The past and present trends in educational research in health professions are discussed. Future challenges to be met and overcome are discussed.

1. Emerging Areas of Educational
Research in Health Professions
Prof KR Sethuraman.
Sri Balaji Vidyapeeth,
Puducherry
www.sbvu.ac.in

2. 20th Century
21st Century
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3. My objective is to share ideas on…
• The characteristics of Educational Research
• Current issues in Health-Professions Education
Research
– The Asian Scenario in comparison to the Global
scene
• Trends in Health-Professions Education
Research
• The way forward & Challenges ahead
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4. Ways of Knowing
• Five ways we can know something
– Personal experience
– Tradition
– Experts and authorities
– Logic
• Inductive (Bottom-Up)
• Deductive (top-down)
– The Scientific Method
• Educational Research utilizes all these ways
to generate knowledge
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5. Purposes of Educational Research
Four purposes are, to
• explore
– generate ideas about educational phenomenon,
• describe
– the characteristics of educational phenomenon,
• predict
– forecast an educational phenomenon
• explain
– to show why and how an educational phenomenon
operates
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6. Research Methods
• Two general categories used in educational
research
– Quantitative; – Qualitative
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7. Quantitative Methods
• Characteristics
– Numerical data
– Use of formally stated hypotheses and procedures
– Use of controls to minimize the effects of confounders
– Large numbers of participating subjects
– An objective, detached researcher
– Use of pencil and paper tests, questionnaires, etc.
Obj. 3.6 & 5.1
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8. Qualitative Methods
• Characteristics
– There are no hypotheses guiding the researcher
– Phenomena are studied in a natural context, and they are
viewed from the participants’ perspectives
– There are only a few participants involved in the study
– The researcher interacts extensively with the participants
– Problems and methods tend to evolve over the course of
the study
– Data analysis is interpretative in nature
Qualitative
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9. Qualitative Methods (eg.Learning in Rounds)
Obj. 3.9
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10. 11ERICON-2017

11. A mixed-mode research combines the complementary
strengths of the qualitative & quantitative approaches
Purpose guides Approach
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12. Production
for
Promotion!
Research for Whom?
Peers or End-users? – a continuum
Production for Producers (PFP)
Researchers advocate for:
• Knowledge Production aimed at
Peer Researchers
• Autonomy of the Field; research
focus defined internally by
researchers
• Research for Knowledge
building
• Peer-review procedures for
evaluation
• Exclusion of non-scientific
criteria (“Silo mode”)
-- Bourdieu P. in Soc Sci Inf. 1975;6:19–47.
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Production for Users (PU Pole)
Researchers advocate for:
• Knowledge Production for end-
users (non-Producers)
• Opening the field to educator-
practitioners to define the
research focus
• Research for problem solving or
service improvement
• Participation of non-academics in
evaluation process
• Inclusion of non-scientific criteria
such as social relevance and
societal values

13. Research Outcomes: Knowledge – Utility
Donald Stokes in his book, Pasteur's Quadrant, 1997.
“me-too” or
Junk
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14. The Recent Past:
UNESCO on
Educational Research
26 Years Ago
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15. A Felt Need even then (1991)
Five Issues prioritized:
1. Social, cultural &
economic adjustments.
2. Education & the
environmental issues.
3. Women/gender issues.
4. Minority & marginal
groups (equity of access).
5. Ecology of educational
research.
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16. Problems identified…
• The position of educational research
– Low priority in national agendas
– Policies are seldom based on robust research
• The coordination of educational research
– no definite research strategy;
– vulnerable to conflicting demands from different agencies
• The development & maintenance of research capacity
– Educators unable to conduct robust Educational research.
• The framework for the dissemination of educational research.
– serious language barriers that hinder the international
exchange and mutual understanding
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17. Recommended Actions in 1991
• Improve research quality
• Improve institutional capacity for research
• Facilitate dissemination and utilization of
research
• Enhance the value of educational research;
• Foster innovative research on problems of
education and development.
• Set up an international commission to
promote collaborative research
Strengthening educational research in developing countries. Unesco - 1991
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18. Research in Medical Education:
The Current Scene
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19. Best Evidence Medical Education (BEME)
• “the nature of profession today demands that
educators provide evidence of effectiveness
and efficiency of their programs“
• BEME is an extension of the Evidence Based
Medicine initiative to Medical Education
– Acad Med. 2004;79:925—930.
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20. Medical Education Research:
High Fliers and Role Models
Samy A. Azer, The Top-Cited Articles in Medical Education: A
Bibliometric Analysis. Academic Medicine, 2015; 90.8:1-15
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21. Top Authors 1988-2010
-- Adv in Health Sci Educ DOI 10.1007/s10459-011-9328-x 22ERICON-2017

