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The Journal of Cases in Educational Leadership ( JCEL ) publishes, in electronic format, peer-reviewed cases appropriate for use in educational leadership preparation efforts across the globe. The cases provide a narrative and teaching notes with the aim being to prompt rich discussion and inquiry about issues pertinent to educational leadership across global contexts. We encourage cases that are supported by digital media or other creative forms of expression. JCEL is always looking for great ideas regarding special issues. If you would like to consult with us about this process, please reach out to our Editorial Team.

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Educational Case Reports: Purpose, Style, and Format

  • Published: 03 March 2022
  • Volume 46 , pages 147–150, ( 2022 )

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case study education journals

  • Alan K. Louie   ORCID: orcid.org/0000-0002-6762-1835 1 ,
  • Richard Balon   ORCID: orcid.org/0000-0001-6598-2242 2 ,
  • Eugene V. Beresin   ORCID: orcid.org/0000-0001-5627-7146 3 ,
  • Anthony P. S. Guerrero   ORCID: orcid.org/0000-0002-2496-4934 4 ,
  • Mary K. Morreale   ORCID: orcid.org/0000-0002-7921-0822 2 ,
  • Rashi Aggarwal   ORCID: orcid.org/0000-0002-9744-3638 5 ,
  • John Coverdale   ORCID: orcid.org/0000-0001-9301-4687 6 &
  • Adam M. Brenner   ORCID: orcid.org/0000-0001-7244-651X 7  

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Case reports continue to play a time-honored role in academic medicine, by communicating clinical findings and advancing medicine [ 1 ]. Though a less rigorous level of evidence, because they describe one case that later may prove to be anomalous or “one-off,” some cases nevertheless have led to significant discoveries. Other fields, including law, business, and education, utilize their versions of case reports, often termed case studies. Law students read legal cases, proceedings, judgements, and verdicts. Business journals publish detailed accounts of the success or failure of corporations. The most germane to medical education is the use of case studies in graduate schools of education. Examples include reports of the implementation of a new teaching method, interventions, or programs at a particular school and, more broadly, the effects of a change in educational policy or regulations.

In this editorial, we discuss case reports about medical education and reflect on lessons we might learn from the tradition of case studies in the field of education at large. To be clear, we are focusing on reports in medicine about educational methodologies, interventions, initiatives, policies, application of adult learning theory, and the like. These reports are not to be confused with clinical case reports that are meant to be educational. Several journals specializing in medical education accept educational case reports, commonly about innovations in teaching medical students or residents. For instance, educational case reports have a specified manuscript type in some journals (e.g., Teaching and Learning in Medicine ) , while several other medical education journals have manuscript categories that will consider manuscripts that are essentially educational case reports (e.g., Innovation Reports ). To the extent that the nature of traditional case reports in clinical medicine differs from that of case studies in the discipline of education, one might suggest that medical education case reports could borrow the most useful guidelines from each field.

Academic Psychiatry includes among its types of manuscripts Educational Case Reports, which previously were subsumed under the educational resources’ column [ 2 ]. From 2014 to 2021, the percentage of this manuscript type has averaged 12% of the total published articles of all types in the journal. The acceptance rate is similar to the rate for all peer-reviewed articles in the journal. The exact nature of the articles in this manuscript type has evolved over time, as have the associated instructions to the authors. In recent years, the editors have encouraged, through the editorial process and suggested revisions, educational case reports to follow the description in this editorial. In what follows, we attempt to clarify further their current purpose, style, and format.

The following text is found in the instructions for authors of Academic Psychiatry [ 3 ]:

Educational case reports are practical in nature and might analyze, descriptively or ethnographically, how a particular teaching practice was applied in a specific setting. Examples include unexpected and subtle discoveries made while developing an innovative teaching method, reforming a curriculum, or launching a new course. A holistic review process considers that case reports in education tend to be naturalistic and relatively lacking in empirical data, but outcome data are still expected, such as qualitative or quantitative participant feedback. Quality of data, novelty of the case, and topic significance will be considered.

Comparison with the Journal’s In Brief Report category will be valuable. Both Educational Case Reports and In Brief Reports might be used to describe a novel teaching intervention implemented at a single site or institution. The In Brief Report would be most appropriate when the authors wish to focus on statistical analysis of the outcome measures. By contrast, an Educational Case Report would be chosen when the authors believe that the primary goal of publication is to share lessons learned from the process of defining the need, creating the intervention, overcoming the challenges in implementation, or interpreting ambiguous outcomes. It is important that the authors identify which of these (or other) kinds of lessons their case report is meant to illustrate.

A number of educational case report manuscripts are rejected by Academic Psychiatry , unfortunately, due to a frequent misunderstanding that the main objective of publishing an educational case report is to disseminate and share a course curriculum, created by the authors, absent outcomes other than student satisfaction. Sharing of curricula is a worthy objective, sparing others the task of creating the same curriculum on their own, but it is not the purpose of this manuscript type. Dissemination of one’s curriculum might be better accomplished by submission to websites that have a review process for curricula and regularly post them (e.g., MedEdPortal [ 4 ] and the website of the American Association of Directors of Psychiatric Residency Training [ 5 ]). The authors may list these peer-reviewed postings on their curriculum vitae.

Academic Psychiatry has been publishing fewer and fewer case reports that present new curricula, for several reasons. First, page and space limitations prevent the inclusion of particulars necessary for the dissemination of a curriculum in detail. Second, the journal’s reviewers evaluate submissions on the basis of their expertise in medical education and not in the content area of the curriculum being described in the manuscript. For example, if an author wants to share a model curriculum for teaching emergency psychiatry, a curriculum reviewer would be needed to assess whether the content about emergency psychiatry was accurate, appropriate, and acceptable for wide dissemination. Academic Psychiatry , however, does not provide reviews in subspecialty content areas, like emergency psychiatry; reviewers instead are asked to assess manuscripts on the basis of what they impart to the reader about medical education. Educational case reports about an emergency psychiatry curriculum should describe lessons learned about education, like difficulties in implementing the curriculum, how students reacted to the teaching methodology, the use of simulation, and educational outcomes. The fact that the curriculum, in this example, is about emergency psychiatry is somewhat incidental to these tasks. Of course, the content of the curriculum is of importance, but it only needs to be described to the extent necessary to explicate the educational lessons and observed outcomes.

By definition, an educational case report is usually about one “subject” (or at most a few in a multiple case report) whose case is described and studied with rich details. Educational case reports often use methods that are more qualitative and descriptive, in contrast to surveys or trials, which collect more superficial quantitative data from large samples that are amenable to statistical analysis and generalizable to populations. Thus, an educational case report may be idiographic, or even ethnographic, in style in order to tell the story of its singular subject. Akin to most qualitative research, educational case reports are more naturalistic in design, highly influenced by the specific context or single setting. They are generally narrative in style, since they tell the story of why the authors made the educational intervention and how the process played out.

Here, we may find some divergence in style between case reports in education from those in clinical medicine, in which clinician authors might frame the report as quasi-experimental and hypothesis-driven. For instance, the clinician may use the subject as his or her own control, involving periods on a medication, then off the medication, and finally back on the medication, and correlating symptom changes with these periods. Symptom severity might be given numerical ratings represented with descriptive statistics. Despite the disadvantage of having only one subject, many clinical case reports have been written in this manner and have been valuable, leading to larger quantitative studies.

Authors of educational case reports may want to continue in this clinical case report style but should also feel free to infuse elements of style from qualitative research traditions. This approach is appropriate for educational case reports due to their greater complexity. In particular, the subject is generally not a person, as in clinical cases, but rather, the unit of study is more often an educational intervention (e.g., course, curriculum, initiative). In telling the “story” of an intervention, the authors need to define clearly its boundaries [ 6 ]. Unlike a person who has easily understood physical boundaries, educational interventions need borders drawn between the subject of the report and the context in which it is embedded. For instance, in studying educational outcomes, is one looking at the effects of a single exercise embedded in a session, of a session embedded in a course, or of a course embedded in a curriculum, and how does one separate the effects of each? Which is the subject—the exercise, the course, or the curriculum? These important questions might use qualitative methods by including the learners in a focus group and understanding how the teaching intervention was understood and potentially assimilated into practice.

Additionally, the context surrounding the educational intervention is usually complex in the academic world, with multiple learners and many uncontrollable and unpredictable influences, perhaps more so than in clinical settings with one patient and pure pharmacological treatments. This context may include details that are not content-specific: whether attendance is required and consequences exist for not attending; whether advance readings for a flipped classroom model are reviewed by learners; if faculty are given protected time or paid for teaching and the course is given protected hours of instruction by the administration; how grades are determined; and other details often omitted in descriptions of model curricula. These factors influence the quality and effectiveness of education, such that the same curriculum delivered in two different contexts may have quite different degrees of success or failure, and may help readers to decide whether to adapt a described educational intervention in their institution (e.g., depending on resources).

The qualitative part of an educational case report should interrogate the “how” and “why” of the case [ 7 ]. Many authors overemphasize the “what,” the content of the curriculum, and focus on whether the “what” was effective, usually with learner satisfaction surveys. While this formula has resulted in some perfectly useful case reports, we do not think it leverages the strengths and potential of an educational case report. More valuable are the “how” (e.g., learning process) and “why” (e.g., mechanisms of learning) questions with regard to learning processes and speculation about mechanisms and causation. Readers may find transferability of some of these processes and mechanisms to their context. Of note, the “how” may include unanticipated and/or unpreventable changes or challenges relating to the educational intervention, occurring during the period of study, which may lead to modification of the intervention midstream. In clinical trials, this occurrence is undesirable, because conditions of the trials will then change, but in an educational case report, describing such changes gives a sense of the forces impinging on the intervention and its ability to adapt to them, which offers lessons learned along the away and the attempts to redirect efforts.

Many educational case reports describe a new course or curriculum designed in response to an educational need or gap in knowledge, skills, or attitudes. The report should start with evidence of this need and gap based on review of the literature (or lack of evidence in the literature), current existing solutions and how they have failed to date, and the authors’ innovative answer. Next, the educational intervention may be outlined; the content of the intervention (e.g., topics, assignments) need not be fully specified but can be shared in an abbreviated form. Particular attention should be drawn to defining the boundaries of the intervention, as alluded to earlier, and its context, along with how it is innovative. Assessment and qualitative measures, and possibly quantitative methods, used should be described that establish the educational outcomes. If quantitative methods are used, their validity needs to be addressed. Study data are then presented along with a narrative of what happened during the study, from start to finish. This text should include how the intervention ran, observation of learning processes, barriers, modifications, and changes that were required and the reaction to them, educational outcomes, and final impact and scalability. Additionally, inclusion of student perspectives, perhaps more than simple comments from evaluations, should be considered. Lessons learned along the way, propositions about how and why the outcomes came to be, and questions raised with novel perspectives should be proposed and critically argued in the conclusion. Mentioning limitations and the potential existence of multiple explanations, unsettled ambiguities, and researcher bias is also important.

The issue of informed consent and ethics review should be addressed. The manuscript should indicate the conclusions of an Institutional Review Board (IRB) review of the case report study and data to be published (e.g., exempt from further review status, approved). The IRB can advise about whether informed consent for being in the study is necessary, and the release of the case report should be considered from both the faculty members and learners.

As mentioned earlier, educational case reports may benefit from a hybrid of the styles from clinical case reports and qualitative reports. Various standardized formats for clinical case reports have been published. An international group developed the CARE ( CA se RE ports) guidelines for clinical case reports [ 8 ], and it is useful for authors to be aware of these. Several tools are provided with the CARE guidelines for authors, including a checklist for writing clinical case reports. Listed are traditional elements like clinical findings, diagnostic tools, treatments, and follow-up and outcomes. Of note, the guidelines include prompts to incorporate instruments measuring treatment adherence and side effects, explaining alteration of the treatment plan, and presenting a rationale for the clinical conclusions. Also requested is the treatment perspective of the patient and obtaining the patient’s informed consent for release of the case report. The CARE guidelines are best suited for clinical case reports, but authors may wish to adapt some elements to educational case reports, such as using tools to measure compliance with and acceptance of the educational intervention, explaining changes in the curriculum during the study, and describing a rationale for educational conclusions and lessons learned.

Authors may want to also consider formats designed for presentation of qualitative research. The Standards for Reporting Qualitative Research (SRQR) enumerates 21 points that should be covered [ 9 ]. Educational case reports may illustrate outcomes with qualitative methods like focus groups, interviews with learners and faculty, observations of the learning process, and textual analysis [ 10 ], which would provide a higher level of evidence and iterative data analysis than afforded by the use of Likert-scale student satisfaction questionnaires. SRQR endorses increasing trustworthiness and credibility with conclusions based on triangulation from more than one data source and providing transparency about any author’s attributes that might have biased the data gathering, analysis, and transferability. The application of advanced design and methods in case study research, used in education at large, may be found elsewhere [ 7 ].

