generating good research questions in health professions education

• DOI: 10.1097/ACM.0000000000001413
• Corpus ID: 46826703

Generating Good Research Questions in Health Professions Education.

• C. Dine , J. Shea , J. Kogan
• Published in Academic medicine : journal… 1 December 2016
• Education, Medicine
• Academic medicine : journal of the Association of American Medical Colleges

3 Citations

Tools for medical education scholarship: from curricular development to educational research., planning and conducting clinical research: the whole process, academic primer series: five key papers about study designs in medical education, related papers.

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Generating Research Questions Appropriate for Qualitative Studies in Health Professions Education

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• 1 University of California, San Francisco School of Medicine University of California, San Francisco School of Medicine Hofstra Northwell School of Medicine.
• PMID: 27749306
• DOI: 10.1097/ACM.0000000000001438

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• Generating Good Research Questions in Health Professions Education. Dine CJ, Shea JA, Kogan JR. Dine CJ, et al. Acad Med. 2016 Dec;91(12):e8. doi: 10.1097/ACM.0000000000001413. Acad Med. 2016. PMID: 27749302 No abstract available.
• Criteria for social media-based scholarship in health professions education. Sherbino J, Arora VM, Van Melle E, Rogers R, Frank JR, Holmboe ES. Sherbino J, et al. Postgrad Med J. 2015 Oct;91(1080):551-5. doi: 10.1136/postgradmedj-2015-133300. Epub 2015 Aug 14. Postgrad Med J. 2015. PMID: 26275426 Review.
• Public policies to promote community-based and interdisciplinary health professions education. Coffman J, Henderson T; Community-Campus Partnerships for Health. Coffman J, et al. Educ Health (Abingdon). 2001;14(2):221-30. doi: 10.1080/13576280110074087. Educ Health (Abingdon). 2001. PMID: 14742020
• Higher education and health professions education: shared responsibilities in engaging societal issues and in developing the learned professional. DePaola DP. DePaola DP. J Am Coll Dent. 1994 Fall-Winter;61(2):34-9. J Am Coll Dent. 1994. PMID: 7829774
• Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement. Johnson CE, Keating JL, Boud DJ, Dalton M, Kiegaldie D, Hay M, McGrath B, McKenzie WA, Nair KB, Nestel D, Palermo C, Molloy EK. Johnson CE, et al. BMC Med Educ. 2016 Mar 22;16:96. doi: 10.1186/s12909-016-0613-5. BMC Med Educ. 2016. PMID: 27000623 Free PMC article. Review.
• Revisiting the quantitative-qualitative-mixed methods labels: Research questions, developments, and the need for replication. Leppink J. Leppink J. J Taibah Univ Med Sci. 2017 Jan 5;12(2):97-101. doi: 10.1016/j.jtumed.2016.11.008. eCollection 2017 Apr. J Taibah Univ Med Sci. 2017. PMID: 31435222 Free PMC article.
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• Academic Primer Series: Five Key Papers about Study Designs in Medical Education. Gottlieb M, Chan TM, Fredette J, Messman A, Robinson DW, Cooney R, Boysen-Osborn M, Sherbino J. Gottlieb M, et al. West J Emerg Med. 2017 Jun;18(4):705-712. doi: 10.5811/westjem.2017.4.33906. Epub 2017 May 15. West J Emerg Med. 2017. PMID: 28611892 Free PMC article. Review.

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Generating Research Questions Appropriate for Qualitative Studies in Health Professions Education

O’Brien, Bridget C. PhD; Ruddick, Victoria J.; Young, John Q. MD, MPP

University of California, San Francisco School of Medicine

Hofstra Northwell School of Medicine

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Academic Primer Series: Five Key Papers about Study Designs in Medical Education

Michael gottlieb.

* Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois

Teresa M. Chan

† McMaster University, Department of Medicine, Division of Emergency Medicine, Hamilton, Ontario, Canada

Jenna Fredette

‡ Christiana Care Health System, Department of Emergency Medicine, Newark, Delaware

Anne Messman

§ Wayne State University, Department of Emergency Medicine, Detroit, Michigan

Daniel W. Robinson

¶ University of Chicago, Department of Medicine, Division of Emergency Medicine, Chicago, Illinois

Robert Cooney

|| Geisinger Medical Center, Department of Emergency Medicine, Danville, Pennsylvania

Megan Boysen-Osborn

# University of California, Irvine, Medical Center, Department of Emergency Medicine, Orange, California

Jonathan Sherbino

Introduction.

A proper understanding of study design is essential to creating successful studies. This is also important when reading or peer reviewing publications. In this article, we aimed to identify and summarize key papers that would be helpful for faculty members interested in learning more about study design in medical education research.

The online discussions of the 2016–2017 Academic Life in Emergency Medicine Faculty Incubator program included a robust and vigorous discussion about education study design, which highlighted a number of papers on that topic. We augmented this list of papers with further suggestions by expert mentors. Via this process, we created a list of 29 papers in total on the topic of medical education study design. After gathering these papers, our authorship group engaged in a modified Delphi approach to build consensus on the papers that were most valuable for the understanding of proper study design in medical education.

We selected the top five most highly rated papers on the topic domain of study design as determined by our study group. We subsequently summarized these papers with respect to their relevance to junior faculty members and to faculty developers.

This article summarizes five key papers addressing study design in medical education with discussions and applications for junior faculty members and faculty developers. These papers provide a basis upon which junior faculty members might build for developing and analyzing studies.

INTRODUCTION

A thorough understanding of study design is essential for creating successful studies. 1 While there are multiple approaches to designing an experiment, one must understand the limitations inherent in each technique, as well as potential biases and challenges that may result from a selected approach. One must be thoughtful and cognizant of this prior to beginning a project, as errors in study design and data collection can severely compromise a study’s results. Additionally, it is important to understand these limitations when evaluating a study as a peer reviewer, as well as when applying and interpreting studies for clinical or educational use.

While the Accreditation Council for Graduate Medical Education (ACGME) requires residents to participate in research, the degree of involvement in the process and training can be variable. 2 After completing residency, junior faculty members may start their careers without having had sufficient training or mentorship in study design for medical education. 3 , 4 They may then struggle to successfully produce high-quality scholarship.

The Faculty Incubator was created by the Academic Life in Emergency Medicine (ALiEM) team to provide early-career educators with a community of practice where they can discuss and debate topics relevant to the 21st century medical educator. To that end, we created a one-month module focused on study design.

This paper is a narrative review that highlights some important literature that may assist junior educators seeking to learn more about study designs in medical education.

