Category: Hot Topics

Hot Topics: Neuroeducation: Realistic or Idealistic?

Posted on by sarah.allsop

In this week’s top topic blog, Dr Fiona Holmes explores the challenges and realms of our minds in her blog on neuroeducation.

“Education is not the learning of facts, but the training of the mind to think.” – Albert Einstein

Photo by Milad Fakurian on Unsplash

I’ve spent most of my career so far as a neuroscientist, but more recently my role and research interests have an education focus. So, in this blog I’m combining both and discussing neuroeducation: the application of neuroscientific evidence to pedagogy to understand and enhance learning.

Since learning happens in the brain, the link between neuroscience research and educational research should be a no-brainer – right? Well, it’s rather complex and controversial and so far, neuroeducation research has not yet revealed a magic strategy to make geniuses of us all – but it’s relatively early days!

 Photo by Siora Photography on Unsplash

The idea of brain-based learning

Caine and Caine (1990)1 proposed the following 12 basic principles, extrapolated from the neuroscience-derived ideas at the time:

  1. The brain processes multiple things in parallel therefore teaching should orchestrate all the dimensions of parallel processing by teaching in complex multi-sensory environments;
  2. Learning engages the entire physiology so teaching must incorporate stress management, nutrition, and exercise;
  3. The search for meaning is innate so teaching should incorporate a stable and rich environment to facilitate this;
  4. The search for meaning occurs through patterning so teaching should incorporate thematic teaching, curriculum integration, and life-relevant approaches to learning;
  5. Emotions are critical to patterning so ensure a supportive emotional environment and co-operative learning;
  6. The brain simultaneously perceives and creates parts (details) and wholes (global concepts) so learning is cumulative and developmental;
  7. Learning involves both focused attention and peripheral perception therefore utilise the entire sensory context of the learning through appropriate visual and emotional stimuli;
  8. Learning involves conscious (remembering) and unconscious (priming) processes so incorporate active learning and reflection in teaching;
  9. There are at least two types of memory: spatial memory system (strongest) and rote learning memory, so avoid just fact memorisation;
  10. The brain understands and remembers best when facts and skills are embedded in contextual (spatial) memory therefore use a multisensory experiential learning approach;
  11. Learning is enhanced by challenge and inhibited by threat so maintain an environment of relaxed alertness;
  12. Each brain is unique and uniquely adaptable therefore use multifaceted teaching to address diversity.

But are these principles really novel and does a neuroscience-focused approach to evidencing, understanding and advancing these ideas provide strategies to improve educational practice?

A key aim for neuroeducation is to work out what happens in the brain when it learns and then how to best stimulate this in an educational environment. It has been shown that neuroeducation research may help inform, refine, select, and support aspects of pedagogy, alongside other methods.

There have been numerous studies over the last 20 years or so which support a neuroeducational strategy, including the identification of brain areas involved in reading – and the proposed neurobiological basis of dyslexia; the neural circuitry of numerosity; the neural substrates of attention, emotion and social cognition, relevant for further understanding of e.g. attention deficit hyperactivity disorder and autistic spectrum disorder.

It has potential for neuroprognosis (i.e. predicting educational intervention outcomes); assessing the effect of educational, genetic and/or environmentally induced changes on neurophysiology and cognition; engagement, motivation, and risk to potentiate learning. Furthermore, neuroeducation could influence curriculum design and educational reform.

Neuromyths

However, such principles and popular brain science may over-simplify and over-interpret complex and incomplete neuroscience research and may contribute to the establishment and perpetuation of neuromyths – misconceptions generated by a limited or misunderstanding of data from brain research, albeit based on a kernel of truth, e.g. the learning styles myth2,3.

Despite its widespread acceptance, research fails to support the idea that teaching which aims to fit an apparent learning style enhances learning. So, is ‘a little knowledge a dangerous thing’? There is concern that significant resources may be invested in policies, training, research, and practice based on half-truths. This has emphasised the importance of bidirectional education, mutual cultural understanding and shared experience of each other’s environments between neuroscientists and teachers and students.

Useful advances in the field can come from reciprocal training in relevant knowledge, concepts, and research methods, ensuring robust, relevant and practically applicable research findings through co-constructing research projects; and using neuroscience to distinguish between educational theories rather than drive them. An appreciation of each other’s knowledge and perspectives through co-education and collaboration will facilitate increasingly beneficial outcomes for education and help to bust neuromyths.

Neuroeducation-informed practice

It will come as no big surprise that we should be designing teaching that engages mental activities that enhance the acquisition, processing, storing and use of knowledge in a diversity of learners, as well as promoting meta-cognition – thinking about thinking. So… we must be aware of cognitive diversity and use a variety of teaching methods to accommodate and engage all our students. Lets think about afew ideas and examples:

Active experiences linked to positive emotions are critical for learning: Provide student-centred, active and adaptive learning-by-doing memorable experiences such as problem-based, project-based and co-operative in a supportive environment. Simulation and gamification places students in an environment where they can experience how to be, how to do, and has been shown to increase concentration and reduce tension.  Get students to use the learning at different times in different contexts. Include repetition, retrieval, and association tasks to enhance efficient memory systems.

Memory acquisition relies on attention: Engage and motivate students by starting a session with something provocative and relevant to contextualise the teaching and learning process. It could be an anecdote, an image or question that affects and connects with the lives and interests of your students. This will enable reflective discussion and critical analysis to help them acquire knowledge through their own conclusions.

Encourage students to be active in their own learning journey: This can be achieved through reflection, problem-solving and critical thinking as well as providing them with specific, meaningful, actionable, and timely feedback.

Implement mental and/or physical activities at the beginning of a session: A puzzle or meditation can aid concentration and therefore assimilation of knowledge. Include games, fun, social interaction, and reward to foster interest and pleasure, ensuring the learning objective is clear so that the students will be able to appropriate and transform the acquired knowledge.

