The voices of medical education scholarship: Describing the published landscape

A Medical Education Research Library: key research topics and associated experts

When clinician-educators and medical education researchers use and discuss medical education research, they can advance innovation in medical education as well as improve its quality. To facilitate the use and discussions of medical education research, we created a prefatory visual representation of key medical education research topics and associated experts. We conducted one-on-one virtual interviews with medical education journal editorial board members to identify what they perceived as key medical education research topics as well as who they associated, as experts, with each of the identified topics. We used content analysis to create categories representing key topics and noted occurrences of named experts. Twenty-one editorial board members, representing nine of the top medical education journals, participated. From the data we created a figure entitled, Medical Education Research Library. The library includes 13 research topics, with assessment as the most prevalent. It also notes recognized experts, including van der Vleuten, ten Cate, and Norman. The key medical education research topics identified and included in the library align with what others have identified as trends in the literature. Selected topics, including workplace-based learning, equity, diversity, and inclusion, physician wellbeing and burnout, and social accountability, are emerging. Once transformed into an open educational resource, clinician-educators and medical education researchers can use and contribute to the functional library. Such continuous expansion will generate better awareness and recognition of diverse perspectives. The functional library will help to innovate and improve the quality of medical education through evidence-informed practices and scholarship.

Medical Teacher's equity diversity inclusion policy

Medical Teacher is a leading international journal in health professions education. The Journal recognizes its responsibility to publish papers that reflect the breadth of topics that meet the needs of its readers around the globe including contributions from countries underrepresented in the health professions education arena. This paper sets out the Journal's policy with regard to Equity Diversity Inclusion (EDI) and the steps to be taken to implement the policy in practice.

Factors influencing clinician-educators' assessment practice in varied Southern contexts: a health behaviour theory perspective

In many contexts, responsibility for exit-level assessment design and implementation in undergraduate medical programmes lies with individuals who convene clinical clerkships. Their assessment practice has significant consequences for students' learning and the patients and communities that graduates will serve. Interventions to enhance assessment must involve these assessors, yet little is known about factors influencing their assessment practice. The purpose of this study was to explore factors that influence assessment practice of clerkship convenors in three varied low-and-middle income contexts in the global South. Taking assessment practice as a behaviour, Health Behaviour Theory (HBT) was deployed as a theoretical framework to explore, describe and explain assessor behaviour. Thirty-one clinician-educators responsible for designing and implementing high-stakes clerkship assessment were interviewed in South Africa and Mexico. Interacting personal and contextual factors influencing clinician-educator assessment intention and action were identified. These included attitude, influenced by impact and response appraisal, and perceived self-efficacy; along with interpersonal, physical and organisational, and distal contextual factors. Personal competencies and conducive environments supported intention to action transition. While previous research has typically explored factors in isolation, the HBT framing enabled a systematic and coherent account of assessor behaviour. These findings add a particular contextual perspective to understanding assessment practice, yet also resonate with and extend existing work that predominantly emanates from high-income contexts in the global North. These findings provide a foundation for the planning of assessment change initiatives, such as targeted, multi-factorial faculty development.

What makes an article a must read in medical education?

BACKGROUND

The dissemination of published scholarship is intended to bring new evidence and ideas to a wide audience. However, the increasing number of articles makes it challenging to determine where to focus one's attention. This study describes factors that may influence decisions to read and recommend a medical education article.

METHODS

Authors analyzed data collected from March 2021 through September 2022 during a monthly process to identify "Must Read" articles in medical education. An international team of health sciences educators, learners, and researchers voted on titles and abstracts to advance articles to full text review. Full texts were rated using five criteria: relevance, methodology, readability, originality, and whether it addressed a critical issue in medical education. At an end-of-month meeting, 3-4 articles were chosen by consensus as "Must Read" articles. Analyses were used to explore the associations of article characteristics and ratings with Must Read selection.

