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      Simulation-based medical education in Thailand: a cross-sectional online national survey


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          Simulation-Based Medical Education (SBME) is a teaching method commonly used in undergraduate medical education. Although Thai medical schools have developed a system that incorporates SBME, various aspects of that system require improvement. We surveyed medical school administrators, instructors, and students about SBME in their institutions and the obstacles involved in its implementation, as well as their experiences, expectations, and attitudes regarding the current system.


          We conducted a cross-sectional online survey between August 2019 and July 2020 among administrators, instructors, and 6th-year medical students. A structured questionnaire was developed and distributed to volunteers as an online survey. We recorded details about the SBME system as well as participant characteristics, obstacles, experiences, expectations, and attitudes. We used descriptive statistics as appropriate.


          We received responses from 15 (68.2%) administrators, 186 instructors, and 371 (13.7%) sixth-year medical students. SBME was commonly used in teaching and evaluation but less so in research. It was mainly used to improve psychomotor tasks, knowledge, patient care, and communication skills. The expected outcomes were improvements in students’ performance, knowledge, and practice. The clinical courses were longer and had fewer participants than the pre-clinical courses. Obstacles encountered included shortages of faculty and simulators, time and space limitations, inadequate faculty training, and insufficient financial support. The administrators surveyed had positive attitudes toward SBME. Medical students reported having experience with SBME and strongly agreed that it was beneficial; however, they expected fewer students per class and more learning time to be devoted to these methods.


          SBME in Thailand is focused on teaching and assessment. The system could be improved through better-trained faculty, greater available space, more simulators, and sufficient funding. There were also some aspects that failed to meet students’ expectations and need to be addressed. However, participants expressed positive attitudes toward SBME.

          Trial Registration

          TCTR20210524003 (Thai Clinical Trials Registry).

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12909-022-03369-9.

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          Technology-enhanced simulation for health professions education: a systematic review and meta-analysis.

          Although technology-enhanced simulation has widespread appeal, its effectiveness remains uncertain. A comprehensive synthesis of evidence may inform the use of simulation in health professions education. To summarize the outcomes of technology-enhanced simulation training for health professions learners in comparison with no intervention. Systematic search of MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Original research in any language evaluating simulation compared with no intervention for training practicing and student physicians, nurses, dentists, and other health care professionals. Reviewers working in duplicate evaluated quality and abstracted information on learners, instructional design (curricular integration, distributing training over multiple days, feedback, mastery learning, and repetitive practice), and outcomes. We coded skills (performance in a test setting) separately for time, process, and product measures, and similarly classified patient care behaviors. From a pool of 10,903 articles, we identified 609 eligible studies enrolling 35,226 trainees. Of these, 137 were randomized studies, 67 were nonrandomized studies with 2 or more groups, and 405 used a single-group pretest-posttest design. We pooled effect sizes using random effects. Heterogeneity was large (I(2)>50%) in all main analyses. In comparison with no intervention, pooled effect sizes were 1.20 (95% CI, 1.04-1.35) for knowledge outcomes (n = 118 studies), 1.14 (95% CI, 1.03-1.25) for time skills (n = 210), 1.09 (95% CI, 1.03-1.16) for process skills (n = 426), 1.18 (95% CI, 0.98-1.37) for product skills (n = 54), 0.79 (95% CI, 0.47-1.10) for time behaviors (n = 20), 0.81 (95% CI, 0.66-0.96) for other behaviors (n = 50), and 0.50 (95% CI, 0.34-0.66) for direct effects on patients (n = 32). Subgroup analyses revealed no consistent statistically significant interactions between simulation training and instructional design features or study quality. In comparison with no intervention, technology-enhanced simulation training in health professions education is consistently associated with large effects for outcomes of knowledge, skills, and behaviors and moderate effects for patient-related outcomes.
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            • Abstract: found
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            Barriers to Faculty Pedagogical Change: Lack of Training, Time, Incentives, and…Tensions with Professional Identity?

