A review of the AKU-MCEA post-graduate research methods curriculum was conducted based on implementing Departments’ experience, institutional policies, and residency programme output.
Post Graduate Research Methods Curriculum Implementation
This section outlines the development of research methods curriculum, the content, implementation, delivery strategies and curriculum governing principles, regulations, and practices.
1. Curriculum Development
The postgraduate research methods curriculum adopted by AKU-MCEA responds to the needs identified in practice and policy. Based on needs assessment, clear, measurable learning objectives were defined for the curriculum.
The curriculum undergoes review every 5 years as recommended by the regulatory body in Kenya, the Commission for University Education (CUE), aimed at ensuring it is fulfilling its purpose as well as being responsive to emerging trends, changing student needs and an ever-evolving research field. In addition, regular evaluation of the effectiveness of the curriculum is undertaken through residents’ surveys, course evaluation through the Virtual Learning Environment (VLE) platform and outcomes assessment. The information generated from these evaluations is used to guide any adjustments and enhancements to the delivery of the curriculum and this goes a long way in improving the curriculum and in meeting the expected outcomes.
2. Curriculum Content
The research methods curriculum content aims at enhancing the ability of residents to develop research question, undertake a systematic literature search, design a research study, collect, and manage data, conduct data analysis, write a research paper, and disseminate findings in different forums. The curriculum is designed to cover various core components including fundamental research methodologies, data management and statistical analysis, as well as critical appraisal techniques, while addressing essential research skills, such as literature review, research ethics, data management, and research proposal writing, in a structured manner. The resulting curriculum guides delivery of a research methods course that is divided into four thematic areas delivered in four modules. The implementation roadmap is overseen by the office of the Postgraduate Medical Education (PGME), while content delivery is led by the Department of Population Health (DPH).
The first of the four thematic areas; Introduction to Research and Ethical Conduct of Research, is aimed at providing a broad introduction to the concepts and principles of research, ethical conduct of research using human subjects and to impart skills necessary for the development of research questions and scientific writing. Content covered in this section include Ethical conduct of research; Introduction to research and steps in the research process; Formulating Research Questions; Sources of and acquisition of literature; Critical appraisal of healthcare literature; Introduction to summarizing evidence; and Introduction to scientific writing.
The second thematic area is Introduction to Research Methods, whose purpose is to introduce epidemiology by exposing residents to the principles, methodologies, uses, and application of epidemiological methods in biomedical, clinical, and population health research. Content covered in the second section is Introduction to Epidemiologic concepts and principles; Measurement of disease and health in populations; Introduction to Common research designs; and Issues in Epidemiologic studies.
The third thematic area is Introduction to Qualitative Research, which aims to introduce residents to the field of qualitative research and to equip them with knowledge, skills, and techniques necessary to undertake independent research using this methodology. Content covered in the third section is Introduction to qualitative research; Qualitative research designs; Sampling in qualitative research; Qualitative research methods; and analyzing and interpreting qualitative data.
The fourth thematic area is Biostatistics in health research. The purpose of this final thematic area is to introduce residents to biostatistical approaches by exposing them to the principles, methodologies, uses, and applications of statistical methods in biomedical and clinical research. Content covered includes Introduction to Biostatistics; Descriptive Statistics; and Inferential Statistical Methods. Residents additionally receive training in Data Management Practices.
3. Curriculum Implementation
AKU-MCEA has adopted a Dissertation-centric Research Curriculum that runs across the four-year Master of Medicine (MMEd) programme, across nine different specialties (12). The framework of the curriculum supports progressive learning and skill acquisition. Starting with introductory content and gradually introducing advanced concepts as residents progress with their research. The latter creates pathways for residents to build expertise over time, encouraging them to continually refine their research methods and strategies. Research ethics and responsible conduct of research and compliance with institutional regulations is integrated into the curriculum. Each resident is expected to understand the ethical considerations specific to their research topic. The Research methods and Biostatistics is also offered as a mandatory common course for all enrolled residents and is intended to enable the trainees to develop a well-designed, implemented and reported research dissertation in partial fulfillment of the requirements for graduation.