RESULTS

Over a period of 19 months, 7487 articles from 856 journals were screened, 207 (2.8%) full texts were evaluated, and 62 (0.8%) were chosen as Must Reads. During screening, 3976 articles (53.1%) received no votes. BMC Medical Education had the largest number of articles at screening (n = 1181, 15.8%). Academic Medicine had the largest number as Must Reads (n = 22, 35.5%). In logistic regressions adjusting for the effect of individual reviewers, all rating criteria were independently associated with selection as a Must Read (p < 0.05), with methodology (OR 1.44 (95%CI = 1.23-1.69) and relevance (OR 1.43 (95%CI = 1.20-1.70)) having the highest odds ratios.

CONCLUSIONS

Over half of the published medical education articles did not appeal to a diverse group of potential readers; this represents a missed opportunity to make an impact and potentially wasted effort. Our findings suggest opportunities to enhance value in the production and dissemination of medical education scholarship.

The writer's voice repertoire: Exploring how health researchers accomplish a distinctive 'voice' in their writing

INTRODUCTION

Much published research writing is dull and dry at best, impenetrable and off-putting at worst. This state of affairs both frustrates readers and impedes research uptake. Scientific conventions of objectivity and neutrality contribute to the problem, implying that 'good' research writing should have no discernible authorial 'voice'. Yet some research writers have a distinctive voice in their work that may contribute to their scholarly influence. In this study, we explore this notion of voice, examining what strong research writers aim for with their voice and what strategies they use.

METHODS

Using a combination of purposive, snowball and theoretical sampling, we recruited 21 scholars working in health professions education or adjacent health research fields, representing varied career stages, research paradigms and geographical locations. We interviewed participants about their approaches to writing and asked each to provide one to three illustrative publications. Iterative data collection and analysis followed constructivist grounded theory principles. We analysed interview transcripts thematically and examined publications for evidence of the writers' described approaches.

RESULTS

Participants shared goals of a voice that was clear and logical, and that engaged readers and held their attention. They accomplished these goals using approaches both conventional and unconventional. Conventional approaches included attention to coherence through signposting, symmetry and metacommentary. Unconventional approaches included using language that was evocative (metaphor, imagery), provocative (pointed critique), plainspoken ('non-academic' phrasing), playful (including humour) and lyrical (attending to cadence and sound). Unconventional elements were more prominent in non-standard genres (e.g. commentaries), but also appeared in empiric papers.

DISCUSSION

What readers interpret as 'voice' reflects strategic use of a repertoire of writing techniques. Conventional techniques, used expertly, can make for compelling reading, but strong writers also draw on unconventional strategies. A broadened writing repertoire might assist health professions education research writers in effectively communicating their work.

Unravelling epistemic injustice in medical education: The case of the underperforming learner

CONTEXT

Epistemic injustice refers to a wrong done to someone in their capacity as a knower. While philosophers have detailed the pervasiveness of this issue within healthcare, it is only beginning to be discussed by medical educators. The purpose of this article is to expand the field's understanding of this concept and to demonstrate how it can be used to reframe complex problems in medical education.

METHODS

After outlining the basic features of epistemic injustice, we clarify its intended (and unintended) meaning and detail what is required for a perceived harm to be named an epistemic injustice. Using an example from our own work on introversion in undergraduate medical education, we illustrate what epistemic injustice might look like from the perspectives of both educators and students and show how the concept can reorient our perspective on academic underperformance.

RESULTS

Epistemic injustice results from two things: (1) social power dynamics that give some individuals control over others, and (2) identity prejudice that is associated with discriminatory stereotypes. This can lead to one, or both, forms of epistemic injustice: testimonial and hermeneutical. Our worked example demonstrates how medical educators can be unaware of when and how epistemic injustice is happening, yet the effects on students' well-being and sense of selves can be profound. Thinking about academic underperformance with epistemic injustice in mind can reveal an emphasis within current educational practices on diagnosing learning deficiencies, to the detriment of holistically representing its socially constructed and structural nature.