            The time has come for all biology faculty, particularly those who teach undergraduates, to develop a coordinated and sustainable plan for implementing sound principles of teaching and learning to improve the quality of undergraduate biology education nationwide. (Vision and Change, 2011, xv) Recent calls for reform, such as Vision and Change: A Call to Action, have described a vision to transform undergraduate biology education and have noted the need for faculty to promote this change toward a more iterative and evidence-based approach to teaching (American Association for the Advancement of Science [AAAS], 2011). A key challenge is convincing many faculty—not just a handful of faculty scattered across the country but the majority of life sciences faculty in every institution—to change the way they teach. Few would disagree that this is an ambitious goal. Change is difficult in any setting, but changing academic teaching appears to be especially tricky. Calls for change imply that the pedagogical approaches our own professors and mentors modeled and taught us might not be the best way to engage large numbers of diverse populations of undergraduates in our discipline. This effort potentially also involves telling faculty that what they have been doing for the past 5, 10, or even 30 yr may not the most effective approach, especially for today's students. Widespread change in undergraduate biology teaching—or in any of the sciences for that matter—has been documented to be difficult (Henderson et al., 2011). The general perception is that while there are pockets of change driven by individual faculty, there is little evidence that the majority of our faculty members are reconsidering their approach to teaching, despite dozens of formal policy documents calling for reform, hundreds of biology education research publications on the subject, and the availability and award of substantial amounts of external grant funding to stimulate change toward evidence-based teaching (Tagg, 2012). In fact, it is somewhat perplexing that we as scientists are resistant to such change. We are well trained in how to approach problems analytically, collect data, make interpretations, form conclusions, and then revise our experimental hypotheses and protocols accordingly. If we are experts at making evidence-based decisions in our experimental laboratories, then what forces are at play that impede us from adopting equally iterative and evidence-based approaches to teaching in our classrooms? What can we—as members of a community of biologists dedicated to promoting scholarly biology teaching—do to identify and remove barriers that may be impeding widespread change in faculty approaches to teaching? A substantial body of literature has highlighted many factors that impede faculty change, the most common of which are a lack of training, time, and incentives. However, there may be other barriers—unacknowledged and unexamined barriers—that might prove to be equally important. In particular, the tensions between a scientist's professional identity and the call for faculty pedagogical change are rarely, if ever, raised as a key impediment to widespread biology education reform. In this article, we propose that scientists’ professional identities—how they view themselves and their work in the context of their discipline and how they define their professional status—may be an invisible and underappreciated barrier to undergraduate science teaching reform, one that is not often discussed, because very few of us reflect upon our professional identity and the factors that influence it. Our primary goal in this article is to raise the following question: Will addressing training, time, and incentives be sufficient to achieve widespread pedagogical change in undergraduate biology education, or will modifying our professional identity also be necessary? FOCUSING ON THE BIG THREE: LACK OF TRAINING, TIME, AND INCENTIVES Insufficient training, time, and incentives are among the most commonly cited barriers for faculty change, and the focus of most of the current efforts to understand and promote faculty pedagogical change (Henderson et al., 2010, 2011; AAAS, 2011; Faculty Institutes for Reforming Science Teaching [FIRST] IV, 2012; National Academies of Science/Howard Hughes Medical Institute [NAS/HHMI], 2012). In terms of training, many faculty have indicated they feel ill-equipped to change the way they teach and thus would like access to structured, formal training. Unsurprisingly, we as faculty may not be knowledgeable about what constitutes a student-centered classroom (Hativa, 1995; Miller et al., 2000; Winter et al., 2001; Hanson and Moser, 2003; Luft et al., 2004; Yarnall et al., 2007) or we may be unconvinced as to whether new teaching methods are really more effective than traditional instruction (Van Driel et al., 1997; Miller et al., 2000; Winter et al., 2001; Yarnall et al., 2007). Even if faculty are aware of reform efforts, science faculty will most likely not have had training in these types of teaching methods (Rushin et al., 1997; Handlesman et al., 2004; Ebert-May et al., 2011). Vision and Change specifically highlights the need for training of early-career scientists, including postdoctoral fellows and assistant professors (AAAS, 2011). Efforts such as the NSF-funded FIRST IV program and the NAS/HHMI Summer Institutes for Undergraduate Biology Education are examples of programs intended to provide postdoctoral scholars and faculty of all ranks, respectively, with the needed expertise in innovative teaching through hands-on training (FIRST IV, 2012; NAS/HHMI, 2012). Although it is too early to gauge the long-term success of these programs, one wonders whether some of these training efforts may be hindered by the lack of buy-in from the home institutions. After faculty go to nationally or regionally organized training workshops and become excited about implementing new teaching strategies, are they met with support or resistance from their colleagues upon return to their home institutions? Furthermore, trying to achieve pedagogical change through 1-d or even 1-wk training sessions seems incongruent with the notion that pedagogical change for