All right, I'm pleased to introduce our next speaker, a lot of whose work you've seen in a bunch of our slides today. So I'd like to bring up Dr. Catherine Walsh, who's an Associate Professor of Pediatrics at the Hospital for Sick Children in Ontario, Canada. Dr. Walsh will be speaking about medical education research and endoscopy. Thanks so much for the kind invitation to speak today. So I have no disclosures. So I was given the task of speaking about educational research and endoscopy, which is a huge topic. It's like talking about clinical research. So what I really hope to do is kind of try to focus in and provide you with a framework to think about conducting research related to endoscopy and education, and discuss some tips that may be helpful in getting started on embedding research within your educational scholarship. So just to start off with, in terms of what is educational research. So it's defined as research that really seeks to deepen our knowledge or understanding of learning, teaching, and education by studying phenomenon relations of how and why something works and for whom. And it's not about solving concrete problems. So often educational research comes out of local need, but you want to make it broader than the local context. And it's also not about providing universal solutions, because education differs across residency programs, across GI training programs, and across institutions. So there's likely to be a one-size-fits-all solution. It's really focused on examining researchable problems that relate to broad questions about teaching, learning, and education that are often studied within a local context. And just in terms of another term is education scholarship, and this is more of an umbrella term that encompasses research, but it also goes beyond that to encompass innovations in education, things like curriculum design or designing new teaching tools or other things. And in terms of education scholarship, it's felt to be scholarly when the work is peer-reviewed, when it's publicly disseminated, and when it makes it so that others can build upon the work. And within GI, you guys are probably doing a lot of the work around education scholarship on a daily basis, but it's taking it to the next step where you actually publish and disseminate the work. So just as an example, this is a recent publication from VideoGIE that outlines very inexpensive polyps that you can use to train trainees around polypectomy and bleeding. And in terms of this work, it was disseminating how to make these polyps and doing a small evaluation of the polyps. But then it allows others to use this technology and to build upon it and use it within their curricula. So within education scholarship, there's been a huge increase in the number of publications and journals related to education scholarship, both within GI and with outside of GI. In GI, as an example, the publications related to education have risen over 300% between 2013 and 2022. So it is becoming kind of increasingly common. So in terms of thinking about education scholarship, it's very much akin to kind of clinical research where you start off looking at a study idea and then conducting a literature review, crafting your question. And I think a key thing is identifying a conceptual framework. So in terms of questions, these generally arise from some problem or issue that you're having in a local context, but then you have to make that kind of applicable or interesting to a broader audience. So as an example, often you'll have a broad idea. So for example, does simulation-based education work? So this is a good topic for a systematic review, but not necessarily for an individual study. So you can take that question and you can look at a particular aspect of that. So for example, do simulation-based education, does it transfer to the clinical practice? And within that, you can pick a particular skill. So for example, polypectomy skills. You can pick a particular conceptual framework, so mastery-based learning. And then you can pick a specific outcome, such as clinical practice and whether polypectomy decreases post-polypectomy bleeding. So this comes down to a much more specific question, does polypectomy simulation-based mastery learning reduce patient complications in clinical practice? So you can go from a very broad idea to a very specific question. This acronym, FINER, is a very useful way to think about creating an educational research question. So you want to make sure that it's feasible, that it's interesting and important, not only to your local institution, but to the broader educational literature, that it's novel, so making sure somebody else hasn't addressed it within the literature, that you can answer it ethically, and that it's relevant, again, to your institution, but also broad. And one way Lorelei Lingard, who's an educational scholar, has thought about kind of conceptualizing, thinking about a question, is the problem gap heuristic. So when you think of an issue, thinking about, what is the problem in the world that you're talking about? And then articulating the gap, or the current knowledge gap related to that problem. And then finally, articulating the hook, or the so what factor. So why does what you're doing matter, and why is that gap of consequence? And this is a very useful way for, when you have a question, thinking about whether it's relevant. And you can also then use this