St Andrews BEME systematic review protocol MH

1 PROTOCOL FOR PROPOSED BEME SYSTEMATIC REVIEW A SYSTEMATIC REVIEW OF THE EFFECTIVENESS OF THE METHODS USED TO DEVELOP RESEARCH SKILLS IN MEDICAL STUDENTS GROUP MEMBERS: Simon Guild Pr

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PROTOCOL FOR PROPOSED BEME SYSTEMATIC REVIEW

A SYSTEMATIC REVIEW OF THE EFFECTIVENESS OF THE METHODS USED TO DEVELOP RESEARCH SKILLS IN MEDICAL STUDENTS

GROUP MEMBERS:

Simon Guild Professor of medical science and education, School of Medicine, University

of St Andrews

Gerard Browne Academic fellow in general practice, School of Medicine, University of St

Andrews Vicki Cormie Senior academic liaison librarian, The Library, University of St Andrews Rachel Davies Teaching fellow, School of Medicine, University of St Andrews

Alun Hughes Teaching fellow, School of Medicine, University of St Andrews

Jon Issberner Deputy director of teaching, School of Medicine, University of St Andrews Anita Laidlaw Senior teaching fellow, School of Medicine, University of St Andrews

Contact:

Prof Simon Guild

School of Medicine

Medical and Biological Sciences Building

University of St Andrews

North Haugh

St Andrews

Fife, KY16 9TF

Email: sbg@st-andrews.ac.uk

Phone: + 44 (0)1334 463533

BACKGROUND TO THE TOPIC

Why is it important that medical practitioners should have research skills? Firstly, it has been reported that although research into basic science is expanding the number of clinicians participating in research is shrinking1,2 This perhaps reflects that clinicians are made to choose between performing research or practicing medicine, and find it increasingly difficult to include both in their careers This raises concerns over the future of clinical research and the

‘physician-2

scientist’ career choice1-5 Medical education must ensure that future medical professionals are equipped with the basic skills of research and have an awareness of research ethos if they are to participate in research during their careers

Of equal importance is that research is an important part of scholarship and professional practice where independent lifelong learning and the ability to appraise literature is essential A good doctor needs research skills and attributes6 Training in research skills and the development of research attributes is therefore required to ensure that students are competent both as future practitioners, and clinical or basic science investigators

Research skills and attributes are important outcomes of higher education and programmes should permit students to acquire and develop these7 Furthermore, medical education guidelines may specify that undergraduate medical curricula should have outcomes for the graduate such as the following from the General Medical Council (GMC)8:

 ‘apply to medical practice biomedical scientific principles, method and knowledge’

 ‘apply scientific method and approaches to medical research’

These two outcomes are defined in the ‘The doctor as a scholar and a scientist’ domain

In the light of this, we previously attempted to establish which research skills and attributes could, and should, be outcomes of medical undergraduate programmes irrespective of whether such graduates intend to follow a research career or not 6 Previously Laidlaw et al have identified the

following as research skills and attributes believed to be essential for medical graduates pursuing both professional and research careers: enquiring mind, core knowledge, critical appraisal, understanding of the evidence base for professional practice, understanding of ethics and governance, ability to work in a team and ability to communicate9

How to develop these in medical students within an already full curricula is a challenge medical education institutions are currently facing10 There are barriers to this kind of training such as lack

of faculty expertise11, lack of opportunities12 Some institutions however take the view that all students rather than a selected cohort, should not only be equipped with the skills of research, but should also be provided with the opportunity to experience research

Research skills and attributes should be outcomes of medical education and it is clear that some medical schools attempt to develop these in students13 Having said that, how effective are methods used in undergraduate medical curricula to develop research skills in medical students? This systematic review will address this question focusing upon research skills viewed as fundamental to scholarship and professional practise

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REVIEW QUESTION, OBJECTIVES AND KEY WORDS

How effective are teaching methods used in medical curricula to develop research skills in medical students?

Additional questions:

 What research skills are currently being developed in medical curricula?

 How do the teaching methods used to develop these different research skills vary?

 What teaching methods have developed which skills?

Key words:

 Medical education

 Medical curricula

 Research attributes

 Research skills

 Teaching effectiveness

SEARCH SOURCES AND STRATEGIES

Possible databases

 Medline

 Embase

 ERIC

 Australian Education Index

 British Education Index (BEI)

 CINAHL

 Web of Knowledge (Science Citation Index and Social Science Citation Index)

 SCOPUS

 Cochrane Library

 PsycINFO

 ASSIA

 Research and Development Resource Base (RDRB)

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 Campbell Collaboration

Possible Search Terms

Search terms will be using subject headings where thesauri exist in conjunction with free text terms using truncation and appropriate Boolean operators The main search terms will be students, medical/biomedical education, critical appraisal/thinking, research skills, science and research A scoping search has been performed that has identified the following proposed search terms:

