Preface: Case Studies of Medical Education Research Groups

The case studies in this special theme issue of Academic Medicine depict eight highly productive research in medical education groups. They document each group's productivity, albeit variously measured, and review each group's history, size, organizational structure, and funding. They discuss perceived reasons for their research success. Finally, they reflect upon past and future challenges and describe responses to them. Staff of Academic Medicine selected the groups included in this issue. After they compiled a list of medical education research groups and informally noted highly productive ones, they compared their informal choices with the groups’ publication rates in medical education journals over the last five years. Adjusting for geographic diversity, the staff invited the medical education research groups at Dartmouth Medical School; Johns Hopkins University School of Medicine; University of Kentucky College of Medicine; University of Maastricht Faculty of Medicine; University of Michigan Medical School; University of California, San Francisco, School of Medicine; University of Toronto Faculty of Medicine; and University of Washington School of Medicine to write case studies. Although the characteristics of individual researchers influence productivity, the quality of research environments is even more important for generating scientific work.1 Characteristics of these productive research environments, ranging from the age and size of research groups to the nature of their leadership, have been identified, primarily in the natural sciences.1 This body of work on productive research environments raises a series of important questions about the case studies in this issue for readers to consider. Do the case studies contain themes about environmental characteristics that help us to account for the productivity of these eight groups in medical education? Specifically, is there a diversity among these groups that suggests their productivity is the result of adaptation to unique local conditions? At the same time, are there similarities pointing to more universal forces at work in each group that explain their output? Have the groups created innovations to stimulate productivity? What lessons for the future do these case studies convey? This preface endeavors to begin to answer these questions. Diversity There are a number of apparent differences across the eight groups in characteristics thought to impact research productivity. The groups vary in age, size, and composition. The youngest is five years old while others have existed for over 30 years. The number and composition of group members range from about three FTEs (full-time equivalents) spread over 19 researchers, three FTE staff, and 18 PhD candidates in one instance, to eight core faculty, five staff, 12 fellows and professors, and 100 affiliates in another instance. A variety of circumstances led to the formation of these groups in institutions with distinct academic missions. Several resulted from the conscious decision of an institutional leader to develop a research in medical education enterprise. One group arose out of the demise of previous offices for studying medical education, and one emerged when a new university opened with a mission in educational innovation. Several were evolutionary outgrowths of educational traditions, efforts, and interests of faculty. There are groups in schools known for their biomedical research intensity or for their education orientation and groups in schools with emphases on both research and teaching. The organizational arrangements represented in these case studies are indeed diverse, although the groups’ scope of research responsibilities typically extends across the institution. Several groups enjoy departmental status in their medical schools. Other groups are offices, either within a department of medical education or within the education dean's office. One group, without office status, consists of individuals within a larger office of education. Another group is a research center located in an affiliated hospital. Faculty in a general internal medicine division comprise still another group. Thus, the productivity of research in medical education groups does not seem to depend on their age, size, composition, origins, or organizational arrangements per se. Yet, in each instance, these groups’ characteristics may be necessary and effective adaptations to parochial needs or circumstances. Examples of responses to local conditions include the creation and expansion of a research group due to the school's education program in five states and the development of a division-specific research program due to a chair's initiative. A loosely coupled organizational arrangement for educational research without a dedicated office due to constrained resources and a two-office structure merging the research potential of an evaluation group with a grant-supported initiative in community-based education and research are other examples of diverse adaptations to unique local circumstances. Similarities The eight groups described in the case studies do exhibit similarity in some characteristics that predict high research output. Their goal of conducting research in medical education is clear: “research is a part of what we do” (Elam). Moreover, their educational research goal is closely aligned with their institutional missions, although the missions might stress medical research or education or both academic functions. For example, Thomas and her colleagues write that their institution's “model of success in the biomedical research arena … has served educational research as well. … The single track, ‘up or out’ promotion system … has motivated clinician–educators to seek opportunities to engage in scholarship.” In short, the groups’ goals match the institutional culture of scholarship of discovery, integration, application, and/or teaching. Dynamic leaders who themselves are accomplished educators and/or researchers in medical education direct these groups. They are capable of advancing the broadly stated goal of research