In the eighth month of the ALiEM Faculty Incubator (October 1–31, 2016), we discussed the topic of study design for medical education. We monitored the proceedings of this group of educators from October 1–31, 2016. Our online discussions involved both junior faculty members and faculty mentors. While discussions occurred, we gathered the titles of papers that were cited, shared, and recommended within our online discussion forum and compiled these into a list. We also asked all of the monthly mentors for additional suggestions on relevant literature.

Once the augmented list was completed, we then conducted a three-round voting process, inspired by the Delphi methodology similar to our previous papers, to build consensus on which papers to feature. 5 – 8 The first round asked the group to rate the article on a scale of 1 to 7. The second round used the existing, blinded data from round 1 to determine whether the article should be included or not. The final round asked the group to select the top five articles for inclusion, with consensus determined by the top five papers receiving a clear majority of the voting. This was not a traditional Delphi methodology since our selection panel was comprised of both novices (i.e. junior faculty members, participants in the Faculty Incubator) and experts in the field (i.e., experienced clinician educators, all of whom have published >10 peer-reviewed medical education publications, who serve as mentors and facilitators of the ALiEM Faculty Incubator). However, we intentionally used this method to involve both junior and experienced clinician educators to ensure we selected papers that would be of use to a spectrum of educators throughout their careers. There were four novice and four experienced medical educators involved in the analysis. All eight members were emergency medicine specialists. All members participated in all rounds of voting with 100% response rates for all rounds.

Our ALiEM Faculty Incubator discussions in combination with expert recommendations yielded a total of 29 articles. Our approach allowed us to create a rank-ordered listing of all of the papers in order of perceived relevance, from the most to the least relevant. The top five papers were expanded upon below. Our ratings of all 29 papers are listed in the table , along with their full citations.

The complete list of study design literature collected by the authorship team.

SD , standard deviation.

The following is a list of papers that we determined to be of interest and relevance to junior faculty members and faculty developers. The accompanying commentaries explain the relevance of these papers to junior faculty members, while highlighting considerations for senior faculty members when using these publications for faculty development workshops or sessions.

1. Bordage G and Dawson B. Experimental study design and grant writing in eight steps and 28 questions. Med Educ . 2003;37(4):376–85. 9

Creating a research question, designing a study, and writing a grant proposal are important skills for the physician educator-researcher. This article provides an eight-step, 28-question guide for researchers to follow at the beginning of the design process to ensure that all elements of design have been carefully considered. The guide incorporates the author’s prior work, explaining common reasons why manuscripts are accepted or rejected from medical education journals. 10 It examines how to define a relevant research question, study design and appropriate statistics, the importance of sample size and sampling procedure, budget and personnel requirements, and writing grant proposals. While this process is best applied to experimental studies the principles outlined are applicable to a wide array of other research designs.

Relevance to Junior Faculty Members

It can be difficult for a novice researcher to choose an appropriate research question and properly design a study. Using this 28-question approach, this paper may provide guidance to junior faculty members who are planning research studies. By considering these important design questions, junior faculty may improve the strength of their research, produce more meaningful outcomes, and have better publication success.

Considerations for Faculty Developers

Faculty developers may find this paper to be a valuable resource for junior faculty members as they become more involved in research and grant writing. The list provides a more manageable approach to research, allowing the faculty developer to expand upon this with both experiential examples and further directions. This could also be used as pre-reading for a research course or as a resource for mentees.

2. Crites GE, Gaines JK, Cottrell S, et al. Medical education scholarship: an introductory guide: AMEE Guide No. 89. Med Teach . 2014;36(8):657–74. 11

Faculty members who wish to advance their careers must produce scholarship. This article provides guidance for planning a scholarly project and advancing one’s career. It begins with a brief overview of the different types of scholarship with particular emphasis on the scholarships of discovery and teaching. 12 Next, the authors provide specific advice in the planning of a scholarly project. This advice includes best practices on finding a mentor. Then, the reader is advised to set clear goals with particular guidance provided on how to develop a good research question, as well as a seven-step scholarship plan. The authors recommend the use of educational theories or conceptual frameworks to guide the scholarly plan. The authors also provide advice on which particular research methods to employ, depending on the type of scholarship the reader is attempting to produce. The final steps that the authors recommend are for the reader to determine whether their scholarly project is adequate and, if so, how to present the results of the scholarly project. The authors emphasize throughout the article the importance of understanding one’s promotion and tenure requirements at one’s institution.

This paper is a must-read for junior faculty members. It provides invaluable advice regarding creation of a scholarly project, as well as general advice for junior faculty members to help advance their career. There is specific advice on the importance of obtaining a mentor and how to be a good mentee. Most importantly, the paper is well-referenced so that if the reader has further questions regarding a particular topic, finding further information is very easy.

This paper provides valuable tips for faculty developers on how to be effective mentors, as well as advice to provide mentees on establishing and maintaining successful relationships. Additionally, this can serve as a blueprint for how to advise junior faculty on the creation of scholarly projects, emphasizing the role of the mentor at each step.

3. Yarris LM, Deiorio NM. Education research: a primer for educators in emergency medicine. Acad Emerg Med . 2011;18 Suppl 2:S27–35. 13

Yarris and Deiorio provide a nice overview of education research for more-novice researchers. They provide a sequential approach to research, beginning with formulating appropriate and testable study questions. They emphasize the importance of performing a thorough literature review and using the FINER (feasible, interesting, novel, ethical, and relevant) approach to developing the research question. The authors subsequently provide a brief review of the various study designs, giving equal weight to both quantitative and qualitative approaches. Finally, the authors provide an approach to dissemination, as well as an extensive list of potential journals dedicated to reporting research in medical education. Throughout the paper, the authors provide numerous examples, as well as approaches to overcoming barriers with each step along the research pathway.

This article provides a valuable overview of the research process within medical education for more-novice researchers. Given the importance of selecting appropriate and testable hypotheses, junior faculty may find the sections on question design particularly valuable to ensure that the study concept is feasible and likely to be useful to the broader community. Additionally, the discussion of different approaches to study design can help with understanding limitations and the best approach to testing one’s study question. Importantly, this paper discusses both quantitative and qualitative research methodology, explaining the differences between the approaches and how each could be applied to study design. Qualitative research is particularly valuable within medical education research yet is poorly taught in comparison with traditional, clinical research. In the latter portion of the article, the authors provide lists of potential funding sources, as well as outlets for dissemination of medical education scholarship, which can also be invaluable resources for junior faculty.

Completion of scholarly activity by faculty is the most frequently encountered cause for a cautionary ACGME citation when emergency medicine residency programs undergo reviews. 14 For this reason, it is imperative that faculty focus on the completion of scholarly activity. Despite the teaching inherent in a faculty role, these educators may not be aware that certain products of teaching can be considered scholarship. This paper provides a simple primer that faculty developers may use to guide faculty to begin generating educational scholarship. The primer covers various formats used within educational scholarship. While brief, this overview is valuable for guiding faculty in the beginning phase of their scholarship. The article concludes with a comprehensive list of journals that accept educational scholarship to help faculty disseminate scholarly products. When combined with the work on the scholarship of teaching by Glassick, 15 this article provides a foundation for faculty to get credit for more than simply teaching.