Educational case reports are an important manuscript type and have been wonderful contributions to Academic Psychiatry . Educational case reports have followed the tradition of clinical case reports in medicine, which have a long history and have sometimes become early progenitors of novel perspectives and discoveries about disease and treatment. We suggest that educational case reports may also benefit from borrowing from the tradition of case studies in the field of education at large, which are considered as a form of qualitative research. In other words, educational case reports in medicine can take advantage of a hybrid style, combining elements from both clinical case reports and qualitative research studies, in proportions determined by the author fitting for the case.

Qualitative approaches and methods are useful in dealing with the great complexity of educational interventions and the contexts in which they are implemented. Qualitative writing encourages telling the story of the intervention in rich and deep detail over the course of the study, developing propositions of how and why the intervention’s processes and outcomes unfolded as they did. Therefore, one consideration for education researchers and perhaps for psychiatry in general is greater attention to teaching qualitative methods, as these have a rich foundation and are particularly applicable to psychiatry as a field. As a foundation, the format might adapt the relevant elements of a clinical case report, as described in the CARE guidelines. Then, authors who want to elaborate on the qualitative research features of their report may add in more rigorous qualitative methodologies, paradigms, and reporting standards. We are delighted to continue the fine tradition of Academic Psychiatry publishing educational case reports, and we look forward to your submissions.

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Louie, A.K., Balon, R., Beresin, E.V. et al. Educational Case Reports: Purpose, Style, and Format. Acad Psychiatry 46 , 147–150 (2022). https://doi.org/10.1007/s40596-022-01610-7

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The IMA Educational Case Journal (IECJ ® ) is a quarterly online journal that publishes teaching cases and notes.

IMA Educational Case Journal

IECJ publishes cases covering a wide range of topics reflecting the diverse skill set required of management accountants.

Its published cases take learning beyond mere “number-crunching” exercises to require interpretation of data in a decision-making context – making them ideal learning tools for graduate and undergraduate students.

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The IMA Educational Case Journal (IECJ ® ) editor is Leif Sjöblom and the managing editor is Susie Duong. The associated editors are Laurie Burney, Margaret Shackell, and Thomas Calderon.

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Do you have a case idea that you want to discuss and get feedback on? Or perhaps an early case draft? Or general questions about IECJ and the requirements and review process?

Members of the IECJ Editorial Board are happy to assist you during the journal’s “office hours” to help authors improve their papers and make the case writing process a productive and rewarding experience.  These open sessions are available to anyone who would like feedback on a case idea, suggestions on writing a case and teaching notes, or clarification on how to address review comments. If you are considering submitting a paper to the IECJ and would like our guidance, please  click here to access our office hours calendar which offers appointments in multiple time zones.  If the time slots are not convenient, please feel free to reach out for individual appointments with one of our associate or senior editors at [email protected]

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IECJ is listed in Cabell’s Directory of Publishing Opportunities for Accounting and welcomes submissions from around the world. Case studies jointly authored by academics and practitioners are encouraged. Real-world cases are strongly preferred, but fictional cases with some basis in practice will be considered.

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Making Learning Relevant With Case Studies

The open-ended problems presented in case studies give students work that feels connected to their lives.

Students working on projects in a classroom

To prepare students for jobs that haven’t been created yet, we need to teach them how to be great problem solvers so that they’ll be ready for anything. One way to do this is by teaching content and skills using real-world case studies, a learning model that’s focused on reflection during the problem-solving process. It’s similar to project-based learning, but PBL is more focused on students creating a product.

Case studies have been used for years by businesses, law and medical schools, physicians on rounds, and artists critiquing work. Like other forms of problem-based learning, case studies can be accessible for every age group, both in one subject and in interdisciplinary work.

You can get started with case studies by tackling relatable questions like these with your students:

  • How can we limit food waste in the cafeteria?
  • How can we get our school to recycle and compost waste? (Or, if you want to be more complex, how can our school reduce its carbon footprint?)
  • How can we improve school attendance?
  • How can we reduce the number of people who get sick at school during cold and flu season?

Addressing questions like these leads students to identify topics they need to learn more about. In researching the first question, for example, students may see that they need to research food chains and nutrition. Students often ask, reasonably, why they need to learn something, or when they’ll use their knowledge in the future. Learning is most successful for students when the content and skills they’re studying are relevant, and case studies offer one way to create that sense of relevance.

Teaching With Case Studies

Ultimately, a case study is simply an interesting problem with many correct answers. What does case study work look like in classrooms? Teachers generally start by having students read the case or watch a video that summarizes the case. Students then work in small groups or individually to solve the case study. Teachers set milestones defining what students should accomplish to help them manage their time.

During the case study learning process, student assessment of learning should be focused on reflection. Arthur L. Costa and Bena Kallick’s Learning and Leading With Habits of Mind gives several examples of what this reflection can look like in a classroom: 

Journaling: At the end of each work period, have students write an entry summarizing what they worked on, what worked well, what didn’t, and why. Sentence starters and clear rubrics or guidelines will help students be successful. At the end of a case study project, as Costa and Kallick write, it’s helpful to have students “select significant learnings, envision how they could apply these learnings to future situations, and commit to an action plan to consciously modify their behaviors.”

Interviews: While working on a case study, students can interview each other about their progress and learning. Teachers can interview students individually or in small groups to assess their learning process and their progress.

Student discussion: Discussions can be unstructured—students can talk about what they worked on that day in a think-pair-share or as a full class—or structured, using Socratic seminars or fishbowl discussions. If your class is tackling a case study in small groups, create a second set of small groups with a representative from each of the case study groups so that the groups can share their learning.

4 Tips for Setting Up a Case Study

1. Identify a problem to investigate: This should be something accessible and relevant to students’ lives. The problem should also be challenging and complex enough to yield multiple solutions with many layers.

2. Give context: Think of this step as a movie preview or book summary. Hook the learners to help them understand just enough about the problem to want to learn more.

3. Have a clear rubric: Giving structure to your definition of quality group work and products will lead to stronger end products. You may be able to have your learners help build these definitions.

4. Provide structures for presenting solutions: The amount of scaffolding you build in depends on your students’ skill level and development. A case study product can be something like several pieces of evidence of students collaborating to solve the case study, and ultimately presenting their solution with a detailed slide deck or an essay—you can scaffold this by providing specified headings for the sections of the essay.

Problem-Based Teaching Resources

There are many high-quality, peer-reviewed resources that are open source and easily accessible online.

  • The National Center for Case Study Teaching in Science at the University at Buffalo built an online collection of more than 800 cases that cover topics ranging from biochemistry to economics. There are resources for middle and high school students.
  • Models of Excellence , a project maintained by EL Education and the Harvard Graduate School of Education, has examples of great problem- and project-based tasks—and corresponding exemplary student work—for grades pre-K to 12.
  • The Interdisciplinary Journal of Problem-Based Learning at Purdue University is an open-source journal that publishes examples of problem-based learning in K–12 and post-secondary classrooms.
  • The Tech Edvocate has a list of websites and tools related to problem-based learning.

In their book Problems as Possibilities , Linda Torp and Sara Sage write that at the elementary school level, students particularly appreciate how they feel that they are taken seriously when solving case studies. At the middle school level, “researchers stress the importance of relating middle school curriculum to issues of student concern and interest.” And high schoolers, they write, find the case study method “beneficial in preparing them for their future.”

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  • v.7; Jan-Dec 2021

Case Study Analysis as an Effective Teaching Strategy: Perceptions of Undergraduate Nursing Students From a Middle Eastern Country

Vidya seshan.

1 Maternal and Child Health Department, College of Nursing, Sultan Qaboos University, P.O. Box 66 Al-Khoudh, Postal Code 123, Muscat, Oman

Gerald Amandu Matua

2 Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, P.O. Box 66 Al-Khoudh, Postal Code 123, Muscat, Oman

Divya Raghavan

Judie arulappan, iman al hashmi, erna judith roach, sheeba elizebath sunderraj, emi john prince.

3 Griffith University, Nathan Campus, Queensland 4111

Background: Case study analysis is an active, problem-based, student-centered, teacher-facilitated teaching strategy preferred in undergraduate programs as they help the students in developing critical thinking skills. Objective: It determined the effectiveness of case study analysis as an effective teacher-facilitated strategy in an undergraduate nursing program. Methodology: A descriptive qualitative research design using focus group discussion method guided the study. The sample included undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018. The researcher used a purposive sampling technique and a total of 22 students participated in the study, through five (5) focus groups, with each focus group comprising between four to six nursing students. Results: In total, nine subthemes emerged from the three themes. The themes were “Knowledge development”, “Critical thinking and Problem solving”, and “Communication and Collaboration”. Regarding “Knowledge development”, the students perceived case study analysis method as contributing toward deeper understanding of the course content thereby helping to reduce the gap between theory and practice especially during clinical placement. The “Enhanced critical thinking ability” on the other hand implies that case study analysis increased student's ability to think critically and aroused problem-solving interest in the learners. The “Communication and Collaboration” theme implies that case study analysis allowed students to share their views, opinions, and experiences with others and this enabled them to communicate better with others and to respect other's ideas which further enhanced their team building capacities. Conclusion: This method is effective for imparting professional knowledge and skills in undergraduate nursing education and it results in deeper level of learning and helps in the application of theoretical knowledge into clinical practice. It also broadened students’ perspectives, improved their cooperation capacity and their communication with each other. Finally, it enhanced student's judgment and critical thinking skills which is key for their success.


Recently, educators started to advocate for teaching modalities that not only transfer knowledge ( Shirani Bidabadi et al., 2016 ), but also foster critical and higher-order thinking and student-centered learning ( Wang & Farmer, 2008 ; Onweh & Akpan, 2014). Therefore, educators need to utilize proven teaching strategies to produce positive outcomes for learners (Onweh & Akpan, 2014). Informed by this view point, a teaching strategy is considered effective if it results in purposeful learning ( Centra, 1993 ; Sajjad, 2010 ) and allows the teacher to create situations that promote appropriate learning (Braskamp & Ory, 1994) to achieve the desired outcome ( Hodges et al., 2020 ). Since teaching methods impact student learning significantly, educators need to continuously test the effectives of their teaching strategies to ensure desired learning outcomes for their students given today's dynamic learning environments ( Farashahi & Tajeddin, 2018 ).

In this study, the researchers sought to study the effectiveness of case study analysis as an active, problem-based, student-centered, teacher-facilitated strategy in a baccalaureate-nursing program. This choice of teaching method is supported by the fact that nowadays, active teaching-learning is preferred in undergraduate programs because, they not only make students more powerful actors in professional life ( Bean, 2011 ; Yang et al., 2013 ), but they actually help learners to develop critical thinking skills ( Clarke, 2010 ). In fact, students who undergo such teaching approaches usually become more resourceful in integrating theory with practice, especially as they solve their case scenarios ( Chen et al., 2019 ; Farashahi & Tajeddin, 2018 ; Savery, 2019 ).

Review of Literature

As a pedagogical strategy, case studies allow the learner to integrate theory with real-life situations as they devise solutions to the carefully designed scenarios ( Farashahi & Tajeddin, 2018 ; Hermens & Clarke, 2009). Another important known observation is that case-study-based teaching exposes students to different cases, decision contexts and the environment to experience teamwork and interpersonal relations as “they learn by doing” thus benefiting from possibilities that traditional lectures hardly create ( Farashahi & Tajeddin, 2018 ; Garrison & Kanuka, 2004 ).

Another merit associated with case study method of teaching is the fact that students can apply and test their perspectives and knowledge in line with the tenets of Kolb et al.'s (2014) “experiential learning model”. This model advocates for the use of practical experience as the source of one's learning and development. Proponents of case study-based teaching note that unlike passive lectures where student input is limited, case studies allow them to draw from their own experience leading to the development of higher-order thinking and retention of knowledge.

Case scenario-based teaching also encourages learners to engage in reflective practice as they cooperate with others to solve the cases and share views during case scenario analysis and presentation ( MsDade, 1995 ).

This method results in “idea marriage” as learners articulate their views about the case scenario. This “idea marriage” phenomenon occurs through knowledge transfer from one situation to another as learners analyze scenarios, compare notes with each other, and develop multiple perspectives of the case scenario. In fact, recent evidence shows that authentic case-scenarios help learners to acquire problem solving and collaborative capabilities, including the ability to express their own views firmly and respectfully, which is vital for future success in both professional and personal lives ( Eronen et al., 2019 ; Yajima & Takahashi, 2017 ). In recognition of this higher education trend toward student-focused learning, educators are now increasingly expected to incorporate different strategies in their teaching.