within the group while respecting the interests of individual investigators. Van der Vleuten et al. observe: “we have become aware of how difficult it is to steer research … [that is] dictated … mostly by the personal interests of those involved.” The leaders also have the people skills to advocate for educational research beyond the group. Hodges writes: “Through an active development process that included negotiations with university and hospital colleagues, he identified resources, space, and personnel that allowed the [group] to come into existence. These efforts created a stable [group] with a strong identity …” An élan coupled with serious intentionality about their research goal also mark these groups. Their energy is evident in annual goals set for output, regular group meetings to track productivity, quality control of the group's achievements, utilization of internal and external programs to hone members’ research skills, and prescribed advice fostering medical education research. An ongoing promotion of each group's capabilities to maintain its visibility and an ambitious strategic planning process after a formal review by external consultants are other expressions of the groups’ vitality. From the groups’ perspectives, their successes are a direct result of seizing the educational moment—be it curricular reform, other naturally occurring experiments, or routine educational activities—and transforming it into the scholarship of education. For example, the group from Dartmouth explains: “dramatic shifts in health care … prompted medical schools to develop ambulatory clerkships. … It quickly became clear that learning in outpatient versus inpatient settings is quite different, and this was seen as an opportunity for study.” From the case studies it is difficult to define precisely the magnitude of financial resources necessary to support the groups’ high productivity. The studies, however, convey the impression that the groups’ funding is constrained. In fact, about half explicitly characterize it as “limited” (Michigan, Maastricht) or “minimal” (Hopkins, University of California, San Francisco). At the same time, enough funding to support a critical core of highly skilled education researchers and important infrastructure, such as research databases, support staff, access to expertise complementing that of the group's members, and various faculty development programs is vital. A mix of internal and external funding supports the enterprises. Internal funding is often indirect. Similarly, external grants, the key to advancing the groups’ research programs, often piggyback educational questions onto initiatives with a broader focus. Perhaps the most influential factor in the groups’ productivity is collaboration. Many case studies refer to it. The groups practice collaboration in multiple ways. There is strong collaboration between education researchers, on the one hand, and clinicians, basic scientists, and student affairs officers, on the other, and between theoreticians and practitioners. Collaboration occurs among researchers with complementary methodological, theoretical, or disciplinary strengths and among researchers and junior investigators including medical students, graduate students, fellows, and faculty in training programs. Groups collaborate with colleagues across their university, region, nation, and world. The groups believe collaboration is necessary not only because it is a way to extend constrained resources but also because the very nature of research in medical education demands it. It is a win-win proposition for all; it “provides leverage for both parties, enabling them to accomplish more together than they could separately” (Gruppen). Innovations To extend their capabilities and renew their ranks, almost all of the groups are involved with faculty development in the scholarship of education. Their efforts target current and future generations of medical educators. There are workshops and courses in education and research skills, teaching or medical education scholars programs, fellowships in medical education research, graduate degree programs, and supervision along with strong mentoring of new research recruits. Also present are mechanisms to recognize and support medical educators such as teaching academies and awards. All these developments have been identified as important for the scholarship of education.2 The Future Because the case studies do not include research groups representing the entire array of productivity levels, we cannot be sure that the characteristics just identified really do account for the success of the eight groups selected for this issue of Academic Medicine. Yet, according to a number of relatively rigorous studies, these characteristics are present in other highly productive research units.1 The case studies, then, may provide guidance to institutions interested in improving their own research in medical education output. But a cautionary note must be added. The case studies do not systematically convey how each of the success factors is intertwined to form an integrated background supportive of research. Interdependency of success factors is even more important for research productivity than the presence of these characteristics in isolation.1 Facing the future, the case studies reflect guarded optimism for the growth of medical education research and the groups themselves. Challenges entail striking the right balance between the tensions inherent in medical education research: tensions between theory and practice, between breadth and depth of research topics, and between research and service (especially in the clinical arena.) A special challenge attends the groups’ successes; research opportunities for the increasing number of trained investigators must be identified lest their enthusiasm and expertise dwindle. The groups’ strong leaders, clarity and vitality of purpose, collaborative approach to research, and programs to nurture current and future medical educators’ ability to generate quality scholarship in medical education bode well for continued success.

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