Starting Research in Clinical Education E-Book
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Starting Research in Clinical Education A practical guide to clinical education research with top tips, common pitfalls and ethical issues. Starting Research in Clinical Education is written by a global team of experienced and emerging clinical education researchers who have a wealth of knowledge designing rigorous research projects and expertise in contemporary methods. Covering a broad spectrum of methods used by clinical education researchers, the book is split into five parts: research design, evidence synthesis and mixed methods research, qualitative research, quantitative research and succeeding in clinical education research. These sections are also accompanied by a companion website which provides further resources. The methods discussed are illustrated with real life examples and case studies to support the reader in designing their own project. The new edition includes information on: * Getting started in clinical education research, constructing a research question, clarifying research paradigms and design, using educational theory, involving stakeholders, sampling and recruiting participants and conducting ethical research * Evidence synthesis, realist research, mixed methods research, action research and emerging possibilities in online data collection * Interviews and focus groups, visual elicitation, ethnography, narrative research, thematic analysis and struggles new researchers often face in qualitative research * Survey research, experimental methods, statistical analysis and big data * Maximising opportunities, project management, writing dissertations, writing for publication, research dissemination and career development This edition is designed to support those new to clinical education research, including those undertaking intercalated or postgraduate degrees in clinical, medical, dental or health professions education.
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Veröffentlichungsjahr: 2023
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
List of contributors
Foreword
References
Preface
Acknowledgements
Companion website
PART I: Research design
1 Getting started in clinical education research
Why do you want to do clinical education research?
Defining clinical education research
Identifying a topic of interest
Undertaking a preliminary literature search
Research aims and objectives
Reflecting on your resources
Getting help
Finalising your idea
Summary
References
2 Constructing a research question
Introduction
What is a research question?
Defining the problem
From problem to question
Beyond the question
Questions to avoid
Evaluating your research question
Summary
References
3 Clarifying research paradigms and design
Introduction
What is research design?
Post‐positivist research design
Constructivist research design
Summary
References
4 Using educational theory in research and scholarship
Introduction
Putting theory to work in clinical education research
What is theory?
Working with learning theory
Illustrative case studies
Summary
References
5 Involving stakeholders
Introduction
Who are the stakeholders?
Why involve stakeholders?
What can stakeholder involvement look like?
How can you identify stakeholders?
Considerations when involving stakeholders
Strategies for involving stakeholders
Summary
References
6 Sampling and recruiting participants
Introduction
Sampling in quantitative research
Sampling in qualitative research
Recruitment
Summary
References
7 Conducting ethical research
Introduction
Ethical principles in research
Procedural ethics
Situational ethics
Relational ethics
Exiting ethics and beyond
Summary
References
PART II: Evidence synthesis and mixed methods
8 Evidence syntheses: choosing an approach
Introduction
What are evidence syntheses?
Evidence syntheses in clinical education
Overview of evidence synthesis approaches
Choosing the appropriate evidence synthesis approach
Summary
Further reading
References
9 Evidence synthesis: key steps and design considerations
Introduction
Assembling a project team
Planning an evidence synthesis
Key steps in evidence synthesis
Summary
Further reading
References
10 Realist research: unpicking the influence of context
Introduction
What is realist research?
Primary and secondary realist research
Could a realist approach help me?
Programme theory and realist analysis
A brief overview of realist analysis
Involvement of stakeholders in realist projects
Designing a realist research project
Summary
Further reading
References
11 Mixed methods research: the sum is greater than the parts
Introduction
What is mixed methods research?
Why choose mixed methods research?
How to plan and design a mixed methods project
How to report mixed methods research
Quality criteria for mixed methods research
Benefits and challenges
Summary
References
12 Action research: improving clinical education programmes
Introduction
Types of action research
Action research by educators
Practical action research
Practitioner action research
Summary
Further reading
References
13 Online data collection: emerging possibilities
Introduction
Study considerations
Types of online platforms
Types of online data
Data collection
Data quality and integrity
Data analysis
Ethical considerations
Summary
References
PART III: Qualitative research
14 Interviews and focus groups: guided conversations
Introduction
What are research interviews and focus groups?
Sampling in interview and focus group data collection
Choosing specific interview or focus group methods
How to conduct interviews and focus groups
How to ensure rigour in focus groups/interviews
Summary
References
15 Visual elicitation: techniques for digging deeper in qualitative interviews
Introduction
Rich pictures
Photo‐elicitation
Point of view video elicitation
Summary
Further reading
References
16 Ethnography: sense and sensibilities in conducting fieldwork
Introduction
History and value of ethnography
Ethnographic fieldwork methods
Planning an ethnographic study
Conducting ethnographic fieldwork
Special considerations
Challenges of ethnography
Summary
References
17 Narrative research: from the general to the particular
Introduction
What is a narrative and narrative research?
Doing narrative research
Theorising from narrative data
Quality criteria
Summary
References
18 Approaches to thematic analysis: becoming a knowing researcher
Introduction
The spectrum of thematic analysis approaches
What is a theme and why does how we conceptualise themes matter?
The thematic analysis family: a tripartite typology
The role of the researcher in thematic analysis
Diversity of thematic analysis methods and questions of quality
Summary
Further reading
References
19 Behind the scenes of qualitative analysis: learning from new researchers' struggles
Introduction
How do I get from data to themes?
How do I deal with subjectivity and interpretation?
Is it possible to make changes along the way?
How do I work with a diverse supervision team?
What is going on here?
What might help?
Summary
References
PART IV: Quantitative research
20 Survey research: uses and misuses
Introduction
Survey uses (and misuses)
Six principles of survey design
A six‐step process for designing a high‐quality survey
Survey administration
Reporting results
Summary
Further reading
References
21 Experimental methods: more than simply testing hypotheses
Introduction
What is an experiment?
To experiment or not?