4. Ramani S, Mann K. Introducing medical educators to qualitative study design: twelve tips from inception to completion. Med Teach . 2016;38(5):456–63. 16

Ramani and Mann provide a focused introduction to qualitative research in medical education. They simplify qualitative research into 12 steps to help guide the novice researcher. Initially, the authors set the groundwork for understanding how qualitative research is relevant to medical education given some of the skepticism about qualitative research. However, medical educators and clinicians are becoming increasingly accepting of qualitative research and the rigor it requires. The authors suggest the following 12 steps: 1) choose a framework (e.g. ethnography, phenomenology, grounded theory, or discourse analysis); 2) understand reflexivity in that the researcher and methods influence the data; 3) understand how to mitigate ethical concerns; 4) know how to sample the population; 5) match the source data to the framework and the intended study outcome; 6) understand how to perform data collection; 7) prepare the data for analysis; 8) analyze the initial data; 9) determine if initial analysis is necessary and resolve internal team thematic conflicts; 10) maintain rigor; 11) report the results; and 12) be aware that specific training in qualitative methods is often necessary.

Understanding how and why to do qualitative research is often a daunting task for the novice researcher who may not have received formal training in these research methods. This article breaks this approach into reasonable steps. As each of the 12 steps requires a more in-depth understanding than one article can provide, this paper serves as a nice initial framework for understanding qualitative methods. Junior faculty members interested in performing qualitative research are advised to expand upon this, using additional resources including many of the publications cited in this article.

Qualitative methodology has taken the medical education field by storm in the past decade. Thus, any medical education interest group or journal club will undoubtedly fold qualitative research into their proceedings. Most junior faculty come from biomedical backgrounds, however, and may find these techniques quite foreign. It is therefore incumbent upon faculty development leaders to provide guidance and teaching centered on these types of research methods. Although this paper will not make a new junior faculty member immediately adept at conducting qualitative research, it can provide a structured approach to understand the processes taken by authors of such work. An overview paper like this may make the methods interesting enough to inspire a new faculty member to learn even more about these useful research methods.

5. Tavakol M, Sandars J. Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part II. Med Teach . 2014;36(10):838–48. 17

This article is the second publication in a two-part series discussing the application of quantitative and qualitative research methodology in medical education. 17 , 18 While the first article focused more on the importance and differences between the two approaches, 18 this article provides a thorough overview of the major components of qualitative research. 17 The authors begin by discussing three common forms of qualitative research: phenomenology (the study of events and occurrences), ethnography (the study of specific cultural groups), and grounded theory (the study of viewpoints and shared meanings). Next, they discuss how to select appropriate populations and how sample size differs from the quantitative approach. Finally, the authors discuss measurement and analysis of the data, emphasizing numerous unique and important features to qualitative assessment.

As noted earlier, qualitative methodologies may not be as familiar to researchers as the more traditional quantitative approaches seen in the basic sciences. However, an understanding of qualitative methodologies is very important, as it is particularly relevant within medical education research. Qualitative research provides an opportunity to both discover new theories and to inductively test existing models and theories. This paper provides an overview of the processes involved, as well as how the various components differ from quantitative methods. Readers may find the discussion of sampling, data measurement and analysis particularly valuable as a basis for further reading on the subject, as well as a primer to improve their understanding and critical appraisal when reviewing other qualitative studies.

Rather than relying on hunches, medical educators must make decisions based on the best available evidence. Tavakol’s is the second paper in this series to focus on qualitative methods, highlighting the importance of qualitative methods for consumers of the medical education literature. Faculty members may be less familiar with qualitative methods, since quantitative methods dominate traditional medical education curricula. Qualitative methods facilitate researchers in the “discovery” of medical education theory or in clarifying mechanisms for why phenomena occur. 19 Therefore, educators must be adept in this methodology to conduct and to understand studies in medical education. Faculty development for medical educators must include instruction or mentorship in many of the methodologies discussed in Tavakol’s overview.

LIMITATIONS

As with our previous papers, we did not design this study to be an exhaustive, systematic search of the literature. We attempted to seek assistance with finding more papers by using expert consultation, which yielded some important recommended papers. Considering the depth and breadth of our final list, we feel that by using these adjunctive methods we have overcome the limitations of our unstructured collection of papers. Additionally, we used a mix of junior clinician educators and experts in the modified Delphi analysis. While the input from junior educators is valuable from an end-user perspective, it is possible that results may have differed if only experts had been used.

We present five key papers addressing research study design with discussions and applications for junior faculty members and faculty developers. These papers provide a basis from which junior faculty members might build upon for designing and analyzing studies.

ACKNOWLEDGMENT

This group would like to acknowledge Drs. Michelle Lin, Adaira Chou, and Nikita Joshi for their support of the Faculty Incubator project. We would also like to thank Dr. Mark Langdorf for his support of our venture.

Section Editor: Mark I. Langdorf, MD, MHPE

Full text available through open access at http://escholarship.org/uc/uciem_westjem

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

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2-2 Defining Research Objectives and Formulating Research Questions

Matt Sibbald and Sarah Blissett

Research ideas in health professions education are everywhere. What are the different approaches to curricular design? Why choose one assessment method over another? Just how does problem-based learning (PBL) work? And yet getting from an idea to a research question which will advance our understanding and add to the conversation in the health professions education is an art and a science. An art to understanding what will spark the interest of the community, and a science to know how to craft the question in a way that focuses on describing, justifying or clarifying.

Good research questions consider carefully the scope of what is being studied – too broad and hard to find meaning – too narrow and hard to apply. Good research questions often lend themselves to a methodology – or are aligned with a methodology – that is best suited to the type and manner of question being posed. Finally, good questions do not shy away from the context in which they emerged. Like distinctive characters in a movie plot, they are uncompromising in their specificity. Rather than being afraid of bias, good research questions  make explicit the assumptions on which they are based and defend against misinterpretation through systematization. This chapter will introduce you to the types of research questions. We will explore how bias is inherent in all research questions, but can be mitigated. Finally, we look at how research questions help decide on methodologies, as they are most effective at advancing the conversation when the methods match or align with the question in a way that leads to clarity, discovery or novelty!

