Research Skills for Medical Students

Books

Ann K. Allen

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  • Front Matter
  • Back Matter
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  • Copyright

    Foreword from the Series Editors

    The Learning Matters Medical Education Series

    Medical education is currently experiencing yet another a period of change, typified in the UK with the introduction of the revised Tomorrow's Doctors (General Medical Council, 2009) and ongoing work on establishing core curricula for many subject areas. Changes are also occurring at Foundation and postgraduate levels in terms of the introduction of broader non-technical competencies, a wider range of assessments and revalidation requirements. This new series of textbooks has been developed as a direct response to these changes and the impact on all levels of medical education.

    Research indicates that effective medical practitioners combine excellent, up-to-date clinical and scientific knowledge with practical skills and the ability to work with patients, families and other professionals with empathy and understanding; they know when to lead and when to follow and they work collaboratively and professionally to improve health outcomes for individuals and communities. In Tomorrow's Doctors, the General Medical Council has defined a series of learning outcomes set out under three headings:

    • The doctor as a scholar and a scientist;
    • The doctor as a practitioner;
    • The doctor as a professional.

    The books in this series do not cover practical clinical procedures or knowledge about diseases and conditions, but instead cover the range of non-technical professional skills (plus underpinning knowledge) that students and doctors need to know in order to become effective, safe and competent practitioners.

    Aimed specifically at medical students (but also of use for Foundation doctors, teachers and clinicians), each book relates to specific outcomes of Tomorrow's Doctors (and, where relevant, the Foundation curriculum), providing both knowledge and help to improve the skills necessary to be successful at the non-clinical aspects of training as a doctor. One of the aims of the series is to set medical practice within the wider social, policy and organisational agendas to help produce future doctors who are socially aware and willing and prepared to engage in broader issues relating to healthcare delivery.

    Individual books in the series outline the key theoretical approaches and policy agendas relevant to that subject, and go further by demonstrating through case studies and scenarios how these theories can be used in work settings to achieve best practice. Plenty of activities and self-assessment tools throughout the book will help readers to hone their critical thinking and reflection skills.

    Chapters in each of the books follow a standard format. At the beginning a box highlights links to relevant competencies and outcomes from Tomorrow's Doctors and other medical curricula, if appropriate. This sets the scene and enables readers to see exactly what will be covered. This is extended by a chapter overview which sets out the key topics and what students should expect to have learnt by the end of the chapter.

    There is at least one case study in each chapter which considers how theory can be used in practice from different perspectives. Activities are included which include practical tasks with learning points, critical thinking research tasks and reflective practice/thinking points. Activities can be carried out by readers or with others and are designed to raise awareness, consolidate understanding of theories and ideas and enable students to improve their practice by using models, approaches and ideas. Each activity is followed by a brief discussion on issues raised. At the end of each chapter a chapter summary provides an aide-mémoire of what has been covered.

    All chapters are evidence-based in that they set out the theories or evidence that underpins practice. In most chapters, one or more ‘What's the evidence?’ boxes provide further information about a particular piece of research or a policy agenda through books, articles, websites or policy papers. A list of additional readings is set out under the ‘Going further’ section, with all references collated at the end of the book.

    The series is edited by Professor Judy McKimm and Dr Kirsty Forrest, both of whom are experienced medical educators and writers. Book and chapter authors are drawn from a wide pool of practising clinicians and educators from the UK and internationally.

    About the Authors

    Ann Allen is a Senior Lecturer in the Institute of Medical Education, Cardiff University. Previously Director of Cardiff University's Master of Public Health Programme, Ann trained initially in sociology and anthropology and has worked in many developing countries as well as acting as an adviser to health-related projects for the UK Department of International Development, and for international agencies in Africa, South America and Commonwealth of Independent States (CIS). As well as teaching global health to medical students she contributes to an open education initiative peoples-uni (www.peoples-uni.org) that supports the continuous professional development of doctors and others working in public health.

    Seema Biswas is a general surgeon, Red Cross Health Delegate and lecturer in surgery and global health. She has taught medical students for over 15 years and works with students on research projects, especially in medical education and global health. As Lead Clinical Editor for onExamination – from BMJ Learning she collaborated with Ann Allen in 2011 in teaching an SSC in Global health and medical education.