Seven steps to designing experiments
Summary
References
22 Statistical analysis: unpacking uncertainty
Introduction
Descriptive statistics
Inferential statistics
Uncertainty and bias
Statistical test
Summary
Further reading
References
23 Big Data: where to start and what to expect
Introduction
Big Data in clinical education
Working with big datasets
Linking multiple datasets
Reporting and dissemination
Summary
Further reading
References
PART V: Succeeding in clinical education research
24 Maximising opportunities and overcoming challenges
Introduction
On your marks: preparing for your research project
Get set: designing your research project
Go: conducting your research project
Summary
References
25 Managing your project
Introduction
What is a project?
Project management stages
Summary
Further reading
References
26 Writing your dissertation
Introduction
Let me tell the world my story
No such thing as too much planning
Pitching your voice
Time and place: setting yourself up for success
Practical considerations from first draft to finish line
Summary
References
27 Writing for publication
Introduction
Getting started
Ethical issues
Writing the story of your work
Submitting your paper; from manuscript to accepted article
Summary
Further reading
References
28 Disseminating your findings
Introduction
Planning your dissemination strategy
Ways to disseminate
Summary
References
29 Developing your career
Introduction
Careers in clinical education
Developing foundational skills
Seeking further qualifications and training
Career paths in research
Establishing research independence
Summary
References
Conclusion
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Definitions and examples of the key terms in the planning of a res...
Chapter 2
Table 2.1 Examples of general and focused research questions
Table 2.2 FINER research questions
Chapter 3
Table 3.1 Table of definitions for research design
Table 3.2 The markers of rigour in post‐positivism in relation to specific v...
Table 3.3 The markers of rigour in constructivism
Chapter 4
Table 4.1 Ideal‐typical features of three educational schools of thought
Chapter 5
Table 5.1 Examples of potential stakeholders
Table 5.2 Stakeholders' roles in clinical education research
Chapter 6
Table 6.1 Four common random‐sampling strategies with examples
Table 6.2 Common purposive sampling strategies with examples
Table 6.3 Common sampling reporting weaknesses and how to avoid them
Chapter 8
Table 8.1 Comparison of evidence synthesis approaches
Chapter 10
Table 10.1 Table of definitions of key realist terminology
Chapter 11
Table 11.1 Purpose of using a mixed method design [15]
Table 11.2 Considerations when planning a mixed methods study [7, 10]
Table 11.3 Mixed methods research design options. (from [6])
Chapter 14
Table 14.1 Strengths and considerations when using interviews and focus grou...
Table 14.2 Different types of interviews
Table 14.3 The different formats of interviews
Table 14.4 Examples of open and closed wording of questions
Chapter 16
Table 16.1 Types of ethnographic research
Chapter 20
Table 20.1 Common errors in survey design [5, 16, 17]
Chapter 22
Table 22.1 Example of Chi‐square table
Table 22.2 Impact of multiple comparisons on type 1 error
Table 22.3 Regression analysis examining the relationship among gender, comm...
Table 22.4 Commonly used statistical tests with corresponding research quest...
Chapter 23
Table 23.1 Table of definitions
Table 23.2 Examples of Big Data and other data sources in clinical education...
Chapter 25
Table 25.1 Common clinical education research stakeholder groups and key con...
Table 25.2 Common milestones included in clinical education research Gantt c...
Chapter 27
Table 27.1 Examples of article types
Chapter 28
Table 28.1 Dissemination considerations at different project stages
Table 28.2 Categories of meeting presentations
Table 28.3 Social Media dissemination approaches and their advantages and di...
Chapter 29
Table 29.1 Framework of overlapping roles within clinical education and asso...
Table 29.2 Activities to build foundational skills in clinical education res...
Table 29.3 Outline and comparison of master’s and doctoral study
Table 29.4 The essentials of a good research proposal
List of Illustrations
Chapter 1
Figure 1.1 The first steps in clinical education research.
Chapter 7
Figure 7.1 Aspects of Tracy's [1] framework at different stages of research....
Chapter 9
Figure 9.1 Key steps and decisions in an evidence synthesis project.
Chapter 10
Figure 10.1 Programme theory of remediation.
Chapter 12
Figure 12.1 Carr and Kemmis's (1986) action research model.
Chapter 15
Figure 15.1 Example of a rich picture.
Figure 15.2 (a, b) Images produced by participants in a photo‐elicitation st...
Chapter 17
Figure 17.1 What is different about narrative research?
Figure 17.2 Strengths of narrative research.
Figure 17.3 Summary of the narrative research process and decision‐making.
Chapter 21
Figure 21.1 Process of final checks for confounds prior to formal comparison...
Chapter 22
Figure 22.1 Sample of a population of interest.
Figure 22.2 Histogram of the distribution of physical exam skill scores.
Figure 22.3 Boxplot comparing history‐taking skills among three schools.
Figure 22.4 Scatter plots of correlation between two variables ranging in st...
Figure 22.5 Scatter plot of correlation between communication and overall sa...
Chapter 23
Figure 23.1 A simple example of an Ibry chart. An early UK example of a simp...
Figure 23.2 Ibry chart showing 2006 and 2007 graduate entrants to UK medical...
Figure 23.3 Dataflow for a large UKMED project, using SPSS and R.Figure 23...
Chapter 25
Figure 25.1 Project management can be defined in five stages, which may be a...
Chapter 27
Figure 27.1 The manuscript submission process.
Guide
Cover Page
Title Page
Copyright Page
List of contributors
Foreword Page
Preface
Acknowledgements
Companion website
Table of Contents
Begin Reading
Conclusion
Index
WILEY END USER LICENSE AGREEMENT
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Starting Research in Clinical Education
EDITED BY
Eliot L. Rees
Lecturer in Medical EducationSchool of MedicineKeele University;National Institute for Health and Care Research (NIHR) Academic Clinical Fellow in General PracticeResearch Department of Primary Care and Population HealthUniversity College LondonLondon, UK; andEducation Research Committee, Association for the Study of Medical Education (ASME)
Alison Ledger
Associate Professor and Academic Lead for Staff DevelopmentAcademy for Medical EducationThe University of QueenslandBrisbane, Australia; andChair, Education Research Committee, Association for the Study of Medical Education (ASME)
Kim A. Walker
Senior Lecturer and Lead for Faculty DevelopmentCentre for Healthcare Education Research and Innovation (CHERI)University of AberdeenAberdeen, UK; andDirector of Publications, Association for the Study of Medical Education (ASME)
This edition first published 2024© 2024 The Association for the Study of Medical Education (ASME).