any instructor is an iterative and ongoing process. Even the most well intentioned of us forget what we learned, need extra practice, and often revert to our old habits when we are, inevitably, pressed for time. So although it is necessary to provide scientists with training opportunities demonstrating new ways of teaching, training alone is likely insufficient by itself to achieve lasting pedagogical change. What about issues of time? With the often-competing demands of research and teaching, faculty often find it difficult to carve out sufficient time to reflect deeply upon their teaching. While faculty at different types of institutions have varying degrees of teaching responsibilities, faculty at most 4-yr institutions are also required to do research and obtain significant external grant funding. Although this expectation is most explicit at R1 research institutions, it also exists at many comprehensive institutions, and even at small liberal arts colleges. Regardless of current faculty teaching loads, there is no doubt that the process of changing an instructional technique is time- and labor-intensive (Krockover et al., 2002; Howland and Wedman, 2004; Stevenson et al., 2005; Schneider and Pickett, 2006; Malicky et al., 2007). Additionally, research has shown that interactive teaching, as compared with traditional lecturing, typically takes more preparation time (Miller et al., 2000; Hanson and Moser, 2003; Pundak and Rozner, 2008). Thus, not only will the actual process of change take more time, but we are asking faculty to shift to a method that might be, by its very nature, more time-consuming. Institutional recognition of this fact, and corresponding allowance in faculty schedules, will thus be critical to accomplishing widespread adoption of evidence-based teaching strategies. In addition, for such changes to be made, there needs to be an incentive for faculty to modify their pedagogical approach; even though time is necessary, time alone is likely not sufficient for widespread change to occur. Incentives likely drive most of our professional decisions, and teaching is no exception. If we as faculty are indeed provided the requisite training and time to enact changes in our teaching, then there must also be a concomitant reason why we should want to change. Research has demonstrated that even if faculty are interested in changing their pedagogical approach, few incentives are available to spur this action (Hativa, 1995; Walczyk and Ramsey, 2003; Gibbs and Coffey, 2004; Weiss et al., 2004; Wilson, 2010; Anderson et al., 2011). Many argue that if change takes time and training, then faculty need to be compensated for their efforts in the form of lower teaching loads, financial benefits, recognition for tenure, teaching awards, or even, at the most basic level, verbal acknowledgment from colleagues and supervisors. Research has shown that in many universities there are few to no rewards for teaching in novel ways or introducing evidence-based strategies (Kember and McKay, 1996; Frayer, 1999; Krockover et al., 2002; Romano et al., 2004). In fact, there are some reports that change in instruction can lead to poor teaching evaluations, due to student resistance to change, which can negatively affect progression to tenure (Anderson, 2002, 2007). Until universities reward teaching as much as research (Hannan, 2005; Porter et al., 2006) or find ways to better integrate teaching and research (Kloser et al., 2011), the pressure is on faculty, in particular pretenure faculty, to spend the majority of their time on research, sometimes at the expense of high-quality teaching or any attention to the constant calls for change in teaching practice. The needs for training, time, and incentives are the most commonly cited impediments to widespread change in undergraduate biology faculty teaching practice, and indeed these are real and present barriers. However, let us pause. Imagine a university that provides faculty with all the training, all the time, and all the incentives faculty needed—would that be enough for all biology faculty or even the majority of biology faculty to adopt or build on pedagogical reform? While these “big three” factors are likely necessary for change to occur, it is far from clear that they are sufficient for it to happen. Focusing our efforts exclusively on training, time, and incentives ignores at least one additional and potentially key barrier to faculty change that is largely absent from change discussions: the role of a scientist's professional identity. INTRODUCING THE CONCEPT OF A SCIENTIST'S PROFESSIONAL IDENTITY The process by which we become scientists is often so long and arduous that few of us may have actually taken the time to reflect what constitutes our professional identities as scientists. In the midst of mastering laboratory techniques and crafting research grants, we are also learning, often subconsciously and implicitly, what professional norms we need to obey, or at least tolerate, to be perceived as successful academic scientists. Identity is most often thought about in the social sciences in terms of personal identity or how a person thinks of himself or herself in the context of society. Based on the ideas of Mead (1934) and Erikson (1968), identity is not a stagnant property, but rather an entity that changes with time, often going through stages, and is continuously modified based on the surrounding environment. It has been described as “being recognized as a certain kind of person in a given context” (Gee, 2001, p. 99). For the purposes of this article, we consider scientists’ professional identities to be how they view themselves and their work in the context of their disciplines and how they accrue status among their professional colleagues as academic scientists. These aspects are heavily influenced by the training specific to academic scientists, including course work, laboratory experiences, and the everyday culture and rewards of the scientific profession. Peer acceptance, or more formally the process of peer review, is also closely tied to the development of a professional identity in the sciences. Both the publication of the research we accomplish and garnering the resources