MD Research Training Pathway – University of Notre Dame Australia

MD Research Training Pathway – University of Notre Dame Australia

Notre Dame Fremantle’s Research Training Pathway  is a spiralling curriculum that engages students from week one and is integrated throughout the degree. Its goal is for all medical students to understand the research process, from inspiration to publication, and to possess the skills needed for critical review of research outputs as a future clinician. 

Why was the program undertaken? 

In 2016 the University of Notre Dame Australia (UNDA) School of Medicine Fremantle undertook curriculum development to align the MBBS degree (Australian Quality Framework level 7 program) with the competencies required of an MD degree (Australian Quality Framework level 9E program) as well as AMC accreditation guidelines. In particular, the curriculum required additional content specific to training clinical scientists. A research training pathway was created to complement the existing curriculum, focussing on evidence-based practice and principles of epidemiology.  

The Research Training Pathway is a spiralling curriculum covering all four years of the MD. It engages students from week one and requires them to undertake research training activities throughout the degree (see Figure 1, below).  Learning is iterative and each assessment forms part of an overarching, continuous learning portfolio across all domains in the MD. 

In first, second and fourth years, assessments in the Research Training Pathway are graded and constitute a small but significant part of each student’s final grade for their year-long unit. In third year, students are enrolled in a separate unit: Systematic Research Inquiry. There are three graded assessments within this unit contributing to an overall ‘non-graded pass’, with the unit being a pre-requisite to progress to the final year of the MD.

The general aim of the Research Training Pathway is to ensure that all medical students understand the research process, from inspiration to publication, and possess sufficient skills for critical review of research outputs as a future clinician.

How was the program implemented?

All Research Training Pathway activities have been designed within an experiential learning paradigm and follow a backward learning design where the final outcome drives the learning objectives along the pathway. The activities are built on the principles of cognitive theory for skill acquisition, articulated and applied by Neil Mehta as “educational mantras” (personal communication Harvard Macy Foundation, 2018). The mantras state that: deep learning occurs when students do the work; frameworks built at the right level allow discussion of exceptions; more time should be spent on conceptual knowledge; a variety of activities help to build conceptual frameworks; students may not know what they don’t know, and assessments are for learning not of learning. In addition, it is important that learning tasks involve a manageable level of intrinsic load, where extraneous cognitive load is reduced so that generative load is fostered and dual coding is promoted.

In the Research Training Pathway, scaffolded learning activities provide opportunities for students to create knowledge through critical review of scientific literature, through the completion of a detailed template, by planning a blue-sky research project and, finally, by applying their knowledge in carrying out a research project from inspiration to publication. There are no lectures; students acquire information implicitly as they engage in the material. Each activity in the first three years of their research training pathway is completed in small groups.  Each of the 12 groups per year is facilitated by a PhD-qualified and research-experienced tutor.

Tutors are paid on a sessional basis, thereby reducing the overall cost to the school, and many choose to work with students in all stages of the pathway. A framework has been developed to guide learning and ensure that all students have access to the same learning opportunities. Tutors are provided with detailed handbooks and attend briefing sessions prior to each activity/tutorial, for quality assurance. Students are also provided with a handbook and each activity is supplemented with bespoke learning resources.

The details of the learning activities included in the Research Training Pathway are as follows:

Activity 1: WikiMedicine Project – six hours in orientation week.

First year students learn to edit WikiProject Medicine pages as a vehicle to introduce them to the concepts of scientific writing, copyright, primary/secondary/tertiary sources of evidence, and the power of accessible information for education and self-care. This activity takes approximately six hours and utilises the online tutorials available on Wikipedia. Groups of three students work together to make three to four edits to a self-selected Wikiproject medicine page by the end of their orientation week (Week 1). At the commencement of semester two, the students review the status of their edits and present the statistical data reflecting: number of views, whether their edits were removed or changed, if the quality status of the WikiProject Medicine page had changed and if there had been any relevant discussion on the chat page related to their edits.

Activity 2: Journal article review (JAR) – six 90-minute online tutorials preceded by a 60-minute tutor briefing.

The journal article review activity involves peer learning in a small group context. Nine novel journal articles are chosen each year in accordance with several criteria – including relevance to the Problem Based Learning (PBL) topic being undertaken at the time of the tutorial and the type of research design and population involved in the research – to ensure that all students are exposed to a range of topics, design and analysis techniques.

Each student in a group of nine selects one of the available articles. That student is then required to read, review and present the essence of that article to their tutorial peers, through a five-minute presentation with a one-slide overview and a number of questions for class discussion. Students then engage their peers in the discussion of these questions/issues, typically covering aspects of the paper that they are struggling to understand. Each tutorial group uses breakout rooms on Zoom so that subgroups of two or three students can discuss each question for 10-15 minutes. The main group then provides further input to the lead student to assist them in completing their template. Each template is assessed summatively. Each student submission for a specific paper (one from each of twelve groups) is graded by a single tutor to ensure equity and to be on the alert for plagiarism.