to frame the introduction of your paper later on. So within education, you generally want to use a conceptual framework, which are theories or models of learning, and they help to clarify why something is happening. And they really help to transform an idea from a general kind of problem into a research question, and they also help you choose an appropriate methodology, and help guide discussion of the findings. So in terms of the conceptual framework, there's kind of three basic types of questions. One are description, where you just describe what's done. Two is justification, where you're comparing kind of one approach to another. And the third is clarification, where you're actually looking and trying to figure out why things work. And these are centered on conceptual frameworks. And within the educational literature, you're generally seeking to answer questions on a clarification level, as opposed to just describing something. So as an example of conceptual frameworks, and how these can be used to guide research. So if I want to look at improving the effectiveness of feedback during endoscopy, there's many different theories that I can use. But two that I had kind of come up with were potentially cognitive load theory, which says that we all kind of have a limited working memory, and that we can't attend to a lot of information at once. And the other is mindset theory, that some people have a fixed versus a growth mindset, and the way that you look at failure will influence the way you, or your receptivity to feedback. So I could use either of these theories to study the problem of feedback related to endoscopy. So if I took a cognitive load perspective, I could choose interventions such as optimizing the environment, making sure there's not a lot of noise. So that decreases trainees extraneous load. Or I could look at germane load, and having learners stop to focus on feedback as they're doing a task. And those would be two interventions that would be targeting the cognitive load of trainees. On the other hand, I could tackle the exact same problem using mindset theory. So for example, if I wanted to try to foster trainees' growth mindset, I could make sure that people were focusing their feedback on behaviors as opposed to the trainees' abilities. Or I could try to reframe feedback in a coaching lens to try to increase trainees' openness to feedback. So this is just an example of how you can use two different theories to tackle the same problem. Here's an example from my own line of research. I've used challenge point theory, which is a theory where it shows that as you kind of gain skills, you should be challenged in an optimal way. So if you give a learner a task that's too easy, they won't be challenged, and they won't be engaged, and their learning will be low. On the other hand, if you give them a task that's too hard, they'll likely be overwhelmed, and again, their performance will be poor. And in the center, there's this point where they have an optimal level of learning for their ability. And that challenge increases over time. So as you gain skills, you have to have harder and harder tasks to remain engaged and to increase your learning. So we applied this to colonoscopy, looking at simulation-based training, where we gave trainees initially a very low-fidelity simulator where they practiced their basic handling skills, and then they moved on to the virtual reality simulator, where we focused on things like loop recognition and torque steering. And then we finally had them move on to animal models, where they learned more complex skills such as polypectomy. And we compared this with them learning on a virtual reality simulator and doing kind of all the tasks from the get-go. And those in the progressive group had improved clinical skills when we tested them 68 weeks out in clinical practice. So this is just one example of how we used a theory and applied it to the endoscopy setting to see if it held true within that context. So once you've developed your question and crafted your, and chosen your conceptual framework, you want to identify kind of your methodology and write your proposal. And your question will really help to determine your methodology, and I'm not going to go into all the different study designs, but generally speaking, if you're asking a do or is or can or should question, it's generally more applicable to quantitative methods versus what and why are more applicable to qualitative methods. So things around perceptions or exploring people's feelings about a particular topic. And with how, it depends on the question, but it could be any type of methodology. And the methodology will then really set up your study design. If you are using quantitative methods, Kirkpatrick's Hierarchy is a very useful guide for selecting outcome measures. So this looks at various levels of outcome measures, and ideally, you really want to be looking at behavior change. So whether some intervention actually affects behavior, or whether it actually affects clinical practice or the organizational practice. These are much higher level outcomes, and they're harder to measure, but it's ultimately what we should be striving for. Finally, once you have done your study and you've collected your data, dissemination is another kind of key step within the research process. Justin Sewell just published this article outlining a roadmap for publishing educational