Funding medical education research: opportunities and issues.

Editor’s note: The opinions expressed in this editorial do not necessarily reflect the opinions of the AAMC or its members. This issue of Academic Medicine is devoted to an exciting set of research reports, reviews, and commentaries selected for publication from more than 60 submissions as part of our ongoing collaboration with the Research In Medical Education (RIME) program.1–17 The topics are wide-ranging—experiences of moral distress among trainees, interprofessional team leadership, assessment and feedback during training, and the role of arts and humanities in professional identity formation, to name just a few. As in the past, each of these published articles will be presented and discussed as part of the RIME program at Learn Serve Lead 2024: The AAMC Annual Meeting, which takes place this month. RIME’s work highlights creativity and quality in education scholarship and communicates the importance of medical education inquiry to stakeholders throughout academic medicine, such as institutional leaders, promotions committee members, and learners. RIME articles elevate issues of concern to medical education in a timely manner. Such attention can lead to dialogue, consensus, and advances in the field. RIME also supports the professional development of medical education scholars. Manuscripts submitted for consideration by the RIME Program Planning Committee receive written feedback from reviewers and committee members, and service on the RIME committee itself is a valuable learning experience and opportunity for leadership in medical education and academic medicine. In celebrating RIME’s 60th anniversary in 2021, members of the RIME Program Planning Committee conducted a survey of past RIME chairs to better understand how RIME has helped advance medical education research.18 The past chairs recognized RIME as a catalyst for medical education research, strengthening the rigor and impact of medical education research, developing a community of scholars, and supporting academic career development. They also identified as priorities the need for greater innovation and translation of medical education research to practice. They welcomed new activities and collaborations, such as faculty mentorship initiatives and support for educators pursuing advanced degrees in education.18 Each year leaders on the RIME committee prepare a commentary, published as part of the RIME collection, that addresses a way to improve medical education research in academic medicine. In 2012, RIME leaders called for a more intentional, strategic, and inclusive effort. Medical education research requires an intellectual structure, a framework into which seemingly random studies can come together to improve learning and practice. The challenge before us is to look forward and develop a well-laid plan to further the field of medical education research nationally and internationally.19 For this year’s commentary, Sukhera and colleagues1 similarly challenge the field of academic medicine to do work that will improve learning and practice. They encourage medical education researchers to think beyond rigor, relevance, and utility in their work and to find ways to generate new knowledge that is readily—and will actually be—used. Drawing upon insights from implementation science, the authors call upon medical education researchers to mobilize toward actionable, scalable, impactful scholarship. Over the years, Academic Medicine has partnered with RIME to publish 30 journal supplements; RIME collections have also appeared in our regular issues in October 2012, October 2013, and November 2014. The editorial teams of Academic Medicine and our AAMC sister journal, MedEdPORTAL, have also been fortunate to benefit from the service of members of the RIME community, such as manuscript authors, creators of curricular and education resources, and expert reviewers. Authors of RIME articles have been featured on the Academic Medicine Podcast, which further increases the reach of the scholarly contributions. Academic Medicine also was pleased to collaborate with the leadership of RIME in 2022 when it launched its mentorship program for early and underrepresented faculty scholars, a program that has evolved to become MedEdSCHOLAR.20 This year, we are pleased to feature the RIME articles and commentaries in this issue of Academic Medicine. This decision reflects our continued strong support for the work of the RIME planning committee, RIME authors, and the broader RIME community in furthering medical education scholarship.

Medical education researchers are inherently collaborators. This paper presents a discussion of theoretical frameworks, issues and challenges around collaborative research to prepare medical education researchers to enter into successful collaborations. It gives emphasis to the conceptual issues associated with collaborative research and applies these to medical education research. Although not a systematic literature review, the paper provides a rich discussion of issues which medical education researchers might consider when undertaking collaborative studies. Building on the work of others, we have classified collaborative research in three dimensions according to: the number of administrative units represented; the number of academic fields present, and the manner in which knowledge is created. Although some literature on collaboration focuses on the more traditional positivist perspective and emphasises outcomes, other literature comes from the constructivist framework, in which research is not driven by hypotheses and the approaches emphasised, but by the interaction between investigator and subject. Collaborations are more effective when participants overtly clarify their motivations, values, definitions of appropriate data and accepted methodologies. These should be agreed upon prior to commencing a study. The way we currently educate researchers should be restructured if we want them to be able to undertake interdisciplinary research. Despite calls for researchers to be educated differently, most training programmes for developing researchers have demonstrated a limited, if not contrary, response to these calls. Collaborative research in medical education should be driven by the problem being investigated, by the new knowledge gained and by the interpersonal interactions that may be achieved. Success rests on recognising that many of the research problems we, as medical educators, address are fundamentally interdisciplinary in nature. This represents a transition to bridge the dichotomy often presented in medical education between theory building and addressing practical needs.