The execution of the dissertation work is provided for from the first to the fourth year of training (12). The adoption of a longitudinal approach to teaching research methods aims to provide residents with the knowledge, skills, and support necessary to successfully complete their dissertations. Each academic year has expected research milestones against which a resident is evaluated and assessed and cannot proceed to the next level unless these milestones have been achieved. These milestones include a clear and focused research question and a two-page concept paper at the end of year one; a fully developed dissertation proposal at the end of year two; analyzed data at end of year three which is to be incorporated into the dissertation, expected to be complete and ready for examination at the end of the first quarter of year four alongside a manuscript which ought to be ready for submission to a peer reviewed journal.
Each academic year of the PGME programme has four quarters, and the four thematic areas in the research curriculum are covered in modules delivered over a period of the four years of the MMed programme, with a dedicated cumulative 96.5 contact hours (54 taught hours and 42.5 workshop hours). Upon admission to the University, PGME residents are expected to mandatorily take and pass the Collaborative Institutional Training Initiative (CITI) course on ethical conduct of research, offered as an online self-study course. This is a prerequisite to participation in the rest of the research methods sessions. During the first quarter of year one of the residency, students work with faculty and supervisors in their respective departments to identify potential research questions, which they bring to the first research methods session conducted in the second quarter of year one.
The first module, Introduction to research and ethical conduct of research is covered in the second half of year one over 22.5 contact hours (10.5 lecture and 12 workshop hours). A session to differentiate between qualitative and quantitative research studies is held in the first module as it determines the research approach to be undertaken right from developing the research question. During the workshop, faculty work with residents to refine their research questions, making sure they follow the Patient/Population, intervention, comparison, outcome, and time (PICOT) framework. Residents are also equipped with the knowledge, skills, and tools to undertake a systematic search for and critically appraise and summarize literature relevant to their specific research question as a foundational step in developing their research proposals. In addition, they are provided with sessions on steps of a research process an introduction to scientific writing. The introductory parts of module two, Introduction to Epidemiologic principles and Measurement of Disease and Health in Populations is also covered in the second half of year one. These lay the groundwork for residents’ understanding of the science of epidemiology, its applications, and its significance in quantitative health research. The didactic components of the course are complemented with aligned faculty guided workshops in which residents work individually, in small groups and in the plenary to apply the theory learnt to their actual research topics. Each teaching and workshop session lasts on average 2 hours. Residents are expected to develop a 2-page concept paper as a key deliverable at the end of the module.
The remaining content of module two i.e., Introduction to common research designs; Issues in Epidemiologic studies (Measurement Errors, Selection & Information bias, Confounding and interaction, Causality); Introduction to Biostatistics; Introduction to qualitative research; and Writing for publication are delivered in the first half of year two of residency. Module two is covered over a duration of 44 contact hours (30 taught hours and 14 workshop hours). Didactic interactive sessions cover topics such as introduction to common research designs and issues in epidemiology. Each taught and workshops session last between 1–4 hours. Residents are expected to produce a full dissertation proposal for submission to the Institutional Scientific Ethics and Review Committee (ISERC) as a deliverable. After approval of protocol by various regulatory bodies, data collection commences late in the second year or early in the third year of training.
The third module, Biostatistics in health research and qualitative analysis is covered in the second half of year 3. In this module residents are trained to apply data management, descriptive and analytical statistical approaches, and qualitative analysis through practical application on the range of data produced through their individual dissertation research work. The content covered in this module includes Descriptive Statistics, Students’ t-test, Chi squared tests, Correlation and linear regression, Logistic regression, Poisson regression, General linear models, Kaplan Meier and Cox regression models, Data Management practices and Analyzing quantitative and qualitative data. The content is covered over a period of 30 contact hours (13.5 taught and 16.5 workshop hours) systematically spread out across the third year. At the end of the third year the resident is expected to have completed analyzing their data and drafted a dissertation results section.