Educational Neurotechnology: Brain scan to lesson plan

Exciting advances in the technologies to study the neurophysiology of learning in an education environment are continually developing. This will be the topic of my next blog.

Further reading:

  1. Caine R and Caine G (1990). Understanding a brain-based approach to learning and teaching. Education Leader 48(2): 66-71.
  2. Howard-Jones P A (2014). Neuroscience and education: myths and messages. Nat Rev Neuro 15: 817-24.
  3. Newton P M et al (2021). The learning style neuromyth is still thriving in medical education. Frontiers in Human Neuroscience 15: 1-5.

Hot Topics: The ELMER project

Posted on by sarah.allsop

This week’s blog is from Dr David Hettle, hot off the recent announcement of winning the ASME/GMC Excellent Medical Education Award (postgraduate category). David tells us a bit more about the planned research project with colleagues across the country, exploring the experiences of doctors undertaking an entry-level medical education roles (ELMERs).

Lisa Jayne Collage
Image from ASME Awards page

Lisa-Jayne Edwards (University of Warwick), Claire Stocker (Aston University), Julie Browne (Cardiff University), Cara Bezzina (University of Glasgow), David Hettle (University of Bristol)

Introduction

More and more doctors take time out of clinical training, with many choosing to undertake teaching posts during years out, especially ‘F3 years’: time out of training after your initial standardised two years post-graduation1, the ‘Foundation Programme’. These teaching posts have a variety of names including Clinical Teaching Fellows (as they are locally in Bristol), Teaching Fellows, and Education Fellows.

With the increasing need for educators, these posts host a crucial place for doctors developing interest, skills and expertise in medical education as they progress in clinical and educational training. Therefore, there is need to understand the landscape of educational practice which these positions deliver and support the development of these current educators and future educational leaders.

Previous work reviewed the current landscape of entry-level education posts across the UK, finding over 400 positions per year in the UK in 20232, up from 77 in 20083. Though the numbers of these posts have increased, due to the variety of different titles used and the often transience of the doctors in these positions, research into posts is challenging. Importantly this means research into the quality of these posts remains under-studied.

Why does this matter?

This research holds great opportunity to really find out how early-career educators can be supported. Currently, there seems to be wide variation in the quality of posts, with some offering financial support for educational accreditation, others designated time to teach and develop skills in specific aspects of education.

On the flip side, they are others without any additional time, support or links to educational teams offered, yet still carrying responsibility for others’ learning. This work hopes to facilitate more information and some degree of quality control for early-career educational roles as occurs with other medical specialties, for example through their colleges and specialty societies.

The ELMER study

Building on our work undertaken alongside the Academy of Medical Educators (AoME), this new project through the Association for the Study of Medical Education (ASME) seeks to explore the perspectives of current early-career education post-holders. We will investigate how different role qualities and opportunities impact their experience within medical education and, as a result, doctors’ inclination to pursue future teaching and training responsibilities once they move on from these posts (often back into clinical training).

To encompass all similar roles, our research team has chosen to use the term ‘Entry-Level Medical Education Role’ or ELMER as an individual’s first formal role in medical education.

We will use these doctors’ experience in their ELMERs to identify factors which promote formal teaching and increased educational activity and development. We have positioned the study in a pragmatic paradigm, focusing on the interaction between individuals (i.e. ELMER post-holders) and their environment, emphasising experiential research, and actionable knowledge. The study will use a mixed methods approach using a survey, followed by interviews, inviting any current ELMER post-holders to take part. Qualitative data will be analysed using reflexive thematic analysis, developing and telling the story of current ELMER post-holders.

Alongside the prior review of ELMER posts across the UK, the primary objective of this integral work is to offer insights that can inform policy decisions on how ELMER roles can support doctors in training to become future trainers, assessors, and leaders in medical education.

Why is this work so important to me?

As someone who has been a CTF in the past, but having finished that formal role wondered ‘where next?’, this work adds to the evidence for the development of a more formalised medical education career pathway, supporting educators of the future, alongside their clinical training. The current lack of such a pathway risks losing excellent educators after their ELMER posts, a risk which the field of medical education should not leave to chance.

Watch out for details of how to be involved soon if you are an early-career educator, ‘ELMER’ – we’d love to hear your experience! Drop me an email at david.hettle@bristol.ac.uk if you want to hear any more before then.

References

  1. Church HR, Agius SJ. ‘The F3 phenomenon: Early-career training breaks in medical training. A scoping review’, Med Educ 2021; 55(9): 1033-46.
  2. Hettle D, Edwards LJ, McCormack R, et al. (2023, Dec 4-5). A UK-wide review of Entry-Level Medical Education Roles (ELMERs) [Poster presentation]. Developing Excellence in Medical Education, Manchester, UK.  https://www.demec.org.uk/category/demec-2023/
  3. Wilson S, Denison AR, McKenzie H. A survey of clinical teaching fellowships in UK medical schools. Med Educ 2008; 42(2): 170-5.

Hot Topics in Medical Education Research: Interdisciplinary Medical Education – Learning Better Together

Posted on by sarah.allsop

In the second hot topics blog of 2024, Fiona Holmes considers the benefits and challenges of interdisciplinary learning. The inspiration for this came from teaching Clinical Perfusion Science students (clinical scientists who operate the heart-lung bypass during cardiac surgery) who come from different disciplinary backgrounds (bioscience/bioengineering and nursing/ODP), and who learn together and from each other and work as part of a complex multidisciplinary team.

Photo by National Cancer Institute on Unsplash

What is IDL?

The World Health Organisation defines interdisciplinary learning (IDL) as ‘students from two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes’ and has stated that ‘interprofessional education and collaborative practice can play a significant role in mitigating many of the challenges faced by health systems around the world’.

What are the benefits of IDL?

Shared knowledge. Healthcare students face careers in increasingly complex healthcare systems where mutual understanding and integration of complementary expertise, communication, collaboration and decision making is key to comprehensive patient care and best outcomes. Medical issues and clinical situations often require a holistic understanding that goes beyond a single discipline; generalists and specialists need to work together. Practioners can’t know everything about everything!