22. Top Cited Authors (Role-models)1988-2010
-- Adv in Health Sci Educ DOI 10.1007/s10459-011-9328-x 23ERICON-2017

23. Top 4 Topics of Research 1988-2010
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24. Topics of Research, Rank 5 – 10
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25. Med Edu Research: Concerns
• Not designing systematic research and,
therefore, missing out on the “big questions”
• Piece meal studies: difficulty of aggregating
findings into generalisable themes
• “Potpourri approach.” (Med Educ. 2002;36:1114–5)
• Weak Theoretical Basis: the theories we are
too weak to be productive (Acad Med. 2002;77:1217–20)
Regehr G. Trends in Medical Education Research. Acad Med. 2004;79:939 –947
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26. Med Education – the Asian Scene
• “Medical education in Asia is
– colonial-biased,
– subject-oriented,
– teacher-centred,
– discipline-based,
– lecture-focused,
– hospital-based traditions, &
– Fails to ‘train medical students appropriately for
national health needs’.”
Majumdar MAA, Issues and Priorities in Medical Education Research in Asia.
Ann Acad Singapore 2004; 33:257-63.
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27. Med Edu Research – the Asian Scene
• Papers published from Asia in Academic
Medicine (1%) and Medical Education (8%) are
negligible.
• Efforts are needed
– to bridge the information gap between the
developed and developing countries
– to minimise "information poverty" in this
"resource-poor" region
– to improve the quality of medical education and
healthcare services
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28. Med Edu Research in Asia:
Law of Diminishing Non-returns !
i. Poor socio-economic condition
- Lack of funds
- Donor-funded projects: "commissioned research"
ii. Conservatism and passive "Follow the Rest" mind
iii. Lack of relevance
- Medical training ignores community health needs
- Research has different purposes, scopes and
outcomes
Majumdar MAA, Issues and Priorities in Medical Education Research in Asia.
Ann Acad Singapore 2004; 33:257-63. 29ERICON-2017

