Research in Surgical Education
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Research in Surgical Education Hilary Sanfey MB. BCh. MHPE. FACS Professor of Surgery & Vice Chair for Surgical Education Southern Illinois University, Springfield
Disclosures I have no relevant financial relationships to disclose pertinent to the content of my presentation.
Overview What is surgical education research? Identifying & avoiding the pitfalls Academic success as surgeons performing research in surgical education
Research in Education - Criticisms Opportunistic Reproduce what has already been done Do not add new knowledge. Lack a literature review Inappropriate methodologies Albert M et al. Adv in Health Sciences Educ. 2007 40% published abstracts lack essential elements Cook D et al. Med Educ 2007
Research in Surgical Education A scholarly approach is one that demonstrates evidence of drawing from and building on the work of others, and contributing work through public display, peer review and dissemination; both involve engagement with the community of educators . Consensus Conference on Educational Scholarship convened by the Association of American Medical Colleges (AAMC) Group on Education Affairs (GEA). Simpson D et al. Med Educ 2007
Research in Surgical Education Systematic process of defining, testing & analyzing a problem Identify problem & research question Define independent & dependent variables Review literature Research design (methods & collaborators) IRB Funding Dissemination
Identify a Problem - FINER Significance, rationale Feasible, Interesting, Novel, Ethical, Relevant Breadth & complexity, Resources, time, measurement Narrow the focus
Example Problem Statement Research Question Hypothesis Resident dissatisfaction with their teaching environment will impact their overall satisfaction with their training program Does resident dissatisfaction with their teaching environment negatively impact their satisfaction with a training program? There will be no difference in satisfaction with their training program between those residents who are satisfied with the teaching environment compared with those who are not.
Literature Review Is this an original question? Has it been answered in other disciplines? Has it been answered in other learners? Harvard Business Review New York Times Pubmed /Ovid / Medline ERIC/ EBSCO
Evaluating the Education Literature What groups are being compared? Confounding factors? Is comparison based on risk factor or outcome? Is there any bias? Sample size / p value? Literature inclusion / exclusion criteria ? Generalizable? Conclusions justified?
Research Design Involve a statistician early in the process to ensure appropriate sample size, effect size, reliability , validity
Research Design : Purpose Exploratory Seek to uncover important questions & variables prior to establishing formal hypotheses. Descriptive Seek to characterize & measure sets of variables about people or phenomena. Analytic Seek to determine if there are relationships between specific groups. Bordage G et al Med Educ 2003
Research Design : Time Frame Retrospective Begins with outcome & searches for prior existing variables to explain the outcome Cross sectional Measures two or more variables to establish a relationship, therefore one must precede the other Prospective Follows subjects forwards in time to measure an outcome Bordage G et al Med Educ 2003
Research Design: Role of Observer Observational Interventional Natural Experiments Focus on defining variables & measuring them Goal is to intervene & expect to influence an outcome in subjects. Interventions occur without participation in the planning A study of a new online course that measures the amount of time learners spend in lectures, review sessions and course labs A study designed to give residents practice on simulators to determine if they perform tasks with less errors after using simulator, compared with usual practice ACGME duty hour changes which created an opportunity to study impact on teaching, operative experience and patient care Henry R in Guide for Researchers in Surgical Education 2010
Research Design: Collaborators Establish authorship & responsibilities early! Challenges to research ownership Role confusion & power differential Long term projects Abstract first approach Research hand off Culture of gifting authorship Hauge L in Guide for Researchers in Surgical Education 2010
Research Design: Collaborators For authorship, most journals require contribution in each of the following: Conception & design, or acquisition of data, or analysis and interpretation of the data Drafting the manuscript or revising it critically for important intellectual content Approval of the version to be published International Committee of Medical Journal Editors http://www.icmje.org/urm_main.html
IRB Do I need IRB approval? Research means a systematic investigation including research development, testing & evaluation designed to develop or contribute to generalizable knowledge. Activities which meet this definition constitute research for purposes of this policy, whether or not they are conducted or supported under a program which is considered research for another purpose 45CFR46 http://ohsr.od.nih.gov/guidelines/index.html
IRB The IRB can be your friend IRBs differ Even if you know you are exempt you must submit an application for an exemption Being exempt does not mean that you don t need to worry about consent, or provide access to study results Gaining consent from subjects is worth the time investment
Funding & Grant Writing 30% of studies that received funding, received about half actual cost Reed D JAMA 2005 Identify projects previously funded by agency Read requirements & provide exactly what is requested Abstract / summary Background/ significance / preliminary work/ hypothesis / aims/ design/ methods / Budget Resources / CV
Dissemination - Guide Subjects Medical Students Presentation Publication ASE AAMC AJS Academic Medicine Archives of Surgery Medical Teacher / TLM JSE Surgery Archives of Surgery Residents APDS AAS / ASA / CSA ACS AAMC AAS / ASA / CSA ACS Academic Medicine Surgery JACS Archives of Surgery Faculty Development
Tips - Survey Design Need to know versus nice to know! Engage the respondent Short and focused Format Introductory statement + consent Basic demographic questions Essential questions Comment box Concluding statement
Tips - Survey Design Language Keep language consistent Instructions Brief and clear for each question Sequencing Cluster by theme and format Pilot Test Need to know denominator to calculate a response rate!