Widened horizons. IDL can help students appreciate the interconnectedness of various factors important for patient care such as physiological, psychological, and social. IDL can expose students to different knowledge and perspectives such that they can analyse complex cases from different angles and integrate knowledge leading to more effective problem-solving in clinical settings. It can increase the ability to recognise bias, think critically and tolerate ambiguity.

Effective teamwork. IDL develops effective communication, collaboration and teamwork among healthcare professionals, important for delivering comprehensive and coordinated patient care. This can better prepare students for work in diverse healthcare settings and equip them with broader skills, enabling them to be more versatile and adaptable in their careers and enhancing their professional development.

Improved student experience. IDL can improve the student experience; by and large studies have shown that students express higher levels of engagement and satisfaction when exposed to IDL, which can contribute to improved learning outcomes.

How can IDL be implemented?

IDL can be incorporated into medical education in a number of ways, but to be effective it needs to be purposefully integrated into the curriculum and explicit in learning sessions (you can’t just throw students together and expect the learning to happen spontaneously). IDL lends itself to learning opportunities that can be designed to be authentic real-life situations such as:

  • Case-based learning (CBL) – students work together on case studies that require input from various professions to help them understand each other’s roles and contributions to patient care;
  • Simulated scenarios / role playing – students from different professions (or playing the role of different professions) collaborate to address the simulated patient’s needs, honing their teamwork and communication skills in a safe environment as well as understand the perspectives and responsibilities of each profession;
  • Interprofessional clinical experiences – students from various professions complete clinical placements together to expose them to the interprofessional dynamics of healthcare delivery in reality;
  • Team-based learning (e.g. clinical rounds) – students discuss patient cases and treatment plans collaboratively (builds upon CBL);
  • Interprofessional workshops/projects – bring students from various disciplines together to collaborate and develop solutions for healthcare challenges;
  • Reflective practices – such as team debriefing sessions and individual reflective journals to contemplate experiences, challenges, insights and opportunities for improvement, with a focus on the IDL.

What are the challenges of IDL?

Resource implications. Implementing IDL can pose logistical and resourcing (appropriately skilled staff – ideally interprofessional team teaching, time, costs) challenges; it can be difficult to coordinate curricula and schedules to bring different healthcare students together at appropriate time in their educational journey.

Timing. The jury is out as to when is the best time to implement IDL and for how long (e.g., periodic exposure or continuous immersion). Ideally team dynamics need time to develop, so communication becomes more open and collaborative, with trust and appreciation of diversity of knowledge.

Experience levels. While the point of IDL is to bring together diverse students for learning, there may be issues associated with this such as: Learner-level matching (do they have sufficient background knowledge and experience to work together effectively?); differences in learning preferences may be more exaggerated due to prior teaching and learning experiences; epistemics (the disciplinary ideas about what knowledge is and how to use and produce knowledge) and specific manner of communication are part of the culture of particular disciplines that may hinder IDL.

Perceptions and Biases. Perceptual barriers in competence perceptions may lead to a lack of self-confidence or respect for co-learners and personal characteristics such as curiosity, respect, and openness, patience, diligence, and self-regulation have been suggested to be important characteristics for enabling cognitive advancement in IDL.

Measures of impact. Evaluating the effectiveness of IDL can be challenging. Traditional assessment methods may not adequately capture the depth and breadth of knowledge, behaviour and attitudes or ‘interdisciplinary thinking and doing’ – i.e., the capacity to integrate knowledge and ways of thinking and doing across areas of expertise to produce a better outcome than could be achieved otherwise.

Future Research

While the general consensus is that IDL should be an integral part of the curriculum for healthcare students, the importance of IDL is largely based on theory and there remains a lack of large, multi-centre long-term studies. Therefore, currently it is unclear what strategies are best for long-term behaviour change and positive patient outcomes.

Some additional further reading:

Attitudes towards Interprofessional education in the medical curriculum: a systematic review of the literature | BMC Medical Education | Full Text (biomedcentral.com)

Experiential Learning of Interdisciplinary Care Skills in Surgery Assessed From Student Reflections – ScienceDirect

Interprofessional team-based learning (TBL): how do students engage? | BMC Medical Education | Full Text (biomedcentral.com)

Interdisciplinary education affects student learning: a focus group study | BMC Medical Education | Full Text (biomedcentral.com)

Hot Topics: The Journey Travelled

Posted on by sarah.allsop

In this wonderfully insightful blog, Dr Sarah McLaughlin reflects upon a recent journal article rejection and suggests looking back at the journey travelled to put academic setbacks into perspective. 

Photo by Daniel Herron on Unsplash

How many of us have shared this experience – the article you poured your heart and soul into, and submitted to a journal is returned and has not been accepted?

You are thanked for your submission and it is their pleasure to inform you that the referee’s responses are contained in the email. The referees are unable to accept your article for publication in its current form, but if you are willing to substantially revise according to their requirements and resubmit it, they will reconsider your article.

At this point your heart drops and you feel like you are never going to get any further in academia. Does this sound familiar? It happened to me this week. I know I am not alone in this experience. 

At first you may hear that this is a rejection of your work. Maybe you hear – you are not good enough, you are not as good as the others or maybe you should give up.

This time I have approached this set back differently and want to share my thoughts with you. How about looking not at where you want to be: published and accomplished – but you look back. You look back at how far you have come to get to this point. You focus not on what you have yet to achieve, but you focus on the journey travelled. 

Let’s take our first look back.

To get the point of submitting an article to a journal, you have spent hours writing and completing an article ready for submission.

To get to the point where you write your first sentence, you have conducted some research.

Maybe this was for your Masters or doctoral qualification where you worked your way from your proposal, poured over the literature, worked through your ethics application, to recruiting participants, gathering your data and spending hours writing up your research in order to submit your dissertation or thesis. That is one big achievement in itself.

But let’s look back a little further.

