Introduction
Technology has already become a part of people’s lives in many spheres. The Healthcare system heavily relies on various technological advances as they provide manifold opportunities to improve the services available to patients. Technology helps in treating illnesses and managing individuals’ health conditions. It is also associated with efficiency, error-free procedures, faster healing processes. Podiatry surgery also benefits from the utilization of technology.
One of the areas where technology has proved to be essential is minimally invasive surgery. For instance, endoscopy has become a widely used procedure that minimizes the size of incisions and leads to a faster and less painful healing process (De Leeuw, Van Sterkenburg, Van Bergen & Van Dijk, 2011). The risk of infection is also reduced. Another important technological advancement is associated with the external fixation that is now performed with the use of materials that enable minimum incisions and intrusion into the blood circulation (Didomenico, Ziran & Cane, 2011).
However, ultrasound surgery and color Doppler-guided surgery are now seen as some of the most recent advances that maximize the efficiency of various procedures. For instance, Alfredson and Isaksson (2014) note that these methods are effective when it comes to “chronic painful insertional Achilles tendinopathy” (p. 7). The healing process is less painful and quite shorter. The patients who took part in the study reported that they were satisfied with the outcomes of the treatment. Therefore, it is clear that various technological advances enable surgeons to carry out various procedures in a more effective way.
Randomized Controlled Trial
It has been acknowledged that a randomized controlled trial (RCT) provides sound evidence to support or refute hypotheses in clinical research. At that, Bowen et al. (2012) note that RCT should be characterized by “sufficient detail for replication” to be used as the ground of any clinical research (p. 4). First, it is important to briefly outline the peculiarities of the RCT to understand the researchers’ point.
Randomized controlled trials involve participants who are randomly chosen, which eliminated any bias related to sampling. People of different backgrounds with different health histories often take part in the research, which allows researchers to understand the effectiveness of treatment (procedure, medication, and so on) in a wide population (Gordon, Darbyshire & Baker, 2012). It is possible to note that this is one of the most reliable tools to implement research. However, the lack of details when reporting the results of a trial can undermine the relevance of a study. If the trial cannot be replicated, the results may seem unreliable as there is no way to check if all the procedures were followed properly and whether all results were interpreted carefully.
Gordon et al. (2012) stress that the provision of sufficient details enables researchers to check the validity of the RCT and come to sound conclusions concerning the issue under study. Thus, it is crucial to make sure that the trial is properly reported and can be easily replicated to encourage other researchers to check the results of the trials implemented. Peer reviews are major tools to contribute to the knowledge base and come up with important insights into a variety of healthcare issues and concerns.
Educational Intervention
Intervention
The proposed educational intervention is associated with the use of ultrasound in podiatry surgery. The use of ultrasound is instrumental in identifying the exact areas of concerns that eliminates possible errors as well as minimizes the incisions. The educational intervention includes reading and discussion of several articles concerning the use of the technology mentioned.
The study by Alfredson and Isaksson (2014) can be central to the intervention. Learners can even try to replicate this study (in particular, the part concerning examination). Several videos and visuals are shown during the discussion sessions. The next stage is the learners’ review of the existing literature. The discussion of the information learned is the following stage.
The practice is the final stage of the intervention. Learners practice using the tool and evaluating the results of the examination. The assessment will include the focus on the ability to use the technology as well as learners’ willingness and readiness to use it in their clinical practice. The learners will identify the affected tissue and health conditions following the examination results. They will also carry out the examination. Finally, they will complete a survey concerning their views on technology and their willingness or readiness to use it in their clinical experiences.
Assumptions
The learners will be able to use ultrasound in podiatry surgery effectively. They will be able to use the technology in numerous settings. They will also be willing to try new ways of employing the tool by implementing their trials. Besides, the participants will feel empowered to initiate acquiring tools and technology to improve their performance as well as the performance of the healthcare facility.
Limitations
One of the major limitations is the fact that the intervention will cover a limited number of learners. Furthermore, specific equipment (characterized by certain features) will be used, which limits the learners’ ability to use other types of equipment. The duration of the intervention will be quite brief. However, the intervention can be extended if necessary. It is necessary to add that the evaluation of the intervention will help identify the most appropriate duration of the training course.
