn, inform and advance future research. Our objectives in this second edition of Researching Medical Education are thus to provide readers with the basic building blocks of research, introduce a range of theories and how to use a theory to underpin research, provide examples and illustrations of a diversity of methods and their use, and give guidance on developing your practice as a researcher. By linking theory and design and methods across the context of health professions education research, this book supports the improvement of quality, capacity building and knowledge generation within our field.
Researching Medical Education is written for health professions education, firmly embedded within health professions education and illustrated throughout with examples from health professions education (HPE). Reflecting our own backgrounds and the relationship of this book with the very successful Understanding Medical Education, most examples are drawn from medical education. However, the aims and objectives of the book, and its key messages, are generalisable across any healthcare profession, or indeed any other profession where learning knowledge, skills and attitudes are central to professional development.
As per the original book, this edition of Researching Medical Education provides a guide for Masters and PhD students in health professions education and their supervisors, those who are new to the field, those who are generally inexperienced in research, those who are new to the field of educational research but have prior research experience in the clinical or biomedical domains, and experienced researchers seeking to explore new ways of thinking and working. To achieve this, our authors are a blend of clinicians and PhD researchers in health professions education, representing a range of disciplines and backgrounds. Many are well established and later in their careers. However, we also welcomed contributions from mid‐career and emerging researchers. Their contributions provide a blueprint of how to pose and address research questions, illustrated by practical examples. International examples help ensure that the messages in this textbook are relevant to all health profession educators even though the structures, systems and processes of healthcare delivery and education vary across countries.
Researching Medical Education (Edition 2) is presented in three sections.
The first is labelled ‘Developing your practice as a health professions education researcher’. This section systematically introduces the initial steps in the research process. It starts with a broad overview of the two main research philosophies relevant to the educational research in healthcare professions and how these differ in terms of assumptions about the world, about how science should be conducted and about what constitutes legitimate problems, solutions and criteria from Cleland. McMillan then considers the influence of the individual researcher’s preferences or ‘worldview’ on the research process, and introduces and explains the critical concepts of ontology, epistemology and reflexivity in research. Macleod, Burm and Mann then introduce a ‘grand theory’ (a very general theory that provides a framework for the nature and goals of a discipline), that of social constructivism. They promote alignment of worldview, theoretical frameworks and research approaches (methods) in relation to constructivism and its philosophical underpinnings. The use of theory is picked up further by Nicholson and colleagues, whose focus on widening access to medicine (increasing the diversity of medical students) provides a framework to examine the use of mid‐range theory, theory which acts as a bridge between grand theory and empirical findings. They provide a story of how a field of research evolves from atheoretical evaluation to the use of robust methodologies and mid‐range theory, thus building knowledge.
Bezuidenhout and colleagues describe how to move from an idea or a problem to formulating a research question, using the analogy of distillation and concrete worked examples to illustrate the steps in this process. Following on from this, Ellaway invites you to consider asking better questions about technology use in health professions education, linking this to the use and variety of theory, methodologies, study designs and methods that can be used to frame both subjects and approaches to inquiry.
We then shift to considering a fundamental of quantitative research studies. Stansfield and Gruppen discuss how to conduct a power analysis to help ensure your quantitative study has an adequate number of participants to find effects such as the impact of an intervention, an educational outcome or the relationship between variables.
We finish this part of the book with two chapters which focus on developing yourself as a researcher. Frambach and colleagues invite you to be intentional about your researcher identity, your topic area and your research community. Driessen and Lingard focus on dissemination, taking a rhetorical approach to get writers and speakers thinking about how to tell a compelling story from their research work.
The second part of Researching Medical Education is labelled ‘Methodologies and methods for health professions education research’. Methodologies, study design and methods are present in just about all chapters, but this part of the book focused on introducing key approaches to help you plan your study. This is where most of the new book content can be found. Morris focuses on identifying, then critically examining, the quality, methodological and/or theoretical contribution of the existing literature on a particular topic, then explains the different purposes and approaches to producing a literature review. Varpio, Martimianakis and Mylopoulos focus on the necessity of acknowledging the differences within qualitative methodologies that make a difference, because these variations enable carefully directed research.
Kitto, Alexanian and Goldman then introduce the building blocks of ethnographic research and focus on three contemporary types – focused ethnography, autoethnography and digital ethnography – to illustrate how ethnography can reveal the social and cultural organisation of everyday education practices. Following from this, Cristancho, LaDonna and Field offer an overview of the purposes, features and uses of visual methods in health professions education research. They offer insights into how to think about visuals, why education researchers might wish to incorporate visuals in their research, when to use them and why and what challenges and opportunities visual researchers might encounter.