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List of contributors
Kirsty AlexanderScotGEM Lecturer in Medical EducationSchool of MedicineUniversity of DundeeDundee, UK
Radwa AlyExecutive Director of Clinical ResearchSchool of Medicine & Health SciencesThe George Washington UniversityWashington DC, USA
Megan AnakinSenior Lecturer and Education AdviserDunedin School of MedicineUniversity of OtagoDunedin, New Zealand
Anthony R. Artino, Jr.Professor and Associate Dean for Evaluation and Educational ResearchSchool of Medicine & Health SciencesThe George Washington UniversityWashington DC, USA
Rebecca AtamanPhD CandidateSchool of Physical and Occupational TherapyMcGill UniversityMontreal, Quebec, Canada
Aileen BarrettEditor in ChiefThe Clinical TeacherAssistant Scheme Director, GP Training (South‐East)Academic Lead, Research, Policy and InformationIrish College of General PractitionersDublin
Christy K. BoscardinProfessor and Director of Student AssessmentSchool of MedicineUniversity of California, San FranciscoSan Francisco, CA, USA
Virginia BraunProfessor of PsychologySchool of PsychologyWaipapa Taumata Rau The University of AucklandAuckland, New Zealand
Teresa ChanAssociate ProfessorDepartment of Medicine; andAssociate Dean of Continuing Professional DevelopmentFaculty of Health SciencesMcMaster UniversityHamilton, Ontario, Canada
H. Carrie ChenProfessor of Paediatrics and Senior Associate Dean of Assessment and Educational ScholarshipSchool of MedicineGeorgetown UniversityWashington DC, USA
Victoria ClarkeAssociate Professor in Qualitative and Critical PsychologySchool of Social SciencesUniversity of the West of EnglandBristol, UK
Jennifer ClelandPresident’s Chair in Medical Education and Vice Dean (Education)Lee Kong Chian School of MedicineNanyang Technological UniversityJurong West, Singapore
Emma CollinsLecturer in Nursing and Professional Doctorate CandidateSchool of Nursing & MidwiferyKeele UniversityNewcastle under Lyme, UK
Richard ConnClinical Senior Lecturer in PaediatricsSchool of MedicineUlster UniversityDerry, Northern Ireland
Patrick G. CorrAssistant Professor of Clinical Research and LeadershipSchool of Medicine & Health SciencesThe George Washington UniversityWashington DC, USA
Sayra CristanchoAssociate ProfessorSchulich School of Medicine & DentistryWestern UniversityLondon, Ontario, Canada
Katherine CrookPhD GraduateSchool of MedicineUniversity of LeedsLeeds, UK
Benjamin DaviesGeneral Practitioner PartnerFremington Medical CentreBarnstaple, UK
Giskin DayPrincipal Teaching FellowImperial College LondonLondon, UK
Anne de la CroixAssistant ProfessorResearch in EducationAmsterdam UMC location Vrije UniversiteitAmsterdam, The Netherlands
Lisa DikomitisProfessor of Medical Anthropology and Social Sciences and Director of ResearchKent and Medway Medical SchoolUniversity of Kent and Canterbury Christ Church UniversityCanterbury, UK
Claire DuddyRealist Reviewer and NIHR Pre‐Doctoral FellowNuffield Department of Primary Care Health SciencesUniversity of OxfordOxford, UK
Kristina DzaraSchool of MedicineSaint Louis University
Kaylee EadyAssistant Professor of Health Professions EducationFaculty of EducationUniversity of OttawaOttawa, Ontario, Canada
Rebecca EdwardsPhD CandidateSchool of MedicineKeele UniversityNewcastle under Lyme, UK
Amaya EllawalaLecturer in Medical EducationHealth Professions Education UnitHull York Medical SchoolYork, UK
Simon GayProfessor of Medical Education (Primary Care)Leicester Medical SchoolUniversity of LeicesterLeicester, UK
Catherine M. GirouxPostdoctoral FellowInstitute of Health Sciences EducationMcGill UniversityMontreal, Quebec, Canada
Gerry J. GormleyProfessor of Simulation and Clinical SkillsSchool of Medicine, Dentistry and Biomedical SciencesQueen's University BelfastBelfast, Northern Ireland
Jan Willem GrijpmaPhD Candidate and Teacher TrainerLEARN! AcademyVrije UniversiteitAmsterdam, The Netherlands
Jonathan GuckianAdvanced Medical Education FellowLeeds Institute of Medical EducationUniversity of LeedsLeeds, UK
Dominique HarzAdjunct Instructor of Graduate Program in OrthodonticsDepartment of OrthodonticsPontificia Universidad Católica de ChileSantiago, Chile
Wendy HuProfessor of Medical Education and Associate DeanSchool of MedicineWestern Sydney UniversitySydney, New South Wales, Australia
Sue JacksonAssociate Professor of Adult NursingDepartment of Nursing Midwifery & HealthNorthumbria UniversityNewcastle upon Tyne, UK
Susan JamiesonProfessor of Health Professions EducationSchool of Medicine, Dentistry & NursingUniversity of GlasgowGlasgow, UK
Koshila KumarSub‐Dean (Academic) Development and Associate ProfessorDivision of Learning and TeachingCharles Sturt University New South Wales, Australia
Michelle D. LazarusAssociate Professor & Director of the Monash Centre for Human Anatomy EducationDepartment for Anatomy and Developmental BiologyMonash UniversityClayton, Victoria, Australia
Kathleen E. Leedham‐GreenSenior Teaching FellowMedical Education Research UnitImperial College LondonLondon, UK
Janet LefroyProfessor of Medical EducationSchool of MedicineKeele UniversityNewcastle under Lyme, UK
Rachel LockeDeputy Head of SchoolSchool of Sport, Health and CommunityUniversity of WinchesterWinchester, UK
Susanne MakAssistant Professor and Associate Director of Occupational Therapy ProgrammeSchool of Physical and Occupational TherapyMcGill UniversityMontreal, Quebec, Canada
