Collaborative research: Accomplishments &; potential

Although a substantial part of scientific research is collaborative and increasing globalization will probably lead to its increase, very few studies actually investigate the advantages, disadvantages, experiences and lessons learned from collaboration. In environmental epidemiology interdisciplinary collaboration is essential and the contrasting geographical patterns in exposure and disease make multi-location projects essential. This paper is based on a presentation given at the Annual Conference of the International Society for Environmental Epidemiology, Paris 2006, and is attempting to initiate a discussion on a framework for studying collaborative research. A review of the relevant literature showed that indeed collaborative research is rising, in some countries with impressive rates. However, there are substantial differences between countries in their outlook, need and respect for collaboration. In many situations collaborative publications receive more citations than those based on national authorship. The European Union is the most important host of collaborative research, mainly driven by the European Commission through the Framework Programmes. A critical assessment of the tools and trends of collaborative networks under FP6, showed that there was a need for a critical revision, which led to changes in FP7. In conclusion, it is useful to study the characteristics of collaborative research and set targets for the future. The added value for science and for the researchers involved may be assessed. The motivation for collaboration could be increased in the more developed countries. Particular ways to increase the efficiency and interaction in interdisciplinary and intercultural collaboration may be developed. We can work towards "the principles of collaborative research" in Environmental Epidemiology.     

Modeling Interdisciplinary Research to Advance Behavioral Health Care

Over the past 15 years, scientists have become increasingly interested in interdisciplinary research collaborations. The integration of multiple perspectives to provide input into the most complex issues in science is thought to offer the best opportunity to find real-world answers to difficult problems. In this review and introduction to the special section on interdisciplinary research in behavioral health care, the value of a collaborative strategy is explored. Examples from the research presented in the special section are described to identify how processes were modified and interpretations made richer by these collaborations. Also discussed are potential impediments to researchers choosing to work from an interdisciplinary perspective. Conditions that are thought to encourage collaborative, interdisciplinary perspectives are also described.     

Interdisciplinary education and teamwork: a long and winding road

PURPOSE: This article examines literature on interdisciplinary education and teamwork in health care, to discover the major issues and best practices. METHODS: A literature review of mainly North American articles using search terms such as interdisciplinary, interprofessional, multidisciplinary with medical education. MAIN FINDINGS: Two issues are emerging in health care as clinicians face the complexities of current patient care: the need for specialized health professionals, and the need for these professionals to collaborate. Interdisciplinary health care teams with members from many professions answer the call by working together, collaborating and communicating closely to optimize patient care. Education on how to function within a team is essential if the endeavour is to succeed. Two main categories of issues emerged: those related to the medical education system and those related to the content of the education. CONCLUSIONS: Much of the literature pertained to programme evaluations of academic activities, and did not compare interdisciplinary education with traditional methods. Many questions about when to educate, who to educate and how to educate remain unanswered and open to future research.     

医学信息学的发展

医学信息学是一门集医学、信息科学和管理学于一身的新兴交叉学科。国外医学信息学研究涉及领域较广。发展较快。国内研究的领域比较少，但取得了一定的成绩，医学信息学教育取得了一定成绩，也出现了一些有待解决的问题。为了促进我国医学信息学的研究和教学，本文提出了重视高层次医学信息学人才培养、支持医学信息学研究课题、在临床研究生教学中开设课程、师资培训和教材建设、发挥医学信息学会领导作用等对策。     

Overcoming barriers to priority setting using interdisciplinary methods

Ten years ago, Holm's highly influential paper “Goodbye to the simple solutions: the second phase of priority setting” was published [Holm S. Goodbye to the simple solutions: the second phase of priority setting in health care. British Medical Journal 1998;317:1000–7]. Whilst attending the 2nd International Conference on Priorities in Health Care in London, Holm argued that the search for a rational set of decision-making rules was no longer adequate. Instead, the priority setting process itself was now thought to be more complex. Ten years later, the Conference returns to the UK for the first time, and it is timely to describe some new tools intended to assist both researchers and decision-makers seeking to develop both rational and fair and legitimate priority setting processes. In this paper we argue that to do so, researchers and decision-makers need to adopt an interdisciplinary and collaborative approach to priority setting. We focus on program budgeting and marginal analysis (PBMA) and bring together three hitherto separate interdisciplinary strands of the PBMA literature. Our aim is to assist researchers and decision-makers seeking to effectively develop and implement PBMA in practice. Specifically, we focus on the use of multi-criteria decision analysis, participatory action research, and accountability for reasonableness, drawn from the disciplines of decision analysis, sociology, and ethics respectively.     

