Twelve tips for getting started using mixed methods in medical education research.

BACKGROUND: Mixed methods research, which is gaining popularity in medical education, provides a new and comprehensive approach for addressing teaching, learning, and evaluation issues in the field. AIM: The aim of this article is to provide medical education researchers with 12 tips, based on consideration of current literature in the health professions and in educational research, for conducting and disseminating mixed methods research. CONCLUSION: Engaging in mixed methods research requires consideration of several major components: the mixed methods paradigm, types of problems, mixed method designs, collaboration, and developing or extending theory. Mixed methods is an ideal tool for addressing a full range of problems in medical education to include development of theory and improving practice.

Writing approaches of nursing students.

Over the past 20years, research has focused on the writing processes of college students, however, despite recent support for writing as a tool of reflection in nursing education, little is known about how it is that nursing students go about writing papers and assignments as part of their professional education. In order to determine the writing processes of nursing students, the Inventory of Processes in College Composition, a self-response questionnaire, was administered to 169 nursing students. Results support the independence of the writing approaches that nursing students use and similarity to the writing approaches of a general college student population.

Triaging referrals as part of hematology/oncology fellowship training.

We developed an integrative component of the consult rotation for fellows training in hematology/oncology. This component consisted of triaging all consults to the hematology/oncology service of the CAVHS during a 1-year period of time. The goals of the rotation were to improve timeliness of response to consultation requests, to gain experience in differential diagnosis of patients with potential hematologic/oncologic disorders through of such patients, review of decisions with attending physicians, and communication of such with the referring physician. The major benefits were that fellows integrated didactic learning into real-life clinical cases, selected patients for their continuity clinic to assure sufficient variety and complexity of cases, honed their communication skills, learned about referring and attending physicians' styles, and gained practice in clinical vignettes representative of cases they would be expected to see in clinical practice. Disadvantages were time involvement (approximately 2 h/day) and risks of over- or under-referrals. Administratively, there was a significant decline in the wait time for patients to be seen in the hematology/oncology service. In all, this elective is a valuable integrative experience of senior fellows, but may have less value for first year fellows.

Residents' perspectives on professionalism.

BACKGROUND: Research defining professionalism exists, yet little is known about how residents view this important attribute for medical practice. Knowing more about residents' interpretations of professionalism and about how they value professionalism would enhance definitions and facilitate support for the development of professionalism skills and behaviors at the graduate level. PURPOSE: The purpose of this phenomenological study was to investigate how residents think about professionalism, how they value it, and how it plays out in their educational lives. METHODS: This study uses qualitative methods, employing 5 focus groups representative of a range of disciplines. Methods include providing unstructured prompts, member checking and informant feedback to support credibility, and content analysis to discern significant patterns. RESULTS: Content analysis supported that residents highly value professionalism and see it as a complex construct, dependent on the situation, discipline, and on personal experience. Challenges to professionalism are common in graduate medical education and a great concern for residents. CONCLUSIONS: Physician educators often discuss professionalism as an overarching concept in medicine, especially in classes during the preclinical years. Although some general principles are applicable, residents relate more deeply to aspects of professionalism that concern their own clinical practice, situation, and specialty. Implications for measurement of professional skills and for further research are included in this report.

The writing approaches of secondary students.

BACKGROUND: Research with college students has supported a model of writing approaches that defines the relationship between a writer and writing task along a deep and surface process continuum (Biggs, 1988). Based on that model, Lavelle (1993) developed the Inventory of Processes in College Composition which reflects students' motives and strategies as related to writing outcomes. It is also important to define the approaches of secondary students to better understand writing processes at that level, and development in written composition. AIMS: This study was designed to define the writing approaches of secondary students by factor analysing students' responses to items regarding writing beliefs and writing strategies, and to compare the secondary approaches to those of college students. A related goal was to explore the relationships of the secondary writing approaches to perceived self-regulatory efficacy for writing (Zimmerman & Bandura, 1994), writing preferences, and writing outcomes. SAMPLES: The initial, factor analytic phase involved 398 junior level high school students (11th grade) enrolled in a mandatory language arts class at each of three large Midwestern high schools (USA). Then, 49 junior level students enrolled in two language arts classes participated as subjects in the second phase. METHOD: Classroom teachers administered the Inventory of Processes in College Composition (Lavelle, 1993), which contained 72 true-or-false items regarding writing beliefs and strategies, during regular class periods. Data were factor analysed and the structure compared to that of college students. In the second phase, the new inventory, Inventory of Processes in Secondary Composition, was administered in conjunction with the Perceived Self-Regulatory Efficacy for Writing Inventory (Zimmerman & Bandura, 1994), and a writing preferences survey. A writing sample and grade in Language Arts classes were obtained and served as outcome variables. RESULTS: The factor structure of secondary writing reflected three process dimensions. The first factor, Elaborative-Expressive, describes a writing strategy based on personal investment and audience concern. The second factor, Planful-Procedural, denotes sticking to a plan, following the rules, and 'preparing' for writing. Achieving-Competitive, the third factor, reflects a 'teacher pleasing' strategy or doing only what needs to be done to get a good grade. Two factors from the college model, Elaborative and Procedural, were replicated, and two were not, Reflective-Revision and Low Self-Efficacy. Regression analyses supported that the processes in writing under a timed condition are different from those used when writing over time, and that students' perceptions of writing self-regulatory efficacy were predictive of writing success under both conditions.