How did you get to the point where you commenced your current studies? There was a time when you were applying to university to commence your undergraduate degree, wondering if you would be accepted. Would you pass your entry requirements? Would you even make it to day one of your undergraduate degree?  

Maybe look back even further.

Did you walk into the exam hall for your GCSEs or school exams wondering if you had done enough revision, worked hard enough and would you be able to answer all the questions within the tight time given to sit your exam. Maybe you did not pass your exams first time and had to resit them.  

Maybe you didn’t enter university through the traditional A level route and returned to education as a mature student through an Access course or an equivalent. Can you even remember as far back as your school exams? How many years have passed, how many times have you submitted an assignment or sat an exam since then? How many other times have you received disappointing feedback or felt like giving up… but you didn’t?

So, now let’s come back to our current feelings.

What was your journey to the point where you uploaded your article to the journal and crossed your fingers? How was the journey you travelled to get there? How long did it take you? How many setbacks did you overcome? How many times did you feel like giving up? These reflections may help put this current feeling of rejection and your article into perspective.  

Switching from looking back to moving forward

Photo by Rumman Amin on Unsplash

Firstly, take a break.

Come back to the feedback with fresh eyes and see it for what it is – some advice on how to make your article more aligned with the journal’s aims or make your arguments clearer, or analysis more aligned with theory. It is an opportunity to improve.

Read the feedback carefully to understand why it was not accepted. What you can do to improve your article, and importantly, increase your chances of your revision being accepted and published? 

Don’t take it personally.

Rejection is common, and it demonstrates that these journals have high standards to maintain, which is a good thing. It does not reflect your worth as an academic. Most importantly, don’t give up.

Keep going.

You are one of many scholars who have had an article sent back to amend. This is a normal and common part of the journey towards article publication. Receiving what feels like a rejection may feel like a blow, but it is part of your journey. Looking back at how far you’ve come may help you see that this is just one more step along the way. Don’t give up. Keep going. It’s all about the journey travelled. 

You got this. 

More about this blog author

Sarah is a Lecturer and the MSc. Co-Lead (Teaching and Learning for Health Professionals) and Foundations in Medical Education Programme Lead. She is part of the Centre for Higher Education Transformations research centre (CHET) and tag them (@chet_for)

Hot Topics in Medical Education Research: Virtual Reality – what’s the reality?

Posted on by sarah.allsop

The next hot topic under review from BMERG’s Fiona Holmes is Virtual Reality. In her blog she explores the different types of VR and shares and how her team is trialling the technique to enhance education practice and experience for student learners.

Photo by Bermix Studio on Unsplash

Virtual reality (VR) is not new, but it’s new to me, and I was curious to learn more about VR simulation in the context of medical education: What exactly is it? What has it been used for successfully? What are its limitations?

So, what is VR?

VR is an artificial reality with which a user/student can interact. The main difference between the types of VR is the extent of ‘immersability’ and interaction within the VR.

Fully immersive VR

This is the ultimate VR experience within a virtual environment, disconnected from real life.

It involves wearing a VR head mounted display (HMD) and may also involve other equipment such as haptic (real feel) data gloves, voice recognition and sound software. It puts the healthcare learner completely inside the experience complete with a virtual surgical team, equipment, and patient. Like being in a real-life computer game.

Fully immersive VR has been used particularly effectively in surgical training programmes to practice procedures (decreases injury, increases speed and improves overall outcomes) and manage cases and has been shown to enhance experiential learning and acquisition of cognitive, psychomotor, and affective skills.

Immersive VR can incorporate virtual worlds that can involve multiple participants in different locations. They have been used for training in the management of stressful emergency or major incident situations and can hone attention, decision making, critical thinking, clinical reasoning, multi-tasking and communication skills. However, so far, fully immersive VR hasn’t been used widely in medical education mainly due to the high upfront costs.

Semi-immersive VR

This doesn’t fully enclose the user/student in the virtual environment although interaction can involve using headsets or motion controllers connected to a computer which displays e.g., medical simulations. Augmented reality fits into this category and involves overlaying images onto the real world and it has been used to visualise anatomy and practice surgical procedures on physical models.

Non-immersive VR

Some suggest this isn’t really VR, and although it is a lower tech, provides a more accessible (cost and ease of use) method of providing an interactive environment for clinical educational experiences. Simulations of medical procedures or clinical scenarios (which can be standardised to current protocols) on a computer can be interacted with using a keyboard or mouse. Some applications incorporate gamification which can enhance engagement.

How we are going to trial VR in our programme

I co-ordinate the Clinical Perfusion Science programme at Bristol, where our students are training to be perfusionists, the professionals who operate the heart-lung bypass machine during cardiac surgery. Alongside teaching and learning of relevant theory they hone their practical clinical skills on the job, based in hospitals throughout the United Kingdom and Ireland, becoming independent practitioners over a period of about 2 years.

While in Bristol they do some low-fidelity practicals, and some simulations (situations that replicate real-life clinical perfusion scenarios using a high-fidelity ‘beating heart’ manikin and cardiopulmonary bypass pump followed by feedback and debriefing). There is no doubt that simulation is an essential and effective part of clinical education and it’s always our students’ favourite part of their study blocks. They really value the freedom to practice with their peers and ask questions in a safe environment, but there simply isn’t enough time, space, or resources to fit in as much as we or they would like.

While VR cannot substitute for in person simulations and certainly not the real clinical experience of a multidisciplinary potentially high stress environment of a cardiac surgery operating theatre, we want another way to bring in more clinically relevant and practical teaching to their education. Ideally it would allow standardised and repeatable, with everyone able to have a go multiple times, safe, controlled, flexible, scalable learning at a distance. Clinical experiences could be shared between our students in hospitals across the world.

Due to the accessibility and ease of use of non-immersive VR, we have chosen to trial this type of VR to meet some of our training objectives using the VirCPB system, a gamified online cardiopulmonary bypass training program. VirCPB is relatively easy to set up, affordable, and it doesn’t require the students to have anything more than a laptop to access a virtual cardiac theatre via a link.