From gender bias to gender awareness in medical education

Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was ‘gender blind’ by not considering gender whenever relevant. Secondly, medicine is said to be ‘male biased’ because the largest body of knowledge on health and illness is about men and their health. Thirdly, gender role ideology negatively influences treatment and health outcomes. Finally, gender inequality has been overlooked as a determinant of health and illness. The uptake of gender issues in medical education brings about specific challenges for several reasons. For instance, the political-ideological connotations of gender issues create resistance especially in traditionalists in medical schools. Secondly, it is necessary to clarify which gender issues must be integrated in which domains. Also, some are interdisciplinary issues and as such more difficult to integrate. Finally, schools need assistance with implementation. The integration of psychosocial issues along with biomedical ones in clinical cases, the dissemination of literature and education material, staff education, and efforts towards structural embedding of gender in curricula are determining factors for successful implementation. Gender equity is not a spontaneous process. Medical education provides specific opportunities that may contribute to transformation for medical schools educate future doctors for future patients in future settings. Consequently, future benefits legitimize the integration of gender as a qualitative investment in medical education.     

Researcher-decision-maker partnerships in health services research: Practical challenges, guiding principles

ABSTRACT: BACKGROUND: In health services research, there is a growing view that partnerships between researchers and decision-makers (i.e., collaborative research teams) will enhance the effective translation and use of research results into policy and practice. For this reason, there is an increasing expectation by health research funding agencies that health system managers, policy-makers, practitioners and clinicians will be members of funded research teams. While this view has merit to improve the uptake of research findings, the practical challenges of building and sustaining collaborative research teams with members from both inside and outside the research setting requires consideration. A small body of literature has discussed issues that may arise when conducting research in one's own setting; however, there is a lack of clear guidance to deal with practical challenges that may arise in research teams that include team members who have links with the organization/community being studied (i.e., are "insiders"). DISCUSSION: In this article, we discuss a researcher-decision-maker partnership that investigated practice in primary care networks in Alberta. Specifically, we report on processes to guide the role clarification of insider team members where research activities may pose potential risk to participants or the team members (e.g., access to raw data). SUMMARY: These guiding principles could provide a useful discussion point for researchers and decision-makers engaged in health services research.     

The ties that bind: a network approach to creating a programme in faculty development

Medical Education 2010: 44 : 132–139 Context Current trends in medical education reflect the changing health care environment. An increasingly large and diverse student population, a move to more distributed models of education, greater community involvement and an emphasis on social accountability, interprofessional education and student‐centred approaches to learning necessitate new approaches to faculty development to help faculty members respond effectively to this rapidly changing landscape. Methods Drawing upon the tenets of network theory and the broader organisational literature, we propose a ‘fishhook’ model of faculty development programme formation. The model is based on seven key factors which supported the successful formation of a centralised programme for faculty development that addressed many of the contemporary issues in medical education. These factors include: environmental readiness; commitment and vision of a mobiliser; recruitment of key stakeholders and leaders to committees; formation of a collaborative network structure; accumulation of networking capital; legitimacy, and flexibility. Discussion Our aim in creating this model is to provide a guide for other medical schools to consider when developing similar programmes. The model can be adapted to reflect the local goals, settings and cultures of other medical education contexts.     

The future of medical education: a Canadian environmental scan

Medical Education 2011: 45 : 95–106 Objectives One hundred years after the Flexner report remade medical education in North America, many countries are reviewing the purpose and organisation of medical education. In Canada, a national study is being undertaken to define important issues and challenges for the future of medical education. The objectives of this paper are to describe the process of conducting an empirical environmental scan at a national level, and to present the research findings of this scan. Methods Thirty national key informant interviews were conducted, transcribed and coded to identify key themes. Interview data were triangulated with data sourced from 34 commissioned literature reviews and a series of national focus groups. Results Ten key issues or priorities were identified and used to generate detailed review papers used by the Association of Faculties of Medicine of Canada to create a blueprint for the evolution of medical education. The new priorities have major implications for areas ranging from admissions, curriculum content, educational process and the need to articulate the purpose and responsibilities of medical schools in society. Discussion This research provides a case study of how an empirical research approach can be used to identify and validate priorities for changes in medical education at a national level. This approach may be of interest in other countries.     

