Goh, Poh-Sun

SANDARS, JOHN

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Rethinking scholarship in medical education during the era of the COVID-19 pandemic

The COVID-19 pandemic has significantly disrupted society and communities across the world requiring new and innovative approaches for healthcare, work, education and leisure. Similar changes have been precipitated in medical education, producing a rapid and major impact on students, educators and institutions. However, institutions still require educators to engage with scholarship in medical education, including providing evidence for promotion and tenure. We propose that resolving this tension between the demands of delivering a high quality curriculum and maintaining scholarship in medical education during the era of the COVID-19 pandemic requires urgent consideration of a transformational change in the scholarship in medical education. Key aspects of this change are a focus on rapid cycles of research to inform teaching, with local and wider dissemination using newer rapid approaches to publication and social media, and acceptability of these changes by institutions

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Goh P, Sandars JMedEdPublishhttps://doi.org/10.15694/mep.2020.000097.1Page | 1Personal view or opinion piece Open AccessRethinking scholarship in medical education duringthe era of the COVID-19 pandemicPoh-Sun Goh[1], John Sandars[2]Corresponding author: Dr Poh-Sun Goh dnrgohps@nus.edu.sgInstitution: 1. National University of Singapore, 2. Edge Hill University Medical School, Ormskirk, UKCategories: Scholarship/Publishing, Teaching and Learning, TechnologyReceived: 07/05/2020Published: 13/05/2020AbstractThe COVID-19 pandemic has significantly disrupted society and communities across the world requiring new andinnovative approaches for healthcare, work, education and leisure. Similar changes have been precipitated inmedical education, producing a rapid and major impact on students, educators and institutions. However, institutionsstill require educators to engage with scholarship in medical education, including providing evidence for promotionand tenure. We propose that resolving this tension between the demands of delivering a high quality curriculum andmaintaining scholarship in medical education during the era of the COVID-19 pandemic requires urgentconsideration of a transformational change in the scholarship in medical education. Key aspects of this change are afocus on rapid cycles of research to inform teaching, with local and wider dissemination using newer rapidapproaches to publication and social media, and acceptability of these changes by institutions. Keywords: Scholarship in medical education; action research; educational design research; transformational change;COVID-19IntroductionThe COVID-19 pandemic has triggered an immense and extraordinary change to society and communities across theworld requiring new and innovative approaches for healthcare, work, education and leisure. A major aspect of thischange has been the rapid, and potentially permanent, shift in the use of technology to ensure that healthcare, work,education and leisure activities can be maintained. Medical education has been no exception to these changes, with a similar rapid shift in the use of technology fordelivery of all aspects of the curriculum, from teaching to virtual clinical training to assessments, and across thecontinuum of medical education.  Educators, learners and institutions have had to adjust to these changes andmanage the various increased demands related to workload, new practices and external regulatory authorities.Goh P, Sandars JMedEdPublishhttps://doi.org/10.15694/mep.2020.000097.1Page | 2However, at the same time, educators are expected to continue their active engagement with scholarship in medicaleducation, including providing evidence for promotion and tenure.In this Personal View, we propose that a transformational change in how we consider scholarship in medicaleducation during the era of the COVID-19 pandemic is urgently required. We consider that this change can help toreduce the tension between the demands of rapidly responding to the demands of maintaining the delivery of a highquality curriculum and the need to continue with scholarship in medical education.Scholarship in medical educationOur understanding of scholarship in medical education has been informed by several authors, with each providingdifferent key components. Boyer (1990) described four categories of scholarship: discovery and creation,integration, application and teaching. Several criteria of how scholarship can be assessed were proposed by Glassick(2000), including clear goals, adequate preparation, appropriate methods, significant results, clear presentation, andreflective critique. Additional features were presented by Hutchings and Shulman (1999), including widerdissemination in a form suitable for review and evaluation, which is accessible for exchange with other members ofeducation community. Institutions have widely adopted these different components of scholarship and there is anexpectation that medical educators engage in the entire process and provide appropriate evidence of this process.Scholarship in medical education is often an iterative  cycle, with the experience of teaching identifying problemswhich leads to a research phase of discovery for the creation of new knowledge and understanding about theproblem. These findings can lead to the innovation of new approaches for teaching through the process of integrationwith a variety of sources of knowledge, including colleagues and a review of the literature. Following application ofthe new approach to teaching, the cycle can be repeated (see Figure 1).  