We will use it as a formative learning tool, an adjunct to our in-person simulation sessions. Practice makes perfect and students can engage multiple times, flexibly, autonomously as well as collaboratively. It will be combined with feedback and debriefing to develop technical and non-technical skills. We and the students can monitor their performance and improvement. We hope it will provide a standardised and objective way to potentially assess competency.

We are going to start with a product trial to evaluate the benefits of VR in a study led by Jody Stafford, Honorary Lecturer, Bristol Medical School. We believe that students will benefit from this experience and hope we can incorporate it into our programme more permanently – watch this space!

Read more:

If this blog has sparked your interest, here are a couple of examples of papers about VR techniques in medicine:

Current and Future Applications of Virtual, Augmented, and Mixed Reality in Cardiothoracic Surgery – The Annals of Thoracic Surgery (annalsthoracicsurgery.org)

Virtual Reality: The Future of Invasive Procedure Training? – Journal of Cardiothoracic and Vascular Anesthesia (jcvaonline.com)

Using Virtual Reality Simulation Environments to Assess Competence for Emergency Medicine Learners – McGrath – 2018 – Academic Emergency Medicine – Wiley Online Library

Hot topics: Students as Researchers

Posted on by sarah.allsop

In the latest ‘hot topic’ blog, BMERG introduces one of our Bristol second year medical students, Rahul Kota. Rahul talks about their experience of being involved with research as an undergraduate, including some great top tips for getting started.

…..

Photo by Brooke Cagle on Unsplash

Being involved in research is something that the modern medical careers have made feel almost compulsory for career progression and is often sold to students as something they ‘have to do’ to get to where they want to be. I’m here to tell you otherwise. Whilst undertaking research for your future career may be important, the skills and experience you gain in the process are just as valuable in the present.

My research journey started right at the start of medical school, during my first year in 2021. I had an idea that I wanted to be a surgeon before I came to medical school and knew that if I wanted to have a competitive surgical career application one day, I would need to get extra experience. I looked to find a surgeon who would allow me to come to theatre and shadow them.

Going in with the attitude of “if you don’t ask, you don’t get”, I found the email of Professor Gianni Angelini and emailed him asking if I could shadow him in theatre. I was thrilled when the reply came back as a ‘yes’. If you ask me now why I emailed Prof. Angelini, he was a cardiac surgeon, a career which I find incredibly inspiring and he also had a very impressive description of what he had done in the past online; probably not as important was that he came up on the first page of the ‘Bristol Our People’ website so I didn’t have to look very far.

During my first day shadowing Prof. Angelini, I was inspired by his work and the magic of cardiac surgery; and perhaps most importantly that day, I met Prof’s Angelini’s registrar. Mr Daniel Fudulu is single-handily responsible for inspiring me to start researching; without him, I would not be in the position I am in today.

It was quite lucky how my research journey started. I had been shadowing the team for about 3 months, and one day a researcher who worked with Daniel was in theatre as well, and I got talking to him about how I was keen to do some research. So, we asked if there were any projects I could help with and Daniel suggested I should attend their research group. Once I joined the research group, involvement in a project soon followed. I was supported to research and write my first paper.

I find research quite enjoyable due to its collaborative nature – it is a team sport in a way; you are interacting with many different people from many different specialities, and I like the team spirit and comradery in uniting to achieve a common goal. I also really enjoyed actually writing the paper. It may sound an odd thing to find enjoyable, but for me it as quite satisfying and rewarding to write a paper and then step back and look at the completed product. It really gives a strong sense of achievement.

It is also amazing to be able to say you have contributed to the advancement of medicine. I enjoy reading about the history of medicine and where we have come from, and it is those previous researchers who have been able to advance medicine to where it is today, so to say that I have also contributed to advancements in medicine is rewarding and fulfilling.

Personally, whether correct or not; I do also think research is a marker of success in a career. I would like to do a PhD or an MD one day and aspire to hopefully become a professor in my chosen field. Research is a core part of that dream and journey, so I can one day be knowledgeable enough to be seen as a leader in my chosen field.

My publishing journey did have ups and downs, but I had an excellent mentor in Mr Daniel Fudulu. The first journal we submitted to returned a rejection, so we had to rethink our target. I had never been involved in research and publishing before, so I was confused as to why our paper had been rejected. Daniel helped to explain that it was very rare that a paper gets accepted the first time and we should stay calm and think of another target. This advice is something which will stick with me, and made me feel that it was a team effort to get the paper published. When we got the paper published in Frontiers in Surgery, this was an incredibly proud moment, the culmination of over a year of hard work. I cannot overstate Daniel’s role in supporting me getting the paper published; I think it would have been a very different experience without his support. 

Research can be quite time-consuming, so as a student, balancing it with my studies is very important. There is a misconception that medical students do not have any free time, but in truth, there is free time, it is just how you decide to use it. I personally block out a few hours in a week to concentrate on research, maybe on a weekend or on a weekday after I have finished my uni work; and I find that this has been very effective for me. I am also lucky to have an incredible support network around me in terms of my family, friends and mentors.

Rahul’s top tips for getting involved in research as a student:

  1. Find a mentor: it is essential to find a mentor who will support you and understand your career goal – finding the right person can be transformative in promoting your research journey.
  2. Be proactive: Nobody told me how to get research or how to do it, you have to seek opportunities out yourself and make the most of them.
  3. Don’t be scared of rejection: Often nothing happens the first time, so don’t be scared if a paper gets rejected or a consultant has no research for you; dust yourself off and pick yourself back up and carry on.
  4. Enjoy the journey: Share your wins and losses with your peers, friends and family, because they can be people to take stress off your shoulders or people to celebrate with, they are just as excited to be on this journey as you are.