we need for experimental work, either at our institution or from national funding agencies, are generally dependent on positive peer review and a shared professional identity with these peers. Thus, the development of a professional identity is not unlike the development of a personal identity but is situated in the context of a discipline and thus framed by the “rules of membership” of that discipline. If you are an academic scientist, then it is likely you were either explicitly told the rules of academic science, or you were able to somehow infer them and make choices to fit in or at least make others think that you fit in. Frustratingly, these rules of professional membership are not always obvious or intuitive, sometimes inadvertently keeping out those who are not afforded opportunities to learn the rules, expectations, and currencies of status within a particular discipline. This has been previously documented as a pivotal problem in the sciences, in particular in attracting and retaining women and people of color in the field (Carlone and Johnson, 2007; Johnson, 2007). While a professional identity is by definition an internalized identity, it guides our external actions and decisions in our profession, including the decisions we make about how we teach. If a scientist has a professional identity that does not encompass teaching at all, or if a scientist has a professional identity he or she feels could be put at risk in his or her discipline and among his or her peers by embracing innovative approaches to teaching, then professional identity becomes a critical barrier in efforts to promote widespread change in undergraduate biology education. WHAT ARE THE TENSION POINTS BETWEEN MAINTAINING ONE'S SCIENTIFIC PROFESSIONAL IDENTITY AND PARTICIPATING IN PEDAGOGICAL CHANGE? Several lines of inquiry support why a scientist's professional identity might interfere with his or her willingness to participate in pedagogical change. We describe here three tension points that individual faculty may commonly encounter when deciding whether or not to participate in biology education change efforts: 1) training cultivates a primarily research identity and not a teaching identity, 2) scientists are afraid to “come out” as teachers, and 3) the professional culture of science considers teaching to be lower status than research and positions scientists to have to choose between research and teaching. Each of these tension points, along with research literature that explores its origins, is presented below. TRAINING CULTIVATES PRIMARILY A RESEARCH IDENTITY AND NOT A TEACHING IDENTITY The first tension point between professional identity and pedagogical change efforts is that scientists are trained in an atmosphere that defines their professional identities primarily as research identities to the exclusion of teaching identities. A scientist's professional identity is shaped by a number of factors, but this socialization into the discipline of science often begins in graduate school (Austin, 2002). For undergraduates who spend considerable time in research labs for summer research projects or honors theses, socialization may begin earlier. However, graduate school is when all future scientists formally enter a learning period about the scientific profession and the cultural norms of the profession, often leading aspiring young scientists to adopt the values, attitudes, and professional identities of the scientists who trained them. Graduate school is the shared playground, where scientists learn the culture and values of the field, as well as how to play the game of professional science. Over the past 30 yr, doctoral and postdoctoral training at research institutions has put a tremendous emphasis on research, immersing students in the culture of research for a scientific discipline, while often ignoring teaching (Fairweather et al., 1996; Boyer Commission on Educating Undergraduates in the Research University, 2002). While some time spent as a teaching assistant may be required, in general there is no requirement for evidence of developing competency in teaching. Consequently, it has been asserted that there is a profound disconnect between the training that students are receiving in doctoral programs and the careers that many of these students will ultimately enter (Tilghman, 1998; Golde and Dore, 2001; Austin, 2002; Dillenburg, 2005; Dillenburg and Connolly, 2005; Fuhrmann et al., 2011). Faculty positions at most colleges and universities are primarily teaching positions, and even faculty positions at research institutions require some teaching, but the majority of graduate students in the sciences are only taught how to do research. What support is given to those graduate students who are interested in developing teaching skills in graduate school? A growing number of institutions have graduate student and faculty teacher-training programs (Rushin et al., 1997; Austin et al., 2008; Ebert-May et al., 2011). However, despite recommendations for the implementation of pedagogy-focused training in graduate school, programs focused on innovative teaching strategies are often voluntary and serve only a small percentage of the overall population of graduate students. Currently, there are no federal mandates associated with training grants that would require pedagogical training for future scientists. As a result, most graduate students still learn how to teach through an “apprenticeship of observation” (Lortie, 1975; Borg, 2004). They model their own teaching approaches after their professors. Students without explicit training tend to teach “naively” (Cross, 1990), often relying on inaccurate assumptions about teaching and learning. Most college classes in the sciences are taught in the traditional lecture format, so the majority of beginning science instructors equate teaching with lecturing, both linguistically and conceptually (Mazur, 2009). Without explicit training during graduate school, postdoctoral training experiences, or even early faculty years, these inaccurate assumptions about teaching appear to persist and become solidified. Additionally, even if a scientific trainee or early-career faculty member is interested in adopting pedagogical