Delimitations
The intervention will last for two weeks. The learners will have four training sessions a week and one assessment session during the second week. Ten novice surgeons will participate. This sample is chosen as novice surgeons may lack the necessary knowledge and skills necessary to carry out certain operations with the use of ultrasound technology.
The intervention will remove such gaps if any. The equipment available at the healthcare facility will be employed. The evaluation of the intervention effectiveness will be held within the period of one and three months after its beginning. The extent to which the technology is utilized, patients’ satisfaction, the quality of services provided will be used as criteria for the assessment of the training.
Operationalization of Terms
Several terms will be employed in the study. Ultrasound technology is the equipment used in a healthcare facility to examine the Achilles insertion. Novice surgeons are surgeons who have worked from 3 to 9 months in the healthcare facility.
Theoretical/Conceptual Framework
Theoretical Framework
When conducting research, it is critical to employ an appropriate theoretical framework. The choice of the framework depends on the focus of the study, the field of study, and so on. When it comes to medical technology, it is possible to use several theories. One of these frameworks can be a motivation theory (Geisler & Heller, 2012). It is possible to employ Alderfer’s ERG theory as it helps unveil the motivation of healthcare professionals to utilize technology. Thus, existence, relatedness, and growth need to drive people’s behaviors. When using technology, surgeons will be able to satisfy their growth needs.
Other motivation theories can also be used to identify the extent to which healthcare professionals are committed to using this or that technological advancement. Maslow’s hierarchy of needs can help evaluate the commitment of the medical staff as regards their physiological, safety, belongingness, esteem, and self-actualization needs. It is also possible to use Maslow’s theory of the hierarchy of needs to explore patients’ views concerning the use of medical technology in their treatment. This study can explore the way patients see the benefits and downsides of the use of technology. Their fears and concerns can also be examined. Therefore, the study may detect barriers to the use of technology and ways to overcome them by using methods that will satisfy patients’ needs.
As far as the use of medical technology is concerned, it is possible to employ the utility theory as well. The utility theory focuses on the way a product or service can satisfy the needs of the consumer who chooses following several criteria (Geisler & Heller, 2012). The use of technology is not confined to purely clinical outcomes. Healthcare facilities have quite limited funds and management has to decide which technology to use, and the choice can be rather difficult due to the abundance of products available. The utility theory framework can help identify the most appropriate tools and equipment for a particular health care facility.
Another theoretical approach is associated with professional dominance theory. According to this theory, healthcare professionals seek control over choices made within an organization (Cockerham, 2015). The theory was widely used in the 1970s, but it is still applicable and can be utilized to explore the way technology is chosen and employed in healthcare facilities. The focus can be on the way doctors affect the choices and shape the technological equipping of hospitals. It is also possible to use this framework when evaluating the effectiveness of training associated with the use of technology. The theory can help the researcher identify the extent to which healthcare professionals feel empowered and initiate the use (as well as the purchase of some equipment).
Conceptual Framework
As to the conceptual framework, it is possible to employ several concepts. The first concept to be used is knowledge (Geisler & Heller, 2012). Technology is always connected with the concept of knowledge and the creation of technology as well as its proper usage in the clinical setting involves a certain degree of knowledge and skills. Knowledge management and sharing are also closely connected with medical technology. Therefore, knowledge is a key element of the use of technological advances. Training is closely connected with the concept of knowledge. The medical staff needs training as technological advances appear each day, and healthcare professionals should have the necessary training to utilize new equipment effectively.
Another important concept guiding the research associated with medical technology is administration (Geisler & Heller, 2012). The choice of technology to be purchased often depends on the facility’s management. Therefore, the concept of administration is also very important when focusing on medical technology. Administrators are often free to allocate funds to purchase equipment and invest in staff training. More so, the way the healthcare facility is equipped depends on the views of the administrators’ views on the matter. If the administrator does not find technology essential, the healthcare facility may lack the necessary resources.
Applicability is another concept to be considered. As has been mentioned above, many healthcare facilities have limited resources and have to prioritize. The choice of the most appropriate and relevant equipment is critical. It is essential to have the technology that will be used to its full potential. It is also important to make sure that the equipment will help address the most urgent issues the healthcare facility deals with. This can require the implementation of the research concerning the most common health issues patients have in this or that community.