You can read Rahul’s paper here:

Kota R, Gemelli M, Dimagli A, Suleiman S, Moscarelli M, Dong T, Angelini GD and Fudulu DP (2023) Patterns of cytokine release and association with new onset of post-cardiac surgery atrial fibrillation. Front. Surg. https://doi.org/10.3389/fsurg.2023.1205396

Hot Topics: Medical Education Research – Why, How, Why and What

Posted on by sarah.allsop

In the next of our hot topic blogs, Dr Fiona Holmes from our BMERG committee talks about what actually defines a ‘Hot topic’ in Medical Education, and the importance of thinking about why and how we find out about what’s new and upcoming in our discipline.

 

Photo by Guido Jansen on Unsplash

While I was thinking about what to discuss, I realised that what I think is a hot topic might be just lukewarm to other people. We are all driven by different interests, experiences, and priorities.

In the hope of finding relevant and interesting subjects I started by looking into why a topic is hot, how they are identified and why this is important (which links back to why a topic is hot). This led me to what main areas of medical education are currently widely considered to be hot, and we look forward to exploring some of these in more depth in future hot topic blogs.

Why are topics considered ‘hot’?

Hot topics are influenced by various social and cultural contexts and needs, and may be hot because they are:

  • Relevant
  • Controversial
  • Timely
  • Impactful
  • Novel

Within medical education, and by extension pedagogical research in this field, there are a wide range of factors that have been identified to contribute to hotness:

  • Advancements in knowledge and technology: It has been estimated that new medical information doubles every 73 days. What and how to teach and the evaluation of learning needs to keep pace with these developments. How to prepare students to deal with such rapid developments and to be life-long learners is also a priority. Advances in technology for teaching and learning as well as the practice of medicine are transforming healthcare and its education. Adapting education to these technological changes will ensure future healthcare professionals are prepared to utilise these tools effectively.

  • Patient-centred care: With ever-changing healthcare needs and demographics, education research is needed to address the teaching of emerging health concerns, population health management, and the needs of diverse patient populations. This is twinned with a need for more consideration of patients’ values, preferences, and needs when making healthcare decisions therefore effective education in communication skills, empathy, cultural competence, and shared decision-making.

  • Interprofessional collaboration: Effective co-training of different healthcare professionals to foster teamwork skills to prepare students for collaborative healthcare environments.

  • Accreditation, regulation, stakeholder input: Accreditation bodies and regulatory agencies may revise guidelines to promote quality, safety, and innovation in medical education, prompting educational institutions to adapt their curricula accordingly. Such changes can drive research in this area. Likewise, public expectations, patient advocacy, and input from stakeholders (e.g., healthcare providers, patients, policymakers) play a role in shaping medical education and its research. These can influence curriculum content, teaching methods, and the overall educational experience.

  • Global health and environmental challenges: Global health issues, such as pandemics, emerging infectious diseases, health disparities, as well as environmental contexts highlight the need for a globally competent healthcare workforce. Medical education is addressing these challenges by incorporating global health content, cross-cultural training, and exposure to international healthcare systems.

Then of course there is medical education research itself and the innovation and design that comes with sharing evidence-based practice. This contributes to the evolution of medical education by identifying effective teaching methods, assessment tools, and strategies for continued professional development and aiming to ensure that innovation is beneficial.

How do hot topics get identified and become ‘hot’?

You may initially think that hot topics are simply those that are most prevalent in the current medical education journals, and this may well be true. Most things move in cycles and there are often trends for the types of issues that we see and trends in the solutions implemented. But, when you think about it, how do we find out what is prevalent or ‘trending’ at any given time?

There are number of ways to identify recurring themes, emerging topics and changes in research focus and involve both quantitative and qualitative research methods, and there is some overlap in the methods used. Examples include:

  • Literature review:  The systematic search, selection, and evaluation of relevant studies.
  • Bibliometric analysis: Analysis of publication and citation patterns over time to provide insight into the volume of research, popular topics, influential authors, and collaborations within the field.
  • Content analysis: Systematically categorise and analyse the content of research articles, conference proceedings to identify patterns and trends in research articles, social media discussions and online forums.
  • Surveys/questionnaires: Analysis of perceptions and attitudes of educational practices and emerging trends.
  • Interviews/focus groups: In-depth exploration of topics and contextual information.

Let’s look at an example:

Ji et al (2018) used social network analysis to identify changing trends in medical education and interpreted their findings to suggest 5 eras of medical education:

Figure. Ji et al Eras of medical education research

They determined that “during the 53-year period studied, medical education research has been subdivided and has expanded, improved, and changed along with shifts in society’s needs.” By analysing the trends they determined that medical education is forming a sense of the ‘voluntary order’ within the field and establishing legitimacy and originality. (Ji et al (2018) Research topics and trends in medical education by social network analysis | BMC Medical Education | Full Text (biomedcentral.com)).

So, why do we need to know about hot topics?

Hot topic research is important to ensure that medical education remains dynamic, responsive, and aligned with the evolving demands of the healthcare field and the needs of the learner. It supports the continuous improvement of medical education, leading to better-prepared healthcare professionals and ultimately improved patient outcomes.

Identifying hot topics helps time-limited researchers and educators stay informed about the latest trends, innovations, and challenges in medical knowledge, education and assessment practices to enhance teaching and learning methods, and to focus efforts on areas that require attention. This can then inform curriculum development and promote evidence-based practices.

Sharing hot topic research also helps to foster collaboration and networking among those with shared interests, leading to the exchange of ideas and development of research networks. As this grows, this helps institutions and funders prioritise and allocate resources by identifying areas of high research interest and impact. This is particularly important in identifying areas of medical education that are under-researched or require further attention.

What is hot right now?

Here are 8 of the hottest topics currently shaping medical education research in 2023:

  • Technology in education: Virtual (VR) and augmented reality (AR). Digital tools to engage with, filter and disseminate information that are interactive, efficient, and individualised.

  • Experiential and simulation-based learning: Through VR and AR, standardised patients, manikins, clinical scenarios to allow students to practice complex procedures and decision-making in a safe and controlled environment, improving their skills, confidence and safety.

