Demonstrating causality, bestowing honours, and contributing to the arms race: Threats to the sustainability of HPE research

What Are We Made For? Mobilizing Medical Education Research for Impact

ABSTRACT

During the past several decades, medical education research has advanced in many ways. However, the field has struggled somewhat with translating knowledge into practice. The field has tremendous potential to generate insights that may improve educational outcomes, enhance teaching experiences, reduce costs, promote equity, and inform policy. However, the gap between research and practice requires attention and reflection. In this commentary, the authors reflect on ways that medical education researchers can balance relevance and rigor, while discussing a potential path forward. First, medical education research can learn from implementation science, which focuses on adopting and sustaining best practices in real-world settings. Second, gaining a deeper understanding of the complex and dynamic ways that medical education contexts may influence the uptake of research findings into practice would facilitate the translation and mobilization of knowledge into practical settings. Third, moving from unilateral knowledge translation to participatory knowledge mobilization and engaging diverse stakeholders as active participants in the research process can also enhance impact and influence research findings. Overall, for medical education research to effect meaningful change, it must transition from producing generalizable findings to generating context-specific insights and embracing participatory knowledge mobilization. This shift will involve rethinking traditional research approaches and fostering collaboration with knowledge users to cocreate and implement innovative solutions tailored to their unique settings.

In-Person Healthcare Simulation: An Umbrella Review of the Literature

SUMMARY STATEMENT

Given the large accumulation of research focused on the effectiveness of in-person simulation-based education (SBE), this umbrella review-or systematic review of systematic reviews-was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to analyze collective findings and close identified literature gaps. This study presents a descriptive analysis of the most effective modalities, methods, and measurements of in-person SBE, as well as major themes that emerged during analysis as it relates to SBE outcomes.The major patterns or themes that emerged confirm for the first time a longstanding sentiment in the literature, specifically the following: a need to produce higher-quality research with greater rigor, larger sample sizes, more randomized controlled trials, mixed methods, and longitudinal studies. These findings suggest a need to redirect scientific efforts in SBE. Despite the nearly ubiquitous issues noted across the systematic reviews' findings, results of this umbrella review seem to support the notion that in-person simulation-based education improves learning outcomes including technical and nontechnical skills and behavioral and attitudinal change. Analyses highlighted the need to improve overall research approaches and reduce redundancy, as well as the need to standardize terminology, broaden global diversity, and push for further research funding opportunities to support these efforts.

Validity in the Next Era of Assessment: Consequences, Social Impact, and Equity

Validity has long held a venerated place in education, leading some authors to refer to it as the "sine qua non" or "cardinal virtue" of assessment. And yet, validity has not held a fixed meaning; rather it has shifted in its definition and scope over time. In this Eye Opener, the authors explore if and how current conceptualizations of validity fit a next era of assessment that prioritizes patient care and learner equity. They posit that health profession education's conceptualization of validity will change in three related but distinct ways. First, consequences of assessment decisions will play a central role in validity arguments. Second, validity evidence regarding impacts of assessment on patients and society will be prioritized. Third, equity will be seen as part of validity rather than an unrelated concept. The authors argue that health professions education has the agency to change its ideology around validity, and to align with values that predominate the next era of assessment such as high-quality care and equity for learners and patients.

Training as imagined? A critical realist analysis of Scotland's internal medicine simulation programme

BACKGROUND

Evaluating the impact of simulation-based education (SBE) has prioritised demonstrating a causal link to improved patient outcomes. Recent calls herald a move away from looking for causation to understanding 'what else happened'. Inspired by Shorrock's varieties of human work from patient safety literature, this study draws on the concept of work-as-done versus work-as-imagined. Applying this to SBE recognises that some training impacts will be unexpected, and the realities of training will never be quite as imagined. This study takes a critical realist stance to explore the experience and consequences, intended and unintended, of the internal medicine training (IMT) simulation programme in Scotland, to better understand 'training-as-done'.

METHODS

Critical realism accepts that there is a reality to uncover but acknowledges that our knowledge of reality is inevitably our construction and cannot be truly objective. The IMT simulation programme involves three courses over a 3-year period: a 3-day boot camp, a skills day and a 2-day registrar-ready course. Following ethical approval, interviews were conducted with trainees who had completed all courses, as well as faculty and stakeholders both immersed in and distant from course delivery. Interviews were audio-recorded, transcribed verbatim and analysed using critical realist analysis, influenced by Shorrock's proxies for work-as-done.

RESULTS

Between July and December 2023, 24 interviews were conducted with ten trainees, eight faculty members and six stakeholders. Data described proxies for training-as-done within three broad categories: design, experience and impact. Proxies for training design included training-as-prescribed, training-as-desired and training-as-prioritised which compete to produce training-as-standardised. Experience included training-as-anticipated with pre-simulation anxiety and training-as-unintended with the valued opportunity for social comparison as well as a sense of identity and social cohesion. The impact reached beyond the individual trainee with faculty development and inspiration for other training ventures.

CONCLUSION

Our findings highlight unintended consequences of SBE such as social comparison and feeling 'valued as a trainee, valued as a person'. It sheds light on the fear of simulation, reinforcing the importance of psychological safety. A critical realist approach illuminated the 'bigger picture', revealing insights and underlying mechanisms that allow this study to present a new framework for conceptualising training evaluation.

Embracing the future: Technological developments and sustainability in health professional education

Pusic, Crampton, and Eva announce the release of Medical Education's 15th annual State of the Science issue: Embracing the Future

Aligning structures with values to sustain health professions education research

This commentary highlights the role of leaders for sustaining health professions education research; in doing so, it advocates for identifying explicit values, derived through dialogue with stakeholders, and aligning investments with those values.