Key Points of the Chapter

In this chapter, participants will:

• Classify research questions into different types: descriptive, justification, clarification
• Hunt for bias in research questions
• Broaden the perspective on pursuing a research question through collaboration

What a challenging first year of residency! Xyla moved to a new centre to start her internal medicine and feels that she has developed a new sense of self, and new professional identity as a result of the journey. She wonders how much the shift in cultural context contributed to her new identity formation – what a great idea for a research project. But how to get from this idea to a researchable idea? What kind of questions is she asking anyway? Is this a descriptive, justification or clarifying question? Is there relevant theory? She has experience doing survey research in the past, should she simply adapt this approach?

Deeper Dive into this Concept

Writing a concise and specific research question is well worth the effort. Coming up with a single sentence may not seem like a big endeavour, but it can be really challenging to find a question that contributes to the conversation in the literature. A great question is right where the action is at – the proximal zone of development for the field. It challenges convention but is well situated within the existing conversation. If you are in Xyla’s position, and want to explore something new, make sure that you have started with understanding where the field is currently. Search the literature systematically, read carefully and thoroughly to understand the current conversations, before trying to craft your research question. For your research question to incite conversation within the field, it should build on what others have done, and highlight an important gap in the literature which has not been previously addressed. It is important to think about gaps both theoretically and practically to be meaningful. Does repeating a study for internal residents that was already done with a wider group of residents really address a gap? It might be, especially if there is a theoretical reason to consider internal medicine residents unique, and especially if that theoretical reason is intertwined with the construct being studied. For example, the link between supervision and entrustment is well established, but when the tasks are cognitive – such as in internal medicine – what the terms direct and indirect supervision mean are less clear, but this is highly relevant for the construct of entrustment. Here the gap relates to the construct of interest and represents a meaningful rationale for exploration.

Once you have identified a gap, consider whether you can formulate a research question which will inform that gap. How will you learn something and convince others that you have learned something about that gap? Here, consider the different types of questions – are you taking a descriptive approach? A justification approach? A clarification approach? For more information on these different types of questions, read the article by Cook et al. listed in the suggested readings list (1).

Next consider the language that you are using.  Words are important. It is worth spending time to carefully consider what terms you are using. Are these the dominant terms within the literature? Are these the terms most likely to help advance our understanding of the gap? Are these terms specific and focused enough to be practically researchable? Do you want to explore workplace-based assessment or entrustable professional activity assessment? The difference in terminology sets the stage for your entire research endeavour.

Then, after you have settled on the language, recognize that there is a balance between being concise and thorough – not losing a reader in a detailed, run-on research question, but being sufficiently clear to be a research question and not just an objective or aim. Many will include the context, the population and the methodology in their research question. This is  similar to including the Population, Intervention, Control and Outcome present in many clinical research questions. Finally, consider whether not your research question should be divided into smaller questions, especially if you are referencing multiple methodologies or populations. Research questions that are too broad often end up in complex methods, and results which are hard to interpret.

It is helpful to share your question with your study team and reflect on it. The following are some questions that may guide you through thinking about your research question:

• Is this answerable?
• Does this address the gap that you have highlighted in the literature?
• Is the specificity and context provided sufficient to predict the methods?
• Will this add to the conversation in the literature?
• Will it hold meaning?
• Will it have impact? (See Chapter 3-4 for more thinking around this topic.)

You can also review some of the literature on how to generate good research questions that are listed in the reference list below (2-4)

Also, please listen to the following podcast featuring Drs. Larkin Larmarche & Teresa Chan on the topic of research questions. Some of the papers mentioned in this podcast are available below.

Key Takeaways

• In a research question, words matter. It is worth taking the time to fuss about the terms you pick.
• Focus the question on the literature gap. Remember it should be both theoretically and practically meaningful for your intended audience.
• Scope matters. Questions that are too broad are generally not researchable; and those that are too narrow often not relevant.
• Don’t rush – a hasty question leads to slow publication!

Vignette Conclusion

Xyla starts by deciding to read up on the literature. She realizes that there are many theoretical frameworks around professional identity. She connects with an author of a previous paper, and discusses her ideas. She opts to explore the role of cultural context in professional identity setting by studying those who train in different cultures, using transformative learning theory as a framework to help her clarification question.

• Cook DA, Bordage G, Schmidt HG. Description, justification and clarification: a framework for classifying the purposes of research in medical education. Medical education. 2008 Feb;42(2):128-33. Get it Mac | See on Medical Education

Eva, K. W. (2008). On the limits of systematicity. Medical Education , 42 (9), 852–853. Get it Mac | See on Me dical Education

Dine CJ, Shea JA, Kogan JR. Generating good research questions in health professions education. Academic Medicine. 2016 Dec1;91(12):e8. Get it Mac | See on Academic Medicine

O’Brien BC, Ruddick VJ, Young JQ. Generating research questions appropriate for qualitative studies in health professions education. Academic Medicine. 2016 Dec 1;91(12):e16. Get it Mac | See on Academic Medicine

Monte AA, Libby AM. Introduction to the Specific Aims Page of a Grant Proposal. Academic Emergency Medicine. 2018 Sep;25(9):1042-7. Get it Mac | See on Academic Emergency Medicine

About the authors

name: Matt Sibbald

institution: McMaster University

Matthew Sibbald is an Associate Professor of Medicine, McMaster University and Interventional Cardiologist at Hamilton Health Sciences and Niagara Health System. He is also the Associate Dean of the Michael G. DeGroote School of Medicine Undergraduate Medical Education Program.

name: Sarah Blissett

institution: Schulich School of Medicine & Dentistry, Western University

Sarah Blissett is an Assistant Professor, Department of Medicine (Division of Cardiology) at Western University. She is also a researcher within the Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University.

2-2 Defining Research Objectives and Formulating Research Questions Copyright © 2022 by Matt Sibbald and Sarah Blissett is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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• Research article
• Open access
• Published: 18 November 2020

Identifying research priorities for health professions education research in sub-Saharan Africa using a modified Delphi method

• Susan C. Van Schalkwyk   ORCID: orcid.org/0000-0003-1596-6791 1 ,
• Elsie Kiguli-Malwadde   ORCID: orcid.org/0000-0001-6260-8140 2 ,
• Jehan Z. Budak   ORCID: orcid.org/0000-0002-1545-254X 3 ,
• Michael J. A. Reid   ORCID: orcid.org/0000-0001-6777-9619 4 &
• Marietjie R. de Villiers   ORCID: orcid.org/0000-0001-5431-3801 5  

BMC Medical Education volume  20 , Article number:  443 ( 2020 ) Cite this article

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Recent increases in health professions education (HPE) research in sub-Saharan Africa (SSA), though substantial, have predominantly originated from single institutions and remained uncoordinated. A shared research agenda can guide the implementation of HPE practices to ultimately influence the recruitment and retention of the health workforce. Thus, the authors aimed to generate and prioritise a list of research topics for HPE research (HPER) in SSA.