CONCLUSIONS

This article builds upon recent calls to recognise epistemic injustice in medical education by clarifying its terminology and intended use and providing in-depth application and analysis to a particular case: underperformance and the introverted medical student. Equipped with a more sophisticated understanding of the term, medical educators may be able to re-conceptualise long-standing issues including, but also beyond, underperformance.

Shapeshifters: Global South scholars and their tensions in border-crossing to Global North journals

INTRODUCTION

Global South researchers struggle to publish in Global North journals, including journals dedicated to research on health professions education (HPE). As a consequence, Western perspectives and values dominate the international academic landscape of HPE. This study sought to understand Global South researchers' motivations and experiences of publishing in Global North journals.

METHODS

This study used a hermeneutic phenomenological perspective. Unstructured interviews were conducted with 11 authors from 6 Global South countries. Interview transcripts were analysed through a process of familiarisation, identifying significant statements, formulating meanings, clustering themes, developing exhaustive descriptions, producing a fundamental structure and seeking verification.

RESULTS

Participants described being motivated by local institutional expectations, to improve reputation, to meet Global North perceptions of quality and to draw attention to their Global South context. Participants described experiences where their work was deemed irrelevant to Global North audiences, they were unable to interpret rejections and had learnt to play the publishing game by attending to both local and global imperatives. These motivations and experiences revealed several practical, academic and transformational tensions that Global South authors faced.

CONCLUSION

The tensions and negotiations encountered by Global South authors who publish in HPE journals reflect a 'border consciousness' whereby authors must shift consciousness, or become 'shapeshifters', inhabiting two or more worlds as they cross borders between the Global South and Global North conventions. There is an added burden and risk in performing this shapeshifting, as Global South authors stand astride the borders of two worlds without belonging fully to either.

Clinical supervision in medical education: A citation analysis

PURPOSE

Medical education relies on clinical supervision for critical functions, including trainee assessment and ensuring patient safety. Yet, there is substantial variance in supervision, which has led to calls for a shared definition of the concept and guidelines to inform practice. AMEE Guide No. 27 provided these desired elements and is highly cited, suggesting that translation and utilization of the Guide's knowledge is suboptimal. This study investigates utilization by systematically characterizing citations to the Guide and by describing translation of its recommendations in relation to supervision.

MATERIALS AND METHODS

Citations were identified using Web of Science, Scopus, and Google Scholar. The authors coded all citations and conducted a subanalysis of studies specific to supervision.

RESULTS

583 studies were identified; 268 met inclusion criteria for general analysis of which 167 studies were further analyzed. Most studies reiterated the Guide's characterization of effective supervision, but few demonstrate how these recommendations inform innovations in supervisory practice.

CONCLUSION

Translation of the Guide's recommendations regarding clinical supervision appears limited. Future research should consider the extent of knowledge translation occurring in clinical supervision literature as well as AMEE Guides. Increased attention to knowledge translation in medical education may benefit the distribution of similar knowledge products.

The Inside Scoop: What We Learnt About Getting into Academic Publishing During Our Editorial Internship

The world of publication can seem intimidating and closed to the newcomer. How then does one even begin to get a foot in the door? In this paper, the authors draw from the literature and their recent lived experience as editorial interns to consider this challenge under the theme of access, and how it overlaps with the various components of academic publication. The main three components of the publication 'machine' are discussed in this article, authoring, reviewing, and editing. These are preceded by the first, and arguably foundational, interaction with academic journal publishing-reading. Without reading articles across different journals, and even in different disciplines, understanding the breadth of scholarship and its purpose is impossible. The subsequent components of authoring, reviewing, and editing, which are all enhanced by ongoing familiarity with current literature through further reading, are considered in further detail in the remainder of this article, with practical advice provided as to how to gain access and experience in each of these areas, for example, writing non-research article manuscripts, engaging in collaborative peer review, and applying for editorial opportunities (with perseverance) when the opportunity presents itself. Medical education publication can seem daunting and closed to entry-level academics. This article is written to dispel this view, and challenges the notion that the world of publication is reserved for experts only. On the contrary, newcomers to the field are essential for academic publications to retain relevance, dynamism, and innovation particularly in the face of the changing landscape of medical education.