This study demonstrated that when well implemented, educators can use active learning strategies like case study analysis to aid critical thinking, problem-solving, and collaborative capabilities in undergraduate students. This study is significant because the findings will help educators in the country and in the region to incorporate active learning strategies such as case study analysis to aid critical thinking, problem-solving, and collaborative capabilities in undergraduate students. Besides, most studies on the case study method in nursing literature mostly employ quantitative methods. The shortage of published research on the case study method in the Arabian Gulf region and the scanty use of qualitative methods further justify why we adopted the focus group method for inquiry.

A descriptive qualitative research design using focus group discussion method guided the study. The authors chose this method because it is not only inexpensive, flexible, stimulating but it is also known to help with information recall and results in rich data ( Matua et al., 2014 ; Streubert & Carpenter, 2011 ). Furthermore, as evidenced in the literature, the focus group discussion method is often used when there is a need to gain an in-depth understanding of poorly understood phenomena as the case in our study. The choice of this method is further supported by the scarcity of published research related to the use of case study analysis as a teaching strategy in the Middle Eastern region, thereby further justifying the need for an exploratory research approach for our study.

As a recommended strategy, the researchers generated data from information-rich purposively selected group of baccalaureate nursing students who had experienced both traditional lectures and cased-based teaching approaches. The focus group interviews allowed the study participants to express their experiences and perspectives in their own words. In addition, the investigators integrated participants’ self-reported experiences with their own observations and this enhanced the study findings ( Morgan & Bottorff, 2010 ; Nyumba et al., 2018 ; Parker & Tritter, 2006 ).

Eligibility Criteria

In order to be eligible to participate in the study, the participants had to:

  • be a baccalaureate nursing student in College of Nursing, Sultan Qaboos University
  • register for Maternity Nursing Course in 2017 and 2018.
  • attend all the Case Study Analysis sessions in the courses before the study.
  • show a willingness to participate in the study voluntarily and share their views freely.

The population included the undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018.

The researcher used a purposive sampling technique to choose participants who were capable of actively participating and discussing their views in the focus group interviews. This technique enabled the researchers to select participants who could provide rich information and insights about case study analysis method as an effective teaching strategy. The final study sample included baccalaureate nursing students who agreed to participate in the study by signing a written informed consent. In total, twenty-two (22) students participated in the study, through five focus groups, with each focus group comprising between four and six students. The number of participants was determined by the stage at which data saturation was reached. The point of data saturation is when no new information emerges from additional participants interviewed ( Saunders et al., 2018 ).Focus group interviews were stopped once data saturation was achieved. Qualitative research design with focus group discussion allowed the researchers to generate data from information-rich purposively selected group of baccalaureate nursing students who had experienced both traditional lectures and case-based teaching approaches. The focus group interviews allowed the study participants to express their perspectives in their own words. In addition, the investigators enhanced the study findings by integrating participants’ self-reported experiences with the researchers’ own observations and notes during the study.

The study took place at College of Nursing; Sultan Qaboos University, Oman's premier public university, in Muscat. This is the only setting chosen for the study. The participants are the students who were enrolled in Maternal Health Nursing course during 2017 and 2018. The interviews occurred in the teaching rooms after official class hours. Students who did not participate in the study learnt the course content using the traditional lecture based method.

Ethical Considerations

Permission to conduct the study was granted by the College Research and Ethics Committee (XXXX). Prior to the interviews, each participant was informed about the purpose, benefits as well as the risks associated with participating in the study and clarifications were made by the principal researcher. After completing this ethical requirement, each student who accepted to participate in the study proceeded to sign an informed consent form signifying that their participation in the focus group interview was entirely voluntary and based on free will.

The anonymity of study participants and confidentiality of their data was upheld throughout the focus group interviews and during data analysis. To enhance confidentiality and anonymity of the data, each participant was assigned a unique code number which was used throughout data analysis and reporting phases. To further assure the confidentiality of the research data and anonymity of the participants, all research-related data were kept safe, under lock and key and through digital password protection, with unhindered access only available to the research team.

Research Intervention

In Fall 2017 and Spring 2018 semesters, as a method of teaching Maternal Health Nursing course, all students participated in two group-based case study analysis exercises which were implemented in the 7 th and 13 th weeks. This was done after the students were introduced to the case study method using a sample case study prior to the study. The instructor explained to the students how to solve the sample problem, including how to accomplish the role-specific competencies in the courses through case study analysis. In both weeks, each group consisting of six to seven students was assigned to different case scenarios to analyze and work on, after which they presented their collective solution to the case scenarios to the larger class of 40 students. The case scenarios used in both weeks were peer-reviewed by the researchers prior to the study.

Pilot Study

A group of three students participated as a pilot group for the study. However, the students who participated in the pilot study were not included in the final study as is general the principle with qualitative inquiry because of possible prior exposure “contamination”. The purpose of piloting was to gather data to provide guidance for a substantive study focusing on testing the data collection procedure, the interview process including the sequence and number of questions and probes and recording equipment efficacy. After the pilot phase, the lessons learned from the pilot were incorporated to ensure smooth operations during the actual focus group interview ( Malmqvist et al., 2019 .

Data Collection

The focus group interviews took place after the target population was exposed to case study analysis method in Maternal Health Nursing course during the Fall 2017 and Spring 2018 semesters. Before data collection began, the research team pilot tested the focus group interview guide to ensure that all the guide questions were clear and well understood by study participants.

In total, five (5) focus groups participated in the study, with each group comprising between four and six students. The focus group interviews lasted between 60 and 90 min. In addition to the interview guide questions, participants’ responses to unanswered questions were elicited using prompts to facilitate information flow whenever required. As a best practice, all the interviews were audio-recorded in addition to extensive field notes taken by one of the researchers. The focus group interviews continued until data saturation occurred in all the five (5) focus groups.


In this study, participant's descriptions were digitally audio recorded to ensure that no information was lost. In order to ensure that the results are accurate, verbatim transcriptions of the audio recordings were done supported by interview notes. Furthermore, interpretations of the researcher were verified and supported with existing literature with oversight from the research team.


The researcher provided a detailed description about the study settings, participants, sampling technique, and the process of data collection and analyses. The researcher used verbatim quotes from various participants to aid the transferability of the results.


The researcher ensured that the research process is clearly documented, traceable, and logical to achieve dependability of the research findings. Furthermore, the researcher transparently described the research steps, procedures and process from the start of the research project to the reporting of the findings.


In this study, confirmability of the study findings was achieved through the researcher's efforts to make the findings credible, dependable, and transferable.

Data Analysis

Data were analyzed manually after the lead researcher integrated the verbatim transcriptions with the extensive field notes to form the final data set. Data were analyzed thematically under three thematic areas of a) knowledge development; b) critical thinking and problem solving; and (c) communication and collaboration, which are linked to the study objectives. The researchers used the Six (6) steps approach to conduct a trustworthy thematic analysis: (1) familiarization with the research data, (2) generating initial codes, (3) searching for themes, (4) reviewing the themes, (5) defining and naming themes, (6) writing the report ( Nowell et al., 2017 ).

The analysis process started with each team member individually reading and re-reading the transcripts several times and then identifying meaning units linked to the three thematic areas. The co-authors then discussed in-depth the various meaning units linked to the thematic statements until consensus was reached and final themes emerged based on the study objectives.

A total of 22 undergraduate third-year baccalaureate nursing students who were enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018 participated in the study, through five focus groups, with each group comprising four to six students. Of these, 59% were females and 41% were males. In total, nine subthemes emerged from the three themes. Under knowledge development, emerged the subthemes, “ deepened understanding of content ; “ reduced gap between theory and practice” and “ improved test-taking ability ”. While under Critical thinking and problem solving, emerged the subthemes, “ enhanced critical thinking ability ” and “ heightened curiosity”. The third thematic area of communication and collaboration yielded, “ improved communication ability ”; “ enhanced team-building capacity ”; “ effective collaboration” and “ improved presentation skills ”, details of which are summarized in Table 1 .

Table 1.

Objective Linked Themes and Student Perceptions of Outcome Case Study Analysis.

Thematic Areas/ObjectivesSubthemes Related to Student Perceptions
1Knowledge DevelopmentSubtheme 1- Deepened understanding of content Subtheme 2-The reduced gap between theory and practice Subtheme 3- Improved test-taking ability
2Critical thinking and problem solvingSubtheme 1- Enhanced critical thinking ability Subtheme 2- Heightened learner curiosity
3Communication and collaborationSubtheme 1- Improved communication ability Subtheme 2- Enhanced team-building capacity Subtheme 3- Effective collaboration ability Subtheme 4- Improved presentation skills

Theme 1: Knowledge Development

In terms of knowledge development, students expressed delight at the inclusion of case study analysis as a method during their regular theory class. The first subtheme related to knowledge development that supports the adoption of the case study approach is its perceived benefit of ‘ deepened understanding of content ’ by the students as vividly described by this participant:

“ I was able to perform well in the in-course exams as this teaching method enhanced my understanding of the content rather than memorizing ” (FGD#3).

The second subtheme related to knowledge development was informed by participants’ observation that teaching them using case study analysis method ‘ reduced the gap between theory and practice’. This participant's claim stem from the realization that, a case study scenario his group analyzed in the previous week helped him and his colleagues to competently deal with a similar situation during clinical placement the following week, as articulated below:

“ You see when I was caring for mothers in antenatal unit, I could understand the condition better and could plan her care well because me and my group already analyzed a similar situation in class last week which the teacher gave us, this made our work easier in the ward”. (FGD#7).

Another student added that:

“ It was useful as what is taught in the theory class could be applied to the clinical cases.”

This ‘theory-practice’ connection was particularly useful in helping students to better understand how to manage patients with different health conditions. Interestingly, the students reported that they were more likely to link a correct nursing care plan to patients whose conditions were close to the case study scenarios they had already studied in class as herein affirmed:

“ …when in the hospital I felt I could perceive the treatment modality and plan for [a particular] nursing care well when I [had] discussed with my team members and referred the textbook resource while performing case study discussion”. (FGD#17).

In a similar way, another student added:

“…I could relate with the condition I have seen in the clinical area. So this has given me a chance to recall the condition and relate the theory to practice”. (FGD#2) .

The other subtheme closely related to case study scenarios as helping to deepen participant's understanding of the course content, is the notion that this teaching strategy also resulted in ‘ improved test taking-ability’ as this participant's verbatim statement confirms:

“ I could answer the questions related to the cases discussed [much] better during in-course exams. Also [the case scenarios] helped me a great deal to critically think and answer my exam papers” (FGD#11).

Theme 2: Critical Thinking and Problem Solving

In this subtheme, students found the case study analysis as an excellent method to learn disease conditions in the two courses. This perceived success with the case study approach is associated with the method's ability to ‘ enhance students’ critical thinking ability’ as this student declares:

“ This method of teaching increased my ability to think critically as the cases are the situations, where we need to think to solve the situation”. (FGD#5)

This enhanced critical thinking ability attributed to case study scenario analysis was also manifested during patient care where students felt it allowed them to experience a “ flow of patient care” leading to better patient management planning as would typically occur during case scenario analysis. In support of this finding, a participant mentioned that:

“ …I could easily connect the flow of patient care provided and hence was able to plan for [his] management as often required during case study discussion” (FGD#12)

Another subtheme linked with this theme is the “ heightened curiosity” associated with the case scenario discussions. It was clear from the findings that the cases aroused curiosity in the mind of the students. This heightened interest meant that during class discussion, baccalaureate nursing students became active learners, eager to discover the next set of action as herein affirmed:

“… from the beginning of discussion with the group, I was eager to find the answer to questions presented and wanted to learn the best way for patient management” (FGD#14)

Theme 3: Communication and Collaboration

In terms of its impact on student communication, the subtheme revealed that case study analysis resulted in “ improved communication ability” among the nursing students . This enhanced ability of students to exchange ideas with each other may be attributed to the close interaction required to discuss and solve their assigned case scenarios as described by the participant below:

“ as [case study analysis] was done in the way of group discussion, I felt me and my friends communicated more within the group as we discussed our condition. We also learnt from each other, and we became better with time.” (FGD#21).

The next subtheme further augments the notion that case study analysis activities helped to “ enhance team-building capacity” of students as this participant affirmatively narrates:

“ students have the opportunity to meet face to face to share their views, opinion, and their experience, as this build on the way they can communicate with each other and respect each other's opinions and enhance team-building”. (FGD#19).

Another subtheme revealed from the findings show that the small groups in which the case analysis occurs allowed the learners to have deeper and more focused conversations with one another, resulting in “ an effective collaboration between students” as herein declared:

“ We could collaborate effectively as we further went into a deep conversation on the case to solve”. (FGD#16).

