Medical education scholarship has steadily increased over the past decades.1–3 Although this is encouraging, the literature also mentions a persistent need for further support of medical educators' efforts to develop and evaluate best practices for teaching, learning, and assessment.1,2,4–9 Medical education research is an applied field in which educators, clinicians, researchers, and administrators bring together diverse and complementary expertise, and there is the potential to conduct rigorous studies and move education forward in a scientific and evidence-based way. However, that diversity among stakeholders makes it difficult to determine how to best support medical education research efforts to ensure that those who wish to contribute can meaningfully do so. To address this issue, it is important to understand the barriers educators face in formulating, implementing, and publishing studies that seek to address important questions, educational problems, and unexamined assumptions.

The literature highlights a variety of barriers that medical education scholars face in their research efforts, including lack of training programs, lack of protected time or funding, competing administrative and leadership roles, small numbers of learners, and difficulty in defining relevant, measurable outcomes.2,10–14 Zibrowski and colleagues15 explored lack of time as a barrier and found that although faculty felt most limited by a lack of protected time, fragmentation (finding only sporadic opportunities for work), prioritization (juggling competing roles), and motivation (due, in part, to perceptions that education scholarship is undervalued) contributed to these time constraints.15 Another piece of work from the same group of scholars recommended that efforts center on supporting education research, enhancing interactions among colleagues, and expanding faculty development activities.16 Both studies noted that research training alone may not change perceptions about the barriers posed by lack of time or support or increase research productivity. It is unclear whether these barriers represent a common experience across researchers and institutions, which barriers educators perceive to be the biggest obstacles to achieving their ideal level of research productivity, and what strategies they believe to be most effective in overcoming them.

To further explore this important topic, we engaged a group of medical education research experts and educators in a consensus-building workshop at the 2013 Association of American Medical Colleges (AAMC) annual meeting. The purpose of the workshop was to answer the following questions: “What barriers do educators face in designing and publishing education research that is useful to consumers of that research, and what strategies could overcome those barriers?” In this article we describe the process and results from the consensus-building workshop.

Methods

Results

The consensus-building sessions had 32 participants. table 1 describes the participants' demographic information.

TABLE 1 Participant Demographic Information

View Fullscreen

Identified Barriers

Barriers identified by participants were aggregated into 5 themes, listed in descending order of importance: lack of (1) expertise, (2) time, (3) funding, (4) mentorship, and (5) reward. table 2 lists each theme and the related subthemes.

TABLE 2 Barriers Participants Face: Themes and Related Subthemes

View Fullscreen

Expertise

Participants endorsed lack of expertise, which includes both lack of education research training and difficulty accessing expertise, as the top barrier. Participants noted that a lack of expertise affected them in a variety of ways, from idea generation to study execution to publication. Specific comments included the following:

• “I see what's out there, but for whatever reason I can't come up with the idea I think will be publishable.”

• “Doing a validation study is a relatively challenging undertaking, unless you have experience or you have support for that.”

• “I feel that I don't know enough about study designs.”

• “I don't know enough about the kinds of journals that I want to publish in.”

Lack of expertise overlapped with other barriers, such as time constraints, that limited participants' ability to consult experts, the availability of these experts, and lack of funding. One participant noted, “[For a specific education project] with patient care outcomes for educational interventions, you need health services researchers. It's a funding issue, but often the limitation is access to expertise, to the right people.”

Time

Regarding lack of time as a barrier, participants described a lack of “protected” time to read, write, and conduct research as well as the challenges of balancing the demands of competing roles in administration and leadership. Specific comments included the following:

• “I think another [element of the time barrier] is time to actually read the education literature, to know what's been done . . . in order to frame your study.”

• “[Another barrier] is time to write in order to publish, because I have a lot of papers I think I could publish but I need time to write them up.”

• “Going along with time, I think it's wearing too many hats, having too many responsibilities . . . so your heart might be in the right place but there are just not enough hours in the day.”