How and why social science theory can contribute to medical education research

Likert-type scales are frequently used in medical education and medical education research. Common uses include end-of-rotation trainee feedback, faculty evaluations of trainees, and assessment of performance after an educational intervention. A sizable percentage of the educational research manuscripts submitted to the Journal of Graduate Medical Education employ a Likert scale for part or all of the outcome assessments. Thus, understanding the interpretation and analysis of data derived from Likert scales is imperative for those working in medical education and education research. The goal of this article is to provide readers who do not have extensive statistics background with the basics needed to understand these concepts. Developed in 1932 by Rensis Likert1 to measure attitudes, the typical Likert scale is a 5- or 7-point ordinal scale used by respondents to rate the degree to which they agree or disagree with a statement (table). In an ordinal scale, responses can be rated or ranked, but the distance between responses is not measurable. Thus, the differences between “always,” “often,” and “sometimes” on a frequency response Likert scale are not necessarily equal. In other words, one cannot assume that the difference between responses is equidistant even though the numbers assigned to those responses are. This is in contrast to interval data, in which the difference between responses can be calculated and the numbers do refer to a measureable “something.” An example of interval data would be numbers of procedures done per resident: a score of 3 means the resident has conducted 3 procedures. Interestingly, with computer technology, survey designers can create continuous measure scales that do provide interval responses as an alternative to a Likert scale. The various continuous measures for pain are well-known examples of this (figure 1). FIGURE 1 Continuous Measure Example TABLE Typical Likert Scales

University of Missouri—Kansas City School of Medicine

Medical education research in general is a young scientific discipline which is still finding its own position in the scientific range. It is rooted in both the biomedical sciences and the social sciences, each with their own scientific language. A more unique feature of medical education (and assessment) research is that it has to be both locally and internationally relevant. This is not always easy and sometimes leads to purely ideographic descriptions of an assessment procedure with insufficient general lessons or generalised scientific knowledge being generated or vice versa. For medical educational research, a plethora of methodologies is available to cater to many different research questions. This article contains consensus positions and suggestions on various elements of medical education (assessment) research. Overarching is the position that without a good theoretical underpinning and good knowledge of the existing literature, good research and sound conclusions are impossible to produce, and that there is no inherently superior methodology, but that the best methodology is the one most suited to answer the research question unambiguously. Although the positions should not be perceived as dogmas, they should be taken as very serious recommendations. Topics covered are: types of research, theoretical frameworks, designs and methodologies, instrument properties or psychometrics, costs/acceptability, ethics, infrastructure and support.

BackgroundMedical education research plays a critical role in improving patient care and advancing medical practices, yet the engagement among healthcare professionals remains limited. This study aims to explore the factors that influence participation in medical education research and provide recommendations to foster a research-inclusive culture within healthcare institutions.MethodsA comprehensive literature review was conducted across four databases: Web of Science, MEDLINE, Scopus, and Airiti Library. The search focused on studies published between 2002 and 2024, utilizing keywords related to ‘medical education research,’ facilitate,’ ‘engage,’ and ‘involve’. The initial search yielded 814 records. After removing duplicates and conducting a thorough screening process based on predefined inclusion and exclusion criteria, eight studies were selected for in-depth analysis. These studies were evaluated to identify key facilitators and barriers that influence research participation among healthcare professionals.ResultsThe analysis, guided by the Ecological Model, revealed a complex interplay of facilitators and barriers affecting research engagement. At the individual level, opportunities for professional development and career advancement emerged as significant facilitators. The interpersonal level highlighted the importance of leadership, mentorship, and peer support in fostering engagement. The environmental level, including institutional policies, funding availability, and protected research time, were identified as critical influences on participation.ConclusionsThe findings suggest that a holistic approach is needed to promote participation in medical education research, addressing factors at the individual, interpersonal and environmental levels. Recommendations include developing targeted strategies to improve intrinsic motivation among healthcare professionals, strengthening mentorship and peer support programs, and implementing supportive institutional policies that allocate dedicated research time and secure financial resources. By fostering a culture that values and facilitates medical education research, healthcare institutions can drive innovation in medical education, ultimately enhancing the quality of patient care and safety.