Throughout the iterative cycle, there areopportunities to evidence scholarship through scholarly outputs, such as producing and disseminating an article thatdescribes the intervention and findings. Figure 1: The iterative scholarship cycleGoh P, Sandars JMedEdPublishhttps://doi.org/10.15694/mep.2020.000097.1Page | 3The challenge of scholarship in the era of the COVID-19 pandemicThe rapidity of the evolving disruption and response evoked by the COVID-19 pandemic on medical educationrequires educators, and also institutions, to constantly monitor and make changes to ensure that the delivery of thecurriculum is appropriate and achieving its vision, aims and intended outcomes. The process of monitoring progressidentifies problems that are key to initiating the scholarship cycle. However, over time, these problems are likely tomove from being simple to complex.  Alternative methods for research, such as action research and educationaldesign research, which use rapid cycles of investigation and implementation, will be required to answer theseproblems, but these methods are less familiar to institutions and also to the editors and peer reviewers of manyjournals. In addition, the dissemination required for evidence of scholarship through publications in high impactjournals can be a lengthy process, even in those journals with early pre-publication, and these journals also usuallydo not have open access. Research for scholarshipThe COVID-19 pandemic has required increased use of online methods to deliver the curriculum and Satya Nadella,Microsoft’s Chief Executive Officer, has observed "two years worth of digital transformation in two months"(Spataro, 2020). A curriculum can be considered as a syllabus of content and the variety of methods to achievepredefined learning outcomes. However, a curriculum is also an expression of the core values of the institution, suchas equity for the learners and social accountability. Several categories of problems are recognised but an important distinction can be made  between simple andcomplex (Snowdon, 1999). Simple problems identified through online delivery of the curriculum will have simpleresearch questions, such as what is the impact of student learning outcomes by the use of videos created fromPowerPoint presentations. A single iterative research cycle can help to answer the question but also inform furtherdevelopment of the use of videos. However, complex problems identified through online delivery will be moreGoh P, Sandars JMedEdPublishhttps://doi.org/10.15694/mep.2020.000097.1Page | 4difficult to research, such as how can equity for learners be maintained when there are multiple –inter-related factorscontributing to equity (such as gender, socio-economic circumstances and cultural background). Effective onlinedelivery of the curriculum also has multiple inter-related factors that have to be aligned in the design andimplementation phase of the intervention, including the learner, the educator, the intended educational outcomes,the content, the available technology, the instructional design and the organisational context (Sandars et.al., 2020).For complex problems, iterative research methods over several cycles are essential to increasingly modify theeducational intervention to ensure that it is effective (Hanington and Martin, 2019). An essential aspect of thisiterative approach is the use of design thinking to produce and innovate creative potential solutions (Badwan et al.,2018).  Because of the rapidly evolving impact of the COVID-19 pandemic on medical education, these iterativecycles also have to rapidly conducted.Dissemination for scholarshipDissemination of scholarly outputs, which are essential for the demonstration of scholarship in medical education,has relied mainly on journals and conferences but the frequency and time required for publication has becomeincreasingly inappropriate to inform the wider community of medical educators who need timely new knowledge toinform their responsibilities for delivery of the curriculum. In addition, many journals and conference presentationsare not open access and this limits the reach of global dissemination, especially for low and middle incomecountries.  