The fourth module, Writing support is offered in the 2nd half of year 3 and 1st half of year 4 of study. This is done through editorial support offered by professional editors at the university library alongside the content and methodology supervisors. Residents are supported to write up their results and complete their full dissertation as well as produce a manuscript for publication. A dissertation should be ready in the first quarter of year four of residency. The resident is also expected to develop a manuscript for submission to a peer reviewed journal (it is important to note that manuscript submission follows final dissertation submission for examination). Students are required to disseminate the final work through conferences, symposia, and other approved forums, such as the weekly university wide Faculty Academic Rounds (FARs), the Annual Early Career Researchers symposium (AECRS).
4. Curriculum Delivery Strategies
The delivery of the curriculum is undertaken by multiple health professionals with dynamic experience in epidemiology, biostatistics, qualitative methods, and critical writing skills. Furthermore, each resident is assigned 2–4 experienced methodological and content supervisors to provide guidance, review research proposals, offer methodological expertise, and facilitate networking opportunities.
Technology is used in the delivery of the curriculum content across East Africa-campuses (coupled with in person workshops), in turn promoting access and wide coverage across countries where the residents are based.
The delivery of the curriculum occurs through interactive didactic lecturers, workshops, seminars, and practical training. Hands-on training sessions using research tools and software relevant to the respective residents' research method/design is also undertaken. Varied assessment methods at each stage, including oral presentations, written reports, and peer reviews are utilised through an established feedback loop where residents receive constructive feedback from mentors, peers, and faculty members. These strategies are intended to promote continuous improvement.
To successfully deliver this curriculum, a comprehensive set of resources, including textbooks, journals, online databases, and software tools, tailored to residents' research domains are provided by the AKU Library. Residents are guided by professionally trained librarians on how to search for physical reference materials, and how to use Artificial Intelligence (AI) techniques in literature review. Overall, the curriculum aims to provide methods and tools for a successful dissertation, impart essential research and critical appraisal skills that would equip the students to become adept and successful practitioners of evidence-based medicine as well as to consider career options in clinical research.
5. Curriculum Governing Principles, Regulations, and Practices.
Successful implementation of the research methods curriculum at AKU may be attributed to several principles and practices. Firstly, the postgraduate research policy and guidelines are disseminated to the residents during orientation to the MMed program with an aim of setting out the expected research milestones; and secondly, the research methods course content is thereafter delivered longitudinally over a period of four years in tandem with expected research milestones. Notably, faculty and staff undergo capacity development in dissertation supervision and research, under the stewardship of more experienced MCEA Faculty, led by the DPH with support from other departments, among which include the Academic Office, the Research Office, AKU Library and Grants Office. In addition, delivery of the curriculum is undertaken by multiple health professionals with dynamic experience in epidemiology, biostatistics, qualitative methods, and critical writing skills. Furthermore, residents receive support and supervision from 2–4 supervisors. Technology is used in the delivery of the curriculum content across East Africa-campuses (coupled with in person workshops), in turn promoting access and wide coverage across countries where the residents are based. The MCEA provides each resident with research support of USD $1000 upon successful application. Residents have unfettered access to critical research infrastructure (library, internet), as well as protected research time for successful dissertation completion alongside on-demand research methodology and scientific writing consulting clinics. Quality assurance mechanisms have been put in place to ensure quality dissertation and research outcomes.
6. Curriculum Implementation Outcome
Implementation of the Dissertation-Centric research curriculum longitudinally in line with expected research milestones at AKU-MCEA has been instrumental in addressing the barriers to post-graduate research training and promote a culture of scholarly excellence.
The first cohort of residents was enrolled in 2004. Intake into the program happens annually. As of September 2023, a total of 552 residents had been successfully enrolled into the PGME training program. Out of 407 residents eligible for graduation, 363 (89.2%) have successfully completed their training. Notably, dissertation completion is one of the prerequisites for graduation, 6 out of 363 (1.7%) enrolled between 2004–2020 graduated a year after their scheduled date due to a delay in completing their dissertation. This is a stark contrast from delayed completion rates reported in other Health Science institutions within the region. For instance, a study in Makerere University College of Health Sciences reported a delayed dissertation completion rate of 82.2% (13). The demand for, and enrollment to the AKU-MCEA residency programme has been on an upward trend with more than 70% increase in demand for the programmes since 2017.