  • Interdisciplinary education and team-based learning: Students from various healthcare disciplines learn about, from and with each other collaboratively. Case-based discussions and interprofessional simulations and debriefing, allow students to develop the skills needed to function in teams. It improves patient outcomes and enhances healthcare delivery and professional satisfaction by encouraging mutual respect, understanding, and effective communication.

  • Diversity, equity, and inclusion: Recruitment and retention of students from diverse backgrounds so that the healthcare profession better represents the patient population. Educating students in culturally appropriate care practices and social determinants of health. Learning environments to promote respect for diverse perspectives and equality of opportunities.

  • Competency-based education: Teaching and assessing ability to perform specific tasks and skills rather than relying solely on traditional exams to ensure proficiency in essential competencies required for clinical practice.

  • Biopsychosocial education: Effective teaching and learning to provide a more holistic, ethical and comprehensive approach to patient case.

  • Wellness and resilience: Self-care, stress management, and mental health support approaches such as mindfulness and peer support networks. Curriculum reform, including flexible scheduling, reducing workload and modifying assessment practices to create a healthier learning environment and promote a culture of empathy and compassion in healthcare.

  • Data-driven and evidence-based medicine: Education in critical appraisal of biomedical literature, interpret research findings, and apply evidence-based practices in clinical decision-making.

    • Photo by Bermix Studio on Unsplash

    So, I hope it is interesting to consider why we should know the hot topics for research and identify topics that are warming up so that we can strive towards thoroughness in medical education research. We look forward to sharing more hot topics through the BMERG blog.

    “Medical education is not just a program for building knowledge and skills in its recipients… it is also an experience which creates attitudes and expectations.” Abraham Flexner

    You can also check out Grace’s recent hot topic blog on Reflexive Thematic Analysis here

    Do you have a hot topic that you would like to write about for BMERG? Get in touch at brms-bmerg@bristol.ac.uk

Training: Bristol Medical School Short Course Programme 2023/24

Posted on by sarah.allsop

If you are a health sciences education researcher and are looking for training in research methods, check out the new programme from Bristol Medical School Short Courses.

Photo by Amelia Bartlett on Unsplash

Short courses are designed for researchers and healthcare practitioners and cover a range of topics on research methodology, design and analysis in health sciences. From statistics to qualitative methods, data visualisations, or writing up journal papers, there is something to support your research journey.

Bookings will be available from midday on 17th October.

Find out more on the short course website or explore the chart of courses available month-by-month below.

Short-Course-Programme-Chart-2023-2024Download

Hot Topics: Researcher skills – 5 key learning points about Reflexive Thematic Analysis

Posted on by sarah.allsop

This blog is written for BMERG by one of our committee members Dr Grace Pearson. Grace is Bristol Medical School graduate and a current Clinical Research Fellow in Population Health Sciences. Her research interests are in undergraduate medical education, specifically curriculum development and evaluation and geriatrics education.  

Grace shares her experience and tips after attending a workshop hosted by BMERG and the School of Policy Studies on ‘Reflexive Thematic Analysis’ from the expert Qualitative researcher, Professor Virginia Braun from the University of Auckland. 

Image of a galaxy Photo by Bryan Goff on Unsplash
Image of buckets Photo by Sixteen Miles Out on Unsplash

At medical school, future doctors are taught to detect patterns in history and examination to reach a diagnosis. Moving into medical research, this scientific pattern-recognition continues in quantitative data analysis and interpretation. As a result, approaching mixed methods studies or pure qualitative research can be daunting for those of us in medical and other scientific fields – it certainly was for me.  

There are several core aspects of qualitative data analysis that I’ve never truly got to grips with, despite attending multiple training courses… Therefore, getting the chance to learn directly from a world-leading expert was an opportunity not to be missed.  

I went into this workshop wanting to learn how to analyse or ‘code’ my data and develop my themes. I came away with a much wider appreciation of the importance of exploring context, embracing subjectivity, finding latent meaning, and conceptualising what Prof Braun called ‘galaxy’ themes rather than ‘buckets’. Let me explain a bit more.  

When we first look at qualitative data during analysis, certain things can jump out at us as topics. We may think these may start to look like our themes, but if we are not careful, they can end up looking like our original questions and, because everything we connect to a particular topic ends up together ‘in a bucket’ so to speak, may have lots of conflicting ideas within them.  

Conversely, true themes are more like a galaxy with a clear core, a ‘central organizing concept’ holding together all the ideas which although may be different, just like stars and planets are in a galaxy, they remain inherently linked. 

Here are my 5 key learning points from Professor Braun’s fantastic reflexive thematic analysis (RTA) workshop, which I hope might help others to approach their own qualitative data analysis in a reassuringly robust way:  

  • Scientifically Descriptive vs Artfully Interpretive analysis: Descriptive describes and summarises the data in an ‘experiential’ or ‘realist’ manner. Interpretive tells a story, locating the data within a wider context and presents an argument in a ‘critical’ or ‘constructionist’ way. Approaches to thematic analysis (TA), range from ‘scientifically descriptive’ deductive methods such as coding reliability, to ‘artfully interpretive’ inductive methods such as reflexive TA. 
  • Small q vs Big Q: Descriptive analysis suits ‘Small q’ research questions that seek to explore or describe peoples’ experiences, understandings, or perceptions – their ‘individual reality’. Interpretive analysis suits ‘Big Q’ research questions that seek to explore the ‘wider context’, for instance influencing factors, representations, and constructions.  
  • Context and Subjectivity: Analysis occurs in the intersecting space between the researcher(s), the data, and the research question. Subjectivity is present in all 3, as all are influenced by sociocultural, disciplinary, and scholarly context – as a result, analysis is situated in context, which must be clearly communicated.  
  • Coding: codes are ‘units of analytic interest’, the smallest unit of analysis capturing a single analytic idea or facet. These can be semantic (explicit) or latent (implicit) – descriptive analysis generally uses more semantic codes, whilst interpretive analysis uses both. Codes are not ontologically ‘real’, they exist only for the researcher(s) to foster engagement with the data – they need to capture the meaning of the data along with the researchers’ interpretation, orientated towards answering the research question.   
  • Themes: a theme is a construction that captures shared or repeated meaning in the data around a ‘central organising concept’. Themes are conceptual, therefore semantic-level data may seem disparate, but it is unified by latent meaning representing diverse manifestations of the core concept (like a galaxy).  Themes sit in the analytic narrative – they must tell a story of how the data is meaningful and answers the research question.   