Objective and Aim The growing emphasis on accountability, quality assurance, and outcomes-based education has intensified the demand for robust and critically appraised evidence in medical education. While the principles of evidence-based medicine have substantially shaped clinical decision-making, their direct transfer to educational contexts has proven conceptually and methodologically challenging. Objective: This systematic review aims to synthesize the literature on evidence types, critical appraisal frameworks, and methodological quality standards in medical education research, and to present an integrative appraisal matrix suitable for educational decision-making. Methods A systematic review was conducted in accordance with PRISMA 2020 guidelines (7). Searches were performed in MEDLINE (PubMed), ERIC, Scopus, and Web of Science for studies published between 2000 and 2024. Included studies addressed evidence hierarchies, critical appraisal, research quality instruments, or methodological frameworks in medical or health professions education. Data were synthesized narratively due to methodological heterogeneity. Results Eighty-four studies met inclusion criteria. Evidence in medical education was categorized into quantitative, qualitative, mixed-methods, and design-based research. Traditional biomedical hierarchies were insufficient to capture educational relevance and contextual complexity. Appraisal tools such as BEME, MERSQI, CASP, and realist review frameworks were commonly cited, yet inconsistently applied. Conclusions Critical appraisal in medical education requires a pluralistic, theory-informed, and context-sensitive approach. The proposed appraisal matrix integrates methodological rigor, educational relevance, outcomes meaningfulness, and transferability to support informed educational practice. Keywords: Medical education research; Systematic review; Critical appraisal; Evidence hierarchy; Research methodology

Research-oriented hospitals are responsible for medical services tasks, medical education, and scientific research, playing an important role in medical research and application. The research efficiency of a clinical specialty is influenced by factors such as the characteristics of the specialty, the organizational atmosphere, and the clinical director’s leadership. The present study aimed to describe the research efficiency of clinical specialties, explore the factors influencing it, and clarify the argument of co-evolution theory regarding the collaborative development of medical services, education, and research. Logistic regression and multiple linear regression were adopted to estimate the correlation between influencing factors and scientific research efficiency. Hospital H, which is representative of research hospitals in China, was taken as an example. Taking three efficiency values—comprehensive technical efficiency (CTE), pure technical efficiency (PTE), and scale efficiency (SE)—as dependent variables, the independent variables affecting research productivity were statistically analyzed. This study also examined the scientific research efficiency of 41 specialties between 2013 and 2017, and found that the independent variables affected CTE, PTE, and SE to various degrees. Collaborative innovation in medical education and research must be based on clinical research; how to balance medical and teaching quality, and research efficiency requires further discussion. While young people play a major role on the research team because of their creativity and initiatives, which improve CTE and PTE, high-level researchers with better research and leadership abilities lead to the rational allocation and effective utilization of resources, thus improving SE. In 2013–2017, discipline construction focused on scale expansion, resulting in the decline of SE in China. Therefore, this study suggests further improvements for the efficiency of clinical specialties in research hospitals.

Medical education research faces increasing pressure to demonstrate impact and utility. These pressures arise amidst a climate of accountability and within a culture of outcome measurement. Conventional metrics for assessing research impact such as citation analysis have been adopted in medical education, despite researchers' assertion that these quantitative measures insufficiently reflect the value of their work. Every knowledge community has its own definitions of what counts as knowledge, how that knowledge should be produced, and how the quality of that knowledge production should be evaluated. Definitions of impact and knowledge shape and constrain researchers' foci and endeavors. Therefore, metrics that meaningfully evaluate the knowledge outputs of researchers need to be defined within each field. It is time for medical education research, as a field, to examine how to measure research impact and carefully consider the broader implications these measures may have. The authors discuss developments in research metrics more broadly, then critically examine impact metrics currently used in the medical education field and propose alternatives to more meaningfully track and represent impact in medical education research. Grey metrics and narrative impact stories to more fully capture the richness and nuanced nature of impact in medical education research are introduced. The authors advocate for a continual examination of how impact is defined, eschewing unquestioned use of conventional metrics. A new conversation is needed, as well as a research agenda to help medical education conceptualize and study metrics more appropriate for the field.

