This At Point in Time: Research in Medical Education When I submitted my first manuscript to the Journal of Medical Education (JME) in the early 1980's, I wrote in my methods section, "we examined the relationship between X and Y, controlling for the effect of Z". The editor asked me to say that in lay terms "because our readers won't understand that concept". The last three decades have brought dramatic changes in the methods we use to conduct research in medical education and today's readers of Academic Medicine, JME's successor, are sufficiently sophisticated to understand odds ratios, linear regression, modeling, etc. Sadly, the value of medical education today continues to be limited. Let's explore how we might improve. In a way, beefing up one's methods is the easy part. Asking good questions is what's difficult. The instructions for authors in one premiere journal explain, "To be considered for publication in Academic Medicine, submissions to the journal ...must address one or more of the key aspects of a major challenge facing academic medicine today." With increasing numbers of scholars in medical education, competition for space in journals such as Academic Medicine, Teaching and Learning in Medicine, Medical Education, and Medical Teacher is steep. It is incumbent upon us to ask good questions, to design truly innovative programs and studies and then to demonstrate generalizability. A good question and appropriate measures are key elements of the story. But, one needs to tell a coherent story, logically linking the typical elements of a research report to one another: introduction, methods, results and conclusions. The following series of questions serve as a good guide to writing up research as a compelling story: * What do you want to know? (That's your research question or hypothesis, stated in the introduction to your report.) * Why do you want to know? (That's your literature review or observation that led to your question a rationale for the study, again explained in the introduction.) * How will you answer the question? (This is the methods section.) * What did you discover? (This is the results section) * Who cares? (In your discussion section, you should consider how generalizable the findings are and for whom they are important.) To elaborate on a few of these ideas, I offer a few tips to bear in mind if you think that you might like to publish an article about your work in medical education. 1. Do you have something truly innovative to communicate? Much of our work in medical education is imitative. We hear that the Joneses are eliminating textbooks so we decide to keep up with the Joneses. We take books away from half the class and then test whether people who read
books learned more than those who did not. The results aren't terribly surprising. Begin by reviewing the literature to determine whether others have already answered the questions you are posing. A good starting point is a "best evidence in medical education" report, if one exists on the topic (BEME reports appear in the journal, Medical Teacher); this will provide a summary of both methods and outcomes. Check, too, to see what your colleagues at home have already written on the topic and how others have that reviewed work. As in most fields, answers are generally not conclusive but, instead, point toward the next question to ask or new ways to study the question. Remember that when a journal sends your article out for review, it will send it to experts in the field, whom you must impress with your fresh view of the field. 2. Can you rationalize why you did what you did? Sophisticated educators ask whether a change in pedagogy will make a difference, and whether that difference lies in facilitating learning, enhancing memory, changing performance or adding pleasure. One might base one's rationale for a design in learning theory (or other psychological, sociological or management theories, to name but a few) or in the current best evidence in medical education. The introduction to a research report should include statements about what you did and why you did it. 3. Can your work be replicated elsewhere? Much of our work is limited by small sample sizes and cultural peculiarities. Readers want to know whether your innovation will work at their school and their first defense against your idea is that your students are different from theirs (smarter or not as smart, research oriented versus community activists, etc.) or the environment or ethos of your school is different. Collaboration across hospitals and across medical schools increases sample size and decreases the probability that one school's culture or population of students or faculty accounts for the outcome rather than the intervention. Moreover, before finishing your article, ask yourself "Who cares?" Not only is it important to know whether one can generalize the results, but it's important to consider whether others will want to. You might circle back to your rationale why you did what you did or you might connect your work to current societal, health care or educational issues. These are but a few issues in medical education scholarship. The most recent Millennium ...