    Dawn Lau has worked as a Clinical Teaching Fellow at the Cardiff School of Medicine and has been a registrar in Respiratory Medicine at the Cardiff and Vale University Health Board. She is involved both in undergraduate and postgraduate medical education and her range of educational endeavours include organisation of a pilot peer-assisted learning programme in clinical skills within the undergraduate core curriculum, developing assessment schemes for the student selected components (SSCs) and running the formal educational programme for the Core Medical Trainees (CMTs) within the Health Board. She has recently become Consultant in Respiratory Medicine/Cystic Medicine in Cardiff.

    Blanche Lumb and Michael Hollifield carried out initial coding of 24 transcripts of student feedback encounters. These were encounters where pairs of medical students presented patients they had seen to consultants in a variety of medical specialties. This work (made possible by a grant from the Cardiff University Research Opportunities Programme) is being carried in collaboration between Professor Charlotte Rees, University of Dundee, College of Medicine, Dentistry & Nursing, Dundee and Dr Lynn Monrouxe and Dr Andrew Grant, Institute of Medical Education, School of Medicine, Cardiff University.

    Acknowledgements

    The support given from the inception of this book by Dr Sharon Mayor, Senior Lecturer in Healthcare Improvement, Institute of Primary Care & Public Health Cardiff University, is gratefully acknowledged.

    The author and publisher would like to thank the following for permission to reproduce copyright material:

    BMJ Books/Wiley-Blackwell for excerpt from How to Read a Paper: The basics of evidence-based medicine, 4th edition.

    Learning Matters (Sage) for Table 2.1 and Figure 4.1 from McKimm, J and Forrest, K (2011) Professional Practice for Foundation Doctors. Exeter.

    Journal of the American Society for Information Science and Technology for Table 5.3 from Meho, LI (2006) E-mail interviewing in qualitative research: a methodological discussion. Journal of the American Society for Information Science and Technology, 57(10): 1284–95.

    Every effort has been made to trace all copyright holders within the book, but if any have been inadvertently overlooked the publisher will be pleased to make the necessary arrangements at the first opportunity.

  • Glossary

    Association

    A possible co-occurrence or relationship between two variables. Does not mean a cause-and-effect relationship has been established.

    Benchmark

    The management process whereby organisations evaluate various aspects of their processes in relation to the best practice, usually within their own sector.

    Beneficence

    The moral principle of doing good.

    Case-control study

    A type of observational analytic epidemiological investigation in which subjects are selected on the basis of whether they do (cases) or do not (controls) have a particular disease. The groups are then compared with respect to the proportion having a history of exposure or characteristic of interest.

    Case series

    A series of patients with a defined disorder. The term is used to describe a study reporting on a consecutive collection of patients treated in a similar manner, without a concurrent control group. For example, a surgeon might describe the characteristics of and outcomes for 100 consecutive patients with cerebral ischaemia who received a revascularisation procedure.

    Clinical governance

    Chapter 6 of the 1997 White Paper The New NHS: Modern, dependable (Department of Health, 1997) described the means of improving clinical standards at local level throughout the NHS. It involves:

    • action to ensure that risks are avoided;
    • rapid detection of adverse events which are openly investigated and lessons learned;
    • disseminating good practice;
    • establishing systems to ensure continuous improvements in clinical care.
    Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish (Department of Health, 1998).

    Clinical trial

    A prospective controlled study involving patients, i.e. one in which an intervention is allocated and patients are followed up.

    Cluster trial

    An interventional design which attempts to make inferences about individuals but where the intervention is allocated to clusters of individuals.

    Coding frame

    Coding is an analytical process in which data are categorised to facilitate analysis. One code should apply to only one category and categories should be comprehensive. The coding framework is the clear guidelines for coders (individuals who do the coding) to ensure that code is consistently applied.

    Cohort

    A group of individuals who share a characteristic (such as age, gender). In a cohort study, individuals are followed for a period of time to determine disease incidence at different ages.

    Confounding variable

    A factor which is significantly associated with both the occurrence of a disease in a population and with one of the causes or determinants, but is not itself a cause. Confounding variables can result in erroneous conclusions. For example, vegetarians have a lower incidence of obesity than non-vegetarians, but the lower incidence of obesity may be due to the confounding factor that vegetarians tend to be more active as a population than non-vegetarians rather than the lower incidence being due to difference in diet.

    Controlled experiment

    Research studies in which variables are controlled. Typically one group receives a treatment and another (the control group) does not. The groups are similar in every characteristic except for the treatment so that differences in the groups can be attributed to the treatment.

