Aligning structures with values to sustain health professions education research

The sustainability of health professions education (HPE) research is at risk. There are limited resources allocated to HPE research with a failure to align with important changes in HPE and HPE research. Threats to HPE research as described by the three papers in this issue of Medical Education include predominant Eurocentric epistemologies,¹ universal adoption of ‘god terms’ such as patient outcomes and productivity to drive HPE research² and the lack of theoretical framing coupled with hype and accepted ideology regarding innovation and change in HPE.³ Our position is that education leadership can meet the threats to HPE research through examining the changing values underpinning HPE research, engaging with the values of key stakeholders and evolving structures to embrace a values perspective.

Value as defined by Oxford Languages⁴ is ‘the regard that something is held to deserve; the importance, worth, or usefulness of something’. Leaders must not only make explicit the value in supporting educators and HPE research but also critically examine and reframe values implicitly rooted in our culture and in the structures that support HPE research. These implicit values have a powerful influence on who can successfully do education research, the choice of research methodology, the focus of research, resource allocation and what gets published. Leaders should include and engage with indigenous paradigms of education research as presented by McKivett and Paul¹ to strengthen the type and appeal of the research undertaken in an institution. They should advocate for values that alter the current emphasis on patient outcomes and productivity that obscure the contributions of educators and their research agenda as suggested by Varpio and Sherbino.² Leaders and HPE researchers should engage in dialogue to make values explicit in funding opportunities to support education research and in criteria for promotion and retention of HPE researchers.

How can we engage leaders in a values-driven approach to supporting HPE research? Arguably, a ‘god-term’ for leaders in medical institutions is ‘return on investment (ROI)’, and this shapes decision making and resource allocation including investing in HPE educators and research. In our study interviewing leaders in academic medicine and health care,⁵ we explored value factors beyond ROI using the value measurement methodology (VMM) framework with five domains: individual, financial, operational, social/societal and strategic/political. These value factors can be expanded from what we discovered to incorporate contemporary values to sustain HPE research.

In the individual domain, leaders identified the value factors of career and stature of the individual and their personal and professional growth. Expanding should explicitly incorporate supporting diverse faculty to thrive in institutions, have their contributions to the organisation and field recognised and to be promoted as educators and education scholars. Diverse educators are necessary to address gaps in HPE research due to domination of white voices. Leaders should continuously ask: Who is at the table? Who is sponsored to be successful? Whose voices are not being heard? We also argue that the value factor of individual is in itself a ‘god term’ that should be expanded to embrace teams, their importance and contributions.

Leaders described financial value as making the investment, providing tangible support and attracting additional internal and external resources for educators. HPE faculty is deeply committed to all missions of our institutions and is a rich resource for leaders to draw upon to successfully address financial pressures. For example, many clinician educators are leaders in the clinical environment with insight on how to best train our learners and support optimal patient care. Education researchers also bring strong programme assessment skills to evaluate the efficacy of new clinical programmes and systems change. Centring indigenous principles of relationality, holism and interconnectedness to solve institutional financial challenges make us stronger institutions.

Critical operational value factors espoused by leaders were recruitment and retention of faculty. This value must be expanded to include educators and education researchers who are underrepresented in medicine and/or employ diverse research methodologies. Leaders require diverse HPE educators to train our future health care providers to address social and societal health needs in the context of climate change and through incorporating anti-racism/anti-oppression principles across the curriculum. The measure of their ‘productivity’ should include impact on the curriculum and clinical environment.

Within the social/societal domain, leaders were interested in dissemination beyond the institution through publications and presentations. This value would be strengthened by embracing the DORA principles mentioned by Varpio and Sherbino that advocate for approaches to research assessment that apply globally and across disciplines.^{2, 6} This value factor should also align with the indigenous value of reciprocity where the adoption of one's work by others and the adoption of other's work is equally weighed or reciprocally shared between the institution and the communities it serves. Leaders valued impact of investing in educators on the internal community of the organisation including patients, learners and faculty. A concrete opportunity for HPE researchers to impact the greater research community would be for them to be embedded within the IRB and grant development processes to strengthen educational elements of external grant applications to scientific organisations. Educators working together with other researchers to develop curricula would strengthen the connection between the mission areas of the schools.

Strategic and political value factors highlighted by leaders included the symbolic value of investing in educators and educational research through programmes such as academies,^{7, 8} grants⁹ and educator endowed chairs.¹⁰ Leaders described the impact of these investments on innovation, organisational success and the culture. The value factor of innovation could be expanded beyond creating and implementing an innovation to include taking another's innovation and adapting and studying it within one's own context as recommended by Pusic and Ellaway.³ Organisational success should include a thriving, equitable culture within the organisation and external impact that includes underserved communities.

Sustaining HPE research will require developing explicitly stated values derived from dialogue with stakeholders, including the HPE community, leaders, learners and the communities we serve and to create structures and processes aligned with those values using a values framework. We need to leverage our scholarly rigour to continuously examine the current framings and reflect values that support individuals and teams who challenge the dominant culture and power structure to create future practitioners who can provide optimal care to all patients.

Ann Poncelet: Conceptualization (equal); writing—original draft (lead); writing—reviewer and editing (equal). Patricia O'Sullivan: Conceptualization (equal); writing—original draft (supporting); writing—review and editing (equal).