A modified Delphi process was designed to prioritise a shared agenda. Members of the African Forum for Research and Education in Health (AFREhealth) technical working group (TWG) were asked to first list potential research topics. Then, members of the same TWG and attendees at the annual AFREhealth academic symposium held in Lagos, Nigeria in August 2019 rated the importance of including each topic on a 3-point Likert scale, through two rounds of consensus seeking. Consensus for inclusion was predefined as ≥70% of respondents rating the topic as “must be included.”

Health professions educators representing a variety of professions and 13 countries responded to the survey rounds. Twenty-three TWG members suggested 26 initial HPER topics; subsequently 90 respondents completed round one, and 51 completed round 2 of the modified Delphi. The final list of 12 research topics which met predetermined consensus criteria were grouped into three categories: (1) creating an enabling environment with sufficient resources and relevant training; (2) enhancing student learning; and (3) identifying and evaluating strategies to improve pedagogical practice.

Conclusions

Establishing research priorities for HPE is important to ensure efficient and appropriate allocation of resources. This study serves as a reminder of how the prevailing context within which HPE, and by implication research in the field, is undertaken will inevitably influence choices about research foci. It further points to a potential advocacy role for research that generates regionally relevant evidence.

Peer Review reports

Introduction

There has been a rapid increase in the number of health professions training institutions in Sub-Saharan Africa (SSA) in order to train more health professionals for the region. Despite this, SSA remains challenged in meeting the health needs of its populations, exacerbated by existing and emerging epidemiologic challenges [ 1 ]. There has, however, been global interest in strengthening human resources for health (HRH) in the region. Multiple initiatives to improve both the number of graduate outputs and the quality and relevance of their training have been launched [ 2 ]. One example is the Medical Education Partnership Initiative (MEPI) and Nursing Education Partnership Initiative (NEPI), a $130 million competitively awarded grant by the President’s Emergency Plan for AIDS Relief (PEPFAR) to medical and nursing schools in 12 Sub-Saharan African countries from September, 2010 to August, 2015. The goals of MEPI and NEPI were to increase the capacity of the awardees to produce more and better doctors and nurses, strengthen locally relevant research, promote retention of graduates within their countries, and ensure sustainability [ 3 ]. The establishment of the African Forum for Research and Education in Health (AFREhealth), in 2017, has now sustainably consolidated these initiatives. AFREhealth aims to collaborate with stakeholders to improve health outcomes, work towards an AIDS-free generation, establish a research agenda for health priorities in Africa, and mobilise vital resources [ 4 ].

Much of the published material regarding research in Africa has cited the need to establish a coordinated research agenda to inform priorities [ 5 ]. This is equally true for health professions education research (HPER), which is critical to the success of health professions education (HPE) centers and departments [ 6 , 7 ]. Relatively little has been published on HPER in SSA, despite the increase in the number of training institutions. Although there has been an increase in research outputs in recent years, assisted by the establishment of the African Journal for Health Professions Education (AJHPE), this increase has not matched the rapid growth in the number of institutions. During MEPI, over 376 peer-reviewed publications, including a special supplement in Academic Medicine (2014), were published, however most of these articles tended to be descriptive in nature [ 3 ]. Van Schalkwyk [ 8 ] highlighted the need for strengthening research capacity to generate a wider evidence base in HPE, moving beyond description to contributing to theory building in the field [ 9 ]. As a first step towards responding to this call, we sought to establish what role players in the region would regard as priorities for HPER initiatives. An assumption was that having a shared agenda can strengthen collaborative work in the field and can contribute to appropriate allocation of resources. In addition, and given the importance of context in improving health and the delivery of HPE, local research can also identify potential challenges, set priorities, devise original solutions, and make the best use of scarce resources [ 10 , 11 ]. Therefore, through leveraging the input of regional experts and researchers, we sought to identify a set of HPER priorities to facilitate the implementation of regionally relevant initiatives and concomitantly guide resource allocation.

We used the Delphi method (with modifications) to establish priorities for HPER in SSA. The Delphi method is a consensus-building approach which seeks expert opinion on a pre-determined topic in a structured and iterative manner [ 12 , 13 ]. The Delphi method can be useful in areas where evidence-based literature is limited, as it can unearth collective knowledge from those in the field [ 13 , 14 , 15 ]. A series of rounds are used to clarify, refine, and ultimately achieve consensus on the area under discussion. A key feature of the method is that participants or respondents provide input independently and anonymously during each round, resulting in a process that is not unduly influenced by any one individual or subset of respondents [ 12 , 16 ].

The Delphi method usually involves six steps, namely the identification of a research question/problem; conducting a literature search; developing a set of statements around the topic of choice; performing anonymous iterative rounds; providing feedback to the respondents between rounds; and summarising the findings [ 14 ]. We report our process accordingly.

Step 1 – identifying the research problem/question

Our process involved one round of item generation and two rounds of consensus seeking carried out between April 2019 and October 2019. A group of researchers involved in the AFREhealth network led the process. The authors formed a study group that refined the research question over several project meetings and discussions. Three of the authors (SvS, EKM, MdV) are practicing health professions education experts based in Africa. The other two team members (MR and JB) are infectious diseases experts with a special interest in health professions education, based in the USA. The consensus development process is summarised in Fig.  1 .

Flow diagram documenting the Delphi process

Step 2 – literature search

To inform the development of the protocol for our study, we explored the relevant literature, including work describing the Delphi methodology, and studies that have sought to establish research priorities for their specific contexts [ 11 , 14 , 15 , 16 ].

Step 3 – topic generation

A core group of 62 AFREhealth educators and investigators, members of the AFREhealth HPER Technical Working Group (TWG) comprising colleagues from the region with an expressed interest in HPER, were invited to generate topics for consideration. In April 2019, we sent via email a survey designed in Qualtrics© (Provo, UT) [ 17 ] asking, ‘ what are possible research questions, topics, or areas of focus that should be a priority in a health professions education research agenda for sub-Saharan Africa?’ We also requested descriptions and rationales for each research question proposed. Two email reminders were sent. Twenty-three people responded proposing an initial list of 34 research priorities. This list was synthesised by two of the researchers (SvS and MdV) to remove unnecessary duplication, resulting in a list of 26 items. At this point, the research team made a decision to rephrase all of the items as priority topics to ensure consistency across the items.