Similarly, another student noted that:

“ …discussion of case scenarios helped us to prepare better for clinical postings and simulation lab experience” (FGD#5) .

A fourth subtheme related to communication found that students also identified that case study analysis resulted in “ improved presentation skills”. This is attributed in part to the preparation students have to go through as part of their routine case study discussion activities, which include organizing their presentations and justifying and integrating their ideas. Besides readying themselves for case presentations, the advice, motivation, and encouragement such students receive from their faculty members and colleagues makes them better presenters as confirmed below:

“ …teachers gave us enough time to prepare, hence I was able to present in front of the class regarding the finding from our group.” (FGD#16).

In this study, the researches explored learner's perspectives on how one of the active teaching strategies, case study analysis method impacted their knowledge development, critical thinking, and problem solving as well as communication and collaboration ability.

Knowledge Development

In terms of knowledge development, the nursing students perceived case study analysis as contributing toward: (a) deeper understanding of content, (b) reducing gap between theory and practice, and (c) improving test-taking ability. Deeper learning” implies better grasping and retention of course content. It may also imply a deeper understanding of course content combined with learner's ability to apply that understanding to new problems including grasping core competencies expected in future practice situations (Rickles et al., 2019; Rittle-Johnson et al., 2020 ). Deeper learning therefore occurs due to the disequilibrium created by the case scenario, which is usually different from what the learner already knows ( Hattie, 2017 ). Hence, by “forcing” students to compare and discuss various options in the quest to solve the “imbalance” embedded in case scenarios, students dig deeper in their current understanding of a given content including its application to the broader context ( Manalo, 2019 ). This movement to a deeper level of understanding arises from carefully crafted case scenarios that instructors use to stimulate learning in the desired area (Nottingham, 2017; Rittle-Johnson et al., 2020 ). The present study demonstrated that indeed such carefully crafted case study scenarios did encourage students to engage more deeply with course content. This finding supports the call by educators to adopt case study as an effective strategy.

Another finding that case study analysis method helps in “ reducing the gap between theory and practice ” implies that the method helps students to maintain a proper balance between theory and practice, where they can see how theoretical knowledge has direct practical application in the clinical area. Ajani and Moez (2011) argue that to enable students to link theory and practice effectively, nurse educators should introduce them to different aspects of knowledge and practice as with case study analysis. This dual exposure ensures that students are proficient in theory and clinical skills. This finding further amplifies the call for educators to adequately prepare students to match the demands and realities of modern clinical environments ( Hickey, 2010 ). This expectation can be met by ensuring that student's knowledge and skills that are congruent with hospital requirements ( Factor et al., 2017 ) through adoption of case study analysis method which allows integration of clinical knowledge in classroom discussion on regular basis.

The third finding, related to “improved test taking ability”, implies that case study analysis helped them to perform better in their examination, noting that their experience of going through case scenario analysis helped them to answer similar cases discussed in class much better during examinations. Martinez-Rodrigo et al. (2017) report similar findings in a study conducted among Spanish electrical engineering students who were introduced to problem-based cooperative learning strategies, which is similar to case study analysis method. Analysis of student's results showed that their grades and pass rates increased considerably compared to previous years where traditional lecture-based method was used. Similar results were reported by Bonney (2015) in an even earlier study conducted among biology students in Kings Borough community college students, in New York, United States. When student's performance in examination questions covered by case studies was compared with class-room discussions, and text-book reading, case study analysis approach was significantly more effective compared to traditional methods in aiding students’ performance in their examinations. This finding therefore further demonstrates that case study analysis method indeed improves student's test taking ability.

Critical Thinking and Problem Solving

In terms of critical thinking and problem-solving ability, the use of case study analysis resulted in two subthemes: (a) enhanced critical thinking ability and (b) heightened learner curiosity. The “ enhanced critical thinking ability” implies that case analysis increased student's ability to think critically as they navigated through the case scenarios. This observation agrees with the findings of an earlier questionnaire-based study conducted among 145 undergraduate business administration students at Chittagong University, Bangladesh, that showed 81% of respondents agree that case study analysis develops critical thinking ability and enables students to do better problem analysis ( Muhiuddin & Jahan, 2006 ). This observation agrees with the findings of an earlier study conducted among 145 undergraduate business administration students at Chittagong University, Bangladesh. The study showed that 81% of respondents agreed that case study analysis facilitated the development of critical thinking ability in the learners and enabled the students to perform better with problem analysis ( Muhiuddin & Jahan, 2006 ).

More recently, Suwono et al. (2017) found similar results in a quasi-experimental research conducted at a Malaysian university. The research findings showed that there was a significant difference in biological literacy and critical thinking skills between the students taught using socio-biological case-based learning and those taught using traditional lecture-based learning. The researchers concluded that case-based learning enhanced the biological literacy and critical thinking skills of the students. The current study adds to the existing pedagogical knowledge base that case study methodology can indeed help to deepen learner's critical thinking and problem solving ability.

The second subtheme related to “ heightened learner curiosity” seems to suggest that the case studies aroused problem-solving interest in learners. This observation agrees with two earlier studies by Tiwari et al. (2006) and Flanagan and McCausland (2007) who both reported that most students enjoyed case-based teaching. The authors add that the case study method also improved student's clinical reasoning, diagnostic interpretation of patient information as well as their ability to think logically when presented a challenge in the classroom and in the clinical area. Jackson and Ward (2012) similarly reported that first year engineering undergraduates experienced enhanced student motivation. The findings also revealed that the students venturing self-efficacy increased much like their awareness of the importance of key aspects of the course for their future careers. The authors conclude that the case-based method appears to motivate students to autonomously gather, analyze and present data to solve a given case. The researchers observed enhanced personal and collaborative efforts among the learners, including improved communication ability. Further still, learners were more willing to challenge conventional wisdom, and showed higher “softer” skills after exposure to case analysis based teaching method. These findings like that of the current study indicate that teaching using case based analysis approach indeed motivates students to engage more in their learning, there by resulting in deeper learning.

Communication and Collaboration

Case study analysis is also perceived to result in: (a) improved communication ability; (b) enhanced team -building capacity, (c) effective collaboration ability, and (d) enhanced presentation skills. The “ improved communication ability ” manifested in learners being better able to exchange ideas with peers, communicating their views more clearly and collaborating more effectively with their colleagues to address any challenges that arise. Fini et al. (2018) report comparable results in a study involving engineering students who were subjected to case scenario brainstorming activities about sustainability concepts and their implications in transportation engineering in selected courses. The results show that this intervention significantly improved student's communication skills besides their higher-order cognitive, self-efficacy and teamwork skills. The researchers concluded that involving students in brainstorming activities related to problem identification including their practical implications, is an effective teaching strategy. Similarly, a Korean study by Park and Choi (2018) that sought to analyze the effects of case-based communication training involving 112 sophomore nursing students concluded that case-based training program improved the students’ critical thinking ability and communication competence. This finding seems to support further the use of case based teaching as an effective teaching-learning strategy.

The “ enhanced team-building capacity” arose from the opportunity students had in sharing their views, opinions, and experiences where they learned to communicate with each other and respect each other's ideas which further enhance team building. Fini et al. (2018) similarly noted that increased teamwork levels were seen among their study respondents when the researchers subjected engineering students to case scenario based-brainstorming activities as occurs with case study analysis teaching. Likewise, Lairamore et al. (2013) report similar results in their study that showed that case study analysis method increased team work ability and readiness among students from five health disciplines in a US-based study.

The finding that case study analysis teaching method resulted in “ effective collaboration ability” among students manifested as students entered into deep conversation as they solved the case scenarios. Rezaee and Mosalanejad (2015) assert that such innovative learning strategies result in noticeable educational outcomes, such as greater satisfaction with and enjoyment of the learning process ( Wellmon et al., 2012 ). Further, positive attitudes toward learning and collaboration have been noted leading to deeper learning as students prepare for case discussions ( Rezaee & Mosalanejad, 2015 ). This results show that case study analysis can be utilized by educators to foster professional collaboration among their learners, which is one of the key expectations of new graduates today.

The finding associated with “improved presentation skills” is consistent with the results of a descriptive study in Saudi Arabia that compared case study and traditional lectures in the teaching of physiology course to undergraduate nursing students. The researchers found that case-based teaching improved student’ overall knowledge and performance in the course including facilitating the acquisition of skills compared to traditional lectures ( Majeed, 2014 ). Noblitt et al. (2010) report similar findings in their study that compares traditional presentation approach with the case study method for developing and improving student's oral communication skills. This finding extends our understanding that case study method improves learners’ presentation skills.

The study was limited to level third year nursing students belonging to only one college and the sample size, which might limit the transferability of the study findings to other settings.

Implications for Practice

These study findings add to the existing body of knowledge that places case study based teaching as a tested method that promotes perception learning where students’ senses are engaged as a result of the real-life and authentic clinical scenarios ( Malesela, 2009 ), resulting in deeper learning and achievement of long-lasting knowledge ( Fiscus, 2018 ). The students reported that case scenario discussions broadened their perspectives, improved their cooperation capacity and communication with each other. This teaching method, in turn, offers students an opportunity to enhance their judgment and critical thinking skills by applying theory into practice.

These skills are critically important because nurses need to have the necessary knowledge and skills to plan high quality care for their patients to achieve a speedy recovery. In order to attain this educational goal, nurse educators have to prepare students through different student- centered strategies. The findings of our study appear to show that when appropriately used, case-based teaching results in acquisition of disciplinary knowledge manifested by deepened understanding of course content, as well as reducing the gap between theory and practice and enhancing learner's test-taking-ability. The study also showed that cased based teaching enhanced learner's critical thinking ability and curiosity to seek and acquire a deeper knowledge. Finally, the study results indicate that case study analysis results in improved communication and enhanced team-building capacity, collaborative ability and improved oral communication and presentation skills. The study findings and related evidence from literature show that case study analysis is well- suited approach for imparting knowledge and skills in baccalaureate nursing education.

This study evaluated the usefulness of Case Study Analysis as a teaching strategy. We found that this method of teaching helps encourages deeper learning among students. For instructors, it provides the opportunity to tailor learning experiences for students to undertake in depth study in order to stimulate deeper understanding of the desired content. The researchers conclude that if the cases are carefully selected according to the level of the students, and are written realistically and creatively and the group discussions keep students well engaged, case study analysis method is more effective than other traditional lecture methods in facilitating deeper and transferable learning/skills acquisition in undergraduate courses.

Conflict of Interest: The authors declare no conflict of interest.

ORCID iD: Judie Arulappan https://orcid.org/0000-0003-2788-2755

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Exploring Instructors’ Practices in Student Engagement: A Collective Case Study

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Instructors use various strategies to improve learning. To explore what instructors perceived as critical aspects of engaging instruction, we conducted a qualitative case study with seven instructors in the United States. Data was collected through individual face-to-face interviews. The conversations were audio-taped and transcribed verbatim. The analyses of the transcriptions were conducted using the constant comparative method. Findings from the study varied. Yet, participants agreed that an engaging instructor must focus on learning; consider various aspects of students’ personal development including their cognitive, social, and emotional development; and take care of different student learning styles, for example, visual, auditory, and kinesthetic. Participants stressed the importance of student engagement. Body language, verbal and non-verbal cues, and eye contact were the main parameters used by the participants to evaluate student engagement. Participants also emphasized the importance of asking questions and assessing instructional effectiveness by evaluating the questions asked by students.

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; Rodrigo H. Pe�a, Kingsville Independent School District; Gerri M. Maxwell, Texas A&M University � Kingsville. ; Ernestina M. Briones, Student Engagement Facilitator, San Antonio ISD; Don Jones, Texas A&M University - Kingsville; Linda Challoo, Texas A&M University - Kingsville. ; Jeanne M. Bridges, Texas A&M University - Kingsville; Gerri M. Maxwell, Texas A&M University - Kingsville. ; Falih M. Alsaaty, Bowie State University; Archie Morris III, Bowie State University. ; Grace Friesenhahn-Soliz, Texas A&M University � Kingsville; Steve Bain, Texas A&M University � Kingsville; Gerri Maxwell, Texas A&M University � Kingsville. ; Judith A Bazler, Monmouth University; Meta Van Sickle, College of Charleston; Letitia Graybill, Monmouth University. ; Ross L. Stephenson, Jr., Jacksonville University; Wayne Ziskal, Jacksonville University. ; Jan W. Buzydlowski, Holy Family University. ; Norma A. Guzm�n, Texas A&M-Kingsville; Angelita Guzm�n, Harlingen CISD. ; Archie Morris III, Bowie State University. ;Jeff Irvine, Brock University; Wendy Telford, Peel District School Board. ; Monica Rosalina, Texas A&M University-Kingsville, Medina Jim�nez, Texas A&M University-Kingsville; Norma A. Guzm�n, Texas A&M University-Kingsville; Monica Wong- Ratcliff, Texas A&M University-Kingsville. , Fatima H. Eid, Secretariat-General of the Higher Education Council, Kingdom of Bahrain. , Cynthia Garcia, Superintendent, Driscoll ISD; Don Jones, Texas A&M University - Kingsville; Carrie Isaacson, Hardin Simmons University. , Fatima H. Eid, Secretariat-General of the Higher Education Council, Kingdom of Bahrain. , Debra S. Harmening, University of Toledo; Stacy A. Jacob, Slippery Rock University of Pennsylvania. , Scott Campbell, National University. , Jeff Irvine, Brock University. , Melisa G. Guerra, Calallen Independent School District; Gerri M. 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The intersection of promotion policies, research habitus, and capital distribution: a qualitative case study of two higher education contexts in the united arab emirates.

