2010 Learning & Teaching Conference What Do Students Understand By Research, And Research Skills? Can they recognise developmental opportunities within curricular choices? Deborah Murdoch Eaton, Sarah Drewery Leeds Institute for Medical Education University of Leeds, UK On behalf of Northern Medical Schools SSC Consortium ; Sarah Drewery, Sarah Elton, Michelle Marshall, Patsy Stark, John Smith, Cathy Emmerson, Sue Whittle

Why do medical students need research skills? Underpins “critically reflective practitioner” General Medical Council Recommendations : Tomorrow’s Doctors 2009 AAMC Many others

TD 2009: Outcomes for graduates Outcomes 1 − The doctor as a scholar and a scientist Outcomes 2 − The doctor as a practitioner Outcomes 3 − The doctor as a professional

Outcomes 1 − The doctor as a scholar and a scientist: RESS strand of Leeds c Apply scientific method and approaches to medical research. (a) Critically appraise the results of relevant diagnostic, prognostic and treatment trials and other qualitative and quantitative studies as reported in the medical and scientific literature. (b) Formulate simple relevant research questions in biomedical science, psychosocial science or population science, and design appropriate studies or experiments to address the questions. (c) Apply findings from the literature to answer questions raised by specific clinical problems. (d) Understand the ethical and governance issues involved in medical research.

Why do healthcare professionals need to understand research?  Evidence based practice  Cornerstone of effective and good practice  Requires clinicians to make informed judgements  Best possible care for patient /population  Best available evidence  Critical appraisal  How is evidence derived?  Appreciate principles of research

We need to understand how research is done to be able to interpret the evidence…….

Why do medical students need research skills? TD 2009 etc Purpose of Higher Education (as opposed to a training course!)

Benefits of UG research exposure Research skills Product and process of university education Increased participation in PG research PhD completion rates doubled (Bauer & Bennett 2003) Associated with higher levels of student satisfaction Generic skills development (Seymour 2004, Kardash )

Effect of UG research experience? Medicine UG research experience enhances employability 1 Enhanced PG research productivity 2 irrespective of duration of UG research experience “speculate that UG experience fosters knowledge and skills needed to conduct other research and motivates graduates to do so” Other Higher Education PG research, Student satisfaction, generic skills development…… 1.Metcalfe J R Soc Med Dyrbye Academic medicine 2008

How do we provide research skill developmental opportunities? Some “core” Literature review skills, evidence based practice Providing opportunities for research skill development ……… for all Not without difficulty 1 Should involve independent project work 1 Robinson, Murdoch-Eaton, Carter. BMJ 2007

Medev funded project undertaken to evaluate opportunities to develop research skills within the undergraduate curriculum at 5 UK medical schools 1.What do students understand by research and research skills? 2.Can they easily identify research opportunities? 3.How can student identification and selection of research opportunities be better informed? Northern Medical Schools Student Selected Components Consortium

Mixed Methodology Student focus groups Student study and discussion group Databases / documentary analysis

Focus Groups Purpose: Explore students views on curricular opportunities to develop research skills Understanding of what comprised research Factors affecting selection Analysis: awareness of research content / elements within SSC s undertaken or within the programme at their school opportunities that they have had to experience research in curriculum so far

Focus Groups: understanding of research, purpose, and how made choices Awareness of benefits of developing research skills Career benefit “I think it starts to enter your mind when you’re thinking about applying for jobs” “It’s a developmental skill you’re going to have for the rest of your life” “ Even if you just contribute to a section of a research project then you do get a lot of experience that you can use…in the future” “I didn’t actually choose mine with either research or publication in mind. In retrospect I think I would have, having now gone through the F1 process..”

