|ORIGINAL RESEARCH PAPER
|Year : 2012 | Volume
| Issue : 3 | Page : 141-147
A Qualitative Analysis of an Interactive Online Discussion by Health Professions Educators on Education Research
Komaladevi S Damodar1, Jayalakshmi Lingaraj1, Latha R Kumar2, Thomas V Chacko3
1 Vydehi Institute of Medical Sciences and Research Center, Bangalore, Karnataka, India
2 Yenepoya Medical College, Mangalore, Karnataka, India
3 PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
|Date of Web Publication||29-Mar-2013|
Komaladevi S Damodar
Vydehi Institute of Medical Sciences and Research Center, #82, EPIP area, Whitefield, Bangalore-560 066, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: In view of increasing demand for reforms in medical education in India, it is important to generate evidence through education research to increase the relevance and improve the quality of medical education. Education research is still at a nascent stage in India for a number of reasons. This study elicited health professions educators' views about the dearth of education research in Southeast Asia and what is needed to improve it. Methods: Qualitative content analysis of an interactive, online discussion on 'education research' between PSG-FAIMER Regional Institute fellows and faculty was carried out. Results and Discussion: Forty-four health professionals exchanged approximately 492 email messages during the discussion. One main concern expressed within the group was that the medical curriculum was not in tune with the health care needs of the society and reforms in the curriculum should be based on research. Most fellows felt that their work in education research was not appreciated in their schools. Participants felt that education research was done for altruistic reasons and only by self-motivated faculty. Participants also said that regulatory bodies were not concerned about the quality of education and its related research. Measures that could improve education research also emerged during the discussions. Interactive online discussions elicited important issues about education research in India. Participants noted that there is no recognition or rewards to encourage faculty to conduct education research. They also said that there is need to educate faculty about changes elsewhere in medical education and to make them more aware of education research generally.
Keywords: Concerns/issues, education research, educational scholarship, faculty development programs, funding, listserv, mentor-learner web discussions, quality and regulatory bodies, qualitative research, teacher portfolio
|How to cite this article:|
Damodar KS, Lingaraj J, Kumar LR, Chacko TV. A Qualitative Analysis of an Interactive Online Discussion by Health Professions Educators on Education Research. Educ Health 2012;25:141-7
|How to cite this URL:|
Damodar KS, Lingaraj J, Kumar LR, Chacko TV. A Qualitative Analysis of an Interactive Online Discussion by Health Professions Educators on Education Research. Educ Health [serial online] 2012 [cited 2020 Jul 6];25:141-7. Available from: http://www.educationforhealth.net/text.asp?2012/25/3/141/109788
| Introduction|| |
Medical education in India has come under scrutiny by public and medical groups; there is an increasing demand for medical education reforms. , As in clinical research, the practice of medical education needs to be based on evidence.  Education research provides the necessary evidence to support the decisions of educational administrative leaders. Education research incorporates a wide range of topics, from the admission process to curriculum design and development, teaching methodology, faculty development, evaluation of faculty, assessments of students, use of innovative methods and technologies, educational outcomes and course evaluation.
The Foundation for Advancement of International Medical Education and Research (FAIMER) regional institute is based at PSG Institute of Medical Sciences and Research in Coimbatore, India, that is, PSG-FAIMER Regional Institute (PSG-FRI). PSG-FRI uses an online mentoring approach termed Mentor-Learner web sessions in the training of its fellows, who are health professions educators at a variety of schools.  Mentor-Learner session  is effective in encouraging learning and also in eliciting important issues in the local context from the FAIMER fellows. During the June 2009 Mentor-Learner web session, the fellows discussed the topic of 'education research'. As most of the fellows were medical educators, in this paper the term "education research" generally refers to research in medical education and, less often, research in other health disciplines.
Education research is in a nascent stage in India and a number of reasons have been proposed.  During the Mentor-Learner discussion, we elicited the issues, concerns, and needs participants saw for improving education research. Deliberations included faculty perceptions about the impact of education research on medical education and the role of institutions and regulatory bodies in creating interest and improving education research in South-east Asia, especially India. Qualitative content analysis of the discussions was done and is presented here.
| Methods|| |
FAIMER has five regional institutions worldwide; one of them is the PSG-FRI in the southern part of India. PSG-FRI offers a two-year fellowship program to 16 health professions educators. The fellows selected for the program are generally mid-career health professionals actively involved in undergraduate education and holding key administrative positions at their institutions. The fellowship program trains fellows through four sessions, two on-site sessions and two interactive online sessions through its listserv.  The online sessions are each of one-year duration and follow the on-site session, which lasts for 5-7days. Each online session includes 6-7 Mentor-Learner web discussions on the topics selected by the fellows during their on-site sessions. Fellows volunteer to moderate a topic of their choice under guidance of PSG-FRI faculty.