We then look at language and what is communicated in texts. Paton and colleagues describe the utility of critical discourse analysis (CDA) as a method to rigorously examine, and potentially navigate, complex challenges in healthcare and education. Konopasky and Diaz discuss two approaches to linguistics that HPE researchers can use to make sense of the educational contexts they study: functional and corpus linguistics. Both chapters offer definitions, describe the method(s), provide examples and illustrate the utility of these approaches in opening up dimensions in data which may not otherwise be seen.
Razack, McKivett and de Carvalho Filho provide frameworks such as critical pedagogy, critical race theory and participatory action research (PAR) through which research questions related to equity in HPE can be done rigorously and with attention to the researchers’ own social positioning as the research is conducted.
Finally in this section, Sambeth and colleagues introduce the multi‐ and interdisciplinary research field of educational neuroscience which aims to learn more about the brain’s role in processes that are relevant for education. They introduce a number of methods that are common in educational neuroscience and give examples are given how these may be applied in health professions education.
The third and final part of Researching Medical Education is labelled ‘Theory informing health professions education research’. As introduced earlier in the book, a good theory (one which is internally consistent and coherent) should describe, explain, enable explanations (not just the what, but the why and the how) and yield testable hypotheses or research questions. The use of theory should generate new routes for research – routes that are conceptually related to and build on prior research. This section introduces a number of specific theories that are intended to guide empirical inquiry, action or practice. Each chapter provides additional recommended references to help readers explore topics of interest in more detail. When reading, you will see that different theoretical approaches align more with certain study designs and methodologies: in some chapters, the research studies are predominantly quantitative, to enable the measurement of cause–effect relationships, whereas in others, the methodologies and methods are typically qualitative, reflecting the nature of the phenomena and hence the research questions.
We first focus on theories that emphasise the collective, or social, where relationships between context, environment, people and things matter. Bleakley and Cleland focus on complexity theory as an overarching framework to inform and guide how healthcare professions researchers can meaningfully engage with highly complex contexts, such as clinical teams or educational systems, and where the outcomes of interactions are not always predictable. Ajjawi, Bearman and MacLeod provide an overview of some main ideas shared across different sociomaterial theories and methods, those which foreground materials – bodies, objects, substances, settings, technologies and so on – to examine how they act with and on the human activity and thought. Johnson and Reid then introduce activity theory, a sociocultural perspective, which places a person’s social and cultural surroundings, and history, as central to what they do. We continue with a chapter by Torre and Durning who discuss social cognitive theories, those that consider learning and performance as inherently social and where the uniqueness that each situation brings (in terms of environment, participants, interactions) can often lead to different learning and performance experiences and outcomes. We finish this subsection with Billett, Sweet and Noble who introduce the concept of participatory practices – what opportunities for learning are provided in healthcare workplace settings and how individuals elect to engage in and learn through those practices – for understanding, supporting and developing workplace‐based learning.
We then move on to areas where the dominant theories are those that focus solely on individual‐level beliefs, processes and/or performance. Cilliers, St Onge and van der Vleuten outline a number of different health behaviour theories and illustrate how these can be used as a means of illuminating, explaining and changing behaviour in teaching–learning settings, whether campus‐based or practice‐based. Artino and colleagues introduce theories of self‐regulated learning (SRL), which describe the processes that individuals use to optimise their strategic pursuit of personal learning goals. McConnell and Eva provide an understanding of the role that emotions play in the training, assessment and development of clinicians and, using a cognitive psychology lens, introduce common theoretical constructs and key methodological issues inherent in studying emotion. Frèrejean, Dolmans and van Merrienboer introduce the field of study of instructional design, a field that aims at developing evidence‐informed guidelines and models for the design of instruction, ranging from the design of particular instructional materials, via lessons and courses, to complete curricula. Szulewski and colleagues take this forward by setting out a comprehensive overview of the utility of cognitive load theory for effective instructional design that facilitates learning and problem solving in medical education and practice. McGaghie and Kristopaitis provide a critical‐realist review of the state of knowledge on deliberate practice and clinical skill acquisition, including how clinical skills acquired in the medical education laboratory can transfer to patient care practices and patient outcomes.
These are not the only theories, or ways of applying particular theories, which may be suitable for HPE research. Others are not presented, for no other reason than that no one book can cover everything. Whatever your question and natural inclination towards particular schools of theory, consider different theories and methods carefully. Do not jump too quickly, consciously or not, onto a single option without exploring others. The time spent on reflecting on which theory and methods are appropriate for your purposes early in the research process is time well spent. This is reinforced by two concluding chapters. Taylor and Gibbs explain the importance of planning research in a way that ensures sustainability and long‐term effectiveness, and we (Cleland and Durning) also provide some final thoughts.