Finally, it is also possible to employ the concept of motivation. In many cases, people tend to use something they know well (Geisler & Heller, 2012). Many people are reluctant to use innovations due to their fear of errors. Therefore, healthcare professionals should be motivated to use technological advances. They should try to use new tools and methods in various settings to achieve high results and provide high-quality healthcare services.
Literature Review Strategy
When implementing any research, it is critical to implement a comprehensive literature review. It provides the background for the research as the research obtains the information on the existing knowledge on the matter as well as existing gaps (Ridley, 2012). It can also help the researcher to choose the most appropriate methodology to implement the research.
Many approaches to search appropriate sources to review exist. Ridley (2012) identifies five broad categories that include catalogs, Internet search engines, bibliographical databases, open-access databases, and professional organization websites. As for the catalogs, it is possible to use the Library of Congress catalog to track sources available in US libraries. It is also possible to use BUBL Link to trace online resources (Ridley, 2012).
As far as databases are concerned, it is possible to use EBSCO databases as this online platform contains links to a wide variety of academic sources in numerous fields including medical technology and surgery. Medline is another helpful database that can provide the researcher with links to relevant sources. Of course, PubMed is also a valuable source that can be used to search relevant academic resources on health care issues and medical technology.
One of the most effective search engines is Google Scholar. It provides links to various resources including books, peer-reviewed articles, relevant magazines, and websites. Importantly, all these sources are associated with advanced search tools that help the researcher to refine the search of resources following keywords, topics, publishing dates, and so on. All these features save the researcher’s time and make the process of data collection for the literature review quite fast and efficient.
When implementing the search for resources, it is important to choose the relevant keywords to make the process fast and efficient. The keywords for this study can be as follows: podiatry surgery, medical technology, ultrasound technology, technological advances. These keywords will be instrumental in allocating relevant sources.
Research Design
Quantitaive Research Methodology
Education is one of the pillars of the development of society. It is also a basis of the healthcare system as education is the platform for the transition of knowledge and skills from seasoned professionals to novice practitioners. Education within healthcare bears some traits of education in other spheres, but it also has certain peculiarities.
Moriates, Dohan, Spetz, and Sawaya (2015) stress that education within healthcare should provide professionals who have a set of competencies that enable them to provide high-quality healthcare service. Importantly, these competencies include particular clinical skills, knowledge of policies and financial issues (costs, insurance), as well as emotional intelligence, leadership, the use of technology, mentoring, advocacy, and so on (Moriates et al., 2015). One of the most distinctive features of healthcare education is its possible outcomes as healthcare professionals mainly deal with people’s health. No errors or even gap can be tolerated in this sphere.
The education within healthcare is similar to education in other fields, as apart from acquiring knowledge and skills to provide care, healthcare professionals learn to be an effective researcher to expand the knowledge base and develop new methods and tools to improve the services provided or the entire system. Furthermore, education is not confined to formal methods that involve studying in medical schools.
On-job training is an important component of the system that enables novel, as well as experienced, healthcare professionals to acquire new knowledge and skills to be able to provide high-quality services (Lochmiller & Lester, 2015). This is especially true when the use of technology is involved since technology is constantly changing and upgrading, which makes it important for practitioners to have the necessary skills to use it.
As far as the on-job training, the constructivist theory is an appropriate theoretical paradigm as it is consistent with the peculiarities of this type of education. The theoretical model implies the focus on people’s previous experience as well as collaboration (Pritchard & Woollard, 2013). This theory is applicable as employees tend to use their background knowledge to construct new knowledge and skills, and this process is facilitated through sharing ideas and experiences (Pritchard & Woollard, 2013). Thus, on-job training presupposes that employees already have certain knowledge that is expanded through learning new information and developing certain competencies.
The focus of this study is the examination of the effectiveness of an intervention aimed at improving surgeons’ competence to use ultrasound and color Doppler-guided technology to treat patients suffering from insertional Achilles tendinopathy. Alfredson and Isaksson (2014) report the positive impact of the use of this technology in surgeons’ practice. The intervention will cover novice surgeons. To evaluate the efficiency of the intervention, it is possible to employ a quantitative research design.
