The changing health care system. A research agenda for medical education

Educational Research Priorities for Pediatric Physical Therapy: A Consensus Study

PURPOSE

This study engaged stakeholders internal and external to pediatric physical therapy education in a consensus exercise toward determining and refining priorities and considerations for educational research for pediatric physical therapy.

METHODS

The Delphi method was used to survey 54 physical therapists from 5 stakeholder groups drawn from experts in the field of physical therapy education and from Academy of Pediatric Physical Therapy members invested in educational leadership, research, and/or pediatric physical therapy clinical and residency education.

RESULTS

A 4-round survey process revealed 12 educational research priorities and 13 educational research considerations that reached 80% consensus, with clear and consistent top ranking of 4 of these priorities and 4 considerations across all stakeholder groups.

DISCUSSION

As the Academy of Pediatric Physical Therapy continues to develop and advance its capacity and support for educational research, knowledge of these priorities and considerations might be used to guide an educational research agenda.

Obligation for transparency regarding treating physician credentials at academic health centres

Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty physicians at other health systems. There has been limited transparency in regard to the expertise among the physicians and the academic faculty within these larger entities. Such lack of transparency may lead to confusion among patients regarding the qualifications of who is actually treating them. This could threaten the ethical principles of patient autonomy, benevolence and non-maleficence as patients risk making uninformed decisions that might lead to poorer outcomes. Furthermore, this lack of transparency unjustly devalues the achievements of physician faculty members as well as potentially the university they represent. In this paper, it is suggested that academic health centres have an obligation to foster total transparency regarding what if any role a physician has at a university or medical school when university or other academic monikers are used at a hospital.

A RIME perspective on the quality and relevance of current and future medical education research

In this article, the authors consider the quality and relevance of current and future medical education research by (1) presenting a framework for medical education research and reviewing basic principles of "good" empirical work, (2) extending the discussion of principles to "best practices," (3) considering the distinctive features of medical education that present challenges to the researcher, and (4) discussing opportunities for expanding the scope and influence of medical education research. Their audience is intended to be clinicians involved in education, deans and associate deans who create and direct educational curricula and processes, and those from offices critical to the educational mission such as admissions, student services and financial aid, as well as medical education researchers. The authors argue that the quality and relevance of current work can be enhanced when research is situated within a general framework and questions are asked that are based on literature and theory and push the field toward new knowledge. Obviously methods and designs must be appropriate and well-executed and sufficient data must be gathered. Multiple studies are highlighted that showcase the rigor and creativity associated with excellent quality work. However, good research is not without its challenges, most notably short timelines and the need to work within an ever-changing real-life educational environment. Most important, the field of medical education research has many opportunities to increase its impact and advance its quest to study important learners' behaviors and patients' outcomes. Programs to train and collaborate with clinical and administrative colleagues, as well as researchers in other fields, have great potential to improve the quality of research in the field.

Assessing the performance of doctors in teams and systems

INTRODUCTION

Increasing attention is being directed towards finding ways of assessing how well doctors perform in clinical practice. Current approaches rely on strategies directed at individuals only, but, in real life, doctors' work is characterised by multiple complex professional interactions. These interactions involve different kinds of teams and are embedded within the overall context and systems of care. In addition to individual factors, therefore, we propose that the performance of doctors in health care teams and systems will also impact on the overall quality of patient care. Assessing these dimensions, however, poses a number of challenges.

STRATEGIES

Taking a profile of a National Health Service, UK surgeon as an example, the team structures to which he or she may relate are illustrated. These include formal teams such as those found in the operating theatre, and those formed through various professional and collegial partnerships. The authors then propose a model for assessing doctors' performances in teams and systems, which incorporates the educational principles of continuous feedback to enhance future performance.

DISCUSSION

To implement the proposed model, a wide range of professional, educational and regulatory bodies must collaborate. This raises a number of important implications for the future roles and relationships of these bodies, which are discussed. A strong and constructive partnership will be essential if the full potential of a more inclusive and representative assessment approach is to be realised.

Offices of research in medical education: accomplishments and added value contributions

PURPOSE

Offices of research in medical education have been in existence since the 1st one was begun by Hale Hamm at Case Western Reserve in 1958. There are now 61 medical schools in North America that have a formal office of medical education (OME) and are part of the Society of Directors of Research in Medical Education (SDRME). The purpose of this study was to report how SDRME and OMEs have contributed to the research in medical education (RIME) efforts.

SUMMARY

This study reports specific initiatives that have been begun by the SDRME culled from historical documents and business meeting minutes and profiles results of the 2000 biannual membership survey that describe what the individual units are doing in support of their institutions. As an organization, SDRME sponsors literature reviews, 5 of which have been published in peer-reviewed journals. It has also collaborated with the American Medical Association, the National Institutes of Health Bureau of the Health Professions (NIH BHP), and the Association of American Medical Colleges in offering conferences and workshops. SDRME worked with the Macy Foundation on a grant initiative which by November 1993 had established 6 consortia to develop regional centers on clinical competence and with the NIH BHP in the development of a grants program that established centers for RIME. Results from the 2000 membership survey indicate that individual units are heavily tied into evaluation efforts at both the institutional and national levels. Research efforts being engaged by these units have led to a reasonably high, but variable, level of publication activity. The current wave of new curricula being implemented in medical education centers are being heavily supported by these units, with all units being involved in curriculum planning and administration.

CONCLUSIONS

SDRME has been effective in promoting RIME through sponsoring literature reviews and collaborating with various national organizations. OME units have been effective in serving the needs of their institutions as well as contributing to national research efforts.

Toward setting a research agenda for systematic reviews of evidence of the effects of medical education

PURPOSE

To provide an update on, and a preliminary research agenda for, best evidence medical education (BEME).

SUMMARY

Efforts related to evidence-based medical education are summarized briefly, including BEME, the newly formed Campbell Collaboration, and the Cochrane Collaboration's Effective Practice and Organization of Care review group. A list of topics and priorities for which evidence of effectiveness in medical education should be systematically reviewed is provided based on the results of a session at the July 2000 annual meeting of the Society of Directors of Research in Medical Education. The highest ranked topics clustered around four major conceptual areas: (a) curricular design, (b) learning and instructional methods, (c) testing and assessment, and (d) outcomes.

CONCLUSIONS

BEME is gaining momentum with growing numbers of people becoming involved as well as an increased number of pertinent workshops, publications, and Web sites. The work of creating pertinent systematic reviews of the medical education literature is at hand.