Robert K. McKinleyEmeritus Professor of Education in General PracticeSchool of MedicineKeele UniversityNewcastle under Lyme, UK
Chris McManusProfessor of Psychology and Medical EducationResearch Department of Medical EducationUniversity College LondonLondon, UK
Asta MedisauskaiteSenior Research FellowResearch Department of Medical EducationUniversity College LondonLondon, UK
Katherine A. MoreauAssociate Professor of Health Professions EducationFaculty of EducationUniversity of OttawaOttawa, Ontario, Canada
Clare MorrisCourse Director for MSt Medical EducationInstitute of Continuing EducationUniversity of CambridgeCambridge, UK
Christy NobleClinical Learning & Assessment LeadAcademy for Medical EducationThe University of QueenslandBrisbane, Australia
Susil PallikadavathNational Institute for Health Research (NIHR) Academic Clinical Fellow in CardiologyNIHR Biomedical Research Centre for Cardiovascular DiseaseUniversity of LeicesterLeicester, UK
Sophie ParkProfessor of Primary Care and Medical EducationResearch Department of Primary Care and Population HealthUniversity College LondonLondon, UK
Becky PetleyLecturer in PsychologyFaculty of Sport, Health and Social SciencesSolent UniversitySouthampton, UK
Amudha PoobalanSenior Lecturer in Public HealthCentre for Healthcare Education Research and InnovationUniversity of AberdeenAberdeen, UK
J. Cristian RangelAssistant ProfessorDepartment of Innovation in Medical EducationUniversity of OttawaOttawa, Ontario, Canada
Anne‐Marie ReidProfessor of Medical EducationLeeds Institute of Medical EducationUniversity of LeedsLeeds, UK
Joanne Robertson‐SmithProfessional Practice Fellow, Simulation Educator and Clinical Nurse EducatorOtago Clinical Skills LaboratoriesUniversity of Otago and Te Whatu Ora – SouthernDunedin, New Zealand
Jennifer RouthPhD Candidate in Veterinary EducationSchool of Veterinary MedicineUniversity of SurreySurrey, UK
Catherine ScarffSenior Lecturer in Medical EducationMelbourne Medical SchoolUniversity of MelbourneMelbourne, Victoria, Australia
Nick SchindlerPostgraduate Tutor in Medical EducationInstitute of Continuing EducationUniversity of CambridgeCambridge, UK
Justin L. SewellProfessor of MedicineSchool of MedicineUniversity of California, San FranciscoSan Francisco, CA, USA
Milou SilkensResearch FellowDepartment of Health Services Research and ManagementCity, University of LondonLondon, UK
Sarah SimpsonAssociate Clinical Lecturer in Paediatric DentistrySchool of Dental SciencesNewcastle UniversityNewcastle upon Tyne, UK
Frederick SpeyerPhD CandidateSchool of Medicine, Dentistry and Biomedical SciencesQueen's University BelfastBelfast, Northern Ireland
Georgina C. StephensSenior LecturerMonash Centre for Human Anatomy EducationMonash UniversityClayton, Australia
Malou StoffelsPhD Candidate and Education ConsultantResearch in EducationAmsterdam UMC location Vrije UniversiteitAmsterdam, The Netherlands
Aliki ThomasAssociate ProfessorSchool of Physical and Occupational Therapy and Institute of Health Sciences EducationMcGill UniversityMontreal, Quebec, Canada
Gillian VanceProfessor of Medical EducationSchool of MedicineNewcastle UniversityNewcastle upon Tyne, UK
Lara VarpioProfessorDepartment of PediatricsUniversity of Pennsylvania andCo‐Director of Research in Medical EducationThe Children's Hospital of PhiladelphiaPhiladelphia, PA, USA
Lucy WallisResearch Associate in Qualitative Health Services ResearchBristol Medical SchoolUniversity of BristolBristol, UK
Brianne WenningLecturer in Global HealthKent and Medway Medical SchoolUniversity of Kent and Canterbury Christ Church UniversityCanterbury, UK
Tim J. WilkinsonProfessor of Medicine and Medical Education and Deputy DeanEducation UnitUniversity of OtagoChristchurch, New Zealand
Geoff WongAssociate Professor of Primary CareNuffield Department of Primary Care Health SciencesUniversity of OxfordOxford, UK
Alexandra WrightFifth Year Medical StudentFaculty of MedicineImperial College LondonLondon, UK
Sarah YardleyAssociate Professor of Palliative MedicineMarie Curie Palliative Care Research DepartmentUniversity College LondonLondon, UK
Peter YeatesSenior Lecturer in Medical Education ResearchSchool of MedicineKeele UniversityNewcastle under Lyme, UK
Meredith YoungAssociate ProfessorInstitute of Health Sciences EducationMcGill UniversityMontreal, Quebec, Canada
Foreword
The Association for the Study of Medical Education (ASME)'s mission is to ‘advance scholarship in medical education’ through a wide range of activities – events, awards, resources, and the work of special interest groups and committees. It was during an away day of one of these groups, the Educational Research Committee, when the idea for this publication truly evolved. As a committee, we were reflecting on the popularity of the ‘getting started in clinical education research’ workshop regularly offered at ASME's Annual Scholarship Meeting and Researching Medical Education conferences. We were struck by the levels of interest, energy, and ambition of colleagues taking their first steps into educational research and wondered how we might extend the reach of the workshop to others embarking on similar journeys. We talked about our own pathways into clinical education research, crossing disciplinary boundaries, and research traditions encountering new theoretical and conceptual tools. We reflected on the hurdles we had faced, the things we wished we had known, and the guidance we wished we had been able to access.
