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围绕医疗保健专业教育研究重点的不同观点:一种 Q 方法研究。

Differing viewpoints around healthcare professions' education research priorities: A Q-methodology approach.

机构信息

(CG-MERC) Chang Gung Medical Education Research Centre, Linkou, Taiwan, Republic of China.

The Faculty of Medicine and Health, The University of Sydney, Level 7, Susan Wakil Health Building D18, NSW, 2006, Australia.

出版信息

Adv Health Sci Educ Theory Pract. 2021 Aug;26(3):975-999. doi: 10.1007/s10459-021-10030-5. Epub 2021 Feb 11.

Abstract

Recently, due to scarce resources and the need to provide an evidence-base for healthcare professions' education (HPE), HPE research centres internationally have turned to identifying priorities for their research efforts. Engaging a range of stakeholders in research priority setting exercises has been posited as one way to address the issues around reducing researcher bias and increasing social accountability. However, assigning individuals to single a priori stakeholder groups is complex, with previous research overlooking cross-category membership and agreement between individuals across groups. Further, analyses have pitched stakeholder groups against one another in an attempt to understand who prioritises what, and often fails to grasp rationales underlying priorities. A deeper understanding of who prioritises what research areas and why is required to consider applicability of results across contexts and deepen social accountability and transferability. A web-based Q-methodological approach with n=91 participants (who) from ten pre-classified stakeholder groups was employed with post-sort interviews (why). Sixty-seven Q-set items (Chinese/English languages) were developed from previous research (what). Participants were mainly from Taiwan, although international researchers were included. Q-sorting was undertaken in groups or individually, followed by post-sort interviews. Eighty-six participants' Q-sorts were included in the final analysis. Intercorrelations among Q-sorts were factor-analysed (Centroid method) and rotated analytically (Varimax method). Interviews were thematically analysed. Six Viewpoints with eigenvalues exceeding 1 were identified (range = 3.55-10.34; 42% total variance; 35/67 topics), mapping high/low priorities for research foci: Workplace teaching and learning; Patient dignity and healthcare safety; Professionalism and healthcare professionals' development; Medical ethics and moral development; Healthcare professionals' retention and success; Preparing for clinical practice. Eighteen rationales for prioritisation were identified: impact, organisational culture and deficit of educators/practitioners were most highly cited. Each Viewpoint, held by multiple stakeholders, comprised a unique set of topic-groupings, target study participants, beneficiaries and rationales. The two most prolific Viewpoints represent how different stakeholder groups highlight key complementary perspectives of healthcare professions' education in the workplace (efficacy of teaching/learning practices, application of knowledge/values). By illuminating the detail around each Viewpoint, and presenting an holistic description of the who-what-why in research priority setting, others wishing to undertake such an exercise can more easily identify how stakeholder Viewpoints and their epistemic beliefs can help shape healthcare professions' research agendas more generally.

摘要

最近,由于资源稀缺以及为医疗保健专业教育(HPE)提供循证的需要,国际 HPE 研究中心已开始确定其研究工作的重点。让各种利益相关者参与研究重点设定工作已被认为是解决减少研究人员偏见和增加社会责任感问题的一种方法。但是,将个人分配到单个预先确定的利益相关者群体中很复杂,因为先前的研究忽略了跨类别成员资格和群体之间个人之间的一致性。此外,分析试图理解谁优先考虑什么,并经常未能理解优先事项背后的基本原理。为了考虑结果在不同背景下的适用性并加深社会责任感和可转移性,需要更深入地了解谁优先考虑哪些研究领域以及为什么。

采用了一种基于网络的 Q 方法学方法,参与者为 n=91 人(他们)来自十个预先分类的利益相关者群体,进行了(为什么)的排序后访谈。从先前的研究中开发了 67 个 Q 集项目(中文/英文语言)(什么)。参与者主要来自中国台湾,尽管也包括国际研究人员。Q 分类是在小组或个人中进行的,然后进行排序后访谈。最后分析了 86 名参与者的 Q 分类。对 Q 分类进行了因子分析(Centroid 方法)和分析旋转(Varimax 方法)。对访谈进行了主题分析。确定了六个特征值超过 1 的观点(范围=3.55-10.34;总方差的 42%;35/67 个主题),映射了研究重点的高/低优先级:工作场所教学和学习;患者尊严和医疗保健安全;专业精神和医疗保健专业人员的发展;医学伦理和道德发展;医疗保健专业人员的保留和成功;为临床实践做准备。确定了 18 个优先排序的理由:影响,组织文化和教育者/从业者的不足是最常被引用的。

每个观点(由多个利益相关者持有)都由一组独特的主题分组,目标研究参与者,受益人和理由组成。两个最多产的观点代表了不同的利益相关者群体如何突出工作场所医疗保健专业教育的关键互补观点(教学/学习实践的效果,知识/价值观的应用)。通过阐明每个观点的细节,并对研究重点设定中的“谁-什么-为什么”进行全面描述,希望进行此类练习的其他人可以更容易地确定利益相关者观点及其认识论信仰如何帮助更普遍地塑造医疗保健专业的研究议程。

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