Responding to the challenge of scholarship in the era of the COVID-19 pandemicOur recommendations for responding to the challenge can be considered within three major themes: research forscholarship, dissemination for scholarship and the institution. Research for scholarshipThe highly iterative nature of action research and educational design research will likely add to, and accelerate, thescholarship of discovery and creation (Coghlan and Brannick, 2019; McKenney and Reeves, 2018). Many of thecriticisms about action research and educational design research, especially about their appropriateness forscholarship, are about the rigor of the data collection and analysis but this can be easily rectified by careful attentionto detail, such as following standard guidance on performing qualitative and quantitative research. Action research and educational design research have the intention to simultaneously implement an educationalintervention (action) and to understand the various factors that contribute to the educational impact of theintervention (research). Through iterative cycles, the intervention is evaluated and modified to achieve its intendedimpact and each cycle of planning, implementation and evaluation informs the next cycle (see Figure 2). Figure 2: The iterative research cycleGoh P, Sandars JMedEdPublishhttps://doi.org/10.15694/mep.2020.000097.1Page | 5 The research component, which is the creation of new knowledge and understanding though the evaluations, candirectly inform the development of teaching but also the findings can be more widely disseminated to inform thework of other medical educators. Dissemination for scholarshipProviding evidence of scholarship through scholarly outputs in medical education is a high priority for mostinstitutions and subsequently for most educators. The use of technology to support educational scholarship has beencalled digital scholarship (Goh and Sandars, 2019). There are several online approaches for rapid publishing anddissemination, especially open access publication and social media. Opportunities for rapid open access publishinghas become increasingly available, with some offering pre-publication peer review and others offering post-publication peer-review. Similarly, there has been increasing opportunities using a variety of social media, such asFacebook and Twitter.  There are well established metrics to inform digital scholarship and educators can createportfolios to curate these metrics as evidence (Cabrera et al., 2017).  An important aspect of the dissemination of scholarly works is to ensure that it supports decision-making about theirteaching and delivery of the curriculum, such as ensuring that scholarly outputs will focus on examining what worksand what does not work from their experience of the interventions. More explicit reporting of this information,including helping and hindering factors, can be facilitated by the use of templates, such as SQUIRE-EDU (Standardsfor QUality Improvement Reporting Excellence in Education) (Ogrinc et al., 2019) or TIDieR (Template forIntervention Description and Replication) (Cotterill et. al., 2019).The institutionThere are important challenges for institutions in the implementation of our proposed transformational change forscholarship in medical education. The main challenges are likely to be greater acceptance of the action research ordesign research paradigm and also recognition of the evidence and metrics of scholarship which are produced fromdissemination in open access publications and social media. Acceptance of these challenges is essential for takingGoh P, Sandars JMedEdPublishhttps://doi.org/10.15694/mep.2020.000097.1Page | 6full advantage of the rapid cycle iterative investigation and evaluation cycles that underpin the action research anddesign research paradigm. This evolution will need training and time to fully adopt, for senior faculty and academicadministrators.Educators will also need to have sufficient time to continue their scholarly activities. In an environment with multipledemands, including healthcare, teaching, academic and family, it is essential that opportunities for research anddissemination are both relevant to the urgent need to deliver the curriculum but can also satisfy the demands of theinstitution to evidence scholarship in medical education. An important opportunity of combining teaching withresearch are learning communities of educators, with demonstrable impact on the academic achievement of learners(Vescio et al., 2008).ConclusionThe COVID-19 pandemic has significantly disrupted medical education, producing a rapid and major impact onstudents, educators and institutions. However, institutions still require educators to engage with scholarship inmedical education, including providing evidence for promotion and tenure. We propose that resolving this tensionbetween the demands of delivering a high quality curriculum and maintaining scholarship in medical educationduring the era of the COVID-19 pandemic requires urgent consideration of a transformational change in thescholarship in medical education. Key aspects of this change are a focus on rapid cycles of research to informteaching, with local and wider dissemination using newer rapid approaches to publication and social media. Thereare important challenges for institutions in the implementation of our proposed transformational change. Resolvingthese challenges has important implications for both the scholarship of medical education during the COVID-19pandemic but also there are likely to be long term permanent changes in how both educators and their institutionsconceptualise and engage in scholarship.Take Home MessagesThe COVID-19 pandemic has produced rapid and evolving changes in the