Gradually, the idea for this book took shape. We wanted to offer something that could provide a foundation for new researchers, which would appeal to those undertaking research degrees in clinical education as well as those ‘going it alone’. We wanted it to be accessible and practical, to include specific examples and suggestions that would help our imagined readership design, implement and write up their studies…and gradually the book took shape.
It is a privilege to be writing the foreword to the imagined book, now very tangible and I congratulate the editors on the work they have done to bring together what I believe will become another of the ‘go‐to’ publications for our community of scholars.
I believe Starting Research in Clinical Education to be a scholarly text, one that embraces the full extent of Boyer's (1990) typology of scholarship as discovery (fostering research that can shape and inform our educational practices), integration (drawing on inter‐disciplinary and inter‐professional dialogue), and application (fostering engagement, dialogue, and knowledge‐exchange). One way I might support my claim is to look to the authorship of the chapters contained within; for me, there are a number of noteworthy characteristics. The first is that the chapters bring together experienced and early career researchers; researchers close to the experience of the anticipated readership to help ensure chapters were accessible, invitational, and useful. Furthermore, the authorship goes some way to redressing a growing commentary on the characteristics of authors in our community, be it around gender, geography, or disciplinary field. Albert et al. (2020) noted that medical education researchers tend to draw upon a narrower knowledge field than their peers in higher education, suggesting this impedes inter‐disciplinary knowledge exchange. In contrast, the authors of these chapters span an impressive mix of disciplines. It creates a heady mix of expertise, reflecting a depth of understanding of context, practice and, I would suggest, praxis. Praxis, for me at least, is about the ways we embody and enact theory, and how we thoughtfully and creatively direct our activity at purposeful change. I believe this book contains a wide range of tools that will equip new members of the clinical educational research community to achieve just that.
Professor Clare Morris
Past Chair ofASME EducationResearch Committee
References
Albert, M., Rowland, P., Friesen, F. et al. (2020). Interdisciplinarity in medical education research: myth and reality.
Advances in Health Sciences Education
25
: 1243–1253.
Boyer, E.L. (1990).
Scholarship Reconsidered
. Carnegie Foundation for the Advancement of Teaching.
Preface
The idea for this book was conceived from a discussion at an Italian restaurant the night before the Association for the Study of Medical Education (ASME)'s Researching Medical Education conference in 2019. We were discussing resources for clinical education students. ASME has already produced two excellent books: Understanding Medical Education, which serves as the authoritative guide to teaching and learning approaches in medical education; and Researching Medical Education, which offers a range of theories and how they can be best deployed to conduct rigorous research.
However, we perceived there was an unmet need for a single coherent research methods resource for the students we supervise in clinical education programmes. The response was ‘let’s do it’. Now, after a couple of more visits to that Italian restaurant and some concentrated work in between, we are delighted to see this book come to fruition.
Starting Research in Clinical Education is the definitive practical guide to designing, conducting, and reporting clinical education research projects that address important topics and employ rigorous methods. We chose the term clinical education research to encompass research related to the learning or development of students or professionals within any healthcare profession worldwide. Sometimes the terms research, scholarship, and evaluation are used interchangeably. We think there is an important difference in that research aims to answer a specific question and generate new knowledge that can inform wider practice. While the book is focused on research, many of the methods and principles discussed can be used for rigorous educational evaluation and scholarship.
Our ethos, from conception through to publication, has been to ensure this book meets the needs of new researchers in clinical education. We recognise, however, that these new researchers come from many different backgrounds. Some may be undertaking education fellowships or intercalated or postgraduate degrees in clinical education, medical education, dental education, or health professions education. Others may be coming to education research later in their clinical or academic careers. This book is the ideal resource for those embarking on their first clinical education research projects or using methods with which they are unfamiliar. The authors draw on examples of previous projects to illustrate the important factors to consider when designing studies and the strengths and challenges of different methodological approaches. On the companion website, we provide information, activities, and exercises for you to work through in order to help support your thinking in research design.
When inviting authors, we were keen to ensure we were drawing on both the wisdom of experienced researchers and the recent insight of early career academics. You will find, therefore, that most chapters have been authored by a combination of senior and junior contributors. We hope this helps in making sure the content balances credibility and accessibility.
Similarly, we wanted to ensure we had diversity in our authorship team in terms of geography and disciplinary background. We were delighted to include a global team of chapter authors from 44 different institutions in 9 different countries. Likewise, we have authors from the whole spectrum of disciplinary backgrounds including anatomy, anthropology, dentistry, education, global health, medicine, nursing, occupational therapy, physiotherapy, psychology, public health, and veterinary medicine.
Each chapter has been peer reviewed by at least two other chapter authors (one early career and more experienced researcher) as well as the three editors. We are extremely grateful for the energy and enthusiasm that authors put into both reviewing and responding to the reviews they received. We believe this has significantly strengthened the individual chapters and the book as a whole.
Moving on to the structure and how to use the book. Starting Research in Clinical Education is divided into five parts. The first, research design, takes you through all the stages of designing a clinical education project. Chapter 1 explains how to get started and identify a topic to research. Chapter 2 then explores how to move from a research topic to a clearly articulated research question. Chapter 3 aims to clarify research paradigms and design to ensure these are coherent with your research question and methods. Chapter 4 considers approaches to using educational theory within research. Chapter 5 discusses the importance of involving stakeholders in your research, how to identify who these might be, and how to involve them meaningfully. Chapter 6 describes different approaches to sampling and recruiting participants for your study. Chapter 7 explores the origins and principles of ethics in research and how these should be applied in the design, conduct, and reporting of your research. We consider that no matter what research methods you decide to use, these seven chapters in Part I are all essential reading.
