As educational theories are increasingly used in medical education research there are concerns over how they are used. In today’s article, the authors share their critical analysis of how and why theories are used in #meded. Why do we use theories in MedEd research….and more importantly, should we? Listen in to hear the co-hosts discuss.
KeyLIME Session 251
McGrath et. Al. 2019. You say it, we say it, but how do we use it? Communities of practice: Acritical analysis Medical Education. [Epub ahead of print]
Linda Snell (@LindaSMedEd)
The title of this paper is misleading: you might think it is all about CoPs (which it is in part) but it actually uses the topic or concept or conceptual framework (I hesitate to call it a theory although the authors do) of CoPs to dive deeper into how and why theories are used in MedEd.
Why do we/ should we use theories in MedEd research? Theories both offer a conceptual frame on which to build and can help explain complex phenomena. Theory develops iteratively where ideas and data are assessed, and they ‘need to align both with the chosen research methodology and with the data collection method to make judgements about research phenomena’.
Remember way back in the early 2000s when some prominent medical educators called for ‘evidence- and theory-informed MedEd research that use explicit conceptual frameworks? Now it is hard to get anything published unless a theory or framework is invoked, although I suspect that much of the time these are add-ons that are not informing or explaining research results. So now there are ‘growing concerns about the (a) rigour, quality and transparency of qualitative research methods and theory …and (b) how theories are used, their depth and their intended meaning.’
The authors chose CoP as they claim it ‘represents a widely-used theory in medical education research, is an emerging theory which has change over time, and represents a predominantly constructivist, social-science theory’. They give a nice review of the development of the concept of CoPs and explain the evolution through participation in practice, learning in practice, legitimate peripheral participation, the connection with development of identity, and the features of a CoP that allow it to be built and sustained. The authors also discuss some concerns re the usefulness of the CoP concept.
The authors ‘aimed to critically analyse how theories are used in medical education research’ using Communities of Practice (CoP) as an example in a bid to address ‘the concern addressed in the medical education research context is that theories are used inconsistently and inexplicitly’.
Key Points on the Methods
“A critical analysis was conducted” (!)
‘An analytical and cynical exploration into matters relating to either academics, art or scientific exploration which is aimed to discern and exact out examination and determinism by inquiring into or assessing facts and available data can be defined as a critical analysis.
Critical analysis is written in order to develop a sense of new understanding for readers.’
Lit search appropriate; papers screened: inclusion criteria (1) in one of the 8 leading MedEd journals, (2) ‘stringency’ (?)
Left with 80 relevant articles
“All articles were read and analysed to identify patterns and consistency of use with respect to the CoP concept, by identifying the concept of CoP and directing critical questions to the text, such as:
- How is the concept introduced?
- How often is it used?
- Are the central tenets clarified and discussed?
- Are the changes in theory and concept formation addressed?
- Are tensions in CoP addressed?
Which literature, primary or secondary, is used to convey understanding of the concept?”
As with many qualitative studies there was an iterative process with analysis and findings.
First round of articles (an initial assessment of how CoP was used) discussion reached a consensus on five patterns of use; a second round found no additional themes.
Categories of how is CoP used in medical education research: two of which categories refer to misrepresentative and predominantly cosmetic uses of CoP: off-target and cosmeticizing, and three of which relate to functional ways in which CoP was used in the literature: framing, lensing and transferring.
- Off target: ‘CoP was used sparingly, the core tenets of CoP were not addressed and the primary literature was rarely consulted’, ‘the way in which CoP was portrayed may offer a misrepresentation of meaning, resulting in confusion regarding its use.’
- Cosmeticizing: ‘brief or cursory uses of the CoP concept, without further elaboration and in an overtly cosmetic way; CoP is inserted into the text without further explanation.’ ‘Connection to lit is fleeting / uncritical.’
- Framing: ‘CoP perspective used to position or demarcate studies in a specific research tradition or discourse; functions as a way of nesting the research in a theoretical and conceptual landscape.’ Demonstrates a rationale for research.
- Lensing: ‘CoP is used in the explicit design of a study, e.g. choice of methodology, data and respondents, or to explain empirical findings’. Lensing is the application of the concept to a phenomenon such that it offered insights that increased understanding.
- Transferring: ‘how the findings of a study carry over to different context, into practical work or further studies.’ This is the generalisability
C, D and E each have a different function in moving a paper forward: (thus there must be alignment in paper/project.) All bring clarity
- frame – build a rationale for the study in the current research landscape,
- lens – design of methodology, data analysis of or as a conceptual lens
- transfer and explain findings and show applications in other settings.
A and B show superficial use of theory, ‘theory dropping’, lack of use of literature, do not open door for further exploration, nor unpack the concepts and theories.
The authors conclude… “a considerable number of articles did not offer a rigorous definition of what is meant by CoP but instead used it in a misrepresentative or cosmetic way.
[They] call upon editors and reviewers to ask for for clarity and stringency of use when theory or concepts are evoked in future medical education research articles and call upon our fellow researchers to commit to offering salient, coherent and systematic uses of theory.”
Spare Keys – other take home points for clinician educators
- In a general journal, a sentence or two explaining the methodology is always welcome!
- It’s not just using theory or concepts … it’s using them properly.
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