approaches different than the norm, there may be peer pressure from scientific colleagues to conform to traditional methods of teaching (Van Driel et al., 1997; Gibbs and Coffey, 2004). Not only is teaching not a formal or recommended component of postdoctoral training, some faculty advisors even view teaching as completely ancillary to, and a distraction from, the training that postdoctoral scholars need, ostensibly to become professors. The National Institutes of Health's Institutional Research and Academic Career Development Awards (NIH IRACDA) postdoctoral program is a notable exception to this. IRACDA postdoctoral fellows conduct research in basic science at R1 institutions and concurrently have formal, mentored teaching experiences at minority-serving institutions (IRACDA, 2012); however, IRACDA currently serves only a limited number of postdocs. Additionally, the FIRST IV program also seeks to provide postdoctoral fellows with training and mentored teaching experiences as they transition to faculty roles, but again, this is an option for a limited number of postdocs (FIRST IV, 2012). Both of these programs could serve as models for the more widespread integration of teaching and research into the scientific training and professional identity development of postdoctoral fellows. If scientists do not consider teaching part of their professional identities, then how can we expect them to change their own teaching and, even more importantly, support and encourage others to change as well? SCIENTISTS ARE AFRAID TO “COME OUT” AS TEACHERS A second tension point between maintaining one's professional identity and participating in pedagogical change is that embracing a teaching identity as part of one's scientific professional identity can be perceived as a liability and something to be hidden. Mark Connolly and colleagues have documented that some graduate students who are interested in teaching are afraid to “come out” as teachers (Connolly, 2010). They fear that they will be marginalized and discriminated against by their scientific peers and mentors. Some faculty advise graduate students to hide their interest in teaching; these mentors worry that the rest of academia will not take such students seriously as researchers (Connolly, 2010). There have been reports that some research professors, upon learning their graduate students are interested in teaching, no longer spend the same amount of time mentoring them. Significantly, some doctoral students have faculty advisors who do not allow them to engage in any activities outside laboratory work (Wulff et al., 2004). Some advisors are of the mentality that graduate students should always be at the bench and that any time devoted to teaching negatively affects research, despite a recent study indicating that teaching while doing research might improve research skills (Feldon et al., 2011). Unfortunately, this approach leaves students with both a skill set and perspective on science that is very narrowly focused. Postdoctoral scholars often face similar problems but often without the larger support structure that many graduate students have. Because postdocs tend to be fairly isolated in individual labs, they are even more dependent on their research mentors for guidance about career paths. If graduate students and postdoctoral scholars fear the ramifications of admitting that teaching is part of their identity, an interest in teaching can be internalized as something illicit, to be kept hidden from peers and mentors. Even those who are interested in continuing in academia to become professors are encouraged to limit the amount of teaching they do. This implicit, if not explicit, research-centric norm of graduate school can result in a student's internal conflict between developing a professional identity as a research scientist and a desire to also develop part of a professional identity as a teacher. As students struggle to reconcile these aspirations, they can fall prey to believing that teaching is inherently inferior to research and that if they are to succeed in the academic world of science, they should focus exclusively on research. For a graduate student with a strong interest in teaching, this could even result in doubts about his or her ability as a scientist. In the process of embracing a teaching identity, budding scientists potentially risk their status as researchers, as well as their professional identities, status, and even membership within the scientific community. THE PROFESSIONAL CULTURE OF SCIENCE CONSIDERS TEACHING TO BE LOWER STATUS THAN RESEARCH AND POSITIONS SCIENTISTS TO HAVE TO CHOOSE BETWEEN RESEARCH AND TEACHING Finally, a third tension point between maintaining one's professional identity and participating in pedagogical change is that teaching is often regarded as lower status than research in the scientific disciplines (Beath et al., 2012). A large part of this disparity in status originates from the culture of individual laboratories, departments, institutions, and even the discipline as a whole (Cox, 1995; Quinlan and Akerlind, 2000; Marbach-Ad et al., 2007). However, it is also reinforced by the general salary and status structures with regard to teaching within our society, in which teaching is generally considered to be not as well compensated for or afforded as much respect as many other professions. Faculty members who want to be perceived as successful and “real” scientists may have purposely avoided integrating teaching into their professional identities, because they feel it could undermine their scientific status with their colleagues, their departments, and their institutions. These actions might even be subconscious, a natural result of years of being surrounded by other faculty who view research as superior to teaching and hearing the age-old adage “those who can, do; those who can't, teach.” This contributes to a professional identity that deemphasizes teaching specifically to maintain high professional status, both within the confines of the institution and within the larger context of the discipline. It is perhaps unsurprising then that the community of science itself does not generally assume that a research identity and a