The next three parts explore common research methods within clinical education research which we have grouped into three approaches: Part II evidence syntheses and mixed methods, Part III qualitative research, and Part IV quantitative research. These parts do not intend to be comprehensive. Rather, they intend to discuss the prevailing methods within clinical education research to give you ideas of the opportunities available and how these might best be used. We consider these three parts as akin to a tasting menu. They should give you enough information about different methods to whet your appetite and to have an idea of which might be most appropriate for your research question. They should provide sufficient information to get started with the method and point you in the direction of more detailed resources to refer to as your research progresses.
Part V then offers guidance for how to succeed in your clinical education research project. Chapter 24 explains how to maximise opportunities along the way including how to choose and work with your supervisor. Chapter 25 introduces you to principles of project management to help you keep on track throughout your research. The next three chapters cover different approaches to dissemination. Chapter 26 is suited to anyone doing a project as part of a degree course that needs to write a dissertation or thesis. Chapter 27 discusses different types of journal publication, the journal submission, and peer review process and enhances your chances of publishing. Chapter 28 considers a range of approaches to dissemination including different types of conference presentations, social media, and multimedia. Finally, Chapter 29 discusses how to build on the success of your first project and develop a career in clinical education research. Again, regardless of which method you eventually select, the chapters in Part 5 should all be of use. While some of these chapters may appear to fit at the end of the research process, we encourage you to read these at the start to plan for later success.
Within each chapter you will find a number of common features. Learning objectives are clearly articulated and outline what you should expect to achieve from reading the chapter. Each chapter also has Top tips, Common pitfalls, and Ethical issues. These are nuggets of practical wisdom specific to the method or aspect of research in the chapter and are tailored to the clinical education context. Many chapters also have additional reading or resources available on our companion website. These are signposted within the chapters, but we also encourage you to peruse the site to see what may be of use to you. You will also find that some chapters signpost to specific resources for further reading. These are recommended for anyone who chooses to use that method for their research or wants a more comprehensive understanding.
When reading through the chapters, and in particular the Top tips and Common pitfalls, you will find there are some recurring messages. First, good research results from teamwork and collaboration. This can mean working as part of a larger team or could simply be working with a supervisor. To quote John Donne, ‘no man is an island’ – don't try and go it alone. Having colleagues to work with makes the research more enjoyable and allows you to share your challenges and successes. Second, the clinical education community is extremely welcoming and supportive. Do reach out to people and start to develop a network. This will help your research, make the process more enjoyable, and support you in growing your career.
We hope you enjoy reading this book as much as we have enjoyed creating it. Furthermore, we wish you every success with your first clinical education research projects. We look forward to hearing and reading all about them. Good luck!
Eliot L. ReesAlison LedgerKim A. Walker
Acknowledgements
The idea for this book was sparked by discussions at ASME Education Research Committee meetings, Researching Medical Education conferences, and conversations with our own research students over the years. We, therefore, acknowledge our colleagues and students, past and present, whose experiences informed many of the decisions we made along our editing journey.
Thank you to all our chapter contributors for agreeing to our invitations and for collaborating with us over the past two years. We were delighted to recruit such a diverse authorship team who not only prepared their own chapters but also provided thoughtful feedback on others, strengthening the book as a whole. We are extremely grateful for the work everyone undertook to get the book to print stage. Thanks also to some additional reviewers, who offered valuable opinions when called upon: Kevin Eva, Hannah Gillespie, Victoria Leigh, and Jessica Penney.
Companion website
Starting Research in Clinical Education provides the starting point for you in your research journey. Naturally, any book is constrained by its length, therefore we have additionally developed a companion website to complement the information in the book. The companion website provides you with access to additional reading and resources which aim to deepen your understanding of the topics covered within the book. Not all chapters have companion website material, but those which do offer you further information, videos, exemplars, and case studies to reinforce and enhance your understanding of the concepts in the book. These are clearly signposted within the text and organised by chapter on the companion website. We hope the companion website encourages you to pursue further learning and development.
URL: www.wiley.com/go/clinicaleducation
PART IResearch design
1Getting started in clinical education research
Jennifer Routh and Robert K. McKinley
Learning objectives
By the end of this chapter, you should be able to:
Describe the basic features and aims of education research.
Evaluate possible research topics of interest.
Conduct a preliminary critical literature review to inform the early stages of research planning.
Recognise the importance of collaboration, supervision, and mentorship in clinical education research.
Why do you want to do clinical education research?
Even before you start getting started, it is important to consider why you want to do clinical education research. There are many possible answers to this question. While some may appear more noble than others, they are all valid. You may have a burning desire to answer a question or solve a problem. You may seek personal development by expanding your knowledge or skills, developing relationships, or advancing your career. You may want to gain academic credentials such as publications and may perceive that education research might be an easier way to do it than in other disciplines (hint: it is probably not!). What is most likely is that you are motivated by a combination of these factors. Are these enough to sustain your enthusiasm for a process that may take more time, effort, and perseverance than you expected?
So, you have got the enthusiasm and are being honest with yourself about your motivation and stamina. Hopefully, this chapter will set you on your way to getting started.
Defining clinical education research
What is research?
Research is the search for trustworthy answers to problems. Good research is not haphazard, it is particular and rigorous. The Oxford English Dictionary defines research as the ‘systematic investigation or inquiry aimed at contributing to knowledge of a theory, topic, etc., by careful consideration, observation, or study of a subject’ [1].
Research is exciting. It can also be intimidating. From being someone who searches for, critiques, synthesises, and uses knowledge, you become a knowledge maker. This demands diligence and respect for the scientific method. It is a process that starts with constructing a research question that matters. You then address the question by systematically collecting and analysing appropriate data. Finally, you disseminate your findings, thus adding to the sum total of human knowledge. Your findings may influence practice, policy, or future research. With this comes great responsibility.
What is education research?
Education research is research into, on, or about any aspect of education with the aim of understanding, informing, or improving its practice [2]. It is a relatively young field that emerged from philosophy, sociology, psychology, anthropology, and history during the twentieth century [3], and these disciplines continue to inform our research today. This is a reflection of education's complexity and the resulting need to research it from multiple perspectives.