Tuition Costs of Master's of Health Professions Education Programs: A Cross-Sectional Analysis

PURPOSE

The increasing professionalization of medical education during the past 2 decades has ushered in an era in which formal degrees, particularly master's of health professions education (MHPE), have become important for career advancement in medical education. Although tuition costs can pose a substantial barrier for many seeking advanced degrees in health professions education, data on tuition associated with these programs are lacking. This study examines the accessibility of pertinent cost-related information available to prospective students and the variability of costs among programs worldwide.

METHOD

The authors conducted an Internet-based, cross-sectional study, augmented with emails and direct contact with educators, to extract tuition-related data for MHPE programs between March 29, 2022, and September 20, 2022. Costs were converted to an annual total within each jurisdiction's currency and converted to U.S. dollars on August 18, 2022.

RESULTS

Of the 121 programs included in the final cost analysis, only 56 had publicly available cost information. Excluding programs free to local students, the mean (SD) total tuition cost was $19,169 ($16,649), and the median (interquartile range) cost was $13,784 ($9,401- $22,650) (n = 109). North America had the highest mean (SD) tuition for local students ($26,751 [$22,538]), followed by Australia and New Zealand ($19,778 [$10,514]) and Europe ($14,872 [$7,731]), whereas Africa had the lowest ($2,598 [$1,650]). The region with the highest mean (SD) tuition for international students was North America ($38,217 [$19,500]), followed by Australia and New Zealand ($36,891 [$10,397]) and Europe ($22,677 [$10,010]), whereas Africa had the lowest ($3,237 [$1,189]).

CONCLUSIONS

There is substantial variability in the geographic distribution of MHPE programs and marked differences in tuition. Incomplete program websites and limited responsiveness from many programs contributed to a lack of transparency regarding potential financial implications. Greater efforts are necessary to ensure equitable access to health professions education.

Representation in Health Professions Education: Striving for an Inclusive Health Professions Education Community

Author representation and inclusivity in health professions education (HPE) scholarship is receiving increasing attention in academic medicine, with multiple articles calling for greater equity related to gender, geographic, and institutional affiliations. Despite journal efforts to seek diversity, authors from high-income English-speaking countries are the most highly represented in HPE scholarship. Less attention, however, has been focused on the openness of medical education scholars, themselves, to engaging in international collaborations with authors and institutions from low-and-middle income countries. This eye-opener is inspired by the authors' personal experiences in HPE scholarship from an international medical educator perspective and advocates for the creation of an open and inclusive multinational medical education community. We offer suggestions that can help create opportunities for networking, collaboration, and promoting a sense of belonging among HPE scholars worldwide. As researchers, journal editors and associate editors, and faculty in HPE programs, we can work together to create a welcoming and accommodating environment that embraces non-dominant voices and perspectives, with the ultimate goal of achieving diversity and equity in HPE scholarship.

The impact and the challenges of implementing a faculty development program on health professions education in a Brazilian Medical School: a case study with mixed methods

PURPOSE

Faculty development in health professions education is still challenging in developing countries like Brazil. Work overload and the lack of financial support hinder faculty members' participation. Ribeirão Preto Medical School founded its Center for Faculty Development in 2016. Since then, an essential skills module (ESMo) on health professions education (HPE) has been offered regularly to faculty members and preceptors of seven undergraduate programs. This case study aims to evaluate the impact of this Essential Skills Module on the educational practices of participants two years after attending the module and the challenges faced during the process.

