The MERC at CORD Scholars Program in Medical Education Research: A Novel Faculty Development Opportunity for Emergency Physicians Jeffrey N. Love, MD, Wendy C. Coates, MD, Sally A. Santen, MD, Cherri D. Hobgood, MD, Brian E. Mavis, PhD, and Susan E. Farrell, MD, EdM
Abstract Medical educators are increasingly charged with the development of outcomes-based ‘‘best practices’’ in medical student and resident education and patient care. To fulfill this mission, a cadre of well-trained, experienced medical education researchers is required. The experienced medical educator is in a prime position to fill this need but often lacks the training needed to successfully contribute to such a goal. Towards this end, the Association of American Medical Colleges (AAMC) Group on Educational Affairs developed a series of content-based workshops that have resulted in Medical Education Research Certification (MERC), promoting skills development and a better understanding of research by educators. Subsequently, the Council of Emergency Medicine Residency Directors (CORD) partnered with the AAMC to take MERC a step further, in the MERC at CORD Scholars Program (MCSP). This venture integrates a novel, mentored, specialty-specific research project with the traditional MERC workshops. Collaborative groups, based on a common area of interest, each develop a multi-institutional project by exploring and applying the concepts learned through the MERC workshops. Participants in the inaugural MCSP have completed three MERC workshops and initiated a project. Upon program completion, each will have completed MERC certification (six workshops) and gained experience as a contributing author on a mentored education research project. Not only does this program serve as a multi-dimensional faculty development opportunity, it is also intended to act as a catalyst in developing a network of education scholars and infrastructure for educational research within the specialty of emergency medicine. ACADEMIC EMERGENCY MEDICINE 2009; 16:S37–S41 ª 2009 by the Society for Academic Emergency Medicine Keywords: faculty development, medical education, medical education research, continuing medical education, emergency medicine
INTRODUCTION
E
mergency medicine educators, such as residency program and medical student clerkship directors, are in a prime position to perform education research. Their vantage point provides the perfect
opportunity for observation related to education while having the ideal ‘‘laboratory’’ to explore their ideas. This provides an important opportunity for enhancing the quality of their educational programs. Additionally, by so doing, they facilitate their own academic advancement through scholarship and fulfill the Accreditation Council
From the Georgetown University School of Medicine, Department of Emergency Medicine, Georgetown University Hospital ⁄ Washington Hospital Center, (JNL) Washington, DC; David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, (WCC) Torrance, CA; Department of Emergency Medicine, Emory School of Medicine (SAS) Atlanta, GA; Department of Emergency Medicine, University of North Carolina, (CDH) Chapel Hill, NC; Office of Medical Education Research and Development, Michigan State University, (BEM) East Lansing, MI; Partners Healthcare, Office of Graduate Medical Education, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, (SEF) Boston, MA. Received June 21, 2009; revision received July 19, 2009; accepted July 31, 2009. Address for correspondence and reprints: Jeffrey N. Love, MD; e-mail:
[email protected]. Presented at the Association of American Medical College’s 2009 Annual Meeting, Nov 10th, 2009, Boston, MA. CoI: The author reports that there are no conflicts of financial interest.
ª 2009 by the Society for Academic Emergency Medicine doi: 10.1111/j.1553-2712.2009.00591.x
ISSN 1069-6563 PII ISSN 1069-6563583
S37
S38
for Graduate Medical Education’s (ACGME) requirement to pursue scholarly works. One of the paradoxes of medical education today is that these education leaders could be better prepared to take advantage of the opportunity before them. It is common for faculty members to develop an interest in education research as a natural progression of their role as established educators, without the benefit of training in techniques and approaches common to education research. This training is not traditionally provided through medical school or residency training. Formal venues for acquiring these skills include fellowships and advanced degrees in education. Such options require a significant commitment of contiguous time, which is not available to many educators. The most common alternative is the time-honored method of professional development through peers and mentors with similar interests. The success of this strategy is in part dependent upon the availability of such resources. Understanding these issues, the Group on Educational Affairs (GEA) of the Association of American Medical Colleges (AAMC) developed a series of halfday workshops that culminate in Medical Education Research Certification (MERC).1 Initiated in 2004, these workshops are traditionally offered at regional and national AAMC meetings, with six of the 11 contentbased workshops required for certification. The MERC program is intended to provide the knowledge necessary to understand the purposes and processes of medical education research, to become informed consumers of the medical education research literature, and to be effective collaborators in medical education research (http://www.aamc.org/members/gea/merc.htm). The Council of Emergency Medicine Residency Directors (CORD) recently partnered with the AAMC to create a unique experience to fulfill an important faculty development need within emergency medicine (EM). This joint venture adds the experiential dimension of a mentored, collaborative education research project to the traditional independent learner model of the MERC workshops. Several programs have demonstrated that collaborative research projects appear to be an effective, problem-based approach to learning research methods that facilitate ongoing networks of researchers.2,3 The goals of the MERC at CORD Scholars Program (MCSP) are to develop a venue to support individual faculty development, to promote medical education research within the specialty of EM, to create a community of medical education researchers and mentors, and to facilitate collaboration and multi-institutional research. This article describes the development of the MCSP and reports on the early outcomes of the program’s implementation. METHODS Initiation One of the authors (JNL), who as a residency director, was searching for professional development opportunities to support his growing interest in education research, initially developed the concept behind the MCSP. To determine potential interest of other educators within the CORD membership, a conversation was
Love et al.