    Conversation analysis

    A form of discourse analysis that studies social interaction, embracing both verbal and non-verbal conduct, in situations of everyday life.

    Correlation

    A measure of the association between two or more variables. The measurement scales used should be at least interval. Correlation is not causation but it may imply that link is worth further investigation. The most widely used type of correlation coefficient is Pearson r, also called linear or product moment correlation.

    Cross-sectional

    A cross-sectional study is a descriptive study in which disease and exposure status are measured simultaneously in a given population. Such a study provides a snapshot of the frequency and characteristics of a disease in a population at a particular point in time.

    Crowd-sourcing

    In the world of technology, crowd-sourcing means inviting a group to collaborate on a solution to a problem. It was coined by Jeff Howe of Wired magazine in 2006 to refer to the widespread internet practice of posting an open call requesting help in completing some task.

    Data corpus

    The whole body of data collected.

    Data matrix

    Another word for a table where data are entered into individual cells.

    Data set

    The sample from a data corpus that you select for scrutiny for a particular purpose.

    Deductive reasoning

    The process of arguing from a general to a specific instance (from a theory to an empirical situation, for instance).

    Delphi technique

    With the Delphi technique, individual participants are asked to give their views in response to a series of questions. These views are collated and are then fed back to the participants, who rank them in order of importance to them. This second round is collated and fed back to all the participants again. This creates an opportunity for individuals to revise their judgements on the basis of this feedback and gives some degree of anonymity for their individual contributions. Although time-intensive and somewhat expensive, it is a useful tool for establishing a consensus about priorities relevant for a particular target group (such as elderly people or those with disabilities) who are most knowledgeable about their specific needs.

    Discourse analysis

    A general term for a number of qualitative approaches to analysing written, spoken or signed language use.

    Ecological fallacy

    This occurs when you extrapolate from group data to draw conclusions about individuals.

    Effective

    How well a treatment works in practice (as opposed to the controlled conditions present in a clinical trial, where efficacy is measured).

    Efficient/Efficiency

    An economics concept that relates to the optimal use of resources.

    Emic perspective

    Description of behaviour or a belief in terms meaningful (consciously or unconsciously) to the person within the culture.

    Empiricism

    A theory of knowledge that asserts that knowledge comes only or primarily via sensory experience.

    Epidemiological

    The branch of medicine dealing with the study of the causes, distribution and control of disease in populations.

    Epistemic community

    A network of professionals with recognised expertise and competence with an authoritative claim to knowledge within a particular area. Although an epistemic community may consist of professionals from a variety of disciplines and backgrounds, they have a shared set of normative and principled beliefs.

    Equipoise

    When two treatments are regarded as an equal bet in prospective terms.

    Ethnographic research

    A qualitative study design that entails indepth study of a society's or an organisation's culture and social structure. It uses both qualitative and quantitative methods to do this.

    Evaluation

    The assessment and determination of the quality or value of something (for purposes both of accountability and for learning).

    Evidence-based medicine

    Aims to apply the best available evidence gained from the scientific method to clinical practice.

    Experimental

    A systematic testing process that is carried out in order to verify, falsify or establish the validity of a hypothesis.

    Focus group

    A group interview where people who are strangers to each other but have experience of what is being investigated are invited to contribute their views and ideas. The hope is that as wide a range of differing opinions or experiences as possible will be expressed.

    Formative evaluation

    Looks for areas for improvement in a service.

    Generalisability

    This exists when the results of the research can be applied more generally and more widely than the research study itself.

    Guidelines

    Any document that seeks to standardise processes associated with an activity and thus make employees‘ actions accountable. By definition, following a guideline is never mandatory. ‘Protocol’ would be a better term for a procedure that is mandatory. They are part of the wider process of governance. The National Library of Guidelines is a collection of guidelines for the NHS. It is based on the guidelines produced by NICE and other national agencies.

    Hegemony (hegemonic)

    The predominant political economic and ideological influence (of a state, region or group) over others so that its way of seeing things is perceived as natural and common-sense.

    Heterogeneity

    In systematic reviews, heterogeneity refers to variability or differences between studies in the estimates of effects.

    Histogram

    A frequency distribution by means of rectangles whose widths represent class intervals and whose areas are proportional to the corresponding frequencies.

    Implementation research

    Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, and hence to improve the quality (effectiveness, reliability, safety, appropriateness, equity, efficiency) of healthcare. It includes the study of influences on healthcare professional and organisational behaviour (www.who.int/reproductivehealth/topics/best_practices/greatproject_glossary/en/index.html).