Some examples of recommended resources for getting started using reflexive thematic analysis 

  • https://www.thematicanalysis.net/  
  • Braun, V, & Clarke, V. (2013). Successful qualitative research: A practical guide for beginners. SAGE. 
  • Braun, V, & Clarke, V. (2022). Thematic analysis: A practical guide. SAGE. 
  • Braun, V, & Clarke, V. (2021). Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Counselling and Psychotherapy Research, 21(1), 37-47. https://doi.org/https://doi.org/10.1002/capr.12360 
  • Braun, V, & Clarke, V. (2021). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(3), 328-352. https://doi.org/10.1080/14780887.2020.1769238 

More about Professor Braun https://profiles.auckland.ac.nz/v-braun

Virginia “Ginny” Braun is a New Zealand psychology academic specialising critical psychology of health and gender. She is internationally recognised for expertise in qualitative methodologies, and particularly the now widely utilised method of (reflexive) thematic analysis – developed in collaboration with Victoria Clarke (UWE).

Hot Topics: Researcher skills – Creating your database search strategy

Posted on by sarah.allsop

This blog is kindly written for BMERG by one of our amazing subject librarians, Richard Kielb. Richard takes us through some top tips around searching databases whilst undertaking your research, and some tips for breaking down the process.

Books on shelves
Photo by Paul Melki on Unsplash

When it comes to research, different search strategies are needed dependent on the nature and context of your work. Sometimes you may just need a book or a few relevant articles on a subject, and in this situation a quick search of your local library catalogue can often be sufficient. For more detailed research, it is likely to be more important to be able to carry out a comprehensive review of the literature, and this will usually require an advanced search using bibliographic databases.

So what is a bibliographic database? A database will allow you to search across very large numbers of academic sources simultaneously. Most of these sources will be academic journals, but some databases will include book chapters, conference proceedings, systematic reviews etc.

Different subjects will be supported by particular databases, so it will be important to identify the ones that are most relevant for you. Medical education would be a good example of a topic which would cross over more than one subject, so you would need to consider searching in databases recommended for both Medicine and Education as well as others with a multi-disciplinary focus.

Which databases you choose to use will depend very much on the topic you are researching and also what resources you have access to as an individual or a member of an institution. Many databases are not free to access and can be extremely expensive, but they are often provided by library services in organisations such as Universities and in the NHS.

Although the various databases have search interfaces that look quite different, the basic principles listed below will generally apply to all of them. Some of the functionality and ‘wildcard’ symbols etc might be slightly different, but there are usually help pages and guides available that will help indicate how it all works.

There are four basic stages to the database searching process:

  • Break your question down to its main concepts
  • Decide on the relevant search terms
  • Combine your search terms
  • Review your results

Breaking your question down to its main concepts

For clinical questions you may have come across the PICO formula to identify your concepts, and you can consider doing something similar for your medical-education topic. The social science framework called SPICE can be useful:

S – Setting Where does the research happen?
P – Population Who is your research focused on? Is your population defined by age, gender, ethnicity etc?
I – Intervention What are you investigating? Is it the use of technology or participation in a particular educational programme?
C – Comparator Are you comparing anything with your main intervention?
E – Evaluation Appraising the value, validity, or effectiveness of the intervention.

As with PICO you do not necessarily need to have a concept for every SPICE element.

Decide on the relevant search terms

Next you will need to consider what terms to search in relation to all of the different concepts. Include likely variations in terms in order to carry out a comprehensive review and to avoid missing any papers which are relevant to your topic. It will be important to factor in all synonyms, related terminology and any variations in spelling (particularly UK/US).

Keyword searching, also known as free-text searching, is where you will look for exact matches for your search terms in the titles and abstracts of journal articles. It is also useful to include searches in any controlled vocabulary offered by your chosen database, for example resources like Medline, ERIC and Cinahl offer ‘Subject Headings’, which make it easier to locate papers on a specific subject. Each article listed in the database is assigned a number of Subject Headings which represent what topics it covers. The advantage of this is that all of the articles on the same subject will be given the same subject heading, independent of the terminology used by the individual authors.

Combine your search terms

The Boolean search operators (OR, AND, NOT) can be used to combine your searches effectively.

  • Use OR to combine searches about the same concept – synonyms, related terms, variant spellings (e.g. Vitamin C OR ascorbic acid). This will broaden your search.
  • Use AND to combine searches about different concepts (e.g. caffeine AND asthma). This will narrow your search.
  • Use NOT to exclude terms from your search. This can be useful if you are retrieving some irrelevant content but use an element of caution as this can also remove useful material that may have mentioned the excluded term.

Review your results

Critically appraise your results (are they relevant to your research topic?) and decide if you need to make any changes to your search strategy. When you have run your search, you will often find that you either have more or fewer results than you were expecting.

  • Too many? Look for ways to make your search more specific. Can you add concepts? Are there valid ways to limit your results (publication date range, age group, language etc)?
  • Too few? Look for ways to make your search more general. Are there any terms that could be removed? Would broader search terms be useful?

Setting ‘limits’ can also be helpful as many of the databases will provide a series of in-built limits and filters, so it can be useful to investigate the options available.

Remember that your local Librarian will be more than happy to answer any questions you might have about using bibliographic databases and finding information more generally! At the University of Bristol you can find your subject specific librarian at: www.bris.ac.uk/library/subject-support/