•
MERC AT CORD SCHOLARS PROGRAM
initiated on the CORD mailing list server inquiring about willingness to participate in a MERC-based professional development opportunity among the subscribers. The CORD mailing list server is a communication vehicle for members of CORD that traditionally consists of residency program directors but increasingly includes all emergency physicians engaged in education. Within 72 hours of the initial e-mail, there were 58 e-mails, with 102 faculty ultimately expressing interest over the next few weeks. Cognizant of this conversation, the CORD Board of Directors adopted the response of this inquiry as a ‘‘needs analysis’’ that resulted in CORD’s commitment to developing this opportunity. The newly appointed MCSP director (JNL) initiated a conversation with the AAMC-MERC Steering Committee regarding the development of MERC for emergency physicians. The AAMC was open to this venture, contributing to the process by putting on the workshops and providing the workshop leaders. With the guidance of the MERC Steering Committee and several MERC diplomates, the director selected the first three MERC workshops presented at the 2009 CORD Academic Assembly (March 2009): Formulating Research Questions and Designing Studies, Searching and Evaluating the Medical Education Literature, and HypothesisDriven Research. The director’s responsibilities also included recruiting established medical education researchers from the EM community as mentors for the requisite research projects. These individuals were identified through a process of reviewing the relevant EM literature and discussions with many EM leaders in medical education, including several editors at Academic Emergency Medicine. Once identified, each potential mentor was contacted to discuss the project, their interest in participation, and specific recommendations about other qualified mentors. Once assembled, the four mentors and the course director collaborated as the program committee to further define the MCSP experience. Getting Started The program committee’s functions included gathering data on attendees, gaining insight into what attendees wanted to study, defining the mentored project concept, and developing the means of studying this program’s outcomes. Toward these ends, the 35 participants were asked to complete a pre-course survey and submit a current copy of their curriculum vitae (CV). With information obtained from the pre-course survey, the program committee developed four working groups before the course based on broad areas of interest: simulation, learning environment, evaluation and feedback, and clinical performance. Each area of interest had two designated mentors with interest and experience in that specific area. Time was set aside for each group to meet immediately before the initial set of workshops to introduce themselves and outline a time course and goals of the program. After discussion regarding potential research questions, groups further subdivided based on more-specific research areas. Ultimately, a specific research question defined a collaborative group of four or more participants representing
ACAD EMERG MED • December 2009, Vol. 16, No. 12, Suppl. 2
•
www.aemj.org
different institutions. This structure was adopted to promote group problem-solving and decision-making to maximize learning. Throughout the first three workshops, the mentors and workshop directors worked together to integrate the experience of the breakout sessions with the content of the workshops. Unlike the traditional MERC course, in which participants work through concepts presented in the workshops individually or in loosely formed groups during the breakout sessions, the same MCSP breakout sessions consist of mentored groups, each gathering to use newly acquired knowledge to work through issues pertinent to their identified projects. Such focused, goal-oriented, collaborative experiences are important to effective professional development of medical faculty.3,4 Maintaining Momentum By the end of the first set of workshops at the CORD Academic Assembly in March 2009, each group had selected a leader, created a timeline, assigned tasks, and had preliminary discussions of authorship criteria. Progress since that time has been promoted through ongoing communication. Each group has developed its own mechanism for communication between group members. Options have included conference calls, PBwiki, and e-mail. The mentors remain involved with their groups and are available to facilitate progress. Periodic updates by e-mail from the program committee are designed to keep individuals and groups engaged by providing information on each group’s progress, important papers related to education research, and notices of important upcoming dates. An additional ad hoc work session at the Society for Academic Emergency Medicine (SAEM) annual meeting in May 2009 allowed participants the opportunity to work through questions and issues related to developing a research question. In this ‘‘step-back’’ exercise, a small-group format was used to provide structured feedback from the group to members regarding their research ideas. The process of listening to others discussing your project and then participating in the discussion of someone else’s project facilitated the collaborative atmosphere and the learning process. This exercise was wellreceived and highlighted the importance of gathering more frequently for interactive, multifaceted opportunities to practice what has been learned.