Ahmed Elhakim

  • Director of Institutional Effectiveness and Accreditation, Sharjah Maritime Academy, Sharjah, United Arab Emirates

Introduction: Career advancement must be based on merit, according to the universal norm. However, faculty members continue to express their dissatisfaction with the existing promotion policies and practices, highlighting issues like ambiguity, lack of transparency, inconsistent implementation, and the overall fairness of the evaluation process. This study aimed to explore the intersections of promotion policies with the research habitus and the distribution of different forms of capital in two higher education institutes in the United Arab Emirates.

Methods: Data were gathered from a purposively selected sample of faculty members using semi-structured interviews in addition to key policy documents at both institutes.

Results and discussion: Using Bourdieu’s notion of habitus, capital, and field, the study identified key characteristics of the research habitus and how it shapes perceptions towards aspects of competitiveness and collegiality as practiced in the research world. The study also examined potential relationships between research habitus and promotion policies. Finally, the study explored capital distribution in the research field and identified some of the undisclosed aspects of the promotion world, highlighting areas like prior education, affiliations, professional experience, cultural background, ethnicity, and social networks as some of the factors that may play a role in the promotion outcomes. The findings of the study can be used to offer an additional layer of understanding some hidden rules of academic research fields and capital distribution in light of institutional policy development and enactment. Such understanding can be used to make recommendations on how existing challenges can be addressed to improve perceptions of the clarity and fairness of faculty promotion policies and encourage more transparent practices.

1 Introduction

It is universally accepted that promotion is one of the main indicators of a faculty member’s progression in the academic world. According to Young (2006) , it is arguably the most important incentive used by higher education institutes to encourage their faculty. Moreover, Hanley and Forkenbrock (2006) claimed that the university’s stringent promotion and reward system has been the main driver for faculty excellence. Therefore, the employment and advancement of exceptional professors are essential to an academic institution’s overall success ( Albatch, 2008 ). From an academic or faculty member’s point of view, getting a promotion to a professorship is a remarkable achievement that elevates his or her status in the academic field ( Azman et al., 2016 ). Barrow and Grant (2018) identify promotion as a compelling moment of academic subject formation where, in order to participate, individuals must account for themselves as promotion-worthy through presenting a comprehensive dossier in response to a detailed set of norms.

In the past few decades, education systems around the globe have adapted to political, governmental, and market factors. One of the key results of these changes is that faculty performance is being increasingly evaluated based on quantitative results ( Heffernan, 2017 ). As a result, universities and colleges responded to the requirements of neoliberalism by establishing a competitive atmosphere that included responsibility toward their sponsors and regulators ( Ward, 2012 ). This has resulted in a system for faculty hiring, grading, and advancement that resembles a tournament ( Musselin, 2005 ). By comparing faculty members’ outputs, this tournament-like system of marking allegedly aims at boosting productivity, encouraging competition, and refining selectivity.

Evaluating faculty is crucial to promoting faculty development but changes to the evaluation criteria may have jeopardized this aim. Market liberalism emphasized faculty productivity and efficiency ( Soudien et al., 2013 ), fostering a “performativity” culture. Soudien et al. (2013) define “performativity” as a formalized system to monitor and assess faculty effectiveness. Neoliberalism’s market-based principles affected economic, social, and cultural realms, and the need for economic efficiency changed higher education managerial ideologies and practices ( Saunders, 2010 ). The identities and goals of teachers and students have changed as higher education has adapted to neoliberal practices and ideology ( Saunders, 2010 ). Measurable outputs have replaced open intellectual study and discussion in professional society ( Olssen and Peters, 2005 ). Neoliberal principles and market logic have indirectly impacted faculty promotion, citing a decline in academic reasoning and academic values due to market competition ( Levin et al., 2020 ).

Given the dynamic changes in academia, such as the rise of open-access journals, preprint servers, and the negative impact of the COVID-19 pandemic, various parties, including academics, are now examining the effectiveness of conventional methods used for faculty promotion ( Schimanski and Alperin, 2018 ). According to Faria et al. (2013) , academic promotion has always been a highly debated subject, with discussions typically focusing on efficacy, excellence, fairness, and quality. Sutherland (2017) highlights that research output is the primary criterion for evaluating academics for distinguished faculty appointments, promotions, honors, and rewards. Most of the institutions are still utilizing simple, easily quantifiable metrics such as the journal impact factor (JIF) or the number of publications as an indicator for research output ( McKiernan et al. (2019) . Inconsistent evaluation of research-related standards, giving more weight to research than to instruction, and quantity versus quality issues have been a few of the most common difficulties associated with promotion policies.

Another significant obstacle is the widespread belief that the promotion procedure in general, and research outcome evaluation in particular, cannot be democratic or transparent ( Omar et al., 2015 ). For instance, the Pharmacy Faculty Demographics and Salaries report published by the American Association of Colleges and of Pharmacy (2023) cites that women are disproportionately present in lower-ranking roles such as instructor and assistant professor, whereas they are underrepresented in higher-ranking jobs like senior and administrative roles. Most universities have official regulations and procedures for their promotion processes. However, there is frequently considerable subjectivity in terms of how these guidelines are interpreted and enacted. Promotions are always open to subjectivity and bias, and there are often no normative rules for an institution’s decision-making powers ( Omar et al., 2015 ). Consequently, the way each department or unit within an institutional practice applies its promotion strategy may differ significantly.

In light of these complexities, many faculty members may feel compelled to assert their merit or aggressively refute negative stereotypes ( Durodoye et al., 2019 ). For instance, Kulp et al. (2021) highlight that a large body or research points out that mid-career faculty members deal with a variety of demands and stressors that impact both their likelihood of being promoted to full professor and their level of job satisfaction. One of these pressing demands faced by faculty is to continuously seek to achieve an appropriate balance between their teaching, research, and community service duties to align with their professional goals and to meet institutional needs and curricular requirements. The distribution of these efforts is largely impacted by the institutional culture, which also has a large influence on faculty recruitment and retention as well as promotion and tenure ( Blakely et al., 2023 ). Thus, an efficient and fair system for appointing and promoting faculty members is essential for enhancing the overall well-being of scholars and fostering a thriving academic environment at any educational institution.

Based on his research, Pierre Bourdieu proposed a social theory that classified people into “fields,” “capital,” and “habitus.” In any society, there are numerous fields, each with its own set of norms and expectations ( Bourdieu, 1989 ). Bourdieu regularly used metaphors to explain his ideas, and the term ‘field’ is derived from the tournament field. In football, different experiences, opportunities, and skills have brought each player to the field, and everyone’s past has shaped who they are today as competing footballers ( Bourdieu, 1990 ). Referring to the tournament-like model described earlier where faculty members compete to achieve promotion, Bourdieu’s concept of field seems particularly appropriate in the context of this study. Academics acquire the norms of the field as they progress through their careers as students, mentees, and full-fledged faculty members.

An individual’s capital can be broken down into subcategories, including economic, cultural, and social capital. A person’s economic wealth is the amount of money at their disposal. This may be related to one’s job or one’s family’s wealth ( Bourdieu, 1995 ). On the other hand, language, educational attainment, and involvement in peer cultures are all examples of one’s cultural capital. Access to culture may be influenced by an individual’s economic capital and vice versa. Social capital is the sum of an individual’s social networks. It can refer to being able to use these networks to advance one’s career, but simply belonging to a network is also advantageous. The ability of someone’s capital to reveal information about their past and, in turn, predict their future is a key feature of all types of capital. As a result, there are obvious connections between all kinds of capital and the “structured” and “structuring” events that give rise to their habitus. Second, capital, according to Bourdieu, draws more capital. For instance, if a child’s family’s financial capital is transformed into cultural capital as a result of the child attending outstanding schools, that cultural capital may then be transformed back into financial capital as the child embarks on a financially rewarding career at a later stage of his/her life ( Grenfell and James, 1998 ).

How do people in such a restricted social framework as academia be true to who they are? Bourdieu used the term “habitus” to describe this sense of physical and psychological identity that each of us has in the spaces we occupy. By “habitus,” Bourdieu (1994) means the sum of the experiences, interactions, and impressions that have formed one’s personality, outlook, and values throughout their lifetime. Therefore, habitus forms the properties that combine to form the structured and structuring structure of an individual. Habitus also affects how people interact with the outside world, causing them to adopt particular attitudes, values, and behaviors. As Bourdieu said, it is because of his own habitus that ‘I either see or do not see certain things in a given situation. And depending on whether I see these things or not, I shall be incited by my habitus to do or not do certain things’ ( Schaffer, 2016 ).

Therefore, our habitus cover everything we do, whether or not we are consciously aware of them at the time. Since we are continually evaluating ourselves to others, we are also able to spot habitus in those around us. Education, family upbringing, and social connections all play a role in shaping the professional messages we absorb and convey ( Bourdieu, 1995 ). According to Bourdieu, our connections to others, both below and above us, are as important to our achievement as the work we put in on our own ( Bourdieu, 1998 ). A stable and consistent academic hierarchy is maintained by the interplay between habitus, capital, and field norms ( Bourdieu, 1998 ). Power is not usurped before it has been earned through the traditional rites of passage of faculty promotion, which is why “knowing one’s position” is crucial. This entails working tirelessly at teaching, researching, and writing in order to position oneself as a deserving applicant for inclusion in the academically elite society.

Bourdieu insists that a habitus is first and foremost a conceptual tool for use in an empirical study rather than a concept to be debated in texts ( Reay, 2004 ). Habitus offers a strategy for investigating ‘the experience of social agents and the objective structures which make this experience feasible’ all at once ( Bourdieu, 1988 ). Incorporating habitus as a theoretical framework suggests that studies will consider factors beyond those being studied directly. Bourdieu’s approach stresses how “the structure of those worlds is already predefined by broader racial, gender, and class relations,” highlighting the importance of seeing people as actively engaged in creating their social worlds ( Bourdieu and Wacquant, 1992 ). Although Bourdieu’s theories of habitus, capital, and field can be explained independently of universities or any educational establishment, it is important to note that he was a university professor who interacted with his colleagues and students. Bourdieu’s main work, Homo Academicus, is an application of his theories to the context of higher education ( Heffernan, 2021 ).

Of relevance to this study, Bourdieu’s key concepts and multi-method approach continue to function as a theoretical toolbox for present studies addressing the complexities of career trajectories in higher education. For example, Gander (2022) used Bourdieu’s theory as an integrative framework for career theory, where career stories from university professional staff were analyzed using the lens of The Holistic Career Framework. Smith and Walker (2021) utilized Bourdieu’s analytical framework in an exploratory study that analyzed the role descriptors and promotion criteria of mid-sized United Kingdom universities, citing significant disparities in the job titles within education-oriented career paths, the definitions of scholarship, the anticipated impact, and the connection between scholarship and pedagogic research. Stavrou (2022) investigated the intersection of a knowledge structure with a graduate’s social class by using Bourdieu’s theory to demonstrate how, in each field of study, specific forms of social inequality operate, affecting transitions from higher education to work in increasingly competitive and precarious labor markets. Last but not least, Fudiyartanto and Stahl (2023) explored the role of symbolic capital associated with the training received at the graduate level in informing how academics navigate their careers and how they advance professionally in the context of the Indonesian higher education.

Moreover, Bourdieu’s notions of habitus, capital and filed have been used in higher education research to address areas like inequality and social justice ( Birtwell et al., 2020 ; Bülbül, 2020 ; Jayakumar and Page, 2021 ; Reay, 2021 ; Hassan, 2022 ; Kovács and Pusztai, 2023 ), pedagogy and curriculum reform ( Annala et al., 2020 ; Hindhede and Højbjerg, 2020 ), and learner pathways and mobility ( Katartzi and Hayward, 2019 ).