teaching identity can coexist within the same individual. Unfortunately, participation in teaching or research is often seen as a choice, as a set of alternatives rather than an integrated whole. A recent finding from the Longitudinal Study of STEM Scholars (Connolly, 2012) concluded that graduate students are interested in pursuing careers that involve teaching. However, when this finding was reported more widely, it was misinterpreted to mean that these students did not want to do research. Quite the contrary, these students were expressing an increased interest in teaching that was independent of their commitment to or interest in research (M. Connolly, personal communication). Similarly, a recent publication in PLoS One also reinforced this tension point through a survey asking graduate students to rate the attractiveness of certain career paths and gave the choices of “a faculty career with an emphasis on teaching” and “a faculty career with an emphasis on research” with no option for “a faculty career that involves equal amounts of teaching and research,” thereby, likely unknowingly, setting up the mutually exclusive choice between teaching and research (Sauermann and Roach, 2012). Many scientific trainees and current faculty may want careers that involve a balance of both, and the perception that they need to choose one or the other makes it even harder for them to adopt teaching identities without feeling they must sacrifice their research identities, which are likely their primary source of professional status. Unfortunately, in the professional culture of science, an emphasis on teaching in one's professional career can often be mischaracterized as a choice made because one either cannot do research or does not want to do research. BRINGING PROFESSIONAL IDENTITY TO THE FOREFRONT OF CHANGE DISCUSSIONS: SHIFTING FROM AN INSTITUTIONAL DEFICIT MODEL TO A DISCIPLINE DEFICIT MODEL Given the tension points described above, professional identity may not be just one additional barrier to faculty pedagogical change; it could be hypothesized to be a key underlying reason why change strategies addressing training, time, and incentives have to date had only limited success in engaging broad groups of faculty in widespread biology education reform. If biology faculty are potentially entrenched in a professional identity grounded in a research identity to the exclusion of a teaching identity, then it would behoove us, as a community, to consider the possibility that professional identity could undercut all our efforts centered on the “big three” change strategies. As a scientist grounded in a research identity, one may view pedagogical training with skepticism, considering it to be a waste of time and effort, in particular if the training tries to promote teaching methods that depart from the cultural teaching norm in science: lecturing. In addition, it follows that extra time might not be the answer to promoting faculty change, if tensions with professional identity are at play. If we have extra time in the day, we may more likely spend that time on research activities that raise our status with professional colleagues and are aligned with our professional identities. Finally, tensions between a professional scientific identity and teaching reform may, unfortunately, trivialize any teaching incentives that are developed. If scientists have professional identities that are predominantly research identities, then a Nature report or Science article will always be viewed as higher status than a departmental, university-wide, or even a national teaching award. Giving incentives for teaching will likely only have positive effects if we, as a scientific community, somehow begin to value those incentives to the same degree as research-based incentives. A common approach when we think about the reasons why faculty might not change the way they teach is to raise questions about the culture of individual institutions. We assume that the department or institution does not offer training opportunities, release time to develop new courses, or incentives for teaching in scientific ways. This could be broadly classified as an “institutional deficit model,” in which the institution lacks what is needed for reform. Certainly such problems can be inhibiting, and where they exist, institutional reform may be necessary to promote widespread involvement of faculty in pedagogical change. Many of the current pedagogical change strategies and frameworks operate within this model (Henderson et al., 2010, 2011). However, if we approach the issue of faculty change through the lens of professional identity, we will also want to consider a “discipline deficit model.” Faculty are not only members of their campuses, but also of their national professional societies and the professional community of scholars working in their particular fields. Perhaps it is not only a matter of institutions needing to provide training, time, and incentives, but also a need for a disciplinary culture shift, such that there are both a sufficient level of status attached to teaching and a critical mass of individuals who have professional identities that include teaching. Some might argue that regardless of what institutions offer, most faculty will not change the way they teach, because they view teaching as accessory to their professional identities, derived not from their institutions, but rather from their disciplines, which are cross-institutional. Finally, there is clearly a need for much more empirical research on all the potential barriers to faculty pedagogical change, but especially on the role of professional identity in determining whether a scientist chooses to participate in biology education reform efforts. Would efforts to broaden the professional identities of scientists to include teaching accelerate pedagogical change? To what extent do graduate or postdoctoral pedagogical training programs alter the professional identities of these early-career scientists? What are the long-term impacts of programs such as FIRST IV, NIH's IRACDA, or the HHMI/NAS Summer Institutes, in particular in terms of whether participants are more or less likely to engage in pedagogical reform