The quantitative design is associated with the analysis of numerical data, which, in turn, is characterized by a high degree of generalizability of findings. Thus, the quantitative analysis will allow the researcher to identify whether the intervention can be effective on a large scale. In other words, this type of research design will reveal the outcomes of intervention as an experiment will be carried out. When compared to the qualitative methodology, quantitative studies are regarded as more measurable and generalizable as variables that can be quantified are used. Within the quantitative research methodology, it is possible to consider two methods: a randomized controlled trial and quasi-experimental research (Greener, 2011).
First, it is important to note that these tools are very similar but differ in one of the key points. Both methodologies usually imply the use of an experiment. Thus, two groups participate, and one group receives certain intervention while the other does not get any training. The test group has the training intervention while practitioners in the other group receive some manuals with a list of properties and features, as well as for instructions, concerning the use of the new technology. The performance of the participants is measured with the use of such criteria as the frequency of the use of the technology, occurrence of errors, patients’ satisfaction.
O’Dwyer and Bernauer (2014) state that the major difference between quasi-experimental and true experimental (randomized controlled trial) designs is concerned with sampling. In the randomized controlled trial, the researcher randomly assigns people to the two groups (O’Dwyer & Bernauer, 2014). In a quasi-experimental study, the researcher chooses participants without randomization, which can be explained by the unavailability of participants (for instance, a specific group is in the researcher’s lens).
At that, when choosing a methodology, it is crucial to remember that the randomized controlled trial is associated with a greater degree of relevance as it is more generalizable. Any person has a chance to enter any type of group, which makes the evaluation more effective as the researcher can potentially estimate the way an average practitioner can benefit from the intervention.
In this study, it is possible to employ a randomized controlled trial as the researcher can randomly choose participants. The number of practitioners characterized by the dependent variable (the time they work for this healthcare facility) is sufficient, and several surgeons can receive the intervention while the rest can be provided with the manuals.
Importantly, other variables will be excluded, which means that the intervention’s effectiveness will be checked with a potentially wide population. In its turn, this will contribute to the generalizability of the findings. The researcher will identify the way an average practitioner can benefit from the intervention in question. On the contrary, if a specific group of people will participate in the training program, it will be unclear whether other practitioners will equally benefit from the intervention.
In conclusion, it is possible to note that education within healthcare, like the one in any other field, aims at transferring knowledge to the new generation. On-job training is critical for the healthcare system especially when it comes to the use of technology as it constantly evolves. When considering such training, it is possible to apply the constructivist learning theory as it implies the use of people’s background knowledge and sharing ideas. The collaboration is a key element of this approach, and the intervention in question is also characterized by a significant emphasis on collaboration.
It is necessary to note that research is an important component of education as well. An intervention aimed at the development of skills necessary to use ultrasound technology can be evaluated with the help of a quantitative study. It is possible to use randomized controlled trial or quasi-experimental research, but the former is preferable as it is associated with a greater degree of generalizability. In the randomized controlled trial, sampling procedures allow the researcher to generalize data, which is important for the evaluation of any training program.
Quasi-Experimental Design
This type of research design focuses on a non-random assignment. As a rule, a quasi-experimental design requires a provision of both pretest and posttest procedures of the two groups under comparison. The core of this design is causal hypotheses that need to be either proved or refuted.
Speaking of the conditions, it is essential to pinpoint that treatment versus no treatment (comparison) groups are usually compared. Among relevant techniques to evaluate the results of the study, scholars note “regression discontinuity design (RDD) and propensity score matching (PSM)” (White & Sabarwal, 2014). The above tools constitute the two principal algorithms for the quasi-experimental design.
However, a statistical analysis here is complicated by the very fact of the lack of randomization. In particular, Handley, Schillinger, and Shiboski (2011) emphasize that it creates possible non-equivalence between studied groups. Therefore, it seems beneficial to consider a randomized controlled trial design to compare it with the already discussed quasi-experimental design and choose the most appropriate way to conduct the research.
Randomized Controlled Trial
In its turn, the randomized control trial (RCT) offers greater relevance by definition. Its sampling assumes random assignment of participants to the two groups (O’Dwyer & Bernauer, 2014). Randomization is crucial in conducting this method of design. It should provide a random distribution of patients that is not dependent on any factors and comparability of the groups being compared by clinical and demographic characteristics of patients including the severity of the underlying disease under study, concomitant pathology, and therapy. Therefore, the randomized controlled trial is regarded as the most scientifically rigorous method of hypotheses assessment.