Based on the above, I decided to investigate the intersection of faculty promotion policies and research conceptions, perceptions, and norms using semi-structured interviews with a purposively selected sample of faculty members from two higher education institutes in the United Arab Emirates. In addition, the study utilized content analysis to offer a careful examination of key policy documents at both institutes. In particular, the theoretical lens of Pierre Bourdieu’s theory of practice was used to answer the following research questions:

• What are the key characteristics of the research habitus at the two institutes as perceived by the participants in this study?

• To what extent does the research habitus at each institute reflect the promotion policy implemented?

• How are economic, social, and cultural capital distributed in different fields of faculty promotion represented by the two institutes? And what are the implications of such distributions for promotion policies and practice?

The study aimed to offer conceptual significance in terms of offering an additional layer of understanding of how different academic research fields can have different rules considering institutional policy development and enactment. Bourdieu’s views adopt a fatalist approach where life is almost predictable, and the future is pre-determined upon birth. In essence, this seems to challenge the core aspect of promotion policies, where the future (e.g., potential promotion) is determined by merit and hard work (e.g., research excellence). Therefore, Bourdieusian analysis seemed like an interesting choice, in my view, to investigate promotion policies and practices.

The study also shed light on some of the hidden forms and perceived values of different capital and how they come to play in the power dynamics associated with faculty promotion. Additionally, the study can hold applied significance by identifying some of the sources of tension between decision-makers and faculty members and how existing challenges can be addressed to improve perceptions of the clarity and fairness of faculty promotion policies and promote more transparent practices.

2 Materials and methods

2.1 research position.

A researcher’s epistemological and ontological assumptions must be firmly established as they are underpinned by implicit assumptions that highlight the various ways in which people perceive and construct the world ( Silverman, 2013 ).

The theoretical foundation of Bourdieu’s work is built around a critical social structure that sees society as a field of conflict and dominance molded by symbolic power dynamics. Therefore, this study adopts a critical realist ontology that acknowledges the existence of objective social structures and processes that function independently of individual consciousness while remaining open to interpretation and challenge. While recognizing that social structures like habitus and capital are always subject to interpretation and challenge, critical realism enables us to recognize their objective existence. This indicates that while objective social structures influence people’s actions and views, people also have the power to question and alter these structures.

The study adopts a constructivist stance from an epistemological standpoint, acknowledging that knowledge is created through interactions between people and their environments. When comparing subjectivism and objectivism, constructivism can be seen as a compromise. It recognizes that knowledge is constructed in part based on the individual’s subjective experiences and interpretations of the world (such as their perceptions and reflections on past promotional experiences) and in part based on the objective features of the environment (such as their access to economic and cultural resources). By implication, this view holds that reality is not static but rather open to discussion and change.

2.2 Context

This study was conducted on two higher education institutes in the United Arab Emirates with different academic scopes and contexts. The first institute (herein referred to as Institute X) is a purely academic, research-intense university offering programs to almost 13,000 students at the Bachelor, Master, and Ph.D. levels through nine Colleges. The university has more than 600 faculty members holding the titles of Professor, Associate Professor, and Assistant Professor. The second institute (herein referred to as Institute Y), on the other hand, is considered one of the largest applied higher education institutes in the region offering mostly diploma and bachelor programs in six disciplines to more than 23,000 students across the country. The institute currently has more than 1,200 faculty members.

Institute X has seven strategic objectives covering areas like developing successful future-ready learners, contributing actively to the goals of sustainable development, and fostering national and international partnerships that contribute to the promotion of the university’s reputation and its global standing. Of particular interest to this study is the second strategic goal: Impactful Research and Innovation. Through this goal, Institute X strives to ‘use the University’s research and innovation capabilities to find novel and sustainable solutions to future challenges and enhancing the global competitiveness of the University.’ The university prioritizes seven key area of strategic importance, namely renewable energy, transportation, education, health, technology, water resources and space exploration. As per their website, the university currently has 9 research centers, 2 virtual research institutes, 1 science and innovation park, 590 ongoing research projects, 550 international research grants, and 471 labs.

As per Institute Y, its strategic plan highlights 5 objectives addressing empowering students, offering quality programs, providing quality services, among others. Although no objective directly spells out research, the fifth objective pertains to embedding an innovation culture in the institutional environment. Operationally, this objective is primarily assumed through the Center for Excellence and Research and Training. The center’s homepage identifies applied research as ‘a catalyst to technology-based innovation by converting technology into business incubating opportunities and graduating sustainable companies.’ Institute Y has 3 large innovation and entrepreneurial incubators, which are dynamic environments equipped virtual reality devices, high bandwidth interconnectivity, and fitted with industry scale and high caliber equipment such as the Computer Numerical Control (CNC) machines and virtual reality devices. They cover distinctive areas including design and media, programming and computing, intelligence augmentation, fabrication, business and entrepreneurship, and future industry to support student startups.

In terms of the promotion policies, Institute X identifies academic research, teaching and advising, and community service as the promotion as the promotion criteria, with 60% weight allocated to research. Institute Y, on the other hand, lists teaching, scholarship, service, and collegiality as its promotion criteria, with no specific weight assigned to research. Institute X requires 5 publications to be promoted to Associate Professor, and 8 to be promoted to Full Professor. Institute Y requires 4 publications and 6 publications to be promoted to Associate Professor and Full Professor, respectively. Table 1 offers details of the two promotion policies.


Table 1 . Description of the promotion policies at each institute.

Both institutes are licensed by the UAE’s Commission for Academic Accreditation (CAA) and therefore are required to demonstrate full compliance with the national policies and regulations in terms of promotion and research expectations. According to the Commission for Academic Accreditation (2019) standards for licensure and program, institutions shall “define their expectations for faculty research and scholarly activity, and embodies these in appointment criteria, faculty performance evaluations and criteria for promotion.” That said, the way these national policies are enacted could be different considering the clear difference in the universities’ mandates and contexts.

2.3 The sample selected

The sample for this study was selected using a snowballing approach, a technique particularly useful in reaching participants who are closely connected through professional networks. Initially, a few full -time faculty members who spent at least 5 years at their current institute and who applied at least once for promotion were identified and interviewed. These initial participants were then asked to recommend other colleagues who meet the same selection criteria and could provide valuable insights into the study. The sample reached a point of saturation after interviewing 16 faculty members. Saturation was achieved when no new or relevant information emerged from the interviews, indicating that the data collected was comprehensive and sufficient to address the research questions.

The respondents were comprised of 63% males and 38% females. In terms of ranking, 38% of the participants were assistant professors, 38% were associate professors, and 25% were full professors. The results also showed that 19% of the sample had 5–9 years of experience, 38% had 10–14 years of experience, 31% had 15–19 years of experience, and 13% had 20 or more years of experience. All faculty members contacted accepted to participate in the study.

2.4 The types of data collected and analyzed

This was a non-experimental, descriptive qualitative study where data was collected using semi-structured interviews and document review. The study utilized an inductive approach to coding and analysis, in which the researcher attempts to make meaning of the data without the influence of preconceived notions, allowing the data to speak for themselves through a bottom-up analytical approach ( Wyse et al., 2017 ). As highlighted by Hillebrand and Berg (2000) , inductive coding works well with single cases or when one wants to explore a phenomenon.

Thematic analysis was used to sort and categorize data to make meaning of the participant’s responses during the interviews. Following a process of transcription and familiarization, sub-codes were identified and grouped together using a codebook to form codes, which, ultimately, were used to identify patterns in the data that will be presented as themes. Classical analysis as described by Leech and Onwuegbuzie (2007) was used where I counted how often a code was used to assist in determining which codes are most important. Finally, I moved from a semantic analysis (description of data) to a latent level analysis where data were interpreted to facilitate answering the research questions.

Similarly, an inductive conventional content analysis was conducted for coding and analysis of the faculty promotion policies, faculty handbooks, and faculty promotion records. Using a commercial Computer Assisted Qualitative Data Analysis software, the process included data collection, developing an e-codebook, determining coding rules, iteration on the coding rules, data analysis, and interpretation of the results.

That said, the research design proposed for this study comes with a set of limitations. For instance, participants might tend to provide answers they think the researcher would want to hear. There is also the risk of being disadvantaged or penalized in case their identities are exposed. This could have implications for the reliability of the data gathered from the semi-structured interviews. Another limitation could be attributed to the sample size and the extent to which the findings of this study could be generalized to a larger context. Thus, until the study is replicated at a larger scale, its findings shall be considered indicative rather than conclusive.

Table 2 offers a summary of some of the key methodological decisions for this study.


Table 2 . Summary of some of the key methodological decisions.

In an attempt to address the first research question, semi-structured interviews were conducted with 8 faculty members from each university. The aim was to understand the key characteristics of their research habitus: the history/background of the faculty members in addition to their perceived values, norms, and practices in the research field.

3.1 Identifying the key characteristics of the research habitus at the two institutes as perceived by the participants in this study

When asked about their perception of their past and current (structured) circumstances that probably lead them to become researchers, most of the participants from Institute X cited coming from middle-class families, with a few describing their background as ‘wealthy’. One of the respondents stated:

We had a steady income; I do not recall my family going through financial challenges. Nothing was extravagant or over the top… just a normal standard of living like most of my other friends at that time.

When discussing academic background, most of the participants from Institute X highlighted that they graduated what could be described as highly ranked or esteemed schools:

My father was a university professor, so he was very particular about our education. His university would allow us to study for free, but he refused. He gave me three options to choose from. All were top schools. The same thing (happened) with my brothers and sister.

On the other hand, there seemed to be a much wider variety in terms of social status and educational background for faculty members from Institute Y. One participant mentioned:

I come from a family of the labour class. My father was a farmer and my mother had to take care of seven children. Not all of us went to school. My brothers preferred to help Dad but I wanted to get a university degree, create something better for myself and my future family. It was the only way out.

Discussions about the more recent and future (structuring) structures of the participants and their implications on their identity as researchers revealed another noticeable difference between participants from Institute X and their counterparts from Institute Y. While all faculty from Institute X stated that they have been considering themselves as established researchers before joining their current institute, the majority of faculty members from institute Y believed that their journey as researchers took off at the current institute:

I was never asked to produce papers before. Only here. I think it is one of the requirements of the regulator. I have four papers so far, in 2 years, which is good. It’s more than many of my colleagues.

In contrast, a faculty member from Institute X stated:

I was recruited because of my research portfolio. It’s been my bread and butter for the past 15 years. It is who I am, what defines me as an academician. Now I bring this experience to help my graduate students do the same. Our role is to create knowledge.

Discussions with faculty members from University X revealed competitiveness as a key descriptor of their research culture. Terms like ‘tough’, ‘fierce’, ‘challenging’, ‘stand out’, and ‘proving worth’ with frequently used:

Have you seen the research expectations guidelines? It’s survival of the fittest. No one will tell you this, but I know some people who left because of this. They simply could not cope. It’s a tough job, very stressful, but it’s also what brings to the university its reputation, its elite status.

Another faculty from University X mentioned:

I used to do a lot of collaborative research in the past… Not anymore. If I am to invest in research, I would rather be the first or the only author. Everyone is doing research and you need to stand out. It looks better on your promotion portfolio.

On the other hand, a main theme emerging from discussions on values and norms with faculty members from University Y was collegiality and collaborative work in research:

We all come from the same sector, even those teaching in different programs. We speak the same language, understand each other. It makes it easier to work on projects together. I do not have time to work on a paper alone. It benefits all when we cooperate in research.

Another common theme extracted from the interviewees from University Y was a sense of confusion about their own roles due to the multiple responsibilities and expectations. For examples, one faculty member stated:

I think most of us are suffering from some sort of identity crisis. My classes, all the committees, the short (vocational) courses, and then research. Who are we in all of this? This is not about the faculty only; it is the entire institution. We need to know who we are first.

3.2 Exploring how research habitues at each institute reflect the research policies

Answering the second research question required conducting content analysis to examine the promotion policies and relevant documents at both institutes, identify the key areas of similarities and differences, and finally investigate whether any points of connection exist with the research habitus.

The content review aimed to aid in identifying possible points of connection between the promotion policies and the research habitus of the faculty members at each institute. Perhaps one of the main observations is the emphasis on collaborative research and how it possibly reflected on the faculty members’ perceptions and values of collegiality in research. Although both institutes make general references to collaborative research in different sections of their documents, only Institute Y includes collaborative research (under ‘Collegiality’) as part of the promotion criteria. Institute X only seems to refer to collaborative research to highlight that it is given less weight compared to single-author publications during the review process. As implied by the faculty responses when discussing their research habitus, faculty members from Institute Y described their research culture as collaborative and expressed high regard for collegiality in research.