Step 4 –conducting two iterative anonymous rounds

The list of 26 research priorities generated during stage 3 were distributed in the form of a survey for prioritisation to members of the working group, as well as to a broader group of researchers and stakeholders who attended the AFREhealth Symposium in Lagos, Nigeria in August 2019. This step (Round One) represents a modification in our Delphi in that we introduced additional respondents after the topic generation stage. This meeting involved researchers and educators in the health professions, as well as service providers in the field, mainly from across Anglophone sub-Saharan Africa. Those attending the symposium were asked to complete the prioritisation survey either online (designed in Qualtrics©) or using a paper-based version. Those members of the TWG not present in Lagos were invited via e-mail to complete the same online survey. Two email reminders were sent. Ninety individuals participated in this first round to begin prioritising the topics generated in step 3. Basic demographic information was requested from respondents. Responses were anonymous and treated confidentially. All respondents were asked to rate how important each of the 26 research topics would be to include in a HPER research agenda for SSA using a 3-point Likert scale that ranged from ‘do not include’ to ‘could be included’ to ‘must be included.’ Respondents could also pick ‘no vote,’ if they felt they did not have enough knowledge on a topic to make an informed decision of its importance. Those votes were coded as null. Topics were itemised in random order. Consensus criteria, that only topics rated as ‘must be included’ by ≥70% of respondents would be included, were set a priori. In addition, an open-ended question prompted submission of additional research topics or agenda items in this round. New topics were reviewed and consolidated by the research team into existing themes or added to the list.

For Round Two, in September 2019, all respondents who provided their e-mail addresses in Round One were sent a link via email to the final online survey in Qualtrics©. The final survey included 10 topics which had met consensus criteria in Round One, and 4 additional suggested topics, generating a total of 14 topics. In addition, they were given feedback on the first round. Respondents were again invited to rate each research priority on a 3-point Likert scale in terms of importance to include with consensus set at ≥70% of respondents who rated the topics as ‘must be included. Topics were itemised in random order. After Round Two, sufficient consensus was reached on a smaller number of topics [ 10 ] for the process to be terminated.

Step 5 – providing feedback to respondents

Round One respondents who provided their email addresses received feedback. This feedback was included in the email request to participate in Round Two and outlined the areas that achieved consensus in the first round, in addition to including the percentage of respondents rating each top as ‘must be included,’ as well as the additional items that were generated in Round One.

Step 6 – summarise the findings

The research team, first individually and then collectively, thematically grouped the items that achieved consensus in three areas, thus applying a next order round of analysis. These are reported in the Results section below.

In sum, Table  1 reports the quality criteria for Delphi studies as proposed by Humphrey-Murto et al. [ 14 ], with three additional criteria from Diamond et al., [ 12 ] as applied in our study.

The protocol for this project was reviewed and approved by the University of California, San Francisco’s Institutional Review Board (IRB) in San Francisco, California. Consent was considered implied by participation in the study as approved by the IRB (#19–28,050).

Twenty-three individuals from the HPER TWG participated in topic generation. Ninety responses were received in Round One. For Round Two, the survey was sent via email to the 82 individuals from Round One who provided their email addresses. We received 52 responses (52/90, 58% response rate) in Round Two. Round One’s respondents were from thirteen countries in SSA, with the majority from Nigeria, South Africa, and Uganda. In Round Two, 23/52 (44%) of the respondents were from Nigeria, 10/52 (19%) were from South Africa, and 7/52 (13%) were from Uganda. (Table  2 ) To account for the fact that the majority of respondents in both rounds were Nigerian, an additional sensitivity analysis was performed to determine if research priorities were different among respondents from Nigeria compared to elsewhere in SSA. The final list of priority research issues was the same among Nigerian respondents as compared to respondents from other countries.

Respondents reported a median of 14 years’ experience working in HPE, with a range from one to 42 years. Although the majority of the respondents were medically and nursing qualified, the individuals represented a wider range of health professions as well as a few others (Table  3 ).

In Round One, 71/90 (79%) of respondents regarded themselves as experienced or somewhat experienced in HPE, with 25/90 (28%) having published more than five articles in the field. In Round Two, 41/52 (79%) of respondents regarded themselves as experienced or somewhat experienced in HPE, with 25/52 (48%) having published more than five articles in the field (Table  4 ).

Thirty-four topics and topic descriptions were generated by the TWG members, which were reduced to 26 topics by the research team (see previously). In Round One, ten topics met consensus criteria. Twenty-three new topics were suggested, and four of these were incorporated into the next round; those that were not included were deemed sufficiently similar to ones already included in the existing list. In the second topic prioritisation round, ten topics met consensus criteria. (Table  5 ).

Synthesis of topics

The process of synthesis that occurred as a result of establishing consensus within the Delphi saw interesting shifts in perspectives from the initial set of 26 topics, to the final list of ten priorities. The early list, for example, included more generic issues such as ‘assessment practices’, ‘student retention’, ‘graduate competencies’, ‘post-graduate training’ and ‘self-regulation skills’ – topics that would likely resonate with health professions educators all over the world. The final list, however, represents what could be regarded as higher-order topics which, with one or two exceptions, speak to national and regional issues. They reflect the context within which health professionals in SSA are being trained and the challenges that characterise this context. During the topic generating phase of the study, the rationales that respondents provided in support of their selections emphasised the need for understanding ‘our own’ challenges in order to ‘decolonise our way of teaching and assessment.’ It was also argued that existing frameworks had been generated in ‘developed countries’ acknowledging the need for locally, relevant and responsive research. Ultimately, second-tier analysis by the research team resulted in three over-arching, but inter-connected themes: (1) creating an enabling environment with sufficient resources and relevant training; (2) enhancing student learning; and (3) identifying and evaluating strategies to improve pedagogical practice. These could be regarded as a triumvirate of educational endeavors – the teaching (pedagogy), the learning, and then the environment (context) within which it should occur. The themes are discussed below, supported in some instances with direct quotations from some of the rationales provided during the topic generation phase, and with several priorities having relevance across more than one.

An enabling environment

A key message from this Delphi is that a first step to defining and addressing the HPER priorities in SSA is to create the environment that will foster researchers, with sufficient training and resources to address the most pressing questions. This thesis is underscored by the fact that the top 10 priority topics include three that are focused on understanding the factors that currently make HPER challenging in SSA:

Priority # 1 – addressing the human resources for health challenges in rural and remote settings

This first ranked topic focuses on addressing human resources for health challenges in rural and remote settings. This may be an unexpected result for colleagues around the world, but needs to be seen in the context of HPE in SSA as described in the introduction and points to the lived experience of many educators in the field who practice their teaching in resource-constrained contexts. The importance of the environment in influencing teaching and learning has been well-documented [ 18 ]. It can be inferred that for our respondents, addressing the need for practitioners who can respond to the increasing burden of disease, particularly in rural areas, is a non-negotiable imperative whether in terms of the taught curriculum (as many medical schools and health sciences faculties embrace distributed clinical learning [ 19 ]), or in terms of ensuring an environment in which teaching can meaningfully occur. Linked to this was the underlying premise of providing quality health care for all.