PSG-FRI fellows (past and present) and PSG-FRI faculty participated in the discussions. [Table 1] shows the representation of PSG-FRI fellows from about 34 institutions including two fellows from Nepal, one from Iran, and one from a Malaysian Institution. Out of total 48 fellows, 43 were from medical faculty and 5 were nursing and physiotherapy faculty. More fellows were from basic science departments than clinical departments. Active fellows mean that they had contributed at least once during the month to the discussions.
|Table 1: Representation of PSG-FRI Fellows according to Department, Number of States, and the Number of Institutions they represent|
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During the first onsite session, the six most popular topics for online discussion were selected by fellows' votes. Two or three 2009 fellows and two or three 2008 fellows agreed to co-moderate topics of their choice. Fellows were briefed on the online Mentor-Learner web process, how to interact in and operate a listserv and briefed on basic netiquette, that is, social rules for online communication. "Education research", was the topic discussed by fellows and PSG-FRI faculty during June 2009 Mentor-Learner web sessions.
Moderators began discussions with a general review of the topic followed by a more focused discussion on selected topics. Moderators posted the topics on the listserv to get feedback from participants and to provide topics/issues that they would like to be included in the discussion. Moderators kept threads open until the end of the month. [Table 2] lists the guiding comments/questions about issues, concerns, and needs to improve education research in South-east Asia that acted as triggers to initiate and maintain online discussions on education research. Participants initiated some of the topics and comments listed, which generated lot of response during discussions.
|Table 2: Comments/questions used to guide the Mentor– Learner|
web discussions on education research
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To ensure maximum participation, moderators used various preplanned strategies during the discussion, like presenting real life scenarios for topics like curricular reform and the role of regulatory bodies in enhancing education research. Other strategies used were debates, posting relevant articles, and posing open-ended questions.
Written consent was obtained from the fellows at the beginning of the FAIMER fellowship to document and analyze listserv discussions. The results of the analysis of the online discussions were also presented to the fellows so they could verify their correctness.
The first author (SDK) performed the initial content analysis and held continuous discussions with the second author (LJ) throughout the process. Gross structure and categories were modified based on input from other authors. All authors agreed on the final details. The email transcripts were read through several times to obtain a sense of the whole. Then the text pertaining to participants' opinions about issues/concerns and needs for education research were extracted and brought together into one text, which constituted the unit of analysis. Data were analyzed manually based on thematic content analysis. Parts of the text dealing with main themes (preset) were separated to form individual meaning units. Sub-themes emerging out of each main theme were identified and labeled. Coding units were defined for each meaning unit and sorted into categories and subcategories. Direct quotes from participants (low inference descriptors) from e-mails are used to illustrate key points.
| Results|| |
The June 2009 Mentor-Learner web discussions on educational research were highly interactive. During the month long discussions, 44 participants took part and exchanged about 492 e-mails. Sixteen 2009 Fellows, fourteen 2008 fellows, and six 2007 fellows made at least one posting [Table 1]. In addition, eight PSG-FRI faculty members participated in the discussions. Most (90%) of discussion comments were from fellows. Participants exchanged about 70 links, which included links to websites (46%), web documents (54%), and 60 scholarly articles on various topics. The following themes and subthemes emerged during the discussions:
I. Issue and concerns regarding education research:
Listserv discussions regarding issues and concerns regarding education research were categorized into subthemes.
1. Existing situation about education research in South-east Asia (especially India)
Fellows and faculty discussed the present status of education research and the major areas of research, especially curriculum development and teaching issues. One concern expressed was that the medical curriculum was not in tune with the health needs of society, which called for reforms based on education research.
"…very slow pace…, need to… faster pace, to see the health indicators in our country improve" (2008 Fellow # 06)
Many fellows expressed that there was a critical need for curricular development and reforms. They felt that curriculum and teaching issues were one of important areas of education research to which inadequate attention is given. Most felt that evaluation of curriculum should be an ongoing process and educational research activities will help in this regard.
"…are they aware of the need for evaluation and feedback from universities?" (2009 Fellow # 04)
"Give priority to curriculum development research (2008 fellow # 03)
2. Lack of appreciation/recognition and absence of funding for education research
Most of fellows felt that their work in education research was not appreciated.