Factors associated with dropout in medical education: a literature review

Medical Education 2011: 45 : 440–454 Context Medical school dropout may have negative consequences for society, patients, the profession, schools and dropouts. To our knowledge, the literature dealing with dropout from medical school has never been systematically and critically appraised. Objectives This review aimed to systematically and critically review studies dealing with factors found to be associated with dropping out of medical school. Methods A systematic critical literature review of the international peer‐reviewed research literature on medical education was performed. A primary search was conducted and subsequently supplemented with ancestry and descendancy searches. The population of interest was medical students and the outcome was dropout. Abstract/title screening and quality assessment were performed by two independent researchers. Studies were assessed on six domains of quality: study participation; study attrition; predictor measurement; measurement of and accounting for confounders; outcome measurement, and analysis. Only studies that accounted for confounding were included in the final analysis. Results Of 625 studies found, 48 were quality‐assessed and 13 of these were eventually included based on their fulfilment of our quality‐related criteria. A range of entry qualifications seemed to be associated with greater chances of a student dropping out (odds ratio [OR] = 1.65–4.00). Struggling academically in medical school may be strongly associated with dropout. By contrast, no specific pattern of demographic variables was particularly important in relation to dropout. The effects of socio‐economic, psychological and educational variables on dropout were not well investigated. Conclusions More research into causal models and theory testing, which considers the effects of education, organisation and institution, is necessary if we are to learn more about how we can actively prevent medical student withdrawal.     

新型冠状病毒肺炎疫情暴发对中国医学人才培养的启示

目的本文着重分析中国2019新型冠状病毒肺炎(Corona Virus Disease 2019,COVID 19)疫情暴发以来所暴露出来的临床医学、公共卫生人才培养方面的突出问题,并结合国际经验及我国相关现况,就如何加强我国医学人才培养提出解决问题的策略与建议。方法通过新闻媒体报道、发表文章以及政策文件的查询,对此次疫情暴发、传播的影响因素进行系统分析,着重指出我国临床医学、公共卫生人才培养以及队伍建设等方面存在的突出问题。结果我国临床医学生和临床医生普遍缺乏流行病学、传染病和医院感染防控等方面的系统培训;住院医师规范化培训缺乏公共卫生方面的轮转与疾病防控实践;临床医务人员自我防护意识普遍薄弱。结论需进一步完善住院医师规范化培训制度,加强医学生和临床医生的预防医学、流行病学、生物统计、传染病防控和重大疫情防控能力的培养,建立传染病防控培训与演练制度。     

Making sense of work-based assessment: ask the right questions, in the right way, about the right things, of the right people

Medical Education 2012: 46: 28–37 Context Historically, assessments have often measured the measurable rather than the important. Over the last 30 years, however, we have witnessed a gradual shift of focus in medical education. We now attempt to teach and assess what matters most. In addition, the component parts of a competence must be marshalled together and integrated to deal with real workplace problems. Workplace‐based assessment (WBA) is complex, and has relied on a number of recently developed methods and instruments, of which some involve checklists and others use judgements made on rating scales. Given that judgements are subjective, how can we optimise their validity and reliability? Methods This paper gleans psychometric data from a range of evaluations in order to highlight features of judgement‐based assessments that are associated with better validity and reliability. It offers some issues for discussion and research around WBA. It refers to literature in a selective way. It does not purport to represent a systematic review, but it does attempt to offer some serious analyses of why some observations occur in studies of WBA and what we need to do about them. Results and Discussion Four general principles emerge: the response scale should be aligned to the reality map of the judges; judgements rather than objective observations should be sought; the assessment should focus on competencies that are central to the activity observed, and the assessors who are best‐placed to judge performance should be asked to participate.     

Defining Interdisciplinary Research: Conclusions from a Critical Review of the Literature

Objective. To summarize findings from a systematic exploration of existing literature and views regarding interdisciplinarity, to discuss themes and components of such work, and to propose a theoretically based definition of interdisciplinary research.
Data Sources/Study Setting. Two major data sources were used: interviews with researchers from various disciplines, and a systematic review of the education, business, and health care literature from January 1980 through January 2005.
Study Design. Systematic review of literature, one-on-one interviews, field test (survey).
Data Collection/Extraction Methods. We reviewed 14 definitions of interdisciplinarity, the characteristics of 42 interdisciplinary research publications from multiple fields of study, and 14 researcher interviews to arrive at a preliminary definition of interdisciplinary research. That definition was then field tested by 12 individuals with interdisciplinary research experience, and their responses incorporated into the definition of interdisciplinary research proposed in this paper.
Principal Findings. Three key definitional characteristics were identified: the qualitative mode of research (and its theoretical underpinnings), existence of a continuum of synthesis among disciplines, and the desired outcome of the interdisciplinary research.
Conclusion. Existing literature from several fields did not provide a definition for interdisciplinary research of sufficient specificity to facilitate activities such as identification of the competencies, structure, and resources needed for health care and health policy research. This analysis led to the proposed definition, which is designed to aid decision makers in funding agencies/program committees and researchers to identify and take full advantage the interdisciplinary approach, and to serve as a basis for competency-based formalized training to provide researchers with interdisciplinary skills.     

Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series

Gender nonconforming youth are at risk for body dissatisfaction and disordered eating. Currently, only a small body of literature addresses this high‐risk group. The five cases in this series highlight important themes for this patient population from an interdisciplinary perspective. Identified themes include increased risk for self‐harm/suicide, complex psychiatric, and medical implications of delay to treatment for either gender dysphoria or disordered eating, and the importance of collaborative management to maximize care and facilitate healthy development to adulthood. The purpose of this case series is to expand the interdisciplinary discussion regarding the breadth of presentation and management considerations for gender nonconforming adolescents with disordered eating. An interdisciplinary approach to care might enhance access to comprehensive, collaborative treatment for disordered eating, and gender dysphoria in this unique population.     

Medical education in sub-Saharan Africa: a literature review

Medical Education 2011: 45 : 973–986 Objectives This review synthesises research published in the traditional and ‘grey’ literature to promote a broader understanding of the history and current status of medical education in sub‐Saharan Africa (SSA). Methods We performed an extensive review and analysis of existing literature on medical education in SSA. Relevant literature was identified through searches of five traditional medical databases and three non‐traditional or grey literature databases featuring many African journals not indexed by the traditional databases. We focused our inquiry upon three themes of importance to educators and policymakers: innovation; capacity building, and workforce retention. Results Despite the tremendous heterogeneity of languages and institutions in the region, the available literature is published predominantly in English in journals based in South Africa, the UK and the USA. In addition, first authors usually come from those countries. Several topics are thoroughly described in this literature: (i) human resources planning priorities; (ii) curricular innovations such as problem‐based and community‐based learning, and (iii) the ‘brain drain’ and internal drain. Other important topics are largely neglected, including: (i) solution implementation; (ii) programme outcomes, and (iii) the development of medical education as a specialised field of inquiry. Conclusions Medical education in SSA has undergone dramatic changes over the last 50 years, which are recorded within both the traditionally indexed literature and the non‐traditional, grey literature. Greater diversity in perspectives and experiences in medical education, as well as focused inquiry into neglected topics, is needed to advance medical education in the region. Lessons learned from this review may be relevant to other regions afflicted by doctor shortages and inequities in health care resulting from inadequate capacity in medical education; the findings from this study might be used to inform specific efforts to address these issues.     

Educating about biomedical research ethics

This article examines the global and worsening problem of research misconduct as it relates to bio-medico-legal education. While research misconduct has serious legal implications, few adequate legal remedies exist to deal with it. With respect to teaching, research ethics education should be mandatory for biomedical students and physicians. Although teaching alone will not prevent misconduct, it promotes integrity, accountability, and responsibility in research. Policies and law enforcement should send a clear message that researchers should adhere to the highest standards of ethics in research. It is vital that researchers and physicians understand basic aspects of law and the legal system in order to develop understanding of the medico-legal issues not just in the legal context, but with a sound grounding in ethics, social and theoretical contexts so that they can practice good medicine. Routine and holistic research ethics education across the curriculum for medical students and resident physicians, and continuing medical education for practicing doctors, are probably the best ways to accomplish this goal.     

医学图书馆与医学生信息素质教育

医学图书馆作为医院文献信息中心,应该在医学生信息素质教育中发挥积极的作用,促进医院医疗、科研、教学的发展。本文探讨了信息素质与医学生信息素质教育、医学图书馆开展信息素质教育的优势和方法。     

《医疗质量管理办法》中医疗质量概念及相关问题探讨

采用文献复习和实证研究经验的方法对《医疗质量管理办法》中涉及的医疗质量概念及相关问题进行探讨。《医疗质量管理办法》中的医疗质量的定义存在重大缺失,没有涉及医疗服务的结果,特别是患者安全。医疗质量的定义应与国际相关权威机构保持一致,应高度重视医疗服务的结果,特别是患者安全。