    Inception cohort

    A designated group of persons, assembled at a common time early in the development of a specific clinical disorder (for example, at the time of first exposure to the putative (i.e. supposed) cause or at the time of initial diagnosis), who are followed thereafter.

    Inductive reasoning

    The process of inference from a finite number of particular cases in order to make a generalisation.

    Interpretivist

    This paradigm starts from the view that people construct meanings through language and interaction with others in their daily lives. Thus any attempt to establish cause-and-effect relationships is misguided because meanings will change in different situations and over time.

    Intervention

    Any activity or object whose purpose is to improve health or alter the course of disease.

    Interview

    Formal talk where questions are asked by the interviewer to obtain information from the respondent in order to collect data to answer the research question.

    Interview schedule

    A formal list of precoded questions that must be asked in the same order and in the same way by an interviewer who writes down on it the answers given.

    Key informant

    Anyone who can provide detailed information and opinion based on his or her knowledge of a particular issue.

    Liberalism

    A set of ideas in political and social thought which underlines the importance of individual rights. The role of the state is primarily to protect these rights (referred to as neoliberalism when it includes market-driven ideas of the efficiency of private enterprise justifying the diminishment of the public sector).

    Mainstreaming

    A process whereby an activity or idea becomes popularised or adopted as policy that attracts routine funding.

    Mean

    The average where you add up all the numbers and then divide by the number of numbers.

    Median

    Another form of average that is the numerical value separating the higher half of a sample (or population) from the lower half.

    Meta-analysis

    The statistical analysis of data from more than one study of the same intervention (or association) in an attempt to summarise the current state of knowledge.

    Mode

    Another measure of average that is the value that occurs most often.

    Narrative review

    Discusses and summarises the literature on a particular topic, without generating any pooled summary figures through meta-analysis. This type of review usually gives a comprehensive overview of a topic, rather than addressing a specific question such as how effective a treatment is for a particular condition. Narrative reviews do not often report on how the search for literature was carried out or how it was decided which studies were relevant to include. Therefore, they are not classified as systematic reviews.

    National Institute for Health and Clinical Excellence (NICE)

    Provides guidance, sets quality standards and manages a national database to improve people's health and prevent and treat ill health. It uses research evidence as well as economic information and consultation with service users for policy-making.

    Nominal group

    A group interview where the aim is to establish consensus about the issue being investigated. Nominal group technique is a structured method for group brainstorming that encourages contributions from everyone.

    Non-maleficence

    The moral principle of not doing harm. It is one of the four principles in medical ethics proposed by Beauchamp and Childress (2001).

    Null hypothesis

    The proposition to be tested statistically, that the experimental intervention has ‘no effect’.

    Nuremberg Code

    In 1947 an international tribunal declared the Nuremberg Code the standard by which a group of doctors in Nazi Germany should be judged.

    Odds ratio

    One of a range of statistics used to assess the risk of a particular outcome (or disease) if a certain factor (or exposure) is present.

    Outcome

    Something that follows as a result or consequence of an intervention. Measurable outcomes need to be specified as a part of the design of evaluation research. They are the higher-level results.

    Paradigm

    A shared stable commitment to key theories, instruments, values and underpinning assumptions that form the discipline, thus facilitating the cumulative generation of knowledge. It was a concept used by Thomas Kuhn in The Structure of Scientific Revolutions (1962).

    Performance framework

    Following on from the 1997 White Paper The New NHS: Modern, dependable (Department of Health, 1997), NHS trusts became required to report on the following six areas:

    • health improvement;
    • fair access to services;
    • effective delivery of appropriate healthcare;
    • efficiency;
    • patient/carer experience;
    • the health outcomes of NHS care.

    Phenomenology

    A world view that values the meaning of occurrences, rather than measuring observable events.

    Placebo

    A chemically inert substance which has a psychologically suggestive effect and is used in place of an active drug. It may be used as a control in a clinical trial to determine whether improvement and/or side effects can be attributed to the active substance.

    Positivist

    A world view that values measurement and observable events.

    Post-positivist

    A social science approach studying how people construct meaning through social interaction.

    Power

    The power of a statistical hypothesis test measures the test's ability to reject the null hypothesis when it is actually false – in other words, to make a correct decision. It is the probability of not committing a type II error (failing to recognise a difference when in fact there is one – which can happen when a sample size is too small).

