Setting and Problem
A decade ago, African leaders agreed to strengthen health research agendas in their countries. Still, the number of publications by African health professionals addressing locally relevant research questions remains limited.1–3 The problem and a potential solution may lie further upstream during health professionals' training. Postgraduate medical education in Kenya, like most African countries, requires the successful defense of a 20 000-word Master's degree thesis, which is mandated by regulatory bodies.4 Transforming a thesis to a publication in a high-impact peer-reviewed journal is encouraged, but publication requirements vary by university and generally lack rigor. As a result, many theses collect dust on the shelves of university repositories without becoming manuscripts. Low research interest in publishing among residents is compounded by teacher-centered delivery and passive learning that predominates in African medical education.5 A new method of postgraduate research instruction is needed to encourage broader dissemination of local solutions to health problems.
MicroResearch is a multidisciplinary team-based approach to (1) train novice researchers to carry out research projects with the potential to inform government policy makers and other stakeholders, and (2) nurture novice researchers through a successful publication to help them become committed researchers.6 The success of the program during its first 10 years in East Africa led to an adaptation of the MicroResearch approach as a research methods course for the family medicine residency program at Kabarak University in Kenya. The following describes the iterative steps of this adaptation and the planned long-term evaluation of the process.
Intervention
During the first cycle, we used the 2-week MicroResearch workshop6 in 2017 to review principles of quantitative and qualitative research methods and develop individual thesis proposals with invited research assistants. With the help of a faculty coach, groups of learners were encouraged to identify a common area of interest for synergy and to develop individualized research questions and study designs. The second cycle in 2018 involved only postgraduate trainees formulating their thesis proposals, and it added interprofessional learning from other health professions, supplemental material on mixed methods research, and an assessment of various study designs for the trainee's chosen research topic. The 2019 cycle will include an added module on conceptual and theoretical frameworks for the thesis requirement. The entire program will be evaluated over 4 years using (1) end of course evaluations; (2) success rate of thesis proposal defenses; (3) success rate of thesis defenses; and (4) a post-graduation survey assessing participants' continued research activity.
Outcomes to Date
In total, 13 postgraduate trainees in family medicine and 5 nutrition and dietetics students have completed the MicroResearch workshop to develop their thesis proposals. In the 2017 cycle, 5 of the 6 family medicine residents who completed the course passed their thesis proposal defense, with major and minor corrections. The sixth resident dropped out of the academic program. The cohort in 2018 included 7 trainees from family medicine and 5 from nutrition and dietetics. All 18 participants selected 5 out of 5 on a Likert scale for high likelihood of recommending the course to a colleague. Both cohorts expressed that consistent faculty coach engagement and the experiential learning approach were critical for success. See the Box for a sample of the 13 research questions that emerged from the family medicine residents.
Box Research Questions Emerging From Family Medicine Residents
How prepared do family members of advanced cancer patients feel for providing end-of-life care?
What are health care providers' reasons for prescribing antibiotics for upper respiratory tract infections for children less than 5 years of age in the outpatient clinics of 2 limited resource hospitals?
How effective is universal screening compared to selective risk factor–based screening for gestational diabetes at a limited resource hospital?
Early results suggest the MicroResearch process using experiential learning and feedback from coaches can be successfully adapted to develop thesis proposals for family medicine trainees in Kenya. Another successful attribute is the integration of postgraduate health professional students in an interprofessional model that encourages future team-based research projects. Long-term evaluation processes will assess the impact of the program on success in the final thesis defense and continued research engagement after graduation.
References
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