"…difficult to convince some people about the importance of medical education research" (2008 fellow # 02)
"…Somewhere, the fact that education research does not require too much funding, makes it less respectable/inspiring/believable!" (2007 fellow #01)
Fellows speculated that a lack of funding as the reason for the absence of recognition for education research work. This led to a keen debate about the role of funding in education research.
3. Lack of funding for education research need not be a limiting factor
Fellows and PSG-FRI faculty particularly, did not feel that a lack of funding was a major deterrent to conducting education research. They felt that small research projects especially do not need much funding.
"Institutions will indeed support …make sure that your projects do not suffer for want of funds !" (Faculty #03)
"Our studies are small, and our own efforts will be the biggest investment, requiring little financial input." (2009 Fellow # 02)
Some fellows observed that although small projects in education research can be done without funding, funds are still important.
"…resources for simulators, manikins etc might require funding." (2009 Fellow # 04)
4. Educational research is altruistic in nature and limited to motivated faculty
There were many comments comparing education research to clinical trials.
ER and Clinical Trials - The Twain Shall Never Meet! (Faculty #03)
Faculty and fellows felt that clinical trials are profit-oriented, whereas education research is the selfless work of dedicated teachers.
"…what drives them (educators) is not money but an abiding interest in the art and science of education." (2009 Fellow # 04)
5. Need to recognize and reward teacher effort in medical education and education research
PSG-FAIMER faculty felt that institutes, to some extent, could mitigate lack of recognition for medical education research work by adapting measures like development of teacher appraisal system that reward teacher efforts in improving student learning.
"What is critical is a system, which recognizes values and rewards teaching efforts of its faculty" (Faculty # 01)
6. Should we have a separate institutional review boards for education research?
Some fellows argued that since Institutional Review Boards (IRBs) are mostly concerned with biomedical research and clinical trials. Some argued that there is a need for a separate IRB to review educational research projects to avoid delay in approving proposals.
Most participants said that as the numbers of projects in educational research are few and therefore they do not warrant a separate IRB, which would need more personnel. An alternative suggestion given was to start with a sub-committee of an existing IRB, and then have this gradually transition into a separate IRB when the number of projects increases.
7. Role of Information technology in education research
Most faculty believed that information technology has vastly increased research activities. Fellows discussed that IT has brought about the efficient communication and rapid retrieval of information.
"Internet has contributed largely in today's research …the number of publications has increased by many fold…" (2009 fellow # 08)
Fellows also commented about the effect of the Mentor-Learner web discussions on learning and exchanged articles about impact of internet on physician-patient relationships.
"Mentor-learner web discussions give us on a platter well researched articles without having to go through 100s" (2009 fellow # 10)
II. Impact of education research on medical education
Participants' opinion about impact of education research is presented in [Table 3]. Generally, fellows were of the opinion that education research would not only improve teaching methodology and practice but also help in educational decision-making. Fellows believed that education research is useful to bring about curricular reforms based on evidence.
|Table 3: Participants' observation about the impact of educational|
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In addition, participants felt that education research will show ways to meet the needs of individual learners, document achievements and pitfalls, and allow one to become a better teacher and researcher.
About possible future trends and options arising from current trends was shifting of assessment methods to current trends included learning from existing concepts in developed countries and inclusion of virtual learning.
Fellows discussed changes in the face of scientific advances, new technologies, and diverse student populations and the following quote conveys the message:
"Change is inevitable and to stay on top, any institution has to continue to learn and innovate." (2008 fellow # 06)
III. Requirements of Health professional educators to improve education research
During Mentor-Learner web discussions, moderators explored the nurturing and support needed by health professional educators to create a strong interest and competence in educational research. Most fellows felt that creating awareness regarding different concepts in education research was the top priority. [Table 4] shows recommendations of the listserv participants to enhance education research in India.
|Table 4: Recommendations of listserv participants to enhance|
education research in India
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In addition, fellows exchanged links on various educational information clearinghouses. Fellows responded to an example of educational portfolio posted by one of the fellows. One fellow commented that the educational portfolio would be an eye-opener for medical educators, who can better understand and track their teaching activities. Fellows also pointed out that the educator (or teaching) portfolio is considered as "a must" in many educational institutions. FAIMER faculty also endorsed this. In addition, some participants felt that regulating bodies and leaders of medical education should use teaching portfolios in India to evaluate faculty.