Education research may seem quite alien if you are used to biomedical research. The latter is built on the assumption that there is a single ‘truth’ that can be understood through objective observation. Educational settings are complex social systems and cannot be completely understood from a single perspective or ‘lens’. What you observe is affected by the ‘lens’ you use: psychological, sociological, or anthropological lenses will reveal different insights on the same problem. Further, as the observer, you cannot be entirely separate from the system being examined: you may be outside the system being observed but your unique experiences affect not only what you see but the meaning you make of it. This apparent subjectivity does not align with what many biomedical scientists see as ‘good science’ consisting of objective, quantitative, repeatable measurement. However, understanding people and their complex thoughts, actions, interactions, and relationships which lie at the heart of education requires multiple perspectives, each of which contributes to our broader understanding of the whole.
What sort of questions can education research answer?
Broadly, education research can:
Describe (what was done or is happening?)
Justify (did it work?)
Clarify (why or how did it work?)
[4]
Through answering these questions, your intention may be to change the practice of an aspect of education, e.g. making classroom teaching more effective. Your intention may also be to inform political, social, or cultural change, e.g. to increase the diversity of students who enter higher education. Education research can be transformative, aiming to enable education stakeholders to play an active role in researching matters that affect them (see Chapter 5).
What is clinical education research?
Clinical education encompasses everything to do with learning to deliver healthcare, including undergraduate education, postgraduate training, and continuing professional development. Clinical education research aims to advance understanding about clinical education and develop trustworthy knowledge, replacing tradition, intuition, and dogma as the basis of what and how we teach [5]. The scope of clinical education research extends further than workplace‐based learning, to include selection and recruitment, curriculum design, teaching and learning approaches, assessment, professionalism, fitness to practice, career choices, transitions, well‐being, and beyond [6]. The output of this research can be far‐reaching, with direct benefits to patients, learners, individual clinicians, or entire health and education systems.
What makes good clinical education research?
Coe defined six characteristics of education research, which also apply to clinical education research [2].
Systematic
Good education research is systematic rather than slapdash. Your decisions ought to be deliberate and in service of the research question but also comprehensive and careful so that others can have confidence in your answers. This requires you to be careful and to use methods which are accepted as rigorous by other researchers in our field [3].
Critical
A critique of what has gone before, including previous claims, assumptions, or methods, will enhance the quality of your research. You should not simply accept conclusions offered by other authors, rather you ask whether there is an alternative explanation. For example, you may consider that their findings are the result of their particular perspective or methodology and other approaches may provide alternative insights.
Evidential
Evidential means that recommendations are substantiated. Research findings provide a solid basis for moving practices away from those based on tradition, opinion, or anecdote to evidence‐based education. Original research creates this evidence, but originality does not necessarily mean researching a completely new topic; it can build on the work of other researchers. Your contribution to education research is therefore part of an ongoing scholarly conversation [7], and it can have a greater impact when it builds on what has been done before.
Theoretical
Your research should have a theoretical basis. A theory is ‘an abstract description of the relationships between concepts that help us to understand the world’ [8]. Theory helps you make sense of teaching and learning and can be built and tested through research (see Chapter 4). It also enables you to connect your research with existing knowledge and aids the transferability of your findings to other settings.
Transparent
There are three key considerations in relation to transparency. First, describing your research in sufficient detail to enable others to repeat it. Second, maintaining integrity: e.g. reporting inconsistencies in your data or changes in your project which could have affected the outcome. Finally, it means that you reflect on how your life experiences or personal philosophy might have impacted any aspect of your research, from the research question to dissemination (see Chapter 3).
Identifying a topic of interest
There are several ‘prestudy tasks’ [9] to complete before you commence your research journey. This starts with choosing your general topic of interest. From here, you will develop your specific research questions (see Chapter 2).
Your topic should be both interesting and worthwhile. The results of your research should matter to both you and your intended audience. The topic may emerge from everyday problems and your reflections on personal experiences: what interests you? What irritates you? What concerns you? As a note of caution, you must be able to distinguish between your emotional and intellectual motivations. Proving or validating your own experiences or preconceptions is unlikely to lead to a fruitful research endeavour, unless the topic is also important to others [9]. You must be open to having your views disproven!
While important, reflection on experience is not the only source of research ideas [10]. Sources include discussions with stakeholders, such as educators who research, learners, patients, or policymakers: what are they thinking about? What are their suggestions for good research projects? (see Chapter 5). You should also review academic journals, social media, and medical journalism: are there current topical debates that need answers?
Theory, models, and conceptual frameworks can provide new insights or lines of inquiry into problems in clinical education (see Chapter 4). Just as in physics, where you might test Newton's laws by collecting real‐life data, you can test theories in your own educational settings. These might be from within clinical education (e.g. experience‐based learning [11]) or drawn from other fields (e.g. situated learning theory [12]). The particular benefit of basing your research on theory is that you are helping to build a coherent body of work [13], and your research should be applicable outside the specific context of your study.
Undertaking a preliminary literature search
Once you have identified a topic of interest, you need to find out what is already known about it. Time, talent, and commitment are precious commodities that should not be wasted on reinventing the wheel.
It is imperative to discover what is already known about the topic and, perhaps more crucially, what is not known. You need to ensure that there is a ‘gap’ [7]. In a well‐studied field, finding the gap is challenging. In an understudied field, the challenge is to ensure the gap matters.
There is an entire research discipline devoted to the systematic search for, appraisal, and synthesis of academic literature, the outcomes of which are research projects in themselves (see Part II of this book). This is not always necessary at the start of a project. However, conducting a preliminary literature search is essential. It does not need to be comprehensive, but it should at least aim to answer these questions:
What research has been published on this topic, and where are the gaps?
Are there conflicting findings in previous studies that could be further investigated?
What sorts of research aims, objectives, questions, and methods have been used?
How do I search the literature?
Although your first instinct may be to turn to a familiar search engine (e.g. Google), this is likely to result in thousands of results, which will range from papers in high‐quality scientific journals to material from sources with less rigorous quality control. Instead, we recommend using tools for searching the formal academic literature. These fall into two groups: indexing services and scholarly literature search engines.