delivery of the curriculumWe propose that scholarship in medical education, with the need to engage with research and produceevidence, requires a transformational change Rapid iterative cycles of research by action research and education design research are more appropriate Dissemination of scholarly work in rapidly changing environments requires fast and open access publicationThere are important challenges for institutions in the implementation of our proposed transformationalchange Notes On ContributorsPoh Sun Goh, MBBS, FRCR, FAMS, MHPE, FAMEE, is an Associate Professor and Senior ConsultantRadiologist at the Yong Loo Lin School of Medicine, National University of Singapore, and National UniversityHospital, Singapore. He is a graduate of the Maastricht MHPE program, a member of the AMEE TEL committee,and a Fellow of AMEE. ORCiD: http://orcid.org/0000-0002-1531-2053John Sandars MB ChB (Hons), MSc, MD, MRCP, MRCGP, FAcadMEd, CertEd, FHEA is Professor of MedicalEducation and Director of Medical Education Innovation and Scholarship at Edge Hill University Medical School,Goh P, Sandars JMedEdPublishhttps://doi.org/10.15694/mep.2020.000097.1Page | 7Ormskirk, UK, and is Co-Chair of the AMEE Technology Enhanced Learning Committee.ORCiD: http://orcid.org/0000-0003-3930-387XAcknowledgementsFigure 1. Source: the author, Poh-Sun Goh.Figure 2. Source: the author, John Sandars.Bibliography/ReferencesBadwan, B., Bothara, R., Latijnhouwers, M., Smithies, A., et al. (2018) ‘The importance of design thinking inmedical education’, Medical Teacher, 40(4), pp. 425-6. https://doi.org/10.1080/0142159X.2017.1399203Boyer, E. L. (1990) Scholarship Reconsidered: Priorities of the Professoriate Princeton, NJ: Carnegie Foundation forthe Advancement of Teaching.Cabrera, D., Vartabedian, B. S., Spinner, R. J., Jordan, B. L., et al. (2017)  ‘More than likes and tweets: creatingsocial media portfolios for academic promotion and tenure’. Journal of Graduate Medical Education, 9(4), pp.421-425. https://doi.org/10.4300/JGME-D-17-00171.1Coghlan, D. and Brannick, T. (2019) Doing action research in your own organization. London: SAGE PublicationsLimited.Cotterill, S., Knowles, S., Martindale, A. et al. (2018) ‘Getting messier with TIDieR: embracing context andcomplexity in intervention reporting’, BMC Medical Research Methodology, 18, pp. 12.https://doi.org/10.1186/s12874-017-0461-yGlassick, C. E. (2000) ‘Boyer's expanded definitions of scholarship, the standards for assessing scholarship, and theelusiveness of the scholarship of teaching’. Academic Medicine, 75(9), pp. 877-80.https://doi.org/10.1097/00001888-200009000-00007Goh, P. S. and Sandars J. (2019). ‘Digital Scholarship – rethinking educational scholarship in the digital world’,MedEdPublish, 8, [2], 15. https://doi.org/10.15694/mep.2019.000085.1Hanington, B. and Martin, B. (2019) Universal Methods of Design Expanded and Revised: 125 Ways to ResearchComplex Problems, Develop Innovative Ideas, and Design Effective Solutions. Beverly, Massachusetts: RockportPublishers.Hutchings, P. and Shulman, L. S. (1999) ‘The Scholarship of Teaching: New Elaborations, New Developments,Change’,The Magazine of Higher Learning, 1:5, pp. 10-15. https://doi.org/10.1080/00091389909604218McKenney. S. and Reeves, T. C. (2018) Conducting educational design research. New York: Routledge.Ogrinc, G., Armstrong, G. E., Dolansky, M. A., Singh, M. K. et al. (2019) ‘SQUIRE-EDU (Standards for QUalityImprovement Reporting Excellence in Education): Publication Guidelines for Educational Improvement’, AcademicGoh P, Sandars JMedEdPublishhttps://doi.org/10.15694/mep.2020.000097.1Page | 8Medicine, 94(10), pp. 1461–1470. https://doi.org/10.1097/ACM.0000000000002750Sandars, J., Correia, R., Dankbaar, M., de Jong, P., et al. (2020) 'Twelve tips for rapidly migrating to online learningduring the COVID-19 pandemic', MedEdPublish, 9, [1], 82, https://doi.org/10.15694/mep.2020.000082.1Spataro, J. (2020) 2 years of digital transformation in 2 months, Microsoft. Available at:https://www.microsoft.com/en-us/microsoft-365/blog/2020/04/30/2-years-digital-transformation-2-months/(Accessed: 2 May 2020).Snowdon, D. (1999) The Cynefin Framework, Wikipedia. Available at:https://en.wikipedia.org/wiki/Cynefin_framework (Accessed: 2 May 2020).Vescio, V, Ross, D. and Adams, A. (2008) ‘A review of research on the impact of professional learning communitieson teaching practice and student learning’. Teaching and Teacher Education. 24(1), pp. 80-91.https://doi.org/10.1016/j.tate.2007.01.004AppendicesNone.DeclarationsThe author has declared that there are no conflicts of interest.This has been published under Creative Commons "CC BY 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)Ethics StatementThis is a Personal Opinion piece and does not require Ethics Approval.External FundingThis article has not had any External FundingMedEdPublish: rapid, post-publication, peer-reviewed articles on healthcare professions’ education. For moreinformation please visit www.mededpublish.org or contact mededpublish@dundee.ac.uk.

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Rethinking scholarship in medical education during the era of the COVID-19 pandemic

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