The time barrier also overlapped with funding, which generated the following comment from a participant: “That's where I associate time with, you know, if you had the funding you could have some more time.”

Lack of Funding

The barrier of lack of funding was centered on attendees' perceptions that there are limited funding opportunities for education research and that the few available grants do not adequately cover funding needs, particularly for larger multicenter studies. Specific comments included the following:

• “External grants that support medical education research are few and far between.”

• “[Another barrier is] decreased [funding of indirect costs] on most education grants.”

• “Another piece of it is funding opportunities that don't provide a large enough budget to do as rigorous a research project as you'd like.”

Participants also indicated that funding had the potential for additional benefits other than time and resources, such as structure and required timelines. As 1 participant noted: “Grants enforce a degree of discipline.”

Mentorship

Regarding lack of mentorship, participants reported difficulty with accessing mentors and developing mentoring relationships that met their needs. Subthemes included lack of knowledge about how to identify mentors, how to initiate and engage in a mentoring relationship, difficulty maintaining a relationship with an overcommitted mentor, and misalignment of mentee and mentor expectations.

The mentorship theme overlapped with expertise, as some participants mentioned a desire for mentors to either lend expertise directly or to connect them with expertise. Although we did not fully explore how much overlap existed between the lack of mentorship and lack of expertise themes, participants did identify the 2 barriers as separate entities in both the individual and the group lists of barriers. Participants also valued peer-to-peer mentoring but voiced that efforts to collaborate with peers could be thwarted by competing interests and time constraints. One participant commented: “Sometimes it's difficult to collaborate because maybe you're interested in something more narrow [but] your colleagues are interested in something more broad . . . Everyone has such constraints on their time that they really want to focus on what they want to focus on, and it's hard to find the middle ground sometimes.”

Rewards

The fifth barrier theme is related to participants' perceptions that engaging in education research did not result in intrinsic or extrinsic rewards. They described a lack of intrinsic reward, complicated by feelings of professional isolation and a lack of extrinsic recognition of the value of education research. Although many participants looked to their institution for support, some found that “institutional norms can be a barrier.” For example, a participant described how institutional expectations for promotion could encourage faculty to spend time working on “quick and easy” studies to generate publications rather than approach the questions that were most interesting to them and important to their career over the long term. Another participant endorsed that institutional expectations may also affect intrinsic motivation through a lack of local recognition and reward for personally meaningful areas of study and commented, “Is it worth my energy if it's not going to be recognized in my own [institution]?” Finally, participants voiced concerns that unsuccessful efforts can be a barrier in that they can overshadow reward. One noted: “I have one more [barrier]—painful rejection experiences which I think can also be very disappointing.”

Strategies for Overcoming Barriers

When participants identified strategies to help them overcome barriers they face, a dominant suggestion involved building communities for education researchers. Participants discussed the importance of collaborating with colleagues to share resources, stay motivated and accountable, and share skills. The structure and aims of the visions for these communities were diverse. Although local communities have value, larger institutional communities, such as academies for medical educators, were thought to be important to facilitate access to expertise and mentoring, and to serve as education research advocates. Finally, participants emphasized the importance of collaborating with people outside their institution, specialty, and discipline, and proposed the creation of virtual communities. Virtual communities could serve to facilitate mentoring relationships and mitigate time, funding, and expertise barriers by allowing people to share resources. Additional strategies elicited included adopting personal, departmental, and institutional practices to provide educators with added time for research. Themes and representative quotes relating to potential solutions are presented in table 3.

TABLE 3 Suggested Strategies for Overcoming Barriers

View Fullscreen

In closing comments, the session content expert and observer reflected on the complex interplay between the barriers and the need for systems-level solutions. He described the catch-22 nature of the barriers of time, money, and expertise: “If we don't have time, we can't get money, and if we don't have money, then it's difficult to have the time to acquire the expertise in terms of support from others, or in terms of our own training. Money creates time by offering salary support or offering research assistance . . . these are systemic issues.”

