A novice's guide to qualitative health professions education research.

Qualitative research has long been considered the poor cousin to quantitative research. However, recently it has gained more prominence and respect, particularly within health professions education. This article aims to introduce the novice researcher to the fundamental principles of qualitative research. The objectives were (i) to understand the features of, and rationale for conducting, qualitative research, and (ii) to differentiate between the most common forms of qualitative research. In this review, we introduce the basic features of qualitative research, and describe the rationale for conducting such research. We guide researchers on how to differentiate between the most common forms of qualitative research and to take the time to acquaint themselves with research paradigms, the philosophical positions that guide how research is conducted and interpreted, before selecting the best methodology and methods. Qualitative research is rigorous, and offers deeper understanding of human experiences, context and social phenomena. We demonstrate the key considerations when selecting an appropriate methodology, ensuring that the research aim aligns with the purpose of any given methodology. The power of qualitative research should not be underestimated, but power only comes from well conducted, rigorous research. Qualitative research is not quick or easy but it has much to offer.

The impact of the COVID-19 pandemic on the research activity and working experience of clinical academics, with a focus on gender and ethnicity: a qualitative study in the UK.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on the research activity and working experience of clinical academics, with a focus on gender and ethnicity. DESIGN: Qualitative study based on interviews and audio/written diary data. SETTING: UK study within clinical academia. PARTICIPANTS: Purposive sample of 82 clinical academics working in medicine and dentistry across all career stages ranging from academic clinical fellows and doctoral candidates to professors. METHODS: Qualitative semistructured interviews (n=68) and audio diary data (n=30; including 16 participants who were also interviewed) collected over an 8-month period (January-September 2020), thematically analysed. RESULTS: 20 of 30 (66.6%) audio diary contributors and 40 of 68 (58.8%) interview participants were female. Of the participants who disclosed ethnicity, 5 of 29 (17.2%) audio diary contributors and 19/66 (28.8%) interview participants identified as Black, Asian or another minority (BAME). Four major themes were identified in relation to the initial impact of COVID-19 on clinical academics: opportunities, barriers, personal characteristics and social identity, and fears and uncertainty. COVID-19 presented opportunities for new avenues of research. Barriers included access to resources to conduct research and the increasing teaching demands. One of the most prominent subthemes within 'personal characteristics' was that of the perceived negative impact of the pandemic on the work of female clinical academics. This was attributed to inequalities experienced in relation to childcare provision and research capacity. Participants described differential experiences based upon their gender and ethnicity, noting intersectional identities. CONCLUSIONS: While there have been some positives afforded to clinical academics, particularly for new avenues of research, COVID-19 has negatively impacted workload, future career intentions and mental health. BAME academics were particularly fearful due to the differential impact on health. Our study elucidates the direct and systemic discrimination that creates barriers to women's career trajectories in clinical academia. A flexible, strategic response that supports clinical academics in resuming their training and research is required. Interventions are needed to mitigate the potential lasting impact on capacity from the pandemic, and the potential for the loss of women from this valuable workforce.

Tips to Support the Recruitment, Retention, and Progression of Clinical Academics.

Training to become a clinical academic is a long and arduous process with many obstacles. Many potential candidates fall by the wayside both during and following completion of the combined clinical and academic training pathway with negative implications for clinical and translational research and teaching. Findings from a recent national multi-funder study, alongside clinical academic experiences and current literature, have led to the creation of this 12-tip paper. The tips are targeted at supervisors and employers of clinical academics, aiming to improve recruitment, experiences, retention, and progression through the career path.

Strengthening the clinical academic pathway: a systematic review of interventions to support clinical academic careers for doctors and dentists.

