The PAPERs Podcast

Episode host: Lara Varpio.

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Episode article

Tekian, A., Dekhtyar, M., & Park, Y. S. (2023). “The rapid growth and expansion of Master of Health Professions Education (MHPE) programs: A mixed-methods study of international curricular trends and guidelines for programs. Medical teacher“, 1–8. Advance online publication.

Episode notes

The following breakdown examines the key components of the study’s methodology and highlights the findings.

Background 

I picked this paper because I want to talk about the purposes behind MANY Master’s degrees in Health Professions Education (HPE) that are popping up around the world. EVERYONE seems to be offering or launching an MHPE, which is probably why this paper is entitled The Rapid Growth and Expansion of Master of Health Professions Education programs: A mixed-methods study of international curricular trends and guidelines for programs.

So, WHY are these MHPE programs so popular? 

I fear that what we are witnessing AND participating in degree creep (aka educational inflation / credential inflation) defined as employers requiring more and more education or credential for different jobs. I am teacher in my local MHPE. In fact, I am the co-director of the research block the Masters degree in HPE delivered by the University of Pennsylvania. I love teaching research in that program. When I ask them WHY they are in the program, a common refrain is that they need the degree to advance to the next level in their academic medicine career. Eg: If they want to be Program director — they need a masters. When did a Master’s degree in HPE become mandatory for the position of Program Director? Does the Master’s degree bring about better teaching? Better leadership?  

Method 

This is an exploratory mixed methods study aimed and developing an understanding in 5 areas:  

1. How content is delivered across MHPE programs 

2. The breadth of content taught the MHPE programs 

3. The expected attributes of students graduating from the MHPE programs 

4. The context in which students learn within the programs 

5. The future direction for the improvements of these programs 

The authors did an environmental scan following the Choo approach which advocates for a passive and an active phase.

The passive phase is about collecting insights based on available data, available resources. And that’s the first phase of this study. They went to the websites of the 157 MHPE programs currently run around the world, and sampled by geographic region, and by institutional structure (eg university vs hospital). And then they added a requirement for an English language website. That got them a sample of 46 websites to analyze. This content answered Q1. They don’t go into how they analyzed that data — but it is basic descriptive statistics.  

Phase 2 of Choo’s environmental scan is active and entails going to get information from people about their perspectives, their experiential insights to help bring nuance to the passive data. In this study they used focus groups with directors of MHPE programs. Some of those participants were from the 46 schools represented in the passive cohort. And they enhanced that with participants from the other MHPE programs. So they ran 3 focus groups with a total of 10 people in the discussions.  They analyzed the transcripts of those focus groups by: “developing categories that summarized shared perspectives based on Aims 3, 4, 5. The authors met to discuss the formation of categories within each aim, making iterative changes to convey more clearly the salient components of focus groups collectively and individually” 

Results/Findings 

Q1: How content is delivered across MHPE programs:

• 39% are online only, and 41% are hybrid online and in person.  

Q2: The breadth of content taught the MHPE programs: 

• There are core courses and then electives, covering concepts like scholarship, assessment, leadership, health system sciences 

Q3: The expected attributes of students graduating from these programs: 

2 main expectations reported:

• First students were expected to be leaders and change agents in their local institution.  
• Second, the North American and European participants specifically also added the desire to see their students’ mindsets change “often referencing a growth-oriented behavior” 

Q4: The context in which students learn:  

• Participants described individualized learning opportunities that allowed learners to sub-specialize to meet the demands of their unique environments, ideally connecting theory with practice 

Q5: The future directions for improvement of these programs:  

Two points here.  

• The first, participants from Europe, Africa and Asia talked about the differences in their local contexts and how those differences required that the programs teach different topics like assessment in ways that fit the local needs of their institutions. Then the paper states that participants from Africa and South Asia described wanting more regulations and standards to be in place for who can teaching in these master’s programs. So the program should be individualized to the local context, but the educators in the programs should be more standardized.  
• The second point about future directions for improving is about building an MHPE community. The North American participants talked about forming a consortium to share best practices and provide opportunities for faculty to share their expertise with institutions lacking the subject knowledge or resources. One participant said: “I would love to see more and more sharing of faculty”. The African and South Asian participants discussed formal relationships between med education organizations in their country would be helpful. 

Comments 

If we reverse engineer an answer to my original question (i.e., why these programs exist), based on the information provided, it is to create change leaders locally. If you want change leaders, would a Master’s in Business be more useful? The content taught seems to cover a lot of educational topics, but the expected attributes of students were growth minded change leaders so I’m a bit concerned that the need expressed for these programs and the goals of the programs aren’t necessarily aligned.