METHOD

The study used a mixed-method approach with a description of the demographic and professional profile data of the ESMo participants. Immediate post-ESMo perceptions (satisfaction and learning) of the participants were determined with structured instruments. Two years later, a semi-structured interview was conducted and recorded to determine the long-term effects (application of learning and behavior changing as an educator). NVIVO® software was used to store and systematize the thematic discourse analysis with a socio-constructivist theoretical framework interpretation.

RESULTS

One hundred forty-six participants were included: 86 (59%) tenured faculty members, 49 (33,5%) clinical preceptors, and 11 (7,5%) invited teachers. Most were female (66%), and 56% had teaching experience shorter than ten years. 52 (69%) out of 75 eligible participants were interviewed. The immediate reaction to participating in the module was quite positive and 80% have already implemented an educational intervention in their daily activities. Discourses thematic analysis showed five emerging themes appearing in different frequencies: Changes in teaching activities (98%); Lack of previous pedagogical training (92.3%); Commitment and enthusiasm towards teaching (46.15%); Overlapping functions inside the institution (34.6%) and Challenges for student assessment (23%).

CONCLUSION

This first in-depth evaluation of the long-term effects of a faculty development intervention in a Brazilian Health Profession Education school showed that participation positively changed participants' teaching & learning practices. These interventions consistently fostered a community of practice and valued faculty development processes in local and national scenarios.

His opportunity, her burden: A narrative critical review of why women decline academic opportunities

OBJECTIVES

This paper stems from a desire to deepen our own understanding of why women might 'say no' when allies and sponsors offer or create opportunities for advancement, leadership or recognition. The resulting disparity between representation by men and women in leadership positions, invited keynote speakers and publication counts in academic medicine is a stubborn and wicked problem that requires a synthesis of knowledge across multidisciplinary literature. Acknowledging the complexity of this topic, we selected a narrative critical review methodology to explore reasons why one man's opportunity might be a woman's burden in academic medicine.

METHODS

We engaged with an iterative process of identifying, reviewing and interpreting literature from Psychology (cognitive, industrial and educational), Sociology, Health Professions Education and Business, placing no restrictions on context or year of publication. Knowledge synthesis and interpretation were guided by our combined expertise, lived experience, consultations with experts outside the author team and these guiding questions: (1) Why might women have less time for career advancement opportunities? (2) Why do women have less time for research and leadership? (3) How are these disparities maintained?

RESULTS

Turning down an opportunity may be a symptom of a much larger issue. The power of social expectations, culture and gender stereotypes remains a resistant force against calls for action. Consequently, women disproportionately take on other tasks that are not as well recognised. This disparity is maintained through social consequences for breaking with firmly entrenched stereotypes.

CONCLUSIONS

Popular strategies like 'lean into opportunities', 'fake it till you make it' and 'overcome your imposter syndrome' suggest that women are standing in their own way. Critically, these axioms ignore powerful systemic barriers that shape these choices and opportunities. We offer strategies that allies, sponsors and peers can implement to offset the power of stereotypes.

The personal is political in the struggle for equity in global medical education research and scholarship

Medical education research is rooted in a long tradition of objectivity, evidence-based methods, and clinical surety. However, the inexorable confidence, health professions research education, and scholarship have in the manifest supremacy of western science as the foundational epistemology is questionable. Is this bravado legitimate and if so by what authority? How does this dominance of western epistemic frames determine how we are seen and how we see ourselves as health professions educators scholars and researchers? In what ways does western epistemic dominance influence how and why we conduct research? What do we consider as important to research in health professions education (HPE)? The answers are different depending on where we position ourselves or are placed in a hierarchy of scholarly privilege. I pose that the supremacy of Western scientific epistemology in modern medical education, research, and practice blurs differently colored scientific lenses and silences marginalized voices from legitimate contribution to HPE.