compared with others? How would biologists—with a range of involvement in teaching and biology education reform efforts—themselves describe their professional identities and how these identities shape their professional choices and aspirations? LOOKING FORWARD: HOW COULD WE ALTER OUR PROFESSIONAL IDENTITIES TO BE MORE INCLUSIVE OF TEACHING? To achieve widespread pedagogical change toward more iterative and evidence-based approaches, it appears that we need to find ways to challenge the assumption that a scientist's professional identity should be primarily research-focused and consider ways in which teaching could become more integrated into the fabric of the discipline. Three possible areas for action are explored below. First, one place to start would be to broaden the goals and content of doctoral and postdoctoral training. Instead of having a handful of unstructured teaching requirements, students could be enrolled in training programs specifically designed to give them mentorship and support to teach in scientific ways. Specific faculty could be identified as teaching mentors for graduate students, who in turn could be given increased teaching opportunities and responsibilities as they progressed through the program. An important caveat is that these teaching mentors would themselves need to be properly trained in scientific teaching. In addition to excellence in research, excellence in teaching would also be an expected outcome of graduate education. One could envision a requirement in which dissertations included a chapter that provided evidence of scholarship and achievement in teaching. Those agencies and foundations that fund graduate education in the life sciences could take the lead in requiring such pedagogical training and deep experiences with teaching for the graduate students they support. By better integrating teaching within the current structure of scientific training, one could provide the next generation of scientists with a better foundation and skill set and also foster a teaching identity as part of their professional identities. A second way to better align professional identity with the goals of widespread pedagogical change may be to target the place where many faculty derive and maintain their professional identities: scientific journals. Publication and peer review in these journals is an important aspect of professional identity. Some scientific journals are beginning to include education sections, but these are often commentary, rather than research articles. An exception to this is Science magazine, in which a number of education articles have appeared as research reports over the past few years. By including articles about scholarly teaching and education research, scientific journals can influence scientists to view scientific teaching as a part of their professional activities. Notably, a number of scholarly journals that maintain high standards of peer review and national/international distribution have been developed in recent years that provide biologists with a venue for publication of their pedagogical research. CBE—Life Science Education, supported by the American Society for Cell Biology and the HHMI, is a good example of growth in this area. There has been a recent push to integrate peer-reviewed education articles from journals such as CBE-LSE into the tables of contents of scientific journals of professional societies, to provide more faculty easier access to education articles most relevant to their fields. This may enable scientists to view education articles and often by association, teaching, as important characteristics of their professional identities. Third, a key venue in which scientists construct and maintain their professional identities is at scientific professional meetings. These meetings were generally founded with a research focus, but many professional societies now have education sections within their annual meetings. Unfortunately, these are often not well integrated into the rest of the scientific meeting—sometimes entailing additional costs and being located in different venues and held on different days—reinforcing the concept that the education meeting is distinct from the research meeting. In addition, how are education research findings presented at these conferences? Ironically, the oral presentations are almost always presented as lectures, even when the topic of the talk is about how lecturing is not very effective! This illustrates how prevalent and influential the assumptions are about the expected norms of behavior and interaction at a scientific conference. Even biologists who have strong teaching identities and are well aware of more effective ways to present findings choose, for whatever reason (professional culture? professional identity?), not to employ evidence-based teaching and communication methods in the venue of a scientific conference. And while workshops and poster sessions would allow a higher level of interaction and dialogue—both generally more effective means of conveying information than oral presentations—these venues are often perceived as less important, lower status, and less stringent for high-quality data in the culture of scientific conferences. IN CONCLUSION… The challenge of addressing tensions between professional identity and pedagogical reform is a complicated issue. Importantly, we need to keep in mind that we as scientists ourselves are the ones responsible for the current state of our professional identities. We as academic scientists set up the tenure structure, publication requirements, and training requirements and dictate the group norms and expected modes of interaction in our own disciplines. We have created and contributed to a culture of science in which research generally has higher status than teaching. Some faculty continue to perpetuate the myth that a researcher should not want to teach and broadcast that value judgment to new graduate students, who are trying to forge their way as scientists. But we, as a professional community, also have the opportunity to take steps to broaden our professional identities and in doing so, address a potentially critical barrier in achieving widespread biology education reform.
