Elements of Educational Research for the Academic Physician

1. Elements of Educational Research for the Academic Physician Rebecca Henry, Ph.D. OMERAD College of Human Medicine Michigan State University

2. Researchers Teachers Practitioners Professional Roles In A Specialty

3. Skills Required of Research-focused Faculty • Content Knowledge • Uses a range of information searching tools • (e.g., MEDLINE) • Critically appraises a variety of literature • Synthesizes theory into own research • Becomes expert in a body of knowledge • Informed about ethical conduct of research • Methodological Skills • Formulates researchable questions • Develops valid and reliable measures • Understands threats to internal and external validity • Understands at an advanced level the statistics • relevant to one’s own research • Uses design and statistical consultants • Reports results accurately and can cite strengths • and limitations of the study • Integrates findings into the existing literature

4. Skills Required of Research-focused Faculty (continued) • Management Skills • Develops research management plans • Prepares and submits required reports and • other administrative documents • Adheres to university guidelines and regulations • regarding the conduct of research • Locates appropriate funding sources • Socialization • Establishes professional goals and priorities • for a research career • Understands the promotion environment • Links to networks and associations • Identifies research mentors • Manages and balances competing professional • obligations to achieve research goals.

5. Essential Skills of Teacher/Clinician and Teacher/Administrator • Values the use of new knowledge as it • applies to patient care • Determines when the research literature • can be used as an effective teaching tool • Role models clinical practices based on • evidence and not on tradition • Incorporates evidence-based medicine • into teaching strategies • Interprets conflicting study results and • their implications for patient care decisions

6. Skills Required of Teacher/Preceptors • Critically assesses research literature, • especially that relevant to patient care. • Is aware of issues emerging from • discussions of practice guidelines, • protocols and standards of care. • Articulates to students one’s own rationale • for a particular practice strategy. • Participates in societies, conferences, • and continuing education programs. • Models lifelong learning. • Is self-critiquing, especially when faced • with challenging clinical problems.

7. Why Do We Engage in Research • Satisfy Curiosity • Describe Phenomena • Evaluate Hypotheses • Evaluate New Techniques or Methods

8. Types of Research Questions Is there a relationship? Between the Henry Dexterity Assessment and the Clerkship OSCE? Between MCAT and our shelf exam? Is there a difference? PBL vs Lecture? Direct observation vs simulated patient? Can you predict? Who will fail the inservice exam? Who will practice in rural settings? Can you describe? What are the most frequent diagnoses in a university based clinic? What is charted on domestic violence?

9. Most questions ultimately target: Comparisons between groups on a dependent variable. “Does a mentoring program decrease drop-out rate for first year residents?” Relationships among independent and dependent variables. Students performance on the Henry Dexterity Assessment is related to scores on the surgery OSCE. Descriptions of responses to independent or dependent variables. “How do residents rate on problem solving skills?” “What are the practice choices of graduate general surgery residents?”

10. Not Researchable Should I implement a PBL curriculum? What is the best way to learn suturing? Are some students unable to pass Step 1? Researchable Does PBL or lecture have better test scores Does practice reduce errors in suturing? Will MCAT scores predict Step1 failures? Developing Researchable Questions

11. Dimensions of Research Design • Objective of the Study/Nature of the Question Exploratory Need More Information to Sharpen Question Can’t Measure Variables Descriptive Seeks to Characterize Sets of Variables About People or Phenomena Analytic Seeks to Determine Relationships (ultimately casual) Among Variables

13. Dimensions of Research Design (cont) II. The Timeframe Under Investigation Retrospective Examines Background of Residents Who Select Primary Care Cross Sectional A “one shot” Survey Measuring a Variables(s) at one point in time Prospective Begin in the Present and Follow Subjects Forward in Time

15. Dimensions of Research Design (cont) III. Does the Investigator Influence an Outcome? Observation Watch and RECORD Information Intervention Introduces Some Agent to Impact an Outcome Natural Experiments Curriculum Reform

18. RESEARCH DESIGNS ANALYTIC DESCRIPTIVE Case Series Ethnographies Needs Assessments OBSERVATIONAL Cohort Case Control Cross Sectional INTERVENTIONAL Randomized Controlled Experiments Educational/Health Care Experiments (Quasi experimental) GOAL: Select a Design Which Can Give an Answer to Your Question in the Most PRACTICAL Way.

19. Basic Study Designs DESCRIPTIVE EXPLANATORY Document and communicate experience: share ideas, programs, treatments, unusual events and observations Begin search for explanations Examine etiology, cause, efficacy using the strategy of comparisons EXPERIMENTAL OBSERVATIONAL Evaluate efficacy of therapeutic, educational, administrative interventions. Investigator controls allocation Seek causes, etiologies predictors, better diagnosis Investigator observes nature • Examples: • Case report or series • Rash developing while on drug • Cluster of cases of vaginal cancer • Clinical series • Treatment of 50 hernias by • laparoscope technique • Population • Diagnosis seen in family practice • Community survey of needs of elderly • Examples: • Clinical trial • Compare two antidepressant drugs • Surgical vs. medical management • of angina • Educational intervention • Self-Instruction vs. lecture on • anemia • Health-care trial • Nurse practitioner vs. physician • care • Examples: • Case Control • Diets of toxemic vs. • nontoxemic patients • Follow-up • Development of surgical • complications of inguinal • hernias • Cross-sectional • Prevalence of dental caries • in bottle fed children

20. Type 1 Evidence Randomized Controlled Trial Quasi-Randomized Controlled Trial Type 2 Evidence Cohort Study Before - After Study Type 3 Evidence Case Control Cross-Sectional Type 4 Evidence Descriptive Study Levels of Evidence

21. Research environment Controlled Naturalistic Data not provided/not applicable Research strategy Evaluation Comparison Survey Qualitative Experiment Other Data collection method Observation/testing Questionnaire Historical analysis Interview Discussion 22 (6.2) 245 (69.4) 86 (24.4) 135 (38.2) 80 (22.7) 52 (14.7) 42 (11.9) 29 (8.2) 15 (4.3) 237 (67.1) 97 (27.5) 13 (3.7) 4 (1.1) 2 (0.6) Characteristics of 353 Research Articles on Undergraduate Medical Education, 1975-1994* No. of Research Articles (%) Characteristics

22. Data analysis method Inferential Quantitative Non-quantitative Analytic Other Report of external funding No funding reported Yes, non-U.S. government Yes, U.S. Public Health Service Yes, other U.S. government 200 (56.7) 103 (29.2) 46 (13.0) 1 (0.3) 3 (0.9) 273 (77.3) 49 (13.9) 25 (7.1) 6 (1.7) Characteristics of 353 Research Articles on Undergraduate Medical Education, 1975-1994* No. of Research Articles (%) Characteristics * Of a randomly selected sample of 773 articles, 353 were classified as reports of research activity (I.e., they used specific methods to ascertain new facts, concepts, or ideas).