We hope that Researching Medical Education stimulates fresh thinking and new ideas for educational research in medical and healthcare professions and encourages you to engage further with the many exciting theories, models, methodologies and analysis approaches introduced here, the use of which will progress our field of study.
Jennifer ClelandSteven J. Durning
Words of Recommendation
This is an extraordinary text that combines theory and practice in medical education research. The authors represent the who’s who of medical education research, and their wisdom and insights will help guide novice and experienced researchers alike.
David M. Irby, Professor Emeritus of Medicine, University of California, San Francisco, USA
Research in health professions education is maturing. This is clearly evidenced by the second edition of Researching Medical Education. In 30 chapters this book takes you on an exciting voyage on research theories and research methodologies. This book is a comprehensive resource for anyone engaging in research in health professions education.
Cees van der Vleuten, former Director of the School of Health Professions Education, Maastricht University, The Netherlands
This book will be hugely beneficial not only for health professions educators across the spectrum but also for social science and health policy researchers of varied backgrounds and interests.
Zubair Amin, Associate Professor, Department of Paediatrics, National University of Singapore
A must‐have for everyone who is curious or serious about how to do rigorous/excellent research in health professions education. A collection of essential ingredients (theories, methodologies, tools, and examples) that help make up the rigor/excellence.
You You, Assistant Professor and Research Acientist, National Center for Health Professions Education Development, Peking University, China
Medical education is in constant need of review and reform to stay relevant to the health care needs of people. “Researching Medical Education” addresses some of the most important aspects of research on Medical Education to inform and improve current practices.
Anna B Pulimood, former Principal of Christian Medical College Vellore, Tamil Nadu, India
PART IDeveloping your practice as a health professions education researcher
1Exploring, measuring or both: considering the differences between qualitative, quantitative and mixed methods research
Jennifer Cleland
I overheard some of the trainees/residents talking about the things that are important to them in terms of career decision making. It struck me that they seemed much more concerned with work–life balance and being near friends and family than had been the case when I trained. After looking at the literature and many discussions, a colleague and I started a programme of work examining the factors that influence medical student and trainee careers decision making in our country. We first carried out some telephone interviews to gather the views of students and trainees (residents). We used this to inform a survey to find out which factors were most important to the majority of trainees. Over time, how training was structured changed and so too did the behaviour of trainees, particularly at the stage of training before choosing a specialty. So we did more qualitative and quantitative studies, including collaborating with colleagues from health economics to develop and use a methodology which allowed us to identify what was most important in trainee (resident) career decision making and if there were differences across learners at different stages of training.
This overview of a 10‐year plus series of studies (e.g.,1–6) highlights some of the differences between quantitative and qualitative research, but also how they can be used in a complementary manner in the same programme of research.
It is easy to assume that the differences between different types of research are solely about how data is collected – the randomised controlled trial (RCT) versus ethnographic fieldwork, the cohort study versus the semi‐structured interview. These are, however, research methods (tools) rather than approaches (methodologies). There are very important consequences of choosing (implicitly or explicitly) a particular methodological stance or position to guide and inform your research practice or an individual study. Quantitative, qualitative and mixed methods approaches make different assumptions about the world,7,8 about how science should be conducted and about what constitutes legitimate problems, solutions and criteria of ‘proof’.9,10
In this chapter, drawing on Bryman11 and Crotty,12 I will talk about these assumptions and their implications for research practice. I will then compare and contrast the three approaches in terms of research design, methods and tools, analysis and interpretation. I will draw on examples from health professions education research to illustrate these points. The content of this chapter is more heavily ‘weighted’ towards quantitative and mixed methods research because qualitative research is well covered in other chapters in this book.
Philosophical differences
Quantitative, qualitative and mixed methods research (MMR) come from different underlying assumptions of what is reality (ontology) and what is knowledge (epistemology) (see also chapters by McMillan, and Macleod, Burm and Mann in this book).
Quantitative research
Quantitative research draws originally from the positivist paradigm. The underlying premise of this paradigm (basic belief systems, or universally accepted models providing the context for understanding and decision making) is that the goal of knowledge is simply to describe the phenomena that we experience, and hence can observe and measure (i.e., objectivity). The researcher and the focus of the research are in this way independent of each other: the researcher has no influence on the research process. In a positivist view of the world, the goal of knowledge is to observe, measure and describe the phenomena experienced because reality is tangible and measurable. Knowledge of anything beyond that (a positivist would hold) is impossible. This might seem a little extreme to us now, and much quantitative research has moved on from purely positivist views to post‐positivism. Post‐positivism does not reject the basic tenets of observation and measurement, but it recognises that all observation is fallible and that all theory is revisable. Post‐positivism is also characterised by an acceptance that the background, knowledge and values of the researcher can influence what is observed.