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              Comparative effectiveness of instructional design features in simulation-based education: systematic review and meta-analysis.

              Although technology-enhanced simulation is increasingly used in health professions education, features of effective simulation-based instructional design remain uncertain. Evaluate the effectiveness of instructional design features through a systematic review of studies comparing different simulation-based interventions. We systematically searched MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous review bibliographies through May 2011. We included original research studies that compared one simulation intervention with another and involved health professions learners. Working in duplicate, we evaluated study quality and abstracted information on learners, outcomes, and instructional design features. We pooled results using random effects meta-analysis. From a pool of 10,903 articles we identified 289 eligible studies enrolling 18,971 trainees, including 208 randomized trials. Inconsistency was usually large (I2 > 50%). For skills outcomes, pooled effect sizes (positive numbers favoring the instructional design feature) were 0.68 for range of difficulty (20 studies; p < 0.001), 0.68 for repetitive practice (7 studies; p = 0.06), 0.66 for distributed practice (6 studies; p = 0.03), 0.65 for interactivity (89 studies; p < 0.001), 0.62 for multiple learning strategies (70 studies; p < 0.001), 0.52 for individualized learning (59 studies; p < 0.001), 0.45 for mastery learning (3 studies; p = 0.57), 0.44 for feedback (80 studies; p < 0.001), 0.34 for longer time (23 studies; p = 0.005), 0.20 for clinical variation (16 studies; p = 0.24), and -0.22 for group training (8 studies; p = 0.09). These results confirm quantitatively the effectiveness of several instructional design features in simulation-based education.

                Author and article information

                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                20 April 2022
                20 April 2022
                : 22
                : 298
                [1 ]GRID grid.9786.0, ISNI 0000 0004 0470 0856, Department of Anesthesiology, Faculty of Medicine, , Khon Kaen University, ; Khon Kaen, 40002 Thailand
                [2 ]GRID grid.10223.32, ISNI 0000 0004 1937 0490, Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, , Mahidol University, ; Bangkok, 10700 Thailand
                [3 ]GRID grid.7130.5, ISNI 0000 0004 0470 1162, Department of Anesthesiology, Faculty of Medicine, , Prince of Songkla University, ; Songkla, 90110 Thailand
                [4 ]GRID grid.10223.32, ISNI 0000 0004 1937 0490, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, , Mahidol University, ; Bangkok, 10700 Thailand
                [5 ]GRID grid.512982.5, ISNI 0000 0004 7598 2416, Chulabhorn Royal Academy, ; Bangkok, 10210 Thailand
                [6 ]GRID grid.10223.32, ISNI 0000 0004 1937 0490, Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, , Mahidol University, ; Bangkok, 10400 Thailand
                [7 ]GRID grid.412434.4, ISNI 0000 0004 1937 1127, Department of Emergency Medicine, Faculty of Medicine, , Thammasat University, ; Pathumthani, 12120 Thailand
                [8 ]GRID grid.10223.32, ISNI 0000 0004 1937 0490, Simulation Center for Military Medicine, , Phramongkutklao College of Medicine, ; Bangkok, 10700 Thailand
                [9 ]GRID grid.7132.7, ISNI 0000 0000 9039 7662, Department of Emergency Medicine, Faculty of Medicine, , Chiangmai University, ; Chiangmai, 50200 Thailand
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                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                : 17 October 2021
                : 12 April 2022
                Funded by: Medical research network of the Consortium of Thai Medical schools
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                medical education,simulation training,thailand
                medical education, simulation training, thailand


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