A second observation was triggered by the fact that several participants from Institute Y were holders of an Assistant Professor rank. A look at the institutional documents revealed that a starking 53% of the entire faculty population were ranked as Assistant Professors, compared to 29% of faculty members from Institute X holding the same rank.

In an attempt to explore further possible connections, I opted to examine the faculty promotion trends at each institute. A look at relevant institutional documents and reports highlighted a stark difference between the two institutes. For Institute A, the promotion rates in the past 5 years ranged from 36 to 41%. On the other hand, the promotion rates at Institute Y ranged from 12 to 18% for the same period.

3.3 Investigating how are economic, social, and cultural capital are distributed in different fields of faculty promotion

In order to address the third research question, data were collected from the semi-structured interviews with the participants in this study.

Discussions with the faculty members indicated a strong emphasis on social capital in academic promotions. Several participants identified their educational background as an essential component of their professional identity and a priced asset when it comes to different forms of evaluations, including promotions. One faculty member stated:

My master’s is from Oxford while my Ph.D. is from Nottingham. Of course, it matters. Education is an investment for life, it stays with you forever. Today I carry this badge with a lot of pride. I’ve been there, among the best, and I’ve passed and now I’m here. I see how people panic about equivalencies with every performance evaluation. I’ve never had such problems.

One reoccurring theme pertained to the perceived negative impact of cultural background and ethnicity on their promotions:

I happen to come from a poor country. In my village, those who make it to high school are considered high achievers. I had to work so hard to make it, be where I am today. Because of that, some people think I should feel so lucky to be where I am today. Like I do not deserve a promotion no matter what I do. It’s like a dead end. This is not fair, I worked harder than most to be here, I still do, but they do not see it that way.

One female participant of African ethnicity also highlighted:

You think my skin colour does not matter? Who are we fooling? I walk into a room with my (African country) accent and they stop listening. You think when me and someone with (stereotypical description of a white male) apply for promotion. They choose me? It’s not how the world works.

There seemed to be an agreement on how access to financial capital could impact promotion outcomes, with the majority of faculty members highlighting either how the financial status of their families played a role in their education (subsequently supporting their promotion applications) or, perhaps more directly, how access to research grants supported their stance:

I got promoted (to a Professorial rank) last year and I feel a big part of it was the (name of prestigious grant). It is not only the amount, It is the fact that a team of experts agreed that my research deserved it. The announcement has been on the University’s website for months. I am sure the promotion committee did not miss that.

While looking at the demographics, it was observed that the majority of the expats from other Arab countries (i.e., excluding UAE nationals), felt that their limited access to financial funds at some point in their lives harmed their career trajectories.

Lastly, a few participants stressed the importance of being socially connected in improving the chances of a successful promotion:

You do not see those things when you first join. It takes a while. It is not necessarily a bad thing, not like favouritism or something like that. It’s like… they just need to remember your face. I think it’s called personal branding; I came to learn about it the hard way. Now I know that whoever is on the (promotion) committee, at least a few of them will recognize me.

Others also discussed how participating in formal and informal conferences and other venues can help:

The most important part of attending conferences is networking. The sessions are important but getting to meet the right people, it’s like getting membership in the elite club. Our sector is very specific, you know? We know each other now. We meet at conferences, discuss collaborations, and sometimes even review each other’s application forms (for promotion as part of external peer review).

4 Discussion

This study aimed to investigate the intersection of faculty promotion policies and research conceptions, perceptions, and norms as revealed by interviews and policy documents from two higher education institutes in the UAE.

4.1 The characteristics of the research habitus

While faculty from Institute X identified several similar characters when describing their habitus, there seemed to be a wider variety in terms of social status and educational background for faculty members from Institute Y. Additionally, it became clear that faculty members from institute X identified themselves as experienced researchers, with several participants from Institute Y being relatively new to the research world. This could be reflective of the hiring policies and priorities of the two institutions. As a research-intensive institution of higher education, Institute X may have prioritized the employment of faculty members with solid research experience and a more uniform academic profile. In contrast, perhaps the applied nature of Institute Y also led to recruiting faculty members who spent a large portion of their professional career in the fields as practitioners and only became academicians at a later stage of their lives. The demographics and requirements of Institute Y’s student body may also be a contributing factor to the institution’s more diverse faculty backgrounds. Applied colleges, including the one investigated in this study, typically serve a more diverse student population with a broad range of academic backgrounds and experiences, which may necessitate faculty members with diverse backgrounds and skills to meet their requirements. Occasionally, Bourdieu appears to be implying uniformity. In other cases, he emphasizes the uniqueness of each individual’s habitus while acknowledging the variety that exists even among people of the same culture. As individuals’ social paths vary from one another, so do their habitus, both within and across social groups ( Reay, 2004 ).

These results may imply that Institute X faculty members with similar habitus and academic backgrounds may have a clearer route for promotion within the institution, as their research-oriented profile aligns with the institution’s priorities. Faculty members from Institute Y, on the other hand, may face more challenges in terms of career advancement and promotion because their backgrounds may not match as neatly with the institution’s objectives. It is essential to note, however, that diversity in faculty backgrounds can offer benefits to the institution, such as a broader range of perspectives, experiences, and skills. As a result, both institutes should weigh the advantages and disadvantages of their respective hiring policies and work to develop a fair and transparent promotion system that acknowledges and rewards various forms of capital and habitus.

When comparing the two institutes, faculty members from Institute X would describe their habitus as highly competitive where individual faculty need to prove their worth to survive, while their counterparts from Institute Y seemed to have a higher value for aspects of collaboration and collegiality. This may be attributed to several factors. For example, individual achievement and research output may be prioritized as main criteria for promotion and career advancement at Institute X. Faculty members may feel compelled to compete with one another to gain recognition and progress in their careers in this environment. This competitive environment can foster an individualistic culture in which faculty members are solely concerned with their own research objectives and interests. Institute Y, on the other hand, may value collaboration and collegiality as important components of their academic programs. This environment values collaboration and a shared sense of ownership over student learning outcomes. As a result, faculty members may believe that their success is inextricably linked to the success of their co-workers and the institution.

4.2 Research habitues and promotion policies

A comparison of the promotion policies adopted by each institute revealed more similarities than differences. Both institutes consider research contribution a key component of the review criteria for promotion, albeit Institute X allocates a weighted average of 60% and sets higher expectations for research in terms of the number of papers required and years of experience in the current rank. This could explain why most faculty members described their research habitus as competitive, fierce, and overly challenging. As discussed earlier, the neoliberalism ideology continues to play a key role in shaping academic policies, leading to a tournament-like system ( Musselin, 2005 ) for faculty employment, evaluation, and promotion. The faculty review tournament model works by comparing teachers’ outputs, which motivates them to work harder so that they can rise in the ranks. Only applicants with more outstanding outputs than other applicable faculty are promoted, even if they meet the evaluation requirements for the jobs at the next level. Although typically linked to the economic field, neoliberalism uses institutions to change social and cultural norms and values, making economic principles the cornerstone of social structures and processes ( Olssen and Peters, 2005 ; Ward, 2012 ). Smith and Coel (2018) suggested that teachers are unintentionally breeding hostility by fostering an atmosphere where aggression is rewarded, competition is celebrated, and short-term success is prioritized over long-term goals. Therefore, while encouraging outstanding performance, institutions shall pay close attention to the possible emergence of negative practices associated with tournament-like structures and competition.

On the other hand, the research habitus of Institute Y seems to be more aligned with the values of collegial work highlighted in the adopted promotion policy. That said, it shall be noted that collegiality, although generally favored, has been associated with a few challenges in recent years regarding promotion criteria ( Fogg, 2002 ). Collegiality, as described by Bourdieu (1988) , is a desire for group members to exhibit comparable traits and behaviors. For example, a new lecturer needs to assess the norms of the department and, at the very least, appear to conform to them in order to make a smooth transition into the group’s everyday life. In a university or any other workplace, new hires should be appreciated for the fresh perspectives they offer that can help a department grow beyond its current capabilities, as Bonner (2004) points out. Thus, it would be imperative to ensure that collegiality is not overshadowing the individuality and professional identities of those who are expected to broaden the scope of work in terms of research and scholarly activities.

Moreover, while teaching, research/scholarly achievement, and service have historically been the primary criteria for promotions, the inclusion of collegiality introduces new levels of ambiguity and the possibility of discrimination ( DiGiorgio, 2010 ). Due to the subjective nature of the evaluation process and the lack of clear policies on evaluative criteria in universities, it becomes acceptable to attribute one’s inadequacy to a lack of collegiality or even merit, and evidence can be made or tweaked to support this claim ( Trower, 1999 ).

Further examination of the institutional documents and reports revealed a stark difference between the two institutes in terms of recent promotion trends. For Institute X, the promotion rates in the past 5 years ranged from 36 to 41%. On the other hand, the promotion rates at Institute Y ranged from 12 to 18% for the same period. This could raise questions on why, despite the relatively less challenging research requirements, faculty at Institute Y has had such a low promotion rate. One possible reason could be the relatively short experience with research due to spending big positions in their careers as practitioners and industry experts rather than traditional academicians. Many professors in their late careers at new universities were hired primarily for their teaching abilities, as pointed out by Hazelkorn and Moynihan (2010) . The challenge for them is to participate in and meet the requirements for professional education and research endeavors. Bourdieu used the metaphor of a “fish in the water” to explain how one’s habitus and capital can enable success in a particular field ( Bourdieu, 1990 ). In the realm of applied research, professors whose primary asset is their years of professional expertise report feeling underappreciated. Although some are highly regarded as industry experts, these faculties do not feel like ‘fish in water’. That said, this remains an assumption until further substantiated. The promotion process is nothing short of complex and several other factors could impact its outcomes.

It is also possible that the use of clear weighted averages for each promotion criteria, including research output, at Institute X may be more transparent and structured, which could make it easier for faculty members to understand what is required to achieve promotion. The unspecified weight allocated to research productivity could arguably have led to the reported confusion and uncertainty among faculty members about what is expected of them. This lack of clarity could contribute to the lower promotion rates at Institute Y.

What could be the negative implications of these findings? The lower promotion rates at Institute Y could lead to demotivation and a sense of frustration among faculty members who feel that their contributions are not being adequately recognized. This could lead to higher turnover rates and a loss of talent at the institution. At Institute X, the higher promotion rates may lead to a culture of individualism and competition, which could hinder collaboration and interdisciplinary research.

Therefore, it is essential for institutions to review and revise their promotion policies to ensure that they are clear, transparent, and equitable in terms of future promotion trajectories for faculty members at each institute. Establishing mentoring programs and providing opportunities for professional development could also assist faculty members in understanding what is required for promotion. In addition, institutions could consider revising their promotion criteria to better reflect the nature of their academic programs and the institution’s culture and values.

4.3 Capital distribution and its implications on promotion practices

The last section of the study was allocated to investigate the interplay of different types of capital and how their distribution can impact promotion outcomes. In particular, most participants in this study perceived cultural capital as a main contributor to their research identities and career trajectories. There seemed to be close connections between cultural and economic capital. Faculty members who came from families with stable access to income carried on to join the highly-ranked institution in an example of economic capital transforming to cultural, and at a later stage, institutional capital.

The connection between economic and cultural capital may have significant implications for the fairness and transparency of promotion policies and practices. Individuals who lack access to economic capital may be at a disadvantage if cultural capital is perceived, whether consciously or unconsciously, as a prerequisite for academic success and career advancement. Individuals from specific socioeconomic origins may be underrepresented in higher education institutions, resulting in a lack of diversity and representation in the academic workforce.

In addition, if promotion policies and practices heavily rely on cultural capital, there is a danger of perpetuating existing power dynamics and reproducing inequalities. Regardless of their research output or merit, faculty members from prestigious institutions or with prior connections to influential individuals in the field may have an advantage over others. This can create a situation in which the promotion process is not transparent or merit-based, leading to frustration and dissatisfaction among faculty members as well as potential negative effects on the culture of the institution.

Consequently, institutions of higher education should strive to cultivate a more equitable and inclusive environment in which all faculty members have access to resources and opportunities to develop their cultural capital. This can be accomplished through targeted support programs, mentorship opportunities, and recruitment pool diversification initiatives. In addition, promotion policies and practices should emphasize merit-based evaluations of research output and influence. Such measures can contribute to the development of a more diverse and inclusive academic community, in which individuals from various backgrounds and experiences can contribute to the advancement of knowledge and scholarship.

Perhaps expectedly, different distributions of cultural capital also meant that different faculty members felt the promotion process was not as fair and transparent as it should be. Issues of skin color, ethnicity, and gender bias were raised at different stages of the interviews, with some participants still believing promotion decisions remain to favor those of certain ethnicity and cultural backgrounds. Undoubtedly, the is a serious concern that suggests that there may be biases in place that are hindering the progress of certain individuals, regardless of their qualifications and merits.

