It has been 7 years since an article in the Society for Academic Emergency Medicine (SAEM) newsletter was published that focused on medical education research.1 The article noted the difficulty in performing educational research and the lack of protected time available for educational research and that many educational research articles lacked the scrutiny that clinical research articles are expected to have. Six years later progress has been made, but the points made in that article still hold true today. One solution to the issues of medical education research in emergency medicine (EM) is the development of an EM education research group (EMERG), a centralized consortium that will be a more effective and efficient approach to solving these issues.
The concept of EMERG is not unique to our specialty, and there has been a previously published plea for the development of a national center for health professions education research.2 Educational research is a difficult endeavor. Most projects are small and focused primarily on the residents or medical students at that particular teaching hospital or residency program. The results of these projects are difficult to generalize to other programs. Often these projects are published as “pilot studies.” When clinical pilot studies are reported, an effort is often made by others to reproduce the results with larger numbers of patients. For this to occur in educational research, multi-institution participation must occur. This entails a commitment of time, effort, and expertise. Coordination of activities, training of faculty at these institutions, institutional review board (IRB) submissions, and usually a lack of dedicated support staff make this type of collaboration difficult. Additionally, in the classic clinical research paradigm, supporting sites can be reimbursed with grant money. This is uncommon for education research, and often there are too many sites involved for each site’s primary investigator to be granted authorship status, creating further deterrents to collaboration.
However, we have never been pressed more as educators to incorporate best evidence practices into our teaching and administration. The Accreditation Council for Graduate Medical Education (ACGME) has mandated competency training in procedures and chief complaints. Yet, the competency definition is elusive, as are the requirements for maintenance of competence. With the number of ACGME-accredited EM residencies at 156 and rising, there will be at least 156 different ways of fulfilling these training requirements.
Of even greater importance than teaching procedural and chief complaint competencies, the ACGME Outcomes Project now mandates the full integration of the competencies and their assessment of learning and clinical care in Phase 3. Phase 4, which begins in 2011, calls for the expansion of the competencies and assessment to develop models of excellence.3,4 Again, without research into best practices, each residency program is left to develop its own methodology of assessment of the competencies, without assurances of external validity. A national consortium could coordinate research at collaborating institutions, which could result in known reliability and validity of different teaching and assessment strategies. These results would then be generalizable to individual residencies and clerkships.
An additional area of need is in postgraduate education and assessment. Maintenance of certification could be studied and even performed, through a national network.5 It has been proposed that a network of simulation centers be developed that could provide continuing medical eduation (CME) through simulation assessment of individual practicing physicians.6 EMERG could both research and standardize the process for this so that smaller individual centers could participate, as well. This could allow assessment and training of residents and students through this model, as well.
EMERG could take several forms. It could be a virtual organization, coordinated by individuals from a single or multiple organizations within EM that have an interest in educational research. EMERG could be a component of the newly approved Academy for Scholarship in Education in the Council of Emergency Medicine Residency Directors (CORD). Alternatively, multiple organizations could participate in and support EMERG, overseen by a board composed of representatives of the many EM organizations involved in education. Funding of the consortium could come from multiple sources, including foundations, the government, commercial organizations, and individual donations. Educational research should not be different from other areas of clinical research in that small successes may lead to funding opportunities of larger studies.
In summary, a national emergency medicine education research center could be structured to provide:
- • Support and coordination of multi-institution educational projects, including IRB coordination, grant applications, enrollment of institutions, and training for the study participants.
- • Development, implementation, and research into curricular offerings and effectiveness.
- • Development of assessment tools and strategies for resident and medical student education.
- • Research into competency-based education, including chief complaint–based and procedural competency.
- • Strategies for assessment and certification of practicing physicians.
- • Patient safety initiatives by demonstrated improvement in educational outcomes.
An important step toward this model will be made at the 2012 Academic Emergency Medicine consensus conference. Recently announced, this preconference day at the SAEM annual meeting consists of four tracks in which consensus will be formed on priorities for the following issues: 1) research priorities for establishing the effectiveness of didactic and clinical curricula, 2) research priorities for developing evidence-based competency assessment and evaluation, 3) education researcher development and training, and 4) funding and support to perform quality education research. During the meeting an action plan for a national research consortium in EM education will be developed. Organized work toward this agenda will begin this year, as interested stakeholders will investigate existing research consortia and conduct preparatory discussions to shape the conference recommendations and goals.
A national research consortium can and should be developed, given the context of the current hurdles to doing quality education research and the increasing need for evidence-based teaching and assessment. EMERG can serve as a central unifying body for the coordination of educational research, curriculum development, and assessment practices. EMERG can facilitate the development of multi-institution studies, moving education research past single-center studies. EM is a young field and a relatively small community compared to other specialties. Our specialty can capitalize on these assets and lead other specialties by example with the development of a National Emergency Medicine Education Research Center.