Although these issues may seem overwhelming to individual researchers, the session content expert emphasized that small interventions may have larger downstream benefits, and he stressed the importance of trying to identify a community of practice though “networking at conferences like this, and [perhaps more importantly] . . . for crossing one's own campus to determine how to take advantage of the complementary expertise and resources that you may have locally.”

Finally, he reflected on the importance of leadership and advocacy to help “deans and department heads [recognize] that the reward structure has to be put in place, has to be aligned with the expectations that are being placed on all of us. Because there's nothing that makes anybody more crazy than pursuing goals and doing one's best to try and fulfill expectations and realizing that the reward structure that they are going to be evaluated by is completely inconsistent with those efforts.”

Discussion

When prompted to describe the barriers that prevent them from achieving their education research goals, the participants echoed themes described in the literature, including lack of expertise, time, funding, and mentorship.1–3,13–16 However, the barrier that we found most novel and intriguing was the complex theme of reward.

Participants were familiar with strategies to address previously identified barriers, yet they still feel limited by them. In their effort to address lack of expertise and suboptimal mentorship, participants reported pursuing training opportunities and deliberately seeking mentors. Participants expressed frustration with the limited impact these solutions have in overcoming barriers, and they endorsed the importance of collaborating within and among institutions, fields, and disciplines to share expertise and resources. Although the success of these collaborations and interactions depends on the individual relationships to a certain extent, systemic initiatives that facilitate practical and consistent avenues for collaboration are needed. Participants reported that they do find opportunities for collaboration through professional development offerings that exist at the local and national level, ranging from sessions at conferences to longitudinal faculty development programs, such as the AAMC's Medical Education Research Certificate program and advanced degree programs.17 As an additional resource, participants also called for the development of new platforms for collaboration, such as virtual education research communities.

Collaboration was also seen as a strategy to address the barriers posed by limited time and funding. Strategies for improving time management skills and increasing funding for education research have been suggested, yet these barriers are not unique to educators and are not likely to disappear.18,19 Perhaps the most intriguing aspect of the discussion emerged when participants were polled on whether or not the barriers they faced limited the research productivity they aimed to achieve. Although most endorsed the concept that they are limited by barriers, a few respondents acknowledged that though barriers exist, they did not feel limited by them. Perhaps key answers lie in future exploration of how certain people face the same limitations but achieve success nonetheless.

Although others have explored the effect of extrinsic reward and have advocated for professional pathways that recognize the unique contributions of education researchers, we were struck by participants' expressions about how intrinsic reward affected their productivity. This prompted an important question: How do medical education researchers perceive value in what they do? Participants expressed a feeling of professional isolation, exacerbated by a sense that their role is not clearly defined, valued, or supported. Perhaps more than any other theme, this systemic, culture-based barrier relates to personal and professional identity and may affect motivation.

Intrinsic motivation occurs when people pursue activities because they find them interesting and derive satisfaction from them. In contrast, extrinsic motivation comes from tangible rewards.20 Although some extrinsic motivators may increase intrinsic motivation, others may undermine it.21,22 As educators and institutions explore systemic strategies to support education researchers, consideration of how reward facilitates and limits educational scholarship and how interventions affect extrinsic and intrinsic motivation should inform the development and implementation of these strategies.

Conclusion

Educators continue to feel limited by a lack of expertise, time, funding, and mentorship in achieving their research goals. Although individual strategies to limit the impact of these barriers are needed, systems-level interventions to create and enable communities of practice among diverse medical educators may be more effective. The theme of reward is complex and merits further investigation. Individual researchers' perceptions of the barriers they face may be influenced by feelings of isolation that might be overcome by efforts to promote collaboration. Finally, some educational researchers reported that they did not perceive significant barriers, suggesting a need for further study of the factors that affect extrinsic and intrinsic motivation, which may help some people succeed despite real or perceived barriers to education research productivity.