 Medical students

 Medical education

 Science education

 Research education

 Biomedical research education

 Biomedical education

 Critical appraisal

 Critical thinking

 Research skills

 Problem solving

 Exploratory behaviour

 Decision making

 Problem-Based Learning

 Small group learning

 Case based discussion

 Clinical learning

 Scientific method

STUDY SELECTION CRITERIA

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Method

 Removal of duplicates

 Title screening (working in pairs)

 Abstract screening (working in pairs)

 Full text evaluation (working in pairs)

Population medical student

medical school medicine medical English language publication

primary school students secondary school students technical college student healthcare professions other than medicine

those who have obtained a primary medical qualification

non-English language publication Intervention Teaching method defined

for example (but not exclusively):

lectures tutorials workshops feedback experts small group learning problem-based learning case-based discussion clinical learning clinical applications

No teaching method described

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Outcome Developing research skills in

medical students (critical appraisal, knowledge acquisition

or evidence base for practice)

No outcome or evaluation of an outcome present (or outcome that is not critical appraisal, knowledge acquisition or evidence base for practice)

PROCEDURE FOR EXTRACTING DATA

Each included paper will be reviewed independently by two members of the group

During the pilot search data will be extracted based on the following checklist:

 Full citation

 Method stated

 Details of the population(s) involved and how they were recruited

 Details of the curriculum involved

 Context of the delivery of the intervention

 Research skill(s) involved

 The intervention(s)

 The outcome(s) measures and how (and when) they were recorded

 A description of the study results?

 An assessment of the strength of each outcome (using the BEME 5-point scale)

 A free text comment from the reviewer about the study as a whole

Based on the pilot review results, this data extraction checklist may be modified

Proposed procedure to resolve differences in coding of studies?

Each included paper will be reviewed independently by two members of the group using the agreed data extraction sheet In the case of disagreements, a third group member will review the paper in question in an effort to reach a consensus view

SYNTHESIS OF EXTRACTED EVIDENCE

Data tables will be constructed in Microsoft Excel spreadsheets detailing study design; population characteristics; interventions and the context of their use; and results and conclusions From these

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tables we will identify which research skills are being taught and the efficacy of intervention types The data will also be examined to ascertain the most effective approach to developing the research skills identified and provide recommendations for best practice

PROJECT TIMETABLE

CONFLICT OF INTEREST STATEMENT

The group members report no conflicts of interest

PLANS FOR UPDATING THE REVIEW

The group plan to maintain an up to date bibliography related to the review question From this, any significant changes in the evidence base available would lead to an update of the review

References:

1 Goldstein, J & Brown, M The clinical investigator: bewitched, bothered, and bewildered -

but still beloved Journal of Clinical Investigation 99, 2803 - 2812 (1997)

2 Zemlo, T., Garrison, H., Partridge, N & Ley, T The physician-scientist; career issues and

challenges at teh year 2000 FASEB journal 14, 221 - 230 (2000)

3 Sung, N et al Central challenges facing the national clinical research enterprise Journal of

the American Medical Association 289, 1278 -1287 (2003)

Anticipated duration Proposed scheduling Refining the research

Refining BEME coding sheet 3-5 months Completed by October 2013

2013 Data extraction and coding Up to 8 months Completed by March 2014

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4 Cooke, M., Irby, D., Sullivan, W & Ludmerer, K American medical education 100 years

after the Flexner report The New England Journal of Medicine 355, 1339 - 1344 (2006)

5 AAMC Basic Science and Clinical Research (2001)

6 Laidlaw, A., Guild, S & Struthers, J Graduate attributes in the disciplines of Medicine,

Dentistry and Veterinary Medicine: a survey of expert opinions BMC Medical Education 9,

28 (2009)

7 Tuning educational structures in Europe [ http://tuning.unideusto.org/tuningeu/]

8 GMC Tomorrow's Doctors 2009: outcomes and standards for undergraduate medical

education (General Medical Council, 2009)

9 Laidlaw, A., Aiton, J., Struthers, J & Guild, S Developing research skills in medical students:

AMEE Guide No 69 Medical Teacher 34, e754 - e771 (2012)

10 Putnam, C Reform and innovation: medical education in the 20th century USA

Orvostorteneti kozlemenyek 51, 23 - 34 (2006)

11 MacDougall, M & Riley, S Initiating undergradaute medical students into communicties of

research practise: what do supervisors recommend? BMC Medical Education 10, 83 (2010)

12 Drennan, L Quality assessment and the tension between teaching and research Quality in

Higher Education 7, 167 - 178 (2001)

13 Fishleder A., Henson L., and Hull A Cleveland Clinic Lerner College of Medicine: An

Innovative Approach to Medical Education and the Training of Physician Investigators

Academic Medicine: 82, (4) 390-396 (2007)