IV. Role of regulatory bodies in SE Asia
Another important issue discussed was the role of regulatory bodies in education research. This topic elicited strong reactions from the Indian participants. The most common complaint was that the country's medical education regulatory body was not concerned about the academics or quality of education and research. The discussion emphasized the need for evaluating the quality of institutes by regulatory bodies. The general expectation was that universities and regulatory bodies should play a more responsible, transparent, and consistent role to improve medical education in India. Participants believed that there was a need to build a critical mass of teachers who are knowledgeable and concerned about medical education and research. [Table 5] shows fellows' recommendations for improving education research by regulatory bodies.
|Table 5: Recommendations of PSG FRI fellows and faculty to|
improve educational research by regulatory bodies
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| Discussion|| |
At a national conference on medical education held in New Delhi in 2007, one of the key recommendations included promoting research and scholarship in medical education and linking it to the professional advancement for the faculty. , Although there are numerous studies in developed countries enabling them to have more evidence-based medical education, this research cannot be used in India without appropriate verification within our context. It is time to introduce evidence-based medical education in India on the basis of research carried out within the country. ,
The June 2009 Mentor-Learner web discussions on 'education research' brought out the discontent of the country's medical educators with the existing medical education system. Their greater concern was that the medical curriculum was not in tune with the health needs of the society and needed reforms. A similar view has been voiced by other notable medical educators in the region. , It is an often-repeated criticism that India's medical graduates are not well equipped to tackle the health care needs of society. ,, Problems and concerns expressed by fellows about the curriculum have been previously documented. ,,,
Lack of funding has always been an issue of contention among educational researchers in developed countries ,,, and South-east Asia.  In our context, lack of recognition or any kind of reward for work in medical education and education research was a greater concern than lack of funding for research in medical education. Boyer  sought in particular to bring greater recognition and regard to teaching. In many countries, education-related activities of teachers are valued by standards for promotion or for improving educational programs globally.  In India, teaching and other education-related activities of faculty is still considered expected academic work and is not recognized.  It was the feeling of this study's educators that contributions in education-related activities  should be recognized and rewarded within academic institutions.
Although some faculty and fellows felt that the lack of funding is not a major issue, it should be noted that educational research funding is associated with higher quality research studies with more generalizable and valid findings. ,
It is difficult to measure the impact of medical education research, as students are highly motivated and can compensate for defects in the curriculum. Moreover, the time between learning and important outcomes is long so that the effects of students' previous education are obscured.  One of the uses of educational research is that it is now needed to guide educational decision-making. In addition, research in medical education contributes substantially to understanding the learning process. 
Higher education is based on two critical activities: Teaching and Research.  In recent times, while there have been some efforts to improve teaching skills but there has been little or no support or guidance to enhance the research capabilities of faculty. Studies show that research influences teachers' practice both directly and indirectly.  Medical education researchers now have new opportunities to examine and improve medical education with the availability of valid methods in qualitative and quantitative analysis, measurement tools for cognition and behavior, and technology-based instructional methods. 
Documenting the relationship between education and patient outcomes represents one of the greatest challenges and opportunities for medical education research. 
Senior educationists of India have suggested that part of annual budget of medical colleges should be earmarked for faculty development, innovations in curriculum, and educational research. 
| Limitations|| |
This study is an example of 'simple basic education research'. Even though moderators tried to control bias by soliciting/allowing topics that were initiated by participants and also by keeping threads open until the end of the month, an element of bias could have occurred. Although the language of the listserv discussion was in English, there are differences in familiarity with language between the participants as English is not native tongue, which could have affected discussions.
| Conclusions|| |
The listserv or mailing lists provided a good learning environment and also allowed us to elicit important issues and concerns about medical education research among educators in India. We identified the issues and concerns expressed by participants to improve education research in India. These educators felt that contributions to education-related activities should be recognized and rewarded in academic Institutions. Other recommendations from the group included educating teachers about newer developments in education and education research internationally and for regulatory bodies to include participation in education research in their evaluations of the quality of medical institutions.
| Acknowledgments|| |
The authors are thankful to William Burdick, Associate Vice President for Education, Foundation for Advancement of International Medical Education and Research (FAIMER) Philadelphia for reviewing an earlier draft of this paper and for his valuable suggestions and comments regarding methodology. The authors also thank all PSG-FRI fellows and faculty who actively participated in the online discussion on 'education research'.
The findings and conclusions do not necessarily reflect the opinions of the Foundation for Advancement of International Medical Education and Research (FAIMER).
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]