Over recent decades, the use of qualitative methodologies has increased in medical education research. These include ethnographic approaches, which have been used to explore complex cultural norms and phenomena by way of long-term engagement in the field of research. Often, however, medical education consists of short-term episodes that are not bound to single sites, but take place in a myriad of locations and contexts such as classrooms, examination stations, clinical settings and online. This calls for methodologies that allow us to grasp what is at stake in an increasingly multifaceted and diverse field. In this article, we direct attention to focused ethnography, which has emerged as a useful, suitable and feasible applied qualitative research approach, and which uses adapted classic ethnographic methods, such as direct observation, to gain new insights and nuanced understandings of distinct phenomena, themes and interactions in specific settings in medical education (eg the learning potential of ward rounds, or how hierarchical positions affect learning situations). We introduce methodological key features of focused ethnography to give insights into how the approach can be used, and we offer examples of how the method has been used in medical education research to show how it has contributed in different ways to the field of medical education research. Furthermore, we address and discuss some of the main challenges and limitations of the approach. Focused ethnography offers a methodological approach that sheds light over limited and well-defined social episodes and interactions. Precisely because the field of medical education consists to a large degree of such fragmented interactions, focused ethnography can be seen as a methodology tailored to these characteristics and should become an integrated part of the toolkit of medical education research.

Feminism is for everybody

BackgroundDeficiencies in medical education research quality are widely acknowledged. Content, internal structure, and criterion validity evidence support the use of the Medical Education Research Study Quality Instrument (MERSQI) to measure education research quality, but predictive validity evidence has not been explored.ObjectiveTo describe the quality of manuscripts submitted to the 2008 Journal of General Internal Medicine (JGIM) medical education issue and determine whether MERSQI scores predict editorial decisions.Design and ParticipantsCross-sectional study of original, quantitative research studies submitted for publication.MeasurementsStudy quality measured by MERSQI scores (possible range 5–18).ResultsOf 131 submitted manuscripts, 100 met inclusion criteria. The mean (SD) total MERSQI score was 9.6 (2.6), range 5–15.5. Most studies used single-group cross-sectional (54%) or pre-post designs (32%), were conducted at one institution (78%), and reported satisfaction or opinion outcomes (56%). Few (36%) reported validity evidence for evaluation instruments. A one-point increase in MERSQI score was associated with editorial decisions to send manuscripts for peer review versus reject without review (OR 1.31, 95%CI 1.07–1.61, p = 0.009) and to invite revisions after review versus reject after review (OR 1.29, 95%CI 1.05–1.58, p = 0.02). MERSQI scores predicted final acceptance versus rejection (OR 1.32; 95% CI 1.10–1.58, p = 0.003). The mean total MERSQI score of accepted manuscripts was significantly higher than rejected manuscripts (10.7 [2.5] versus 9.0 [2.4], p = 0.003).ConclusionsMERSQI scores predicted editorial decisions and identified areas of methodological strengths and weaknesses in submitted manuscripts. Researchers, reviewers, and editors might use this instrument as a measure of methodological quality.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-008-0664-3) contains supplementary material, which is available to authorized users.

As Accessible as a Book on a Library Shelf: The Imperative of Routine Simulation in Modern Health Care

The development of successful educational scholarship, either curricula or medical education research, is vital in ensuring that the field of medical education continues to evolve. Fostering the skills of medical educators in conducting high-quality educational research is essential to this process because publishing such research helps to disseminate best educational practices to the medical community at large. Unfortunately, developing rigorous medical education research can be challenging for pediatric hospitalists within busy clinical settings. In this article, we aim to discuss key principles and frameworks for curricular development as well as offer guidance in transforming a curriculum into a scholarly medical education research product for pediatric hospital medicine providers.