that? The values that drive medical education scholarship and - PowerPoint PPT Presentation

Why do you care about that? The values that drive medical education scholarship and research AMEE Webinar, 10 May 2017 Ayelet Kuper MD DPhil & Cynthia Whitehead MD PhD The Wilson Centre, University of Toronto

Objectives • By the end of this webinar participants will be able to: • Identify factors that contribute to their identity • Link their identity to their values • Distinguish between value-free and value-laden understandings of the research process • Consider how their values shape their medical education scholarship/research

Outline 1. Introduction to Identity & Values 2. Ways in Which Values Affect Research 3. Values & Medical Education Research 4. Where to from Here?

Introduction to Identity & Values

Who Are We? What Do We Do? • Ayelet Kuper • Physician & Scientist in Medical Education • My research program is driven by the need to question taken-for-granted assumptions, like what counts as medical knowledge or what should be taught in medical curricula • I also help to address the physician knowledge gaps created by those limitations • As I become more senior and can focus on what I value, I’ve been doing more work related to the patient experience and to social justice

Why Do We Do What We Do? • Ayelet Kuper • I grew up in a family that was strongly social justice oriented and politically engaged; I also have many relatives who were refugees or who were affected by war or genocide • Several years after I became a physician I spent several months as the primary caregiver for a critically-ill hospitalized family member, which gave me a new understanding of the nature of the patient experience in the health care system in which I work

Who Are We? What Do We Do? • Cynthia Whitehead • Physician & Scientist in Medical Education • In my program of research I interrogate assumptions that underpin medical education practices, processes, and structures • In so doing, I aim to expand our ideas about what is possible and desirable in medical education • My motivation to work in this way connects to the values of equity and diversity

Why Do We Do What We Do? • Cynthia Whitehead • I am a ‘child of empire,’ born in a British colony and tracing back four generations of relatives who worked as missionaries (educators and doctors) around the world. As an educator, doctor and researcher, I have an interest in decolonizing medicine/medical education locally and internationally.

Many Contributors to Identity • Different frameworks exist for this • For the purposes of this workshop, we will use a four-part framework: • Personal • Professional • Social/Cultural • Contextual

Many Contributors to Identity • Personal • Your own personal story • The stories of your family and local community • Recent events • History passed down from previous generations • Professional • Your education, training, and/or work experience • As an academic, a clinician, an educator, etc.

Many Contributors to Identity • Social/Cultural • An identity you take on for yourself because of your engagement with a cultural, religious, or other group • Contextual • An identity imposed upon you because of other people’s assumptions about you and because of power dynamics active in your context • In our context in Canada, relevant factors include things like class, income, job, gender, race, religion, age, and (dis)ability • In your context, these categories (or perhaps the hierarchy of what’s better or worse within them) might be quite different

Writing Exercise Part 1 • The technology limits what we can do interactively • Instead of a Think-Pair- Share exercises, we’ll do Think-Write exercises (and we can try to share a bit as a group if some of you want to) • In our experience, writing exercises with optional sharing can actually be better for potentially sensitive, personal subjects

Writing Exercise Part 1 • Take a minute to list three things about yourself (which could be personal, professional, social/cultural, or contextual) that contribute to the ways in which you see the world • After the next question/slide we will try to share some answers if the technology works and if anybody wants to share (entirely optional)

Writing Exercise Part 2 • For each one of those three (personal, professional, social/cultural, or contextual) things, is there • Something you focus on in your professional life (academic, clinical, research, admin, other) because of it; AND/OR • Something that you deliberately choose to avoid in your professional life (academic, clinical, research, admin, other) because of it; AND/OR • Something that you would like to focus on in your professional life (academic, clinical, research, admin, other) because of it but don’t (and why don’t you?) • Write for 2-3 minutes, then optional reporting back

Reporting Back • If you want to share, type into the comment box now and we will read it aloud to the group • Whether or not you want to share, keep what you’ve written for now – we will work with it again later on in the Webinar

Identities and Values • This is supposed to be a seminar about values in research • So why are we talking about our identities and how those identities link to what we do in our work? • Our identities affect how we see the world (what we do, what we think is important, and what we value) – so they affect the research questions we ask and the ways in which we choose to answer them

History: The Value-Free Ideal • The separation of superstition and intuition from testable, reproducible, and value-free findings was thought to be essential to the scientific revolution that began in the 16 th Century • Ever since (and to this day) many scientists have been passionately committed to the idea of the objective search for truth in the natural world • Within Faculties of Medicine, most approaches to research still assume this “objectivist” stance • Objectivism is: The notion that there is an absolute truth or reality that can be discovered (outside of an individual’s feeling, imagination, and interpretation), so knowledge is neutral and objective

History: The Value-Free Ideal • Since most medically-related research is conducted within this objectivist paradigm, the history and values of the researcher are still seen as having little relevance in light of the ‘truths’ being tested or discovered • In this paradigm, “ideal” science is seen as “value - free” (and thus as free of anything, methodological or personal, that would bias its results)

The Value-Free Ideal in MER • Until recently, medical education research (like most medically-related research) was largely objectivist • Many researchers still assert the possibility and desirability of value-free objectivism in MER • e.g., Best Evidence Medical Education (BEME) • BEME aims to “make available the latest findings from scientifically-grounded educational research” and create “a culture of best evidence education amongst individuals, institutions and national bodies,” to end what they describe as medical education’s legacy of reliance on anecdotal or observational studies • BEME’s ideal sources of data come from meta -analyses and randomized controlled trials (RCTs), which proponents argue provide value-free results.

The Value-Laden Thesis • Most contemporary philosophers of science have formed a new understanding of science that claims that values are inherent in all parts of research • From choosing projects worthy of funding … • ... to making judgments about the implications of the findings • They argue that since values affect all aspects of research, they ought to be acknowledged and better understood: • That good science is ‘reflexive’, or self-aware (i.e., conscious of the assumptions which underlie and shape its research) • That not to acknowledge the values inherent in scientific inquiry leaves part of the research process unmonitored • This is called the “value - laden thesis”

Ways in which values affect research A Brief (and Selective) Overview

Extrinsic vs Intrinsic Values • Extrinsic and intrinsic values affect different stages of the research process • Extrinsic values affect science before and after carrying out a study, guiding • The choice to pursue a particular project • How the results of a study are implemented • Intrinsic values affect the research itself, guiding • The appraisal of research data • Choices between competing theories

Social/Cultural Values • The science studies literature has shown the scientific establishment to be an interconnected, homogeneous community that is difficult to infiltrate and to change • The cultural uniformity of those who conduct scientific research means the projects pursued are those that appeal to that particular cultural group • In North America and western Europe, scientists are disproportionately white and male • If a single demographic defines the norms and nature of research, it makes it difficult to notice when one falls into ways of thinking that aren’t ‘objective’ but are taken for granted within that demographic • That makes it easy to miss out on perspectives from which we could interpret data or design experiments more accurately