Rationale for Choosing the most Appropriate Design
As it was stated in previous sections, the purpose of the research is to study the effectiveness of an intervention focused on enhancing surgeons’ proficiency to utilize ultrasound and color Doppler-guided technology in patients with insertional Achilles tendinopathy. In this connection, the use of the randomized controlled trial is much more applicable due to its high generalizability. In other words, a wide population might be embraced by the researcher to make the study more credible. Jin, Hua, and Cao (2016) also note an increased evidence-based relevance and popularity of the randomized controlled trials in a clinical environment. The results of the study would contribute to the experience of average practitioners.
Data Collection and Evaluation Instruments
To conduct a quantitative study that was chosen before, it is essential to use the survey data collection. According to Cleophas (2012), survey questions allow data monitoring and acquiring that is crucial to achieving the established research goals. In the context of the quantitative study, a statistical analysis would serve as the most opportune method of data examination. The focal objective of the statistical analysis of the RCT is the establishment of a difference and the degree of its credibility concerning outcomes between the group with the test intervention and the control group.
Currently, there are plenty of packages of programs for statistic analysis of the results such as BMDP, SOLO, and others. However, to address the research questions, it is useful to apply SurveyMonkey data collection mechanism and subsequent SPSS analysis.
Antonius (2012) states that this is a significant instrument to analyze data effectively and accurately. Moreover, to obtain objective information on the effectiveness of the intervention, the analysis should include all originally randomized patients (intention-to-treat analysis) and those whose treatment was carried out in strict compliance with the study protocol (on protocol analysis) (Antonius, 2012). This is one of the key ways to minimize possible errors when the intention-to-treat analysis is based on the assumption that all patients received the treatment prescribed at randomization.
Chapter Analysis
The previous chapters provide an in-depth analysis of the research designs and methods. First, it was revealed that the chosen topic of digital intervention in invasive podiatry surgery is of great importance in a modern healthcare system. In particular, the impact of ultrasound and color Doppler-guided technology was chosen to examine in detail. After that, several educational intervention peculiarities including assumptions (effectiveness of technology implementation), limitations (limited number of learners and specific equipment), delimitations (two weeks and four training sessions), and others were identified.
Furthermore, both theoretical and conceptual frameworks were delineated. The first one comprised such theories as motivational, Alderfer’s ERG, utility, and professional dominance while the second one employed the following concepts: knowledge, administration, and applicability. Databases search was chosen as the paramount literature review strategy, yet it would require the use of relevant keywords that might be as follows: podiatry surgery, ultrasound technology, or technological advances.
Speaking of the methodology, a direct connection between the purpose statement and research questions was detected. Alignment of the four fundamental elements including research method, design, purpose statement, and research questions was found crucial for the effectiveness of the study as they serve in the role of a basis. Finally, the last section examined both quasi-experimental and randomized controlled trial designs pointing out the evident advantages of the latter for this research. Also, it was stated that the quantitative study analysis in the framework of SPSS would be appropriate to present credible results.
Research Questions and Hypotheses
Quantitative Dissertations Review
Medical research can be implemented with the use of qualitative and quantitative tools. It has been acknowledged that quantitative studies are characterized by a significant degree of generalizability which allows practitioners to apply the findings in various settings (Koop, 2011). It is necessary to note that studies based on the use of the quantitative research design may involve a research question (or several research questions), hypothesis (or hypotheses) or both. In many cases, both hypotheses and research questions are available. It is possible to review several quantitative dissertations to understand the peculiarities of effective research questions and hypotheses.
As far as the hypothesis is concerned, it can be referred to as the major expectation of the researcher. It should also be as detailed as possible to enable the researcher to see whether the goals of the study have been met (Lum, 2008). It is essential to make sure that the hypothesis is consistent with the purpose of the study (Koop, 2011). There are different approaches to crafting hypotheses. For example, Johnson (2008) provides a null hypothesis that is proved to be true.