    Process measures

    The activities that can be identified that feed into an outcome. They can be monitored to ensure work is on track to achieve its objectives.

    Prospective

    A research design that follows respondents into the future (also called longitudinal).

    Protocol

    A formal and explicit treatment regimen for care. A clinical trial will have two or more such protocols along with a description of the research design or method, eligibility requirements and the proposed method of analysis. It can also be used to describe the comprehensive written document detailing all procedures to be followed in a trial.

    Publication bias

    A tendency to publish results that appear significant, rather than negative or near-neutral results, which are almost never published. This can distort the true picture of research findings if a meta-analysis is performed as the success of an intervention is overrepresented.

    Q-squared (Q2) methods

    Also known as mixed methods, Q-squared methods refer to a study design that incorporates both quantitative and qualitative methods. Data is analysed severally. Such an approach deepens understanding.

    Qualitative research

    An approach that aims to form an indepth understanding of human behaviour and the reasons that govern such behaviour.

    Quality

    Measures of excellence in either a service or product.

    Randomised controlled trial (RCT)

    An epidemiological study where people are randomly allocated to receive (or not receive) a particular intervention (this could be two different treatments or one treatment and a placebo). This experimental study design is used to determine whether an intervention or treatment is more effective than the alternative control.

    Relative risk

    Risk of an event (or of developing a disease) relative to exposure. Relative risk is a ratio of the probability of the event occurring in the exposed group versus a non-exposed group.

    Reliable

    The consistency of a set of measurements or of a measuring tool (interview schedule, for example). Reliability is necessary but not sufficient for validity.

    Representative

    The extent to which sample data reflect accurately the characteristics of the population from which they are drawn.

    Retrospective study

    A study that examines events that have already taken place; a study on previously collected data.

    Sampling frame

    A comprehensive list of names and contact details.

    Selection bias

    A statistical bias that can arise through the method of choosing the individuals or groups to take part in a scientific study.

    Social accountability

    Being mindful of the emerging social concerns and priorities of internal and external stakeholders (patients, community, employees, governmental and non-governmental organisations, management and owners).

    Social constructivism

    A paradigm interested in how an individual's learning takes place because of his or her interactions in a group.

    Stakeholder

    A person, group or organisation that has direct or indirect stake in an organisation because it can affect or be affected by the organisation's actions, objectives and policies.

    Standards

    Both governance and quality issues. Organisations publish practical guidance and examples of good practice to which they wish employees to adhere and for which sanctions apply if they are not followed.

    Structured questionnaires

    A series of questions asked to individuals to obtain statistically useful information about a given topic that may be posted to people/be online and so be self-completed, or may be asked by an interviewer (referred to as interview schedules).

    Summative evaluation

    Forms a judgement of the value and merits of whatever is being evaluated, usually for decision-making and accountability purposes.

    Survey

    Observational or descriptive, non-experimental study in which individuals are systematically examined for the absence or presence (or degree of presence) of characteristics of interest.

    Synonyms

    Different words with almost identical or similar meanings – a thesaurus can be used to identify such words.

    Systematic review

    A synthesis of medical research on a particular subject to represent the current stage of knowledge about what is effective clinical practice. It uses thorough methods to search for and include all or as much as possible of the research on the topic. Only relevant studies, usually of a certain minimum methodological quality, are included.

    Transactions costs

    The resources needed (time, money, expertise, for example) to deliver a product or service. In healthcare this would include costs arising from different governance structures of local and health authorities when a patient's care entails crossing organisational boundaries.

    Translational research or implementation science

    Promotes the uptake of research findings into routine healthcare in both clinical and policy contexts. It is multidisciplinary research that scientifically studies methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, so as to improve the quality and effectiveness of healthcare. It includes the study of what influences healthcare professional and organisational behaviour.

    Triangulation

    This involves using more than one method to produce different forms of data (or the same method to gather data from different sources). The data can be compared, and similar findings from different methods may support the validity and comprehensiveness of the research findings.

    Type II error

    The false acceptance of the null hypothesis (a false negative). The type I error (false positive) is more serious: it wrongly rejects the null hypothesis.

    Valid

    The metric corresponds accurately to what it claims to be occurring in the real world.

    Variable

    The name given to a category that can change its value.

    White Paper

    A White Paper issued by the government lays out policy, or intended action, on a topic that is of current concern. It signifies an intention to issue new law, and in the UK is also known as a Command paper. White Papers are often preceded by Green Papers, which are consultation documents.

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