Invited Commentary: Philosophy of Science
Academic Medicine, Vol. 95, No. 5 / May 2020
693
stronger confidence in findings; this is a
fundamental law of inferential statistics.
Case Study: Lee’s Experiment
In Box 3, we present a scenario in which
a resident (“Lee”) injects 10 times the
normal medication dose. In this final
section, we use this sample case to
prompt an application of a positivist
paradigm to design an experiment
that uses theory, articulates and tests a
hypothesis, operationalizes variables, and
informs theory.
After the experience of administering
an incorrect medication dosage under
pressure, Lee decides to examine this
issue further. Lee chooses to design a
study investigating how to improve
training to correct medication dosage
using different curricular interventions
(mastery-based simulation versus
traditional curriculum). Below are steps
Lee would follow to engage in a positivist
educational research study.
Theory-based hypothesis
Lee approaches the program director
with a proposal to design a mastery-
based simulation curriculum that trains
residents under pressure to apply correct
doses of Narcan (Naloxone), specific
to patient age and race/ethnicity. Lee
hypothesizes that using a mastery-based
simulation curriculum approach can
improve trainees’ ability to identify and
administer correct medication doses
under pressure, relative to traditional
instruction she received through direct
patient contact (non-simulation-based
training).
Operationalizing variables
Under the supervision of the
program director, Lee recruits 2
groups of learners—an experimental
(intervention) group who receive the
mastery-based simulation training for
applying correct medication doses under
pressure, and a control group of learners
who are trained under the traditional
curriculum.
21
All other learning
conditions are comparable. Lee designs a
simulation-based assessment to compare
the 2 groups of learners following
their training. Measures that define
outcomes (e.g., correct medication dose,
duration of medication application)
are identified. The literature informs
the effect sizes that Lee uses to signal
significant improvement in outcomes,
which allows calculating the required
sample size and power for recruiting
learners.
Experimentation
Following appropriate ethical approval,
Lee measures outcomes before
experimentation in both groups.
After the intervention, Lee measures
outcomes again, then compares pre- and
postintervention outcomes between the 2
groups from the simulation assessment.
Results to inform theory
Lee makes a statistical comparison
between the outcomes of the 2 groups
and the findings reported to confirm
(verify) the hypothesis. If Lee identifies
that mastery-based simulation training
is more effective than a traditional
curriculum in improving application of
correct medication doses, then this result
contributes to mastery-based learning
theory. Specific nuances of the study
findings (e.g., type of mastery-learning
condition or instruction) can help refine
the mastery-based learning theory.
Conclusions
This article provides the definition,
assumptions, and application examples
of research that can be conducted in
a positivist paradigm, summarized as
follows:
• Scientific research in a positivist
paradigm focuses on explanation and
prediction.
• The hypothetico-deductive model of
science is used to facilitate the research
process, taking a theory-verification
approach.
• Research operates in a dualistic
and objective world, where the
researcher does not interact with study
participants to minimize bias.
• Theories of nature depend on empirical
data, with larger samples used to make
generalizations.
While different research paradigms
provide their unique value in advancing
science, positivism has been a dominant
form of research in basic and clinical
science for over 150 years.
6,8,22
As such,
understanding positivism and its
language is important for researchers
hoping to conduct research in
interdisciplinary fields such as medical
education.
Funding/Support: None reported.
Other disclosures: None reported.
Ethical approval: Reported as not applicable.
Disclaimers: The views expressed herein are
those of the authors and do not necessarily
reflect those of the Uniformed Services
University of the Health Sciences, the United
States Department of Defense, or other federal
agencies.
Y.S. Park is associate professor and associate head,
Department of Medical Education, and director of
research, Office of Educational Affairs, University
of Illinois at Chicago College of Medicine, Chicago,
Illinois; ORCID: https://orcid.org/0000-0001-8583-
4335.
L. Konge is professor, Copenhagen Academy
for Medical Education and Simulation, University
of Copenhagen, Copenhagen, Denmark; ORCID:
https://orcid.org/0000-0002-1258-5822.
A.R. Artino Jr is professor and deputy director,
Graduate Programs in Health Professions
Education, Department of Medicine, F. Edward
Hébert School of Medicine, Uniformed Services
University of the Health Sciences, Bethesda,
Maryland; ORCID: https://orcid.org/0000-0003-
2661-7853.
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