In post‐positivism, a variety of epistemologies underpin theory and practice in quantitative research.13 One of the most common post‐positivism stances is that of critical realism or criticality. A critical realist believes that there is a reality independent of our thinking about it that science can study, and questions (hence the ‘critical’ label) the infallibility of observation and theory. Moreover, they also believe that researchers can put aside their biases and beliefs to strive for objectivity. The differences between positivism and critical realism are discussed further in the chapter by MacMillan later in this book. For the purposes of the current chapter, however, it is sufficient to know that those working from a (post‐) positivist position believe that the scientific method (i.e., the approaches and procedures of the natural science such as chemistry, biology and physics) is appropriate for the study of social phenomena (e.g., learning).
Qualitative research
The premise of qualitative research is subjectivity.8,11,13 Qualitative research is concerned with how the social world is interpreted, understood, experienced or produced. Reality cannot be measured directly. Instead, reality is relative and multiple, perceived through socially constructed and subjective interpretations. There are many structured approaches to apprehending such realities and the methods and procedures of the natural sciences are not (generally) suitable for doing so (see later). The qualitative tradition is also underpinned by a number of different theories. These give researchers different ‘conceptual lenses’ through which to look at complicated problems and social issues, focusing their attention on different aspects of the data and providing a framework within which to conduct their analysis.14 Many of these are described elsewhere in this book (for example, see chapters by McLeod, Burm and Mann, Nicholson and colleagues, Varpio and colleagues) and see also Reeves et al.15 for a very useful overview.
The philosophical differences between qualitative and quantitative research are reflected in the language associated with each approach (see Figure 1.1).
Figure 1.1 Word clouds of quantitative and qualitative language.
Mixed methods research
Mixed methods research (MMR) is underpinned by pragmatism which – rather than committing to any sort of philosophical stance – ‘is pluralistic and oriented towards “what works” and practice’16 (p. 41). In other words, pragmatism uses multiple methods but the use of the methods should always be guided by research problems.16–18
Taking a pragmatic stance frees the researcher from any philosophical commitments or obligations:18 (s)he can instead use the most suitable design and methodology in terms of what is best suited to the purpose of their investigation.
So what do these differences mean in practice?
Broadly speaking, quantitative research involves hypothesis testing and confirmation whereas qualitative research is concerned with hypothesis generation and understanding (see Table 1.1). MMR is a combination of both (how qualitative and quantitative approaches can be combined is discussed later).
Expanding on this, quantitative research tends to be deductive, seeking to gather validity evidence for an idea or theory by conducting an experiment and analysing the results numerically (see Table 1.1). Theory is often seen as something from which to derive a hypothesis, a tentative explanation that can be tested by further investigation. For example, one hypothesis we might want to test (the null hypothesis) is that there is a relationship between students’ self‐confidence in examination skills and the amount of time they spend on the wards. Hypotheses are often in the form of an if/then statement; for example, if we teach handwashing, then infection rates will reduce. A hypothesis is always provisional as data may emerge that cause us to reject it later on (i.e., the outcome might be to reject the null hypothesis if the data indicates no significant relationship between self‐confidence and time on the wards).
In this way, in quantitative research, the theories determine the problems (the research moves deductively, from theory to the data), which generate the hypotheses, usually about causal connections. On the other hand, the use of theory in qualitative research tends to be inductive; that is, building explanations from the ground up, based on what is discovered (although more deductive qualitative studies are possible). Inductive reasoning begins with specific observations and measures, for detecting patterns and regularities, formulating tentative hypotheses to explore, and, finally, ends by developing some general conclusions or theories.
MMR integrates the philosophical frameworks of both post‐positivism and interpretivism (which assumes that there are multiple realities because meaning is grounded in experience)19 interweaving qualitative and quantitative data in such a way that research questions are meaningfully explained. Creswell and Plano Clark16 described six scenarios or examples of research problems that are best suited for MMR: when one data source is insufficient; further explanation of results is needed; when there is a need to generalise exploratory findings or enhance a study with a second method; where a theoretical perspective dictates the need to collect both quantitative and qualitative data; and, finally, where multiple, sequential research phases are needed achieve the overall research goal. These same purposes have been articulated in other ways by other researchers. For example, Greene, Caracelli and Grahan20 suggest five purposes of using MMR: triangulation, complementarity, development, initiation and expansion.