Focus Groups: Practical difficulties Factors affecting selection “ …. so it wasn’t proper research, it wasn’t long enough…” Research ethics committees Geographical location & travel Self proposed SSCs - a way of ensuring experiences - perceived difficulty in setting up Prior Supervisor knowledge: good or bad, experience or word of mouth

Focus Groups: What is realistic? What constitutes research? Achievable? “ideally you want a paper and the skills….” Lack of appreciation of methodological rigor and time consuming, repetitive nature of tasks “if it gets published then that’s a positive experience but if it doesn’t it will be just doing the donkey work……”

Study group Purpose: Further explore students’ understanding of skills involved in research Factors affecting identifying research opportunities in projects offered Method: 3 students from each participating Medical School attended Menu of projects (80)presented from total sample (n=905)

Research Skill Areas Research Methods Information gathering Critical analysis and review Data processing Stark et al Med Teacher 2005

Projects offered: Students’ Perceptions  Research parameters e.g. differences between clinical attachments and research “ if you are observing then you’re not gathering information” “you’re always gathering information every time you’re in a different situation”

Projects offered: What constitutes research methods?  Critical analysis “a clinical skill not a research skill” “critical analysis is analysing papers, its just the same as data processing”  Data processing “data processing can be defined as writing a report, you are reviewing the literature to write the report therefore you are processing the data”

Projects offered:  Audit vs Research “audit is research” “audit is not a type of research, you’re just looking at the guidelines, the research has already been done”  “Hidden” knowledge Supervisor / research team clinical environment e.g intensive care

Enhancing Research Skill Opportunities in the Curriculum - Lessons  Providing students with guidance on nature and scope of research…… Information about what are components of research skills Opportunity to discuss  Resulted in enhanced Identification of projects offering potential for research skills development Identification of the specific skills they might develop

So where do we go to from here? New medical UG curriculum – being implemented from 2010

Core outcomes of our professional spine Patients at the heart of design Series of core (generic) skills used to define our core outcomes Overlapping - highlighting importance through the course Delivered as individual topics, or integrated throughout the course Integrating science teaching throughout the course Strong Research Theme (research led L&T delivery where applicable, increased student awareness)

RESS Work so far….. Overall statement of purpose & broad aim: “ A doctor needs to be able to select the most appropriate clinical management strategy for the individual or population challenge posed by their clinical function. At graduation the newly qualified doctor will be able to critically evaluate research findings, recognise the inherent limitations and strengths of evidence, understand how this should be used in management guidelines, and be able to evaluate application to clinical practice. They will have participated in a breadth and depth of curricular experience to develop individual evaluation and research skills”

RESS Work so far….. Overall statement of purpose & broad aim: “ A doctor needs to be able to select the most appropriate clinical management strategy for the individual or population challenge posed by their clinical function. At graduation the newly qualified doctor will be able to critically evaluate research findings, recognise the inherent limitations and strengths of evidence, understand how this should be used in management guidelines, and be able to evaluate application to clinical practice. They will have participated in a breadth and depth of curricular experience to develop individual evaluation and research skills”

RESS Work so far….. Overall statement of purpose & broad aim: “ A doctor needs to be able to select the most appropriate clinical management strategy for the individual or population challenge posed by their clinical function. At graduation the newly qualified doctor will be able to critically evaluate research findings, recognise the inherent limitations and strengths of evidence, understand how this should be used in management guidelines, and be able to evaluate application to clinical practice. They will have participated in a breadth and depth of curricular experience to develop individual evaluation and research skills”

RESS Work so far….. Overall statement of purpose & broad aim: “ A doctor needs to be able to select the most appropriate clinical management strategy for the individual or population challenge posed by their clinical function. At graduation the newly qualified doctor will be able to critically evaluate research findings, recognise the inherent limitations and strengths of evidence, understand how this should be used in management guidelines, and be able to evaluate application to clinical practice. They will have participated in a breadth and depth of curricular experience to develop individual evaluation and research skills”

How is RESS going to be delivered? Integrated within curriculum Not an “add on” Progressive development of skills Small group  individual work Year 1 Year 2/3 Year 4/5

Research Skill Developmental Framework Wilson and O’Regan, Adelaide 2007 Tool for explicit development of research skills Knowledge new to learner Knowledge new to humankind

Students understanding of research? Meeting expectations of student and supervisor?