When it comes to research questions, they can be defined as particular objectives of the study or specific elements of the issue under analysis. Eshun and Eshun (2013) put special questions or the so-called Wh- questions. This provides a certain plan for evaluation of the intervention under analysis. These questions should also be very detailed and consistent with the hypothesis (or hypotheses) identified (Johnson, 2011; McLaughlin, 2012).
The Research Questions and Hypothesis for the Present Study
This study aims at evaluating the effectiveness of an intervention. The researcher is specifically interested in such areas as the frequency of the use of the equipment, peculiarities (settings) of this use, patients’ satisfaction and the participants’ commitment to contribute to the development of the healthcare facility through the improvement of technology-associated policies. The research questions of the present study can be formulated as follows:
- How does the intervention correlate with the frequency of the use of technology, patients’ satisfaction, as well as the quality of services provided?
- How does the intervention affect the participants’ willingness to implement their research or find new ways of utilizing the equipment?
- How does the intervention affect the participants’ willingness to affect the hospital’s performance as well as certain purchasing policies?
The hypotheses of this research can be formulated as follows:
- The intervention will lead to an increase in the frequency of the equipment use, improvement of patients’ satisfaction, and quality of services provided.
- The participants will be willing to find new ways of using the tool and implement their research regarding the use of technology in the operating room.
- The participants will feel empowered to have an impact on the development of the healthcare facility by shaping their policies concerning the use and purchase of technology.
To sum up, it is possible to note that the quantitative research design is characterized by a considerable degree of validity and generalizability. To achieve his aims, the research has to create sound and detailed hypotheses and research questions. The hypothesis is the researcher’s expectation while research questions can be referred to as particular steps to achieve the aim of the study. The hypotheses and research questions provided are consistent with the purpose of the present study.
Scope, Limitations, and Delimitations
Scope
The scope of the study includes information concerning the central domains of the study (Jacobsen, 2016). This study focuses on improving certain practitioners’ knowledge and skills in the use of specific equipment. Surgeons of a local healthcare facility will take part in the research. The practitioners who have worked in the healthcare facility for 3-9 months will take part in the study as it is vital to identify the effectiveness of the intervention with new healthcare professionals.
The overall clinic experience of these professionals will not exceed 2-3 years. Thus, the ability to learn and share knowledge in a particular hospital is also under analysis. At that, the focus is on the utilization of ultrasound in podiatry surgery. The study by Alfredson and Isaksson (2014) is the basis of the intervention as the participants will try the method described in the article mentioned.
Sample
As has been mentioned above, new surgeons will take part in the study. It has been acknowledged that the use of the randomized controlled trial allows researchers to ensure the validity of the research (Greener, 2011; Bowen et al., 2012). This study is characterized by elements of this method. Ten participants will be in the experimental group, and the same number of participants will be in the control group. The participants will have similar working experience in the healthcare facility in question (3-9 months). Their overall clinical experience will be between 2 and 3 years. Other variables (for example, age, gender, ethnicity, credentials, and so on) will be disregarded. All the participants will be employees of a local healthcare facility.
Limitations
Limitations of the quantitative research may be associated with the sample size, the scope of the study, methods of data collection and analysis, and so on (Creswell, 2013). The sample size is rather small as only ten participants will take part in the research. However, this can be the first (preliminary) study that focuses on the methodology rather than the intervention.
The researcher will pay attention to a limited number of variables (working experience). Nonetheless, gender can be an important variable to study as males and females often respond to interventions differently (Edmonds & Kennedy, 2016). Another limitation is the scope of the study as it involves a local healthcare facility only. Employees of other facilities (located in a different place) can respond differently to the intervention due to the peculiarities of the community.
Delimitations
This study aims at evaluating the effectiveness of an intervention developed for new healthcare practitioners. This sample is chosen as graduates and employees who have worked a limited period in a healthcare facility often need the training to enable them to provide high-quality healthcare services using the resources available in their hospitals. The intervention in the study implies a significant proportion of communication, which is also essential for new practitioners who may have difficulties with knowledge sharing.
The only experience was chosen as the variable due to its relevance. Such variables as gender or ethnicity can be included in further research concerning the subject matter of this study. Finally, the small sample size allows the researcher to collect and analyze data within a short timeframe. These data can be used as the basis for further research as the intervention can be modified to make it more effective. Further research may involve the focus on larger sample size as well as different healthcare facilities.
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