Priority # 5 – faculty development for clinical teaching

Supporting those responsible for teaching, specifically clinical teaching, ranked fifth. Recommendations spoke specifically to looking to discern the status of faculty development in the region, describing it as a particular area requiring further investigation. Given the current drive towards the professionalisation of the educational role, and the growing need for faculty who can teach the growing numbers of HPE students, this focus was expected as there has been limited work in this area. An exception is research into the role of emerging clinical teachers which has been conducted in the region in recent years, [ 20 , 21 ] with studies emphasising the need for further work and ongoing support for those responsible for HPE students in clinical training, particularly those who are placed in rural or distributed sites.

Priority # 7 – resources, political commitment and funding for HPE in SSA

This priority picks up on the higher order focus established in Priority # 1, foregrounding the economic and political instability that characterises much of the SSA region, the impact that this has on health care and the subsequent effect on HPE. During topic generation, respondents felt that education, research and service delivery activities should all be directed, “towards addressing priority health concerns of the community, region and/or nation that they have a mandate to serve.”

Enhanced student learning

Among the priorities identified, four foregrounded approaches could potentially enhance student learning. An important proviso for these priorities was that the ultimate aim of enhanced student learning was the delivery of graduate professionals who could respond to local and regional health care imperatives and provide quality health care.

Priority # 2 – Interprofessional collaboration in clinical practice in SSA

Priority #2 highlights an essential approach to healthcare training and practice, namely interprofessional education and collaborative practice (IPECP), that should inform the student learning experience. IPECP is currently foregrounded in HPE research, visible in a plethora of publications [ 22 ]. In the rationales provided for interprofessional collaboration during the topic generating phase of this study, respondents spoke directly to the under resourced context within which many in SSA work, and the extent to which collaboration across all healthcare practitioners will be crucial to address the workforce challenges identified under Priority # 1 including that it would enhance patient care. It should be noted that the establishment of a SSA organisation dedicated to fostering IPECP (The African Interprofessional Education Network (AfrIPEN): https://afripen.org/ ) in 2017 may account for why this particular topic was ranked so high. AfrIPEN has an affiliate relationship with AFREhealth, and it is plausible that some of our respondents are members of both organisations. In their rationales, however, respondents also made reference to the ‘African patriarchal social system’ that needs to be problematised as it is ‘contrary to the philosophical underpinnings of shared leadership, shared decision-making etc.’ that are so needed in the region.

Priority #9 – potential of rural communities as platforms for training health care professionals

Linked strongly to the need to address human resources for health challenges was a focus on enhancing student learning through distributed clinical training, specifically in rural areas. This priority emphasised the growing awareness of how large academic hospitals are not necessarily the best environment for training students to meet community needs.

Priority # 3 – teaching a holistic and person-centered approach and priority # 10 – relevance of communication skills training in culturally diverse contexts

Teaching person-centered and holistic care underscores the value of a comprehensive approach to the person in the African context which also takes into account the person’s values and needs, as well as their family and community [ 23 ]. A further indicator of the complexity of context can be seen in priority # 10 which recognises the need for students to be trained to communicate effectively with patients across multiple contexts and different cultures. This links with previously mentioned perspectives of respondents who felt it was important to support research initiatives that would provide responses for local and regional contexts.

Identifying and evaluating strategies to improve pedagogical practice

A final group of priorities, which includes some already mentioned above, relates to identifying and evaluating strategies to improve pedagogical effectiveness or assess new modes of curricula and pedagogical innovation.

Priority # 4 – the role of information communications technology in HPE

It could be argued that a focus on the role of information communications technology (ICT) in HPE would have been expected given the ubiquitous nature of blended and e-learning approaches in modern-day HPE [ 24 ]. Interestingly, however, this topic did not feature in the topic generating process, but was introduced in Round One and validated in Round Two. There can be no doubt as to the importance of this research focus, particularly investigation that can explore options for drawing out the affordances of ICT amid resource constraints. For example, while many rural areas in SSA may be isolated in terms of connectivity, the region is known for its high rate of cellular telephone coverage providing a lifeline for health care workers in these remote regions. Investigating the potential for HPE using mobile technology could, therefore, have particular relevance [ 25 ].

Priority # 6 – quality assurance processes and procedures in health professions education

This priority demonstrates the intent of respondents to ensure that educational practices and teaching innovations are carefully monitored and evaluated. Responses provided during the topic generation phase suggested that this focus has to do with being accountable given expectations by stakeholders for the provision of quality education.

Priority # 8 – determining how to develop and implement curricula that are responsive to the health needs of SSA

In 2010, the Lancet commissioned article exploring Health professional in the twenty-first Century , [ 26 ] argued that curricula had not kept pace with community healthcare needs, catalysing introspection among health professions educators and curriculum developers across the world. Given SSA specific resource constraints, and its unique burden of disease, exploring what a responsive curriculum for the region might look like would appear to be of significant value for the HPE community. It could be argued that this priority possibly provides a research focus that could encapsulate most if not all of the others that made the final list.

Establishing research priorities for HPE at a national or higher level is important to ensure maximum impact of efforts. Related work has previously been conducted in countries such as Canada [ 27 ], New Zealand [ 28 ], and Scotland [ 11 ], catalysed by a desire to foster collaborative and coordinated approaches to research [ 28 ] and to ensure targeted allocation of increasingly scarce resources [ 11 ]. Comparison between our results and those obtained in these studies highlights both similarities and differences. For example, issues of student access and selection, the role of assessment and feedback, resilience and well-being, phases of transition across curricula, amongst others, are strongly foregrounded in these earlier studies, but do not make it to our final list even though some featured in earlier iterations. The importance of faculty development is, on the other hand, one area of congruence, as is the importance of interprofessionalism. The key difference, however, resides in the extent to which the described need for political and economic stability, and the imperative to ensure suitably trained health professionals who can respond to national and regional challenges, is relatively silent in this earlier work, although there is reference to change management and the importance of leadership to facilitate such change.

What does this study mean for HPER in SSA going forward? What our Delphi highlights is that it is precisely the factors that currently undermine HPER activities in the region that have emerged as research priorities. Thus we are faced with a conundrum on a number of levels. Firstly, the identified set of priorities does not reflect specific research gaps, but rather points to respondents’ perception of challenges within HPE in general, emphasising the complexity of the context in which the training of future health professionals much occur. We acknowledge that this is probably linked to the fact that many of the respondents were clinicians and researchers with an interest in HPER, but not necessarily experts in the field itself. It could be argued that research activities per se are unlikely to impact the national political and economic structures that currently determine the different health systems represented in the study, but perhaps that advocacy work, strengthened by locally generated evidence, is what will be needed.