Indexing services (e.g. PubMed) enable you to search a database of journals systematically using subject‐specific search terms. This enables you to streamline your search and ensure you are only retrieving reports published in the academic literature. However, there are two cautions when searching for them. First, no database indexes all journals. Therefore, it is good practice to search multiple databases to maximise your chances of finding relevant material. Second, your choice of search terms is critical and may not align with keywords in individual papers or the terms within the indexing service. To overcome this, we recommend considering synonyms and combining terms with Boolean operators (e.g. AND/OR/NOT) [14].
If you have access to a university or health library, you will be able to search academic databases which require subscriptions (e.g. SCOPUS, EMBASE) and draw on librarians for support. Your library might have its own search engine, which allows you to access results from all of its subscribed databases at once, and they can provide links to full texts seamlessly without multiple login steps. Your library may also offer training on how to use the databases and help with constructing search terms.
Scholarly literature search engines, such as Google Scholar, Microsoft Academic, and Semantic Scholar, are freely accessible. These are easy to use if you are familiar with using generic search engines, can be used with both natural language and keyword searching, and provide links to freely available full texts. However, these will return many more results than the indexing services, meaning you will retrieve more irrelevant material. Furthermore, you cannot limit the search by subject area or material type, nor can you only search titles and abstracts.
I have got my search results, what do I do now?
If you have no results, we counsel caution. If there appears to be very little or nothing published, we urge you to stop and think ‘why?’ Is it because your idea is truly novel? Is that likely? Or is it an important topic that is very difficult to research? Or is it irrelevant and not worth researching? Or has your search strategy failed to find the appropriate studies?
Alternatively, you may have thousands of results. This does not mean that there is no need for further research on the topic, but the challenge then is to identify the important gaps. In this case, we would encourage you to identify and focus on review articles first to get a feel for the field. While they summarise what is known, review articles can identify gaps in knowledge that may help you to focus on a particular area. It is also worthwhile looking at the methodologies that have been used. Are there key techniques that you will need for your own project? Or are there novel methodologies with which you could generate meaningful insights?
The optimum situation is when you find a manageable number of publications. Your search terms should have found any relevant review articles, but you should have assimilated individual papers too, particularly those published more recently than the reviews. Consider the research questions which have been asked, the methods applied, the results, and the author's ideas about the next steps in research. As you start to identify key authors or papers, look at the literature they cite and the literature which has cited them. That will help you understand how research in your chosen area has developed and continues to evolve. Tools such as Google Scholar or http://connectedpapers.com can help with this.
No matter how many results you have, you will need a process for reviewing them. We suggest you do this in two distinct stages. The first is to identify papers which are likely to be useful (screening), and the second is to decide whether they are useful or not (critical appraisal).
When screening your results, we suggest you initially scan titles and save those which seem relevant (see ‘How do I keep track of the papers I have found?’ section). Having identified a smaller subset as potentially interesting, the next task is to review the abstracts; this will enable you to further refine your selection. Subsequently, you should obtain and read the full papers. Many will be available either online or as printed journals through your library. If your library does not have a subscription which allows access, it is worthwhile searching for online versions using Google Scholar. Your library may be able to request a copy of the paper through an interlibrary loan service, although there is often a charge. If these routes fail, you can email the paper's corresponding author and request a copy.
Critical appraisal is the process of making a judgement of the quality of a paper and its relevance to your work. There are tools available for critically appraising academic literature (e.g. Critical Appraisal Skills Programme [15]). However, for the purposes of conducting your preliminary search, these may not be necessary. We suggest reading this literature with the following questions in mind:
Is this paper relevant to my emerging research topic?
Are the methods robust and trustworthy?
What are the main findings and implications?
Are the conclusions supported by the methods and results?
How can this study inform my research topic or project design?
How do I keep track of the papers I have found?
We strongly encourage you to use citation management software from the start of your research journey. A good citation management package will allow you to import the citation details, the abstract, and often a PDF of the item. You can read the abstract and PDF, track what you have read, and add your own notes or keywords to help organise your library. However, the most useful feature of this type of software is the way it works with your word processor. They enable you to insert citations into your writing and to compile reference lists. These are formatted automatically and can be easily reformatted if needed. See the resource on the companion website for a comparison of different citation management applications.
Taking stock
At the end of your preliminary search, you should be able to identify the existing research around your topic of interest and where the gaps are. You should have an understanding of the range of methodologies employed and formed opinions on the strengths and weaknesses of previous work.
Do not be too modest about the validity of your perspective as a novice clinical education researcher. Regardless of your experience, your perspective is new and therefore valuable. We encourage you to engage in debates, defend your ideas, and be ready to listen and learn.
Research aims and objectives
Once you have a topic, you can start to construct the aims and objectives of your research, which will inform the specific research questions (see Chapter 2).
Research aims, objectives, and questions are intimately connected and will direct how your research will be conducted. Definitions and examples for each are provided in Table 1.1. Your research aim represents the overarching purpose of your research stated in general terms [16]. Possible aims include adding to the knowledge base, achieving a personal, social, institutional, and/or organisational impact, measuring change, understanding a complex phenomenon, testing new ideas, generating new ideas, or examining the past [17]. The focus required for good research means that there is usually only one aim per study.
Your research objectives will be determined by your aim. Each study will usually have two to three research objectives to keep the project manageable. They will use action verbs to describe the tasks that must be completed to achieve your aim and answer your research question(s). They should be specific, measurable, appropriate, realistic, and time specific (SMART) [16, 18]. It is a good idea to number them for reference in research proposals, study protocols, and ethics applications.
Constructing a good research question is usually much more challenging than stating aims and objectives and is the focus of Chapter 2. They are critical, the ‘linchpin of the research process’ [19]. They will orientate your study, directly determine your methodology and methods, and the wording of your research questions can make or break your project. It is worth investing considerable time and effort to get it right.