29. Med Edu Research in Asia:
iv. Leadership crisis
- No effort to undertake large-scale medical education
experiments
- No "culturally relevant" policy and guidelines
- Half-hearted commitments of regional & international
agencies
- 'Brain drain' of academics due to poor working environment
v. Faculty development
- Low availability of training on qualitative research methodology
- Educational research reaps no professional reward
- Weak collaboration among departments and institutes
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30. Med Edu Research in Asia:
vi. Information poverty
- Lack of up-to-date books and journals
- High subscription costs of journals
- No regional medical education journal
- Scanty publication: language barrier, editorial bias,
uncertainty about appropriate journal options
- Poor Information Technology facilities and training
- Information gap between developed and developing
countries
vii. Unforeseeable research outcome
- Impact on healthcare is difficult to assess as it needs long-
term studies
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31. Strengthen Research Capabilities
i. Leadership and commitment - "culturally
appropriate" (Think Global – Act Local)
ii. Relevance = - Community needs assessment;
setting of priorities for educational research
iii. Establish an education research centre
iv. Availability of financial resources
v. Research methodology – capacity building
vi. Access to information
Majumdar MAA, Issues and Priorities in Medical Education Research in Asia.
Ann Acad Singapore 2004; 33:257-63.
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32. Open access:
Sad state of Indian repositories
• 69 Indian repositories listed in the Directory of
Open Access Repositories (DOAR)
• Only 12 added “at least one item during a
month” during July 2015 to June 2016.
• 17 repositories did not add even a single item
• 40 were “irregular” in adding items to the
repositories,
http://www.thehindu.com/sci-tech/science/Open-access-The-sorry-state-of-Indian-
repositories/article17108642.ece?homepage=true
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33. Challenges and Barriers to
Medical Education Research
Barriers that prevent implementation of research in medical education. Journal
of Advances in Medical Education, 2015; 1.1:10-21
Barriers that prevent implementation of research in medical education. Journal
of Advances in Medical Education, 2015; 1.1:10-21
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34. Lament From USA –
Applies to India too !
• “Medical education has a history of reports by
prestigious bodies calling for reforms.
• Yet the reform has been slow to come.
• - there is still no consensus, national policy, or
unified body of research on health professions
education and its relationship to areas such as
practice-needs...”
Traxler HG. Proceedings of the BHPr–AAMC Conference, “Research in Medical
Education: Policies for the Future.” Introduction. Acad Med. 1994;69:601–3.
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35. Intrinsic Difficulties in
Educational Research
– Involves human beings and the complexities
associated with them
– Difficulties generalizing from specific studies
– Problems in imposing sufficient controls to
conduct research in educational settings
– Complications when observing in educational
settings (Hawthorne Effect, biases, etc)
– Indirect measurement of the variables being
studied
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36. Barriers to Education Research
• Lack of protected time for educational project
• Fragmentation
– opportunities for education projects are sporadic
• Prioritisation:
– service-teaching-research dilemma
• Motivation
– limited recognition and support for education
research
Zibrowski et al, issues of fragmentation, prioritisation and motivation for
education scholarship among medical faculty. Med Edu 2008: 42: 872–878
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37. 1. Personal barriers
• Lack of knowledge of issues worthy of study
• Lack of sufficient incentives to carry out
research priorities at the university.
• Inadequate skills and knowledge of statistics
and research methodology.
• There was No need to do research at the
university for career progression.
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Barriers that prevent implementation of research in medical education. Journal
of Advances in Medical Education, 2015; 1.1:10-21