Tips: Kirkpatrick Evaluation Framework Level Definition Level 1 Participation : Learners' views on the experience Outcomes related to change in attitude / perceptions / knowledge / skills Behavioral change : Willingness to apply new knowledge / skills Change in organizational practice Level 2a & 2b Level 3 Level 4a & 4b Kirkpatrick, D. L. In Training and Development Handbook New York: McGraw Hill. 1967
Academic Success - Resources Statistician with expertise in educational research PhD in education Qualitative research methods Research assistants Graduate students Nurse educators/coordinators Residents
Academic Success Job description should reflect educational effor Double dip Each educational innovation has potential for research & publication Find a mentor Improve your skills Masters degree/ Workshops/Literature in education Be visible Offer to write critiques / speak / moderate Collaborate outside surgery
Additional Resources The following slides contain lists of resources specific to health professions educators
Professional Development ACS Surgeons as Educators Course http://www.facs.org/education/sre/surgedbrochure.pdf Association for Surgical Education Workshops http://www.surgicaleducation.com/mc/page.do?sitePageI d=31641&orgId=ase ASE Surgical Education Research Fellowship http://www.surgicaleducation.com/mc/page.do?sitePageI d=28279
Professional Development Association of Program Directors in Surgery http://www.apds.org/index.htm Association of American Medical Colleges http://www.aamc.org/ Regional AAMC Groups e.g. CGEA http://cgea.net/ ACGME http://www.acgme.org/acWebsite/home/home.asp
Masters Degree Programs University of Illinois Chicago: http://www.uic.edu/com/mcme/mhpeweb/MHPE_Progra mOverview.htm University of Illinois Urbana Champaign & Southern Illinois University http://www.siumed.edu/dme/online_masters1.html University of Southern California, Rossier School of Education http://rsoeweb2.usc.edu/helpdesk/master/edd.html
Masters Degree Programs Master of Medical Education, University of Toronto http://www.oise.utoronto.ca/oise/ Prospective_Students/Graduate_Studies.html Masters of Education in Teaching with an Emphasis in Health Sciences. University of Houston http://www.coe.uh.edu/academic- programs/health-education/index.php
Funding Sources CESERT http://www.surgicaleducation.com/mc/page.d o?sitePageId=28551 SAGES http://www.sages.org/leadership/committees/ research/grants.php AHRQ http://www.ahrq.gov/fund/
Funding Sources AERA http://www.aera.net/grantsprogram/ Macy Foundation http://www.josiahmacyfoundation.org/apply/g rant-programs Department of Defense http://www.federalgrantswire.com/departmen t-of-defense-federal-grants.html
Journals Academic Medicine. Advances in Health Science Education Theory & Practice Joint Commission Journal on Quality & Patient Safety. Journal of Surgical Education. Medical Education. Medical Teacher. Teaching, & Learning in Medicine.
Journals - Clinical Archives of Surgery American Journal of Surgery Journal of the American College of Surgeons Annals of Surgery Surgery Surgical Endoscopy Best Evidence in Medical Education http://www2.warwick.ac.uk/fac/med/beme/
Guide for Researchers in Surgical Education Jeannette Capella, MD, MEd, Steven J. Kasten, MD, Susan Steinemann, MD, Laura Torbeck, PhD, 2010. $35.00 Cine-Med at www.cine- med.com
