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What next for research in medical education?

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John Norcini

on 26 December 2013

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Transcript of What next for research in medical education?

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John Norcini
What next for research in
medical education?

Reform is initiated and then studied
Problem-based learning
Research needs to focus on capacity while maintaining quality
Research should be conducted in geographic areas of greatest shortage
Naturally pairs the questions of capacity and quality
Requires research in a number of areas, especially assessment
Enables the implementation of research findings
Can we develop intermediate measures of patient outcome or other health indicators?

"The principle is, that a few bad reasons for doing something neutralise all the good reasons for doing it"

Cornfield from Microcosmographia Academica
Prescriptive standards
Increase the leverage of the research we do
Enhance the skills and focus of educational researchers
Increase the value of the research we do
Enhance the skills and focus of the
educational researchers (Albert et al, 2007)

Types of researchers
Types of research they do
We currently have two types of educational researchers

Clinician educators who often do applied research
Social scientists who often do basic research
Collaboration is good but we need to develop
a cadre of researchers who function
in Pasteur's quadrant

PhD programs in health professions education
Recruit heavily in low income countries
Provide research funding
Increase the value of our research

Alter our work from a focus on quality primarily to an equal emphasis on capacity

Increase the use, directly or indirectly, of patient outcomes as a criterion
Shift away from a dependence on time-based education toward outcomes-based education
Effectiveness of our interventions is rarely judged against patient care
Much work using satisfaction, knowledge, skills, behavior...
Little work done with effectiveness against the process and outcomes of care
There is a perception that the quality of international medical education is not the same as North American medical education
Do IMGs produce the same patient outcomes as USMGs?
Are there differences among IMG subgroups and with USMGs?
1. USMGs > IMGs
2. IMGs > USMGs
3. IMGs=USMGs
All AMIs & CHFs in Pa: 244,000 hospitalizations & 6113 doctors
Severity of illness, institutional volume and location, physician volume, years since graduation, self-reported CV specialization, specialty board certification
Mortality differences
All IMGs = USMGs
non-USIMGs 9% < than USMGs
non-USIMGs 16% < than USIMGs
The use of health indicators going forward is essential
Ensures the relevance of our work
Enhances our credibility
Two challenges facing medical education

Three strategies for addressing them

Three strategies for meeting the challenges
Quality of medical education is a challenge

There is a misalignment of competencies
and health priorities

Capacity of health professions
education is a challenge

Global shortfall of 4.3M
healthcare workers (WHO)

Difficulty individualizing learning



Curricula remain time-based rather
than competency-based
Difficulty integrating new skills

Leadership
Public health
Teamwork
Informatics
Patient-centred care
Evidence-based practice...
Difficulty assessing learning

Competency-based curricula make significant demands
Lack of good evidence in support of solutions to
the problems
of quality
Greatest problem is in sub-Saharan Africa

11% of the world's population

24% of the disease burden

3% of the healthcare workers

<5% of the medical schools
Migration adds to the problem
1 in 4 African trained doctors work in industrialized countries
Migration is almost always permanent

Maldistribution makes it worse
Health worker density higher in urban areas
In facing these challenges, leadership does not rely on educational evidence

Tradition
Fashion
Research
Not enough useful research
Not enough researchers
Not enough funding
Accreditation processes were created to ensure school quality
Licensure and certification processes were created to ensure individual quality
Which departments and courses, how many faculty, etc?
Process standards
Broad flexible categories such as content and educational environment
Permit innovation but it is harder to judge compliance
Ensures compliance but stifles innovation
Accommodations for Pharmacology staff in Medical school of class size 100:
Professor & Head of the Department- (18 Sq.m.area);
Associate Professor/Reader-One room (15 Sq.m.area);
Asst. Professor/Lecturers - One room (12 Sq.m.area );
Tutor/Demonstrators-One room (15 Sq.m.area)
Department office cum Clerical room - one room (12 Sq.m.area); and
Working accommodation for non-teaching staff (12 sq.m. area)
Department of Pharmacology staff strength required for medical school call size of 100
Professor 1
Assoc. Prof. 1
Asst. Prof. 2
Tutors/Demonstrators 2
Laboratory Attendants 2
Store Keeper cum clerk cum Computer operator. 1
Sweepers 2
Increase the leverage of the research we do

Use data from educational quality control mechanisms
North American trend recently
US licensure in 1915 and specialty certification in 1917
Extensive body of research on efficacy
But

No published work on efficacy
Research on the efficacy of standards is needed

Research on the efficacy of the accreditation process is needed

Sensitivity of accreditation to local needs is critical
Outcome standards

Focus on competencies
Locally responsive but too reliant on assessment
In high income countries capacity matters less
More resources available
Healthcare workers are imported, shifting costs

In low income countries
Naturally occurring laboratory
Great need
Tradition
Change is difficult
Fashion
Research
Quality and capacity are two challenges facing medical education

Increase the leverage of our research
Enhance the skills of the researchers
Increase the value of our research
Widespread adoption

170+ countries and territories have operating medical schools listed in IMED
90+ countries included in DORA
Some countries have more than one accrediting body
Certification associated with

Quality of medical school
Quality of residency
Performance in residency
Practice volume
Process of care
Outcomes of care
Mission and objectives
Educational program
Assessment of students
Students selection, number, etc.
Academic staff/faculty
Educational resources
Program evaluation
Governance and administration
Continuous renewal
Professional values, attitudes, behavior, ethics
Scientific foundations of medicine
Communication skills
Clinical skills
Population health & health systems
Management of information
Critical thinking & research
Make available data from educational quality control mechanisms

Focus on what is important
Capture the population
High quality
Current and longitudinal
Efficient

Combine it with qualitative and quantitative local research
Full transcript