Expanding Interdisciplinarity: A Bibliometric Study of Medical Education Using the Medical Education Journal List-24 (MEJ-24)

Introduction

Interdisciplinary research, which integrates input (e.g., data, techniques, theories) from two or more disciplines, is critical for solving wicked problems. Medical education research is assumed to be interdisciplinary. However, researchers have questioned this assumption. The present study, a conceptual replication, clarifies the nature of medical education interdisciplinarity by analyzing the citations of medical education journal articles.

Method

The authors retrieved the cited references of all articles in 22 medical education journals between 2001-2020 from Web of Science (WoS). We then identified the WoS classifications for the journals of each cited reference.

Results

We analyzed 31,283 articles referencing 723,683 publications. We identified 493,973 (68.3%) of those cited references in 6,618 journals representing 242 categories, which represents 94% of all WoS categories. Close to half of all citations were categorized as "education, scientific disciplines" and "healthcare sciences and services". Over the study period, the number of references consistently increased as did the representation of categories to include a diversity of topics such as business, management, and linguistics.

Discussion

Our study aligns with previous research, suggesting that medical education research could be described as inwardly focused. However, the observed growth of categories and their increasing diversity over time indicates that medical education displays increasing interdisciplinarity. Now visible, the field can raise awareness of and promote interdisciplinarity, if desired, by seeking and highlighting opportunities for future growth.

Digital education for health professionals in India: a scoping review of the research

BACKGROUND

The World Health Organization (WHO) predicts a global shortfall of 18 million health workers by 2030, particularly in low- and middle-income countries like India. The country faces challenges such as inadequate numbers of health professionals, poor quality of personnel, and outdated teaching styles. Digital education may address some of these issues, but there is limited research on what approaches work best in the Indian context. This paper conducts a scoping review of published empirical research related to digital health professions education in India to understand strengths, weaknesses, gaps, and future research opportunities.

METHODS

We searched four databases using a three-element search string with terms related to digital education, health professions, and India. Data was extracted from 36 included studies that reported on empirical research into digital educational innovations in the formal health professions education system of India. Data were analysed thematically.

RESULTS

Most study rationales related to challenges facing the Indian health care system, rather than a wish to better understand phenomena related to teaching and learning. Similarly, most studies can be described as general evaluations of digital educational innovations, rather than educational research per se. They mostly explored questions related to student perception and intervention effectiveness, typically in the form of quantitative analysis of survey data or pre- and post-test results.

CONCLUSIONS

The analysis revealed valuable insights into India-specific needs and challenges. The Indian health professions education system's size and unique challenges present opportunities for more nuanced, context-specific investigations and contributions to the wider digital education field. This, however, would require a broadening of methodological approaches, in particular rigorous qualitative designs, and a focus on addressing research-worthy educational phenomena.

Guidelines: The Do's, Don'ts and Don't Knows of Creating Open Educational Resources

Background

In medical education, there is a growing global demand for Open Educational Resources (OERs). However, OER creators are challenged by a lack of uniform standards. In this guideline, the authors curated the literature on how to produce OERs for medical education with practical guidance on the Do's, Don'ts and Don't Knows for OER creation in order to improve the impact and quality of OERs in medical education.

Methods

We conducted a rapid literature review by searching OVID MEDLINE, EMBASE, and Cochrane Central database using keywords "open educational resources" and "OER". The search was supplemented by hand searching the identified articles' references. We organized included articles by theme and extracted relevant content. Lastly, we developed recommendations via an iterative process of peer review and discussion: evidence-based best practices were designated Do's and Don'ts while gaps were designated Don't Knows. We used a consensus process to quantify evidentiary strength.

Results

The authors performed full text analysis of 81 eligible studies. A total of 15 Do's, Don't, and Don't Knows guidelines were compiled and presented alongside relevant evidence about OERs.

Discussion

OERs can add value for medical educators and their learners, both as tools for expanding teaching opportunities and for promoting medical education scholarship. This summary should guide OER creators in producing high-quality resources and pursuing future research where best practices are lacking.