Table 1 Barriers to Translation of Ideas to Published Medical Education Research Response 1. 2. 3. 4. 5. 6.
Limited by lack of training in education research Time Funding or money Mentorship Departmental support Networking or need great numbers to complete project 7. Lack of journal support for education research
n (%) 19 15 8 6 5 3
(54) (43) (23) (17) (14) (9)
1 (3)
S39
Three more workshops are planned for the 2009 American College of Emergency Physician (ACEP) Scientific Assembly 6 months after the initial meeting. The three workshops selected by the inaugural participants for this meeting are Qualitative Analysis Methods, Questionnaire Design and Survey Research, and Measuring Educational Outcomes with Reliability and Validity. Upon course completion, each participant will have completed a mentor project and will become a diplomate of MERC (completed six half-day workshops). They will then be designated as MERC at CORD Scholars. RESULTS The first iteration of the MCSP was filled to capacity within 1 week of opening to registration. AAMC-MERC limits the workshop size to 35 participants to maximize the educational value to each. Many of the initial participants were senior educators in the field of EM, including three department chairs, three vice chairs of academic affairs, 19 program directors, 10 associate or assistant program directors, one student clerkship director, and one research director. A pre-course survey included the question, ‘‘How much professional experience do you have with education research?’’ With a 100% response rate to this question, 85% of participants responded that they had little or no such experience. Table 1 lists the free-text answers provided to a second question asking, ‘‘What are the top three barriers, if any, that currently keep you from translating your ideas for education research into publishable studies?’’ The most common obstacle identified can be summed up as ‘‘limited by lack of training in education research.’’ The majority of respondents provided answers that fit into this category, including; ‘‘difficulty with research design,’’ ‘‘asking the right questions,’’ and ‘‘gaining an education in education research.’’ The second most common answer provided to the question concerning barriers to performing research was ‘‘time.’’ The response to one other question from the survey is interesting; 60% of the participants report that it is ‘‘difficult’’ or ‘‘very difficult’’ to identify potential mentors in education research. DISCUSSION Based on the recommendations of the Institute of Medicine and other sources, there has been a growing impetus to reform medical education as we know it today.5–7 More specifically, there is a call for medical education research to demonstrate greater rigor, better quality, and improvement in educational outcomes and care provided to patients.5–10 Published medical education research studies that are deemed to be of the highest quality typically have rigorous study methodologies, are multi-centered in design, and receive extramural funding.11,12 To reach these goals, the infrastructure must be in place to support these efforts of emergency physicians, including professional development opportunities, funding sources, networking opportunities for those with similar interests, and institutional recognition of the value of education research.
S40
The inaugural MCSP experience not only demonstrated the need for medical education research professional development opportunities within EM, it also echoed many of the obstacles that must be overcome. This group of motivated educators, many with extensive experience in education, lacked sufficient training and experience to translate their educational ideas into well-designed research projects. As suggested by the pre-course survey, a system that supports and promotes skills development for the established educator interested in education research is not well developed within the specialty of EM. Difficulty in attempting to identify mentors for the MCSP also highlighted this point. Emergency medicine has a need to develop a readily identifiable cadre of experienced researchers who are proficient in medical education research. The Next Step Although the immediate goal of the MCSP is for participants to make ‘‘the next step’’ in their professional development, we hope to engage the graduating scholars beyond their own completion of this program by having them present their projects to the incoming class of 2010. Furthermore, we plan to encourage successful graduates to participate as working group facilitators for future classes. In several instances, a working relationship has already begun to develop between participants and mentors that increases the likelihood of future collaborations. The mentors are now engaged in guiding the current set of projects and developing plans to study the inaugural experience. Subsequent surveys and follow-up CVs should provide the longitudinal outcomes necessary to evaluate the success of this program. More specifically, the surveys will evaluate the participants’ selfassessments of improvement in their understanding of education research, and the CVs will assess the number of publications and grants pertaining to education research at specific times before and after the MCSP. In addition, mentors who are interested will be asked to contribute to upcoming changes in the curriculum to improve the experience. In the near future, we plan to engage graduates and mentors alike in the process of developing learning opportunities that can build on the MCSP for the graduating scholars. Change is already anticipated for the second iteration of the MCSP. Prior studies have demonstrated the importance of sequenced and multifaceted activities that include interactive learning and opportunities to practice.4 For these reasons, and based on the ‘‘step-back’’ work session at the 2009 SAEM annual meeting, one anticipated change is to increase the number and variety of interactive exercises to facilitate learning. LIMITATIONS As a specialty-specific professional development opportunity, the collaborative design of each project, with participants from different institutions, is one of the strengths of the MCSP. Although strategies for communication have been developed within each group, maintaining project progress with collaboration between
Love et al.
