Rapid realist review
This study adopted a rapid realist review approach (16). This approach focuses on explaining the question under review in a time-sensitive manner instead of the lengthy, consultative approach in definitive theory-development (16,17) traditionally produced in a realist review. This methodological approach addresses the call for more rigorous research related to educational technology and design research that moves beyond the "What works? questions to the deeper, theoretical and knowledge generation required for solving academic problems (18). The RAMESES publication standard (19) guided the structuring of this paper. A primary research team (the authors) and a secondary research team (independent experts in health professions education) contributed to this review.
Conjecture Mapping
The researchers initiated the rapid realist review through the development of a Conjecture Map underpinned by the pedagogical and design theories of the Conversational Framework (9) and Community of Inquiry (10). The conjecture, or hypothesis of how the proposed outcomes of an online faculty development course are achieved, served as a proposed programme theory to align with the realist review methodology(20) (Figure 1).
This Conjecture Map provided the basis for identifying the search terms, developing the data extraction tool, and analysing selected articles. To our knowledge, this has been the first rapid realist review to apply this approach.
Search String
The primary research team identified the Population, Intervention, Context and Outcome (21) (PICO), and inclusion/exclusion criteria relevant to this study. The population referred to health professions educators OR medical educators OR medical teachers OR health professions academic faculty. The interventions included were online faculty development OR technology-mediated health professions education. The context and outcomes specific to the search were low- and middle-income countries OR sub-Saharan Africa OR Africa, and professional development programmes OR faculty development.
The PICO criteria served as search terms applied to EBSCOhost databases, applying the search string to the following databases: Academic Search, Academic Search Ultimate, Africa-Wide Information, Business Source Ultimate, CAB Abstracts, CINAHL with Full Text, Communication & Mass Media Complete, ERIC, GreenFILE, Health Source: Consumer Edition, Health Source: Nursing/Academic Edition, Humanities Source Ultimate, OpenDissertations, APA PsycArticles, APA PsycInfo, Sociology Source Ultimate, MasterFILE Premier, MEDLINE with Full Text, and Scopus. The search process was conducted in 3 phases (Additional file 1).
Selection of the literature
The following inclusion and exclusion criteria guided the selection of the articles for this review:
Inclusion criteria:
- Publication between 1 January 2010 and 1 August 2020
- Full-text articles, commentaries and editorials published in peer-reviewed journals.
- Research reporting on online faculty development initiatives in HPE/medical education.
- Research conducted in low- and middle-income countries focused on online HPE faculty development.
- Faculty development initiatives delivered using a fully or partially online platform
Exclusion criteria:
- Studies presenting research on undergraduate student participants.
- Faculty development initiatives that do not include an online component.
- Reviews and other non-primary research
Search Results
Three searches identified 1 836 citations for abstract review. One member of the primary research team manually removed all duplicates after automatic deduplication by the librarian assisting with the search. Titles and abstracts (n=1 030) were evaluated to confirm the primary studies' compliance with the inclusion and exclusion criteria. The primary researchers, after discussion and consensus, selected fifty abstracts for a full-text evaluation. One of the abstracts was not available to the researchers.
A secondary research team member and two primary researchers used a custom-designed tool (Additional file 2) to evaluate forty-nine full-text articles for eligibility in the review. The researchers, through a consensus-building discussion, discarded articles that did not meet the inclusion criteria. The team selected nine full-text articles for inclusion (22–30), reviewing the reference list for additional literature. However, the search did not yield additional articles. Upon further analysis, one article (22) did not meet the criteria, eliminating it from the final analysis (Figure 2).
Data extraction
Two members of the primary research team piloted the data extraction tool (Additional file 2). The first author and two secondary research team members independently extracted data from the selected full text. Data extracted included the location, facilitator and participant descriptors and recruitment, intervention, tools and materials used, outcomes of the intervention and recommendations. The first author consolidated all extracted data in a single document for analysis by the primary research team.
Analysis and synthesis process
The researchers adopted a phased analysis approach. In the first phase, each article was numerically coded for the synthesis process. The team summarised each of the selected articles to stipulate the intervention's geographical location, context, mechanism, outcomes and theoretical justification for the faculty development programmes' success or failure. The second phase consisted of an inductive thematic analysis of the CMO classifications from phase one. Finally, the researchers mapped the themes identified in the second phase of the analysis to the original Conjecture Map and candidate theories. The analysis included an inductive thematic analysis to categorise the data, map categories against candidate theories and create a draft narrative analysis of the Context, Mechanism and Outcomes. The findings of the analysis are described according to these three phases.