38. 2. Organizational barriers
• Lack of appropriate equipment and facilities.
• The long process of research projects approval.
• Demands of Clinical/Laboratory work-load.
• Failure to allocate credits for research
activities.
• Unwillingness of organizations to implement
the study results in a sustained manner.
• Lack of monitoring and evaluation of the
impact by the Research wing
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39. 3. Strategic and Policy Barriers
• Lack of the comprehensive and transparent
planning.
• Lack of a comprehensive database.
• Low budget allocations.
• The absence of active core-groups to perform
parts of a large-scale research.
• Constant changes in programs and research
projects.
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40. 4. Educational Barriers
• Low research morale in the educational
system.
• Lack of coordination and coherence of
activities in the field.
• Insufficient communication and cooperation
between teachers and students in research
projects and dissertations.
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41. 5. Financial Barriers
• Lack of adequate and equitable distribution of
funds and resources.
• Inadequate funding of scientific-research
work.
• The lack of research incentives .
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42. 6. Cultural Barriers
• Poor Research etiquette and lack of
motivation to work in teams.
• The organizational culture ignores the
importance of research efforts and impact.
• “Crab mentality” of pulling other researchers
down
Barriers that prevent implementation of research in medical education. Journal
of Advances in Medical Education, 2015; 1.1:10-21
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43. Pressure to Publish
Quantity versus Quality Issues
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44. Major Driving Forces for Health
Professions Education Research
• Requirements for Recognition/accreditation
• Institutions making independent decisions
based on local needs and issues
• Perceived need for scientifically directed
peer-reviewed research
• Presently, the pressure from Councils to
publish for career advancement
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45. Proliferation of the
Predatory Publishers
A current Scam in the making!
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46. Pressure to
Publish
Peer-Review Fraud — Hacking the Scientific Publication
Process
Charlotte J. Haug, NEJM. DOI: 10.1056/NEJMp1512330
In August 2015, the publisher Springer retracted 64 articles
from 10 different subscription journals “after editorial checks
spotted fake email addresses, and subsequent internal
investigations uncovered fabricated peer review reports.”
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47. Why Researchers of Developing
Nations Avoid International Journals
• English as a language barrier constitutes a
huge problem.
• Incapability to select the right journal
• Unfamiliar with the range of journals open to
them
• A false perception of an editorial bias against
work submitted from the developing world.
Oktay Tutarel, Geographical distribution of publications in the field of
medical education. BMC Medical Education 2002, 2:3
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48. Research in Medical Education:
Future Directions
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49. IRB* for Educational Research
• The context and methodology of educational
research are far different from biomedical
studies
• The former is closer to soft-sciences like
pedagogy, sociology and psychology
• A common IRB for both may be dismissive of
non-randomized qualitative studies by
educationists Acad Med. 2016;91:229–232.
* Institutional Review Board
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50. Discipline Based Educational Research
• to understand how students learn the concepts,
practices, and ways of thinking in a discipline;
• to understand the nature and development of
expertise in a discipline;
• to contribute to the knowledge base to guide the
translation of DBER findings to classroom practice;
• to identify approaches to make education in
specific disciplines broad and inclusive.
To achieve these goals, DBER scholars need to
conduct studies in basic and applied research.
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51. Emerging Disruptor, MOOC
• MOOC (Massive Open Online Course) has a
great potential to reach the rural and remote
areas in India
• Regulatory bodies have effectively curbed the
Power of MOOC to reach out to Millions
– M (in MOOC) stands for “Miniscule”?!
• Operations Research is urgently needed to
make use of MOOC to foster effective
education using the 70:20:10 framework
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52. Does 70/20/10 Model Suit 21st Century Learning?
Where are Indian Studies to Validate and
operationalize this Model ?
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53. Emerging area: CBME –
Competency Based Medical Education
• The most promising area of study in Health
Professions education in 21st Century lies in
the assessment of individual competence
• Larger systematic studies to monitor CBME to
support meaningful changes in Health
Professions education.
• Clinical Medical Education (2014) Vol. 1, No. 1: 6-11
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54. Emerging Area: Simulation as an
Effective Training Tool
• Many features contribute to its effectiveness:
– feedback,
– cognitive interactivity,
– repetitive practice, and
– exposure to range of difficulty in procedural tasks
• Research on the effects of simulation training
on patient-related outcomes is just beginning
– With immersive simulation (Virtual reality) this is a
field full of opportunities
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55. Emerging area: Use of Social Media
• This represents a major paradigm shift in
education.
• Positive view: Web 2.0 fosters student learning,
i.e., engagement, encouragement of autonomy,
reflection, and group learning as a “connected
community”.
• Critical view: ‘Google retrieval is not learning’
and stress the need to promote critical thinking
and literacy skills in today’s students.
• Piotrowski C. Emerging research on social media use in
education: a study of 29 dissertations. Research in Higher
Education Journal, 2015; 27:1-15
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56. The ‘Digital Generation’ has added
Basements to Miller’s Pyramid!
“Got it in my Pen-Drive”
“Can Google”
KRS
We need to
study the
effects of such
beliefs on the
outcomes
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57. Planning a Comprehensive Health
Professions Education Research
in 7 Clusters
A Quick Scan…
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58. I. Contextual Issues :
(Looking Back to the Future)
• Academic “Silos” and Their Impact on Medical
Education
• Socio-Cultural Issues in Clinical Teaching
• The Effect of Technology on Medical Education
• Medical Sociology – Bioethics and Medical
Education
• The History of Medical Education
Acad Emerg Med. 2012;19(12):1336–1343.
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59. II. Cognition & Educational Theory
• The Nature and Nurture of Medical Expertise
• Transfer of Learning
• Clinical Reasoning and Decision-Making
• Motivation and Deliberate Learning
• Self Assessment and Confidence
• Principles of Adult Learning
Acad Emerg Med. 2012;19(12):1336–1343.
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60. III. Assessment of Individuals
• Selection of Medical Students and Residents
• Individual Competency Assessment
• Workplace-based Assessment
• Simulation-Based High-Stakes Assessment
• Assessment of Non-Cognitive Skills
• Assessment of Teacher Effectiveness
Acad Emerg Med. 2012;19(12):1336–1343.
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61. IV. Teaching & Learning
• Enhancing Effective Teaching in a Clinical
Setting
• Communication Skills
• Designing a Curriculum for Continuity of Care
Training
• Community-Oriented Medical Education
• Residents as Teachers
• The Hidden Curriculum
• Simulation in Medical Education
Acad Emerg Med. 2012;19(12):1336–1343.
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62. V. Curriculum Development &
Evaluation
• Approaches to Curriculum Development and
Design
• Curriculum Mapping
• Curriculum Evaluation
• Effective Strategies to align Intended, Enacted,
Learnt and Assessed Curricular Outcomes
Acad Emerg Med. 2012;19(12):1336–1343.
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63. VI. Leadership & Career Development
• Organizational Change Management
• Educational Scholarship in the Medical School
• Educational Leadership Opportunities
• Effective Mentorship
• Personal and Professional Growth
• Socialization into the Profession
• Professional Identity Formation
• Communication Skills
Acad Emerg Med. 2012;19(12):1336–1343. 64ERICON-2017