•
MERC AT CORD SCHOLARS PROGRAM
four to seven disparate sites is challenging. Frequent communication from the planning committee helps, but a pervading sense remains that the process would benefit from a design change in the timing and number of workshops. One possibility is to provide the six workshops over three meetings instead of the current two by adding an extra session at the SAEM annual meeting (May ⁄ June). The addition of a third opportunity to meet as a group, with fewer workshops per session and greater opportunities for practical work sessions, might serve to facilitate learning and project progress. The ultimate success of the MCSP is in part dependent on several remaining obstacles that the program’s efforts only indirectly affect. As noted in Table 1, these include the lack of time to pursue educational research, lack of institutional support for such endeavors, and lack of specialty-specific journals that value education research. The unifying, underlying theme behind all of these obstacles is insufficient funding through grants that would give value to medical education research across the system. This is as true in EM as in all of medicine today. There is a pressing need for those organizations that represent us to develop substantive medical education grants that support faculty development and quality research. This support is essential if EM is to meet the current demand to provide quality, outcomes-based education for EM residents and fellows that results in quality care to our patients. SUMMARY STATEMENT Professional development is a career-long process. It is increasingly recognized that academicians periodically change their focus, priorities, and direction as a natural evolution in their career development.13 Such transition requires the acquisition of new skills and knowledge. A critical example in medicine today is the disparity between the overall level of faculty who are experts in the ‘‘scholarship of teaching’’ and their ability to engage in the ‘‘scholarship of discovery’’ with respect to medical education research. Ideally, the infrastructure should be in place to support such professional development. The MCSP builds upon the content delivery of the traditional MERC workshops by adding a specialty-specific, collaborative research project, as well as group exercises to increase experiential learning. Through this ability to apply, explore, and build upon what has been learned, each participant should have a deeper and broader understanding of the concepts that have been taught. It is CORD’s intention to develop the MCSP into a successful next step in supporting the skills development and knowledge of emergency physicians interested in medical education research. In the process, we hope to contribute to the foundation of an infrastructure that supports medical education research across the specialty. The authors gratefully acknowledge Drs. Gloria Kuhn and Gary Gaddis for their counsel in initiating the program, Dr. Sharon Muret-Wagstaff for her contributions in this program’s early development, Barb Mulder for administrative support, and Lauren Maggio for research support.
ACAD EMERG MED • December 2009, Vol. 16, No. 12, Suppl. 2
•
www.aemj.org
References 1. Simpson D. Chair’s message. GEA Correspondent 2004; 17(2):1–2. 2. Madariaga MG, Evans AT, Brobbey W, et al. Learning by doing: developing fellows’ academic skills through collaborative research. Med Teach. 2006; 28:77–80. 3. Beckman TJ, Lee MC, Ficalora RD. Experience with a medical education research group at the Mayo Clinic. Med Teach. 2008; 20:1–4. 4. Mazmanian PE, Davis DA. Continuing medical education and the physician as a learner: guide to the evidence. JAMA. 2002; 288:1057–60. 5. Institute of Medicine. Academic Health Centers Leading Change in the 21st Century. Washington, DC: National Academies Press, 2003. 6. Irby DM, Hekelman FP. Future directions for research on faculty development. Fam Med. 1997; 29:287–9. 7. Bligh J, Parsell G. Research in medical education: finding its place. Med Ed. 1999; 33:162–4.
S41
8. Regehr G. Trends in medical education research. Acad Med. 2004; 79:939–47. 9. Carney PA, Nierenberg DW, Pipas CF, et al. Educational epidemiology: applying population-based design and analytic approaches to study medical education. JAMA. 2004; 292:1044–50. 10. Dauphinee WD, Wood-Dauphinee S. The need for evidence in medical education: the development of best evidence medical education as an opportunity to inform, guide, and sustain medical education research. Acad Med. 2004; 79:925–30. 11. Reed DA, Kern DE, Levine B, Wright SM. Costs and funding for published medical education research. JAMA. 2005; 294:1052–7. 12. Reed DA, Cook DA, Beckman TJ, et al. Association between funding for published medical education research. JAMA. 2007; 298:1002–9. 13. Boyer EL. Scholarship reconsidered: priorities of the professoriate. Princeton, NJ: Carnegie Foundation for the Advancement of Teaching, 1990.
