Research The Importance of Educators to Clinical Research

The Importance of Educators to Clinical Research

By James H. Paxton, MD, on behalf of the SAEM Research Committee

SAEM is home to a broad range of academic emergency physicians, including educators and researchers with a diverse background of experiences and training. This makes our organization a unique forum for talented academics to collaborate and synergize efforts to advance our specialty. The Advanced Research Methodology Evaluation and Design (ARMED) and Advanced Research Methodology Evaluation and Design in Medical Education (ARMED MedEd) training programs are two great examples of SAEM bringing together clinical researchers and educators to benefit SAEM members. These programs illustrate the importance of educators in the training of future researchers and underscore the potential benefits of collaboration between educators and researchers in emergency medicine. Health professions education (HPE) research is perhaps the most intuitive arena in which the unique skill sets characterizing educators and researchers complement one another. Clinical researchers are accustomed to utilizing a hypothesis-testing framework to arrive at simple, generalizable findings that can be applied broadly across a variety of domains and contexts. In fact, reproducibility of results is often considered to be a key determinant of the success of a clinical research protocol, with the expectation that an experiment conducted under the same conditions should always yield the same outcomes. While this may appear to be true in well-designed clinical trials, the complexity of factors influencing educational outcomes often undermines our efforts to generalize findings.

In fact, the effectiveness of a teaching intervention may depend upon factors that would usually not be considered in the context of a clinical trial, such as the enthusiasm or communication skills of the person providing the intervention, differences in learning styles, and other educator (or learner) specific characteristics. These differences can make an effective educational intervention in one context ineffective in another context, underscoring the need to study not only the outcomes of the

“Health professions education (HPE) research is perhaps the most intuitive arena in which the unique skill sets characterizing educators and researchers complement one another.”

intervention but also the ways in which various aspects of the intervention’s implementation can influence those outcomes. Thus, education researchers must often seek to simultaneously understand not just whether, but why, an educational intervention works.

The ideal randomized controlled trial is one in which all conditions other than the intervention of interest are the same between the control and intervention groups, but in the real world, things are rarely that simple. Confounders and other unmeasured factors are often cited when a medical intervention appears to work well in one clinical context and not in another. But such discrepancies in clinical outcomes between trials may suggest the need for further investigation into the reasons why the intervention failed, including patient-, provider- and researcher-specific factors. Individuals trained in HPE research may be uniquely qualified to help identify such factors; after all, clinical trials invariably involve some degree of teaching and training, whether the learner is the patient, the clinician, or the research team member executing the intervention. Improved attention to this educational process (including whether and why it failed) could be expected to standardize (and perhaps improve) outcomes for otherwise welldesigned clinical trials.

While training in clinical research skills can provide a foundation for conducting educational research, such basic skills are seldom adequate. Innovative clinical interventions are often developed by basic and translational scientists before being tested by clinical researchers, but HPE researchers are often required to both develop and test their interventions. Clinical trials generally utilize well-defined and easily quantifiable outcomes, with standardized measurement tools. But educational interventions may be assessed according to less easily defined (or even quantified) criteria, such as motivation, satisfaction, empathy, wellbeing, and resilience. Managing such challenges requires the development of a specialized skill set — one that clinical researchers could benefit from as well.

In my experience, including educators in a research project always adds value, whether the educator is an HPE researcher or not. In addition to the potential for better training of patients, clinicians, and research team members, educators can also help to improve awareness of a clinical research study within the department and mobilize medical student and / or resident support. After all, participation in a clinical research project may help residents to complete their scholarly activity requirement for graduation. Educators (including education researchers) are also likely to have specific medical, technical, or statistical expertise that other members of the research team are lacking. These additional resources of manpower, time, and expertise could mean the difference between a successful clinical trial and a failed one, especially for investigators at resource-poor institutions.

Although educators and clinical researchers may have similar skill sets, they can have very different expertise. Each of these groups has a lot to offer the other, and it may be argued that these two areas of inquiry are inextricably linked, even outside of HPE research. After all, the conduct of high-quality clinical research requires an understanding of educational factors that impact learning and behavior, just as effective education is informed and refined by high-quality research. However educators and researchers choose to collaborate, the combination of these two “halves” of SAEM’s academic mission offer the promise of a whole far greater than the sum of its parts.

ABOUT THE AUTHOR

Dr. Paxton is an associate professor of emergency medicine at Wayne State University School of Medicine (Detroit, MI) and director of clinical research at Detroit Receiving Hospital. He is an active clinical researcher and educator, serving as core academic faculty at both Sinai-Grace Hospital and Detroit Receiving Hospital EM residencies. He is also chair of the SAEM Research Committee and a member of the SAEM ByLaws Committee. Dr. Paxton has been involved in the development of many educational programs within SAEM, including the Advanced Research Methodology Evaluation and Design (ARMED) program, and the SAEM Research Learning Series (RLS).