Secondly, that while we do believe that the consultative process followed in generating this list of priorities can assist in establishing a more coordinated strategy for research in the future, it is also clear that capacity for conducting such research will need to be grown. Close to 40% of our respondents, for example, indicated that they had never published in the field, although they may have done so in other disciplines. As mentioned in the introduction to this article, HPER outputs in the region are low. Indeed, one of the stated aims of the AFREhealth HPER TWG is to grow the community of active scholars in SSA and intentional steps towards such growth will be a necessary condition for implementing a research agenda. Nevertheless, we believe that this work provides a platform from which more focused, contextually relevant research questions can be developed and refined [ 29 ]. It could further be argued that strengthening research capacity in the region could also have value for health research generally – an area of critical need.

A final conundrum relates to the issue of funding and of convincing funders to invest in the region. Without funding it can be difficult to initiate the sort of multi-site, in-depth work that will lead to publications in leading journals. Without a proven track record and evidence of expertise, often measured in terms of publication outputs, funding applications are unlikely to be successful. Given that institutional funding for educational research in medicine is scarce and external grants are few and highly competitive, coordination of research efforts could potentially be of great value to the HPER community in SSA. In the New Zealand study mentioned earlier, Wilkinson and colleagues [ 28 ] expressed the hope that working collaboratively, sharing examples of best practice, and purposefully coordinating their research activities, would strengthen local research capacity while at the same time contributing to HPE scholarship globally. We trust that this work may similarly contribute to global debates, reminding us of the importance of context and relevance when embarking on research activities, on the one hand, and the responsibility of HPE researchers to generate evidence that can challenge or inform policies that may be constraining the training of health professionals, on the other.

Strengths and limitations

We premised our choice of the Delphi approach on its relevance for HPE educators and ability to establish consensus on priorities [ 14 ]. The traditional idea of the Delphi technique, is to define, select, and engage a relatively homogenous group of experts throughout the process [ 13 ]. We modified this by engaging a larger and more diverse group for the two consensus building rounds. Involving respondents with divergent opinions increased the number of perspectives to be considered, and relative ‘newcomers’ could have contributed more novel opinions than those established in the discipline [ 30 ]. This may be the reason why our number one priority is of a wider contextual nature. On the other hand, this could also have limited the research priorities that emerged from the structured sub-fields of HPE.

Sustaining participation across rounds in a Delphi study is a known challenge [ 31 ]. Nonetheless, the outcomes of the process are strongly shaped by those most engaged, which is underlined by the fact that the number of individuals with more than five publications remained the same during both the consensus seeking round, meaning that those with more ‘expertise’ remained engaged through the two rounds. Another possible limitation is of course non-respondent bias. Consequently, there may be important research priorities for some settings that are not reflected here. The results of the study was based on the Delphi method only and could have been strengthened by some supporting qualitative data.

To the best of our knowledge, this is the first study in SSA to explore HPER priorities for the region. We did so through leveraging the input of regional experts and researchers from diverse backgrounds, but with a shared interest in healthcare and the education thereof. The research was premised on the assumption that having a shared agenda could build evidence that is regionally relevant while facilitating the efficient and appropriate allocation of resources. Nested within this assumption is an acknowledgement that those of us who live and work in the region are best positioned to chart a way forward, and to resist hegemonic practices that are often externally imposed. Our challenge going forward will be to see the effective translation of this priority setting activity into education research policy and practice. Notwithstanding the challenges identified in terms of policy and funding, individual institutions in the region can reflect on these priorities as they seek to establish research strategies for themselves. Such strategies can intentionally look to engage regional partners as a first step to growing a larger network of HPE researchers across SSA.

Availability of data and materials

The datasets and materials are available from the corresponding author on request.

Abbreviations

African Forum for Research and Education in Health

The African Interprofessional Education Network

• Health professions education

Health professions education research

Information communications technology

Interprofessional education and collaborative practice

Institutional Review Board

Medical Education Partnership Initiative

Nursing Education Partnership Initiative

President’s Emergency Plan for AIDS Relief

Sub-Saharan Africa

Technical Working Group

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Acknowledgements

Members of the AFREhealth TWG for their input and participation in the study; organisers of the AFREhealth Symposium in Lagos for assisting with the survey distribution; participants of the various rounds of the study.

No sources of external funding were used in the conduct and write-up of the study.

Author information

Authors and affiliations.

Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa

Susan C. Van Schalkwyk

Health Workforce, African Centre for Global Health and Social Transformation (ACHEST), Kampala, Uganda

Elsie Kiguli-Malwadde

Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA

Jehan Z. Budak

Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, USA

Michael J. A. Reid

Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa

Marietjie R. de Villiers

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Contributions

SvS: Contributed to the conceptualisation of the study, the refinement of the Delphi surveys, the analysis of the responses, and led the process of manuscript development preparing the final version for submission. MdV: Contributed to the conceptualisation of the study, refinement of the surveys, analysis of the responses, manuscript development with a focus on the methods and results sections, and co-edited the final version of the manuscript for submission. EKM: Contributed to the conceptualisation of the study, manuscript development with a focus on the introduction and discussion sections, and co-edited the final version of the manuscript for submission. JB: Contributed to the conceptualisation of the study, creation of the surveys, manuscript development with a focus on the methods and results sections, and co-edited the final version of the manuscript for submission. MR: Contributed to the conceptualisation of the study, manuscript development with a focus on the methods and results sections, and co-edited the final version of the manuscript for submission. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Marietjie R. de Villiers .

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Ethics approval and consent to participate.

The protocol for this project was reviewed and approved by the University of California, San Francisco’s Institutional Review Board (IRB) in San Francisco, California. Consent was considered implied by participation in the study as approved by the IRB (#19–28050).

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Not applicable.

Competing interests

No competing interests.

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Van Schalkwyk, S.C., Kiguli-Malwadde, E., Budak, J.Z. et al. Identifying research priorities for health professions education research in sub-Saharan Africa using a modified Delphi method. BMC Med Educ 20 , 443 (2020). https://doi.org/10.1186/s12909-020-02367-z

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Received : 15 May 2020

Accepted : 09 November 2020

Published : 18 November 2020

DOI : https://doi.org/10.1186/s12909-020-02367-z

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Writing for Healthcare Professionals: Creating a Research Question

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The links below are great places to start in developing a research question.  Browsing current events and hot topics can spark your interest and inspire a topic.

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Developing your Research Question

Try asking yourself these questions to help develop a research question:

Topic:  Obesity

Who?  teenagers

What?  consumption of high fat foods

Where?  school cafeterias

Question :  How does the consumption of high fat foods in school cafeterias contribute to teenager obesity?

Topic: Smoke Exposure

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Below is worksheet which will help illustrate how a research question develops from a broad topic to a focused question.  This could be a helpful resource for you during the process of creating your research question.

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