The template requires that students engage in the publication process, methods of evaluating journal and author performance, research design, aims/research questions, hypotheses, methods, analysis and conclusions. It is a chance to ensure that all students acquire the basic information but also provides other more experienced students with opportunities to fill gaps in their knowledge. The template looks deceptively easy, however it provides a strong structure for learning and is a complex undertaking in that it needs to apply equally to a diverse range of research papers.

Activity 3: Journal article review (JAR) – six 90-minute online tutorials preceded by a 60-minute tutor briefing

In second year, students once again engage in a format nearly identical to that of 1^st year, with the exception that the questions in the second-year journal article review template require students to engage in higher-order thinking. They are required to make inferences, critically evaluate, compare and contrast research designs, comment on ethical implications and suggest alternative strategies.

Activity 4: Systematic research Inquiry – one orientation tutorial, six 120-minute tutorials and a tutor training session. All sessions are conducted online.

In third year, all students are enrolled in a separate unit: Systematic Research Inquiry.  Students work in groups of 10 and are able to sign up to a tutor-led group, based on availability, tutor research background and student preference: tutors post a summary of their areas of interest and expertise and, via a preference system, students can select who they wish to work with.

This unit is pass/fail in nature but involves three graded assessments. Students are required to develop a blue-sky grant proposal (assessment one) and submit it on an abbreviated National Health & Medical Research Council grant template. This template requires students to develop a budget, timeline and description of the personnel required, in addition to a project research design. Students are introduced to the concept of fields of research codes (FOR); in addition, they review ethical implications of their research via the completion of the UNDA HREC ethics application, including participant information sheet, data management and consent form (assessment two). These activities are for experience only and are NOT submitted to the university HREC committee for formal review. Finally, students are required to submit a three-minute video pitch of their grant proposal (assessment three).

Activity 5: Final year research project. Approximately 140 hours.

Students interested in undertaking a research project in their final year of the MD submit a research feasibility template towards the end of Year 3. The feasibility template requires students to report details such as the names of the supervisor/s, the project aims and methods, commentary on data availability and the presence of ethics approvals. They also need to report the type of support they may need to complete the project, noting the gap between their current skills and the requirements of the project. The template provides an opportunity for the research academics to assist students in refining projects so that they can be completed within the time allocation of 140 hours and to minimise any other risks that could lead to non-completion. The responsibility for the provision, organisation and management of projects is consciously placed with the student, to provide them with opportunities to refine higher-level professional skills.

Final approval for projects depends on research merit and completion, and is provided within the first weeks of the student’s final year. Students submit their completed research project in the form of a draft research paper for a selected journal of their choice. They are required to follow the detailed instructions for authors specific to the selected journal and are marked against a rubric including measures for adherence to publication guidelines, scientific communication, research design analysis and interpretation. Each student works with a supervisory team, including an academic employed by the School of Medicine as well as community based clinical scientists who provide the research data. Approximately 12 per cent of students elect to undertake a research project; the remainder undertake a clinical audit sharing a number of attributes with the research project option (i.e. meeting AMC requirements), but run by the Population and Preventative Health domain.

What is the program achieving?

There are two main advantages of the integrated Research Training Pathway: the first and most important involves student learning; the second is also important and involves ongoing education and upskilling for research stream tutors, many of whom undertake other duties within the school.

Firstly, all students have the opportunity to develop an understanding of scientific language and the research process in both a theoretical and applied way. Students who enter the MD with a research qualification report that their research knowledge has been enhanced and broadened. For example, many students say they previously had no understanding of qualitative methods or the financial implications of submitting an article to an open access journal. In completing the templates in first and second year, students become more confident in their ability to critically evaluate the author’s aims against the methods and analysis employed – an area that students frequently report feeling the least confident in. They also gain experience in summarising research involving a variety of research designs for their peers. Graduating students realise that “doing research” and “getting a publication” involves more than simply enthusiasm. The assessments provide them with a detailed overview of the skill sets required to undertake successful research and highlight any gaps they might need to address.

The second advantage of the program involves the professional development and teamwork experienced in the tutor briefings. Most of the tutors have remained in the program since its inception. They enjoy the ability to discuss papers with their colleagues and to share their research skills with students in small groups. In essence being a tutor in the Research Training Pathway provides ongoing professional development in current medical literature and a range of research designs and analysis techniques. The tutors bring with them a range of professional research skills and research backgrounds, including journal editors, experience in qualitative design and laboratory research, making for a rich and informative briefing session in which everyone gains skills.