scholarship within GI, and it outlines some tips before, during, and after publication in terms of writing up educational scholarship. And Lorelei Lingard, again, going back to that problem-back-gap-hook heuristic, she recommends that you should really be telling a story within your paper as opposed to a study. So these are some questions throughout the introduction, the methods, results, and discussion, which you can ask yourself to help weave a story throughout the manuscript, to keep the reader engaged, and to make sure that you're answering that kind of problem-gap-hook, or addressing that. In terms of writing a paper, it's also useful to look at some of the reporting guidelines. There are some that are specific to education. So for example, with regard to simulation, they have an extension of the consort and strobe guidelines, which is specific to simulation. And if you are planning a simulation-based study, it's good to look at those ahead of time to see what information is required and plan for that up front. In terms of dissemination, there's also a number of journal choices. There's the more clinically-focused journals, or the more educational journals. I publish in both types of journals, and it really depends on the topic that I'm publishing on. If it's a more theoretically-grounded piece, and it's more contributing kind of to the general educational literature, so for example, a study looking at entrustment and how that's conceptualized in the procedural setting, I'll choose more of an educational journal versus a study, for example, developing an assessment tool that I want gastroenterologists to use, I would target a clinical journal. And you also have to remember the other venues for publication, particularly social media. There's a lot of open-access educational portals, which are really great because you can publish curriculum or other teaching resources that you're doing, and they're indexed on PubMed, and people can access them and use them. And there's also an increasing number of video journals specific to endoscopy, which are a great place to publish innovation and GI. So just in terms of some tips for success, I would say first to try to develop a niche. And this can either be around a specific methodology, or it could be around a particular conceptual framework or theory. So for example, Justin Sewell, who's done a lot of work within endoscopy research, is a real expert within cognitive load theory. And this is just an example of five studies that he's done using cognitive load theory. And they use a variety of methodologies, some developing a tool, used more quantitative methodology versus studies around perceptions of cognitive load in the endoscopy suite, used more qualitative methodology. And then he also published some innovation around teaching around cognitive load on MedEdPortal. So this is just an example of how you can be an expert kind of in one theory and use that as a jumping-off point for many different studies. You also want to think strategically. So you want to think of where can this topic or this area that I'm interested in, where can that lead? And ideally, you want to have a series of studies that build off one another, as opposed to doing kind of individual studies. It's important to ask questions that are of interest to the broader context, and embedding them within a conceptual framework can help with that. You also want to make sure you plan prospectively. Often I'll get people who will say, oh, I did this course, and I have this great data as satisfaction data. What can I do with that? It's very hard to turn something that you collected that wasn't for the purposes of research into research. So you really want to think about it up front. And if you are running a course or doing something educational, to embed it within that course from the get-go. It's also important to develop collaborators and seek mentors. And often these may not be from your division necessarily. I know within my division, I don't have other individuals who are interested in education. So I have a lot of collaborators and mentors who are within my hospital or my university or beyond. And I think this is where the GI societies are very helpful as well, because they often have groups of individuals who are interested in education who you can collaborate with and seek mentorship from. And finally, to disseminate your work. I think a lot of people are doing amazing things within the space of endoscopy education, but often they do them and then they don't publish them or they present them at a conference, but they don't go on to publish them. So really trying to follow through to the stage of peer-reviewed publications so that people can see that work and build off of it. So just in conclusion, to take advantage of the work that you're already doing and try to plan ahead and embed educational research within that, think about your problem kind of to narrow it down and then articulating it in terms of a problem gap and hook. You want to identify a conceptual framework and disseminate your work broadly. And I didn't have a lot of time to go into specific methodologies, so this is just a resource that goes into quantitative, qualitative, and mixed methods, educational research, and various study designs for those types of research, as well as criteria for rigor. Thank you.

Dr. Catherine Walsh

Associate Professor

Pediatrics

Medical Education

Endoscopy