64. VII. Methodology and Research
Principles
• Quality of Research in Medical Education
• Best Evidence in Medical Education
• The Influence of Social and Political Factors on
Funding in Medical Education Research
• Best Practices for Mixed Methods Research
• Ref: Acad Emerg Med. 2012;19:1336–43.
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65. Recent Research in Medical Education
(FAIMER Projects- 2012-'13; n=28)
1. Contextual issues (4)
2. Cognition and educational theory (0)
3. Assessment of individuals (5)
4. Teaching and learning (9)
5. Curriculum development and evaluation (6)
6. Leadership and career development (4)
7. Methodology and research principles (0)
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66. Fostering Education Research:
Roles and Responsibilities
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67. Agency for Educational Research:
Six pearls for effectiveness…
o Recruit Educationists with Leadership and
Managerial skills to run the agency
o Create mechanisms to guide research agenda,
grant funds and goad progress
o Insulate the Agency from Political interference
o Adequately fund the agency
o Develop research agenda that covers short~,
Medium~ and Long-term issues of importance to
medical education
o Invest in research infrastructure
Scientific research in Education – at https://www.nap.edu/read/10236/chapter/1 68ERICON-2017

68. Roles for HPE Institutions…
• Articulate and enable development of
research competencies in students
• Ensure that student-researchers develop in-
depth knowledge and skills to undertake
research
• Provide these students with variety of self-
determined and meaningful research
experiences
https://www.nap.edu/catalog/11112/advancing-scientific-research-in-education
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69. Roles for Professionals & Publishers
• Develop explicit standards for data sharing
• Require authors of journal articles to make
data available to other researchers
• Create infrastructure to facilitate data sharing
and knowledge accumulation
• Develop manuscript review systems that
support professional development
https://www.nap.edu/catalog/11112/advancing-scientific-research-in-education
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70. To Sum Up…
• There seems to be an absence of community
effort to build on our understanding of Medical
Education in Global & Local contexts
• We need a community where data and ideas are
– not merely described, but listened to,
– not merely dismissed or ignored but addressed,
incorporated, and improved upon
– by other members of the community of
educationist-researchers
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71. “Medical Education Is the Ugly Duckling”
Challenges to Medical Educators’ Identity*
• a change in professional
identity is needed
• for medical education,
• medical education
research,
• the practice of
medicine, and
• patient care.
* Acad Med. 2014;89:1474–1480.
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72. Together We Can…
THANK YOU!
• We need to form an effective network to
cooperate, coordinate and collaborate to
create a robust evidence-informed education
that results in quality healthcare delivery in
the 21st Century.
• Let us forge ahead in earnest …
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