OBJECTIVE: Evaluate existing evidence on interventions intended to increase recruitment, retention and career progression within clinical academic (CA) careers, including a focus on addressing inequalities. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, Cochrane Controlled Register of Trials, PsycINFO and Education Resource Information Center searched October 2019. STUDY SELECTION: Eligible studies included qualified doctors, dentists and/or those with a supervisory role. Outcomes were defined by studies and related to success rates of joining or continuing within a CA career. DATA EXTRACTION AND SYNTHESIS: Abstract screening was supported by machine learning software. Full-text screening was performed in duplicate, and study quality was assessed. Narrative synthesis of quantitative data was performed. Qualitative data were thematically analysed. RESULTS: 148 studies examined interventions; of which 28 were included in the quantitative synthesis, 17 in the qualitative synthesis and 2 in both. Studies lacked methodological rigour and/or were hindered by incomplete reporting. Most were from North America. No study included in the syntheses evaluated interventions aimed at CA dentists.Most quantitative evidence was from multifaceted training programmes. These may increase recruitment, but findings were less clear for retention and other outcomes. Qualitative studies reported benefits of supportive relationships, including peers and senior mentors. Protected time for research helped manage competing demands on CAs. Committed and experienced staff were seen as key facilitators of programme success. Respondents identified several other factors at a programme, organisational or national level which acted as facilitators or barriers to success. Few studies reported on the effects of interventions specific to women or minority groups. CONCLUSIONS: Existing research is limited by rigour and reporting. Better evaluation of future interventions, particularly those intended to address inequalities, is required. Within the limits of the evidence, comprehensive multifaceted programmes of training, including protected time, relational and support aspects, appear most successful in promoting CA careers. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework: https://osf.io/mfy7a.

Enablers and barriers to effective clinical supervision in the workplace: a rapid evidence review.

OBJECTIVES: We aimed to review the international literature to understand the enablers of and barriers to effective clinical supervision in the workplace and identify the benefits of effective clinical supervision. DESIGN: A rapid evidence review. DATA SOURCES: Five databases (CINAHL, OVID Embase, OVID Medline, OVID PsycInfo and ProQuest) were searched to ensure inclusion and breadth of healthcare professionals. ELIGIBILITY CRITERIA: Studies identifying enablers and barriers to effective clinical supervision across healthcare professionals in a Western context between 1 January 2009 and 12 March 2019. DATA EXTRACTION AND SYNTHESIS: An extraction framework with a detailed inclusion/exclusion criteria to ensure rigour was used to extract data. Data were analysed using a thematic qualitative synthesis. These themes were used to answer the research objectives. RESULTS: The search identified 15 922 papers, reduced to 809 papers following the removal of duplicates and papers outside the inclusion criteria, with 135 papers being included in the full review. Enablers identified included regular supervision, occurs within protected time, in a private space and delivered flexibly. Additional enablers included supervisees being offered a choice of supervisor; supervision based on mutual trust and a positive relationship; a cultural understanding between supervisor and supervisee; a shared understanding of the purpose of supervision, based on individual needs, focused on enhancing knowledge and skills; training and feedback being provided for supervisors; and use of a mixed supervisor model, delivered by several supervisors, or by those trained to manage the overlapping (and potentially conflicting) needs of the individual and the service. Barriers included a lack of time, space and trust. A lack of shared understanding to the purpose of the supervision, and a lack of ongoing support and engagement from leadership and organisations were also found to be barriers to effective clinical supervision. CONCLUSIONS: This review identified several enablers of and barriers to effective clinical supervision and the subsequent benefits of effective clinical supervision in a healthcare setting.

Critical Realism and Realist Inquiry in Medical Education.

Understanding complex interventions, such as in medical education, requires a philosophy of science that can explain how and why things work, or fail to work, in different contexts. Critical realism and its operationalization in the form of realist inquiry provides this explanatory power. Ontologically, critical realism posits that the social world is real, that it exists independent of our knowledge of it, and that it is driven by causal mechanisms. However, unlike postpositivism, a realist epistemological position is that our understanding of the mechanisms that underlay social reality is limited and subjective. Critical realism is focused on understanding the mechanisms that drive social reality even when they are not directly observable. One of the most commonly used methodologies in the critical realist paradigm is realist inquiry, which focuses on the relationships between context, mechanisms, and outcomes. At its core, realist inquiry is concerned with "What works for whom, under what circumstances, how, and why?" To that end, realist inquiry explores the mechanisms that drive social systems and the ways in which these mechanisms work to develop explanatory theories of the phenomena under consideration. Although, compared with other approaches, realist inquiry is relatively new in medical education, the value of realist inquiry is in its ability to model how complex interventions function differently across multiple contexts, explaining what works, how it works, for whom, and in what contexts.

Supporting international medical graduates' transition to their host-country: realist synthesis.

CONTEXT: Many health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs' transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective. METHODS: The realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement. RESULTS: Sixty-two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self-efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment. CONCLUSIONS: Organisational, training and individual contexts all play a role in IMGs' adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given.