One potential explanation for this bias is that the promotion committees themselves may be lacking in diversity, making decisions that favor people from specific cultural and ethnic backgrounds. Furthermore, informal networks and relationships may influence decision-making, producing a “glass ceiling” effect for certain groups of people. Not only would this have a negative impact on individual faculty members’ career paths, but it could also contribute to a lack of diversity in the academic community. This can lead to a homogeneous academic culture that lacks innovation and inclusivity, eventually impeding the institution’s overall growth and development.

To address these issues, it is critical to include measures in the promotion process that encourage diversity and inclusivity. This can be accomplished by ensuring that promotion committees are diverse and representative of the institution’s staff, as well as by setting clear, transparent, and impartial promotion criteria. Additionally, training for promotion committees to help them spot and mitigate potential biases in the decision-making process may be helpful.

In order to better the promotion process, it is crucial to foster a culture of openness and transparency in which faculty members are encouraged to share their insights and criticism. For example, faculty members can be provided with opportunities to share their research and accomplishments with the larger academic community. In addition, regular channels for feedback and communication between faculty members and promotion committees can be established. Previous research has shown that when faculty members have a more positive view of the promotion process, they are more invested in their jobs, happier in their careers overall, and less likely to leave their positions ( Ambrose and Cropanzano, 2003 ). Whether the academic system and its means of evaluating the worth of its faculty’s contributions have kept pace with societal goals like ensuring equal opportunities for employment and career advancement regardless of gender, ethnicity, or other personal characteristics is a question that López et al. (2018) concluded deserves more attention.

Another issue raised was some faculty members’ confusion about their professional identities as a result of the multiple roles, expectations, and requirements for promotion. One potential source of this confusion is the institute’s lack of clear communication and rules on promotion criteria and faculty member expectations. This lack of clarity can lead to ambiguity in faculty members’ duties and standards, making it difficult for them to align their efforts with promotion requirements. As a result, faculty members who prioritize teaching may feel undervalued and underappreciated during the promotion process, as their efforts toward teaching and the impact they have on students may not be adequately recognized or rewarded. This can result in a lack of motivation and work dissatisfaction, which can have a negative impact on teaching quality and overall institutional performance.

This has been of particular concern to those who perceive teaching as their main function in higher education. External accountability means that institutions are tasked with providing a foundation of evidence for quality teaching, conducting collaborative research, and engaging with the research community. At the same time, they must strive to develop highly skilled and employable graduates ( Kyvik and Lepori, 2010 ). It is difficult for educational organizations to find common ground between the academic, research, and professional spheres. This could explain why some participants in this study have referred to an identity crisis at both the personal and organizational levels as a result of the divergent standards, norms, and practices of these multiple worlds ( McNamara, 2010 ). Individuals who are repositioning themselves toward numerous academic orientations and merging collectivizes may experience identity confusion as outlined by Melles (2011) .

Institutes can mitigate this by incorporating teaching-focused promotion criteria that recognize the efforts of faculty members who value teaching. To reduce ambiguity and confusion, faculty members can be provided with clear communication and instructions on the promotion process and criteria. Furthermore, institutes can offer faculty members professional development opportunities to help them improve their teaching skills and build their teaching-focused promotion criteria. Higher education institutes can promote a culture of teaching excellence and ensure the fair and transparent promotion of all faculty members by recognizing and rewarding the efforts of faculty members who prioritize teaching.

5 Conclusion and recommendations

This study aimed at exploring the intersections of faculty promotion, research habitus, and capital distribution. In an attempt to achieve this goal, it examined the research habitus from two higher education institutions in the UAE; one was traditionally academic while the other was more applied. While comparing research habitus to the institutional promotion policies, the study explained certain values, perceptions, and practices related to the competitiveness of the research habitus as well as the collaborative nature and overall collegiality as practiced in the research world. Finally, the study explored some of the hidden rules of the promotion world, highlighting areas like background education, professional experience, cultural background, ethnicity, and social networks as some of the factors that may play a role in the promotion outcomes.

Several recommendations can be made based on the study’s findings to address the issues found. Firstly, it is critical to acknowledge the role of habitus and capital in shaping views in the research world. This can be accomplished through education and training programs aimed at creating a more collaborative and inclusive research culture that values various forms of capital and encourages diverse research practices.

Second, promotion policies should be reviewed and revised to ensure that they are transparent, equitable, and consistent with the research culture’s values. This could entail revising promotion criteria, establishing clear performance metrics, and establishing chances for mentoring and professional growth.

Third, it is critical to handle the unknown variables that could impact promotion outcomes, such as prior education, affiliations, professional experience, cultural background, ethnicity, and social networks. This can be accomplished by diversifying promotion committees, developing clear guidelines for assessing applicants, and providing opportunities for networking and community building.

Fostering cultures of diversity and inclusion is also essential. Creating opportunities for underrepresented groups, encouraging diversity in hiring and promotion, and ensuring that policies and practices are inclusive and equitable are all examples of such measures. It is critical to realize that diversity and inclusion are not only moral imperatives, but also critical factors in fostering innovation and improving research quality. We can help to ensure that all researchers have equal opportunities to contribute to the advancement of knowledge and make significant contributions to society by encouraging a more diverse and inclusive research culture.

In conclusion, it is critical to realize that addressing these problems will necessitate a collaborative effort from all research stakeholders, including researchers, policymakers, and institutional leaders. A collaborative and multidisciplinary strategy that emphasizes transparency, fairness, and inclusivity is critical for developing a more equitable and effective research culture that values diverse forms of capital and promotes the growth and development of all researchers.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Author contributions

AE developed its conception and design. AE organized the database, conducted the interviews, performed the analysis, and wrote all sections of the manuscript. The author performed several revisions of the manuscript and finalized the submitted version.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflict of interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: promotion policies, research culture, habitus, capital, higher education

Citation: Elhakim A (2024) The intersection of promotion policies, research habitus, and capital distribution: a qualitative case study of two higher education contexts in the United Arab Emirates. Front. Educ . 9:1237459. doi: 10.3389/feduc.2024.1237459

Received: 09 June 2023; Accepted: 03 July 2024; Published: 12 July 2024.

Reviewed by:

Copyright © 2024 Elhakim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ahmed Elhakim, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Article Contents

Introduction, overview of methods, case studies: quasi-experimental vaccine evaluation, conflict of interest, data availability.

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Quasi-experimental methods for pharmacoepidemiology: difference-in-differences and synthetic control methods with case studies for vaccine evaluation

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Lee Kennedy-Shaffer, Quasi-experimental methods for pharmacoepidemiology: difference-in-differences and synthetic control methods with case studies for vaccine evaluation, American Journal of Epidemiology , Volume 193, Issue 7, July 2024, Pages 1050–1058, https://doi.org/10.1093/aje/kwae019

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Difference-in-differences and synthetic control methods have become common study designs for evaluating the effects of changes in policies, including health policies. They also have potential for providing real-world effectiveness and safety evidence in pharmacoepidemiology. To effectively add to the toolkit of the field, however, designs—including both their benefits and drawbacks—must be well understood. Quasi-experimental designs provide an opportunity to estimate the average treatment effect on the treated without requiring the measurement of all possible confounding factors, and to assess population-level effects. This requires, however, other key assumptions, including the parallel trends or stable weighting assumptions, a lack of other concurrent events that could alter time trends, and an absence of contamination between exposed and unexposed units. The targeted estimands are also highly specific to the settings of the study, and combining across units or time periods can be challenging. Case studies are presented for 3 vaccine evaluation studies, showcasing some of these challenges and opportunities in a specific field of pharmacoepidemiology. These methods provide feasible and valuable sources of evidence in various pharmacoepidemiologic settings and can be improved through research to identify and weigh the advantages and disadvantages in those settings.

This article is part of a Special Collection on Pharmacoepidemiology.

Determining the safety and efficacy of drugs and biologics is crucial, yet it faces many statistical, epidemiologic, regulatory, and logistical challenges. A related yet distinct challenge—determining the effects of health and social policies—has incorporated quasi-experimental study designs into its set of methods. Quasi-experimental methods can provide a convenient means for assessing the real-world effectiveness and safety of pharmacological products—especially those with population-level effects—in well-defined populations and specific circumstances that mitigate the risks of bias.

Quasi-experiments (in some cases also known as “natural experiments”) here refer to observational studies that identify a causal effect by taking advantage of circumstances that create variation in exposure status in ways that avoid the usual sources of confounding for that exposure and the outcome of interest. 1 , 2 This often comes through changes in the exposure that are not otherwise causally connected to the outcome, often referred to as exogeneity. 2 , 3

A suite of such approaches developed or formalized in the quantitative social sciences—including instrumental variables, regression discontinuity designs, interrupted time series, difference-in-differences, and synthetic control methods, among others—have become major empirical approaches in those fields 3 , 4 and have become popular in epidemiology as well. 5 For example, during the coronavirus disease 2019 (COVID-19) pandemic, they have been used to assess the effectiveness of universal masking in schools, 6 vaccine lotteries, 7 and other interventions. 8 , 9 Along with this rise in the use of the methods have come articles describing the uses and limitations of these methods in health policy evaluation. 1 , 2 , 10 , - 16

This article focuses on difference-in-differences (DiD) and the synthetic control method (SCM), quasi-experimental designs that are both controlled (ie, include exposed and unexposed units) and longitudinal (ie, exploit a change in exposure status over time to adjust for unmeasured confounders). 11 , 17

Despite their expanding use in health policy research, these methods have not been extensively studied for use in evaluating drugs and biologics. This article provides a brief overview of these methods (including recent developments from the econometrics literature), advice on settings where they are beneficial for pharmacoepidemiology (exemplified through 3 case studies of vaccine effectiveness evaluation), and discussion of the trade-offs and limitations they face. Finally, the article describes future research that can improve their use in pharmacoepidemiology.

DiD and SCM analyses estimate the average treatment effect on the treated (ATT) by constructing the potential outcome for the exposed units in the (counterfactual) absence of the exposure using both cross-unit and within-unit comparisons. Below, I give a brief overview of these methods and their estimators, along with recent extensions. For a more comprehensive treatment, see the relevant econometrics 3 , 4 or public health review literature. 1 , 10 , 14 , 15 , 17


Schematics showing simulated observed and counterfactual data for 4 quasi-experimental methods: A) difference-in-differences (DiD); B) DiD with staggered adoption; C) synthetic control method (SCM); D) augmented SCM. Vertical lines represent the beginning of exposure in exposed units/groups. Black dotted lines (A, B) and gray shaded regions (C, D) represent estimated effects. Note that different counterfactuals are possible with additional assumptions (B) and that augmented SCM is shown here when the exposed unit lies outside of the convex hull of the unexposed units (D).

Schematics showing simulated observed and counterfactual data for 4 quasi-experimental methods: A) difference-in-differences (DiD); B) DiD with staggered adoption; C) synthetic control method (SCM); D) augmented SCM. Vertical lines represent the beginning of exposure in exposed units/groups. Black dotted lines (A, B) and gray shaded regions (C, D) represent estimated effects. Note that different counterfactuals are possible with additional assumptions (B) and that augmented SCM is shown here when the exposed unit lies outside of the convex hull of the unexposed units (D).

Extensions of the DiD model

Several extensions to the DiD model aim to improve the validity of the parallel trends assumption. For example, covariates can be added when parallel trends holds only conditionally, or the so-called difference-in-difference-in-differences (or triple-differences) model can be used to remove nonparallel trends. 4 Both of these have analogous approaches in the epidemiology literature: adjusting for measured covariates in cohort studies for the former, and using negative controls to adjust for residual bias for the latter. 22 , 23

The functional form of the parallel trends assumption can also be changed by transforming the outcome variable. For example, if the counterfactual outcomes are judged more likely to have equivalent multiplicative trends than linear trends, a logarithmic transformation can be used on the outcome. Importantly, only one functional form can truly have parallel trends, so the modeling and estimand choices determine the validity of the causal assumptions made. 24

Recently, literature has extensively investigated DiD in cases where there are units with different exposure-onset times (eg, “staggered treatment adoption”; see Figure 1B ). 25 The TWFE model is subject to biased estimation of the ATT under this setting as the unit and time fixed effects do not properly capture treatment effect heterogeneity. 21 , 25 Various approaches have been proposed to ameliorate this problem in the DiD and related stepped-wedge trials literature 26 , - 30 ; these include different estimators and explicit weighting of time- and unit-specific estimators. 3 , 26 , 27

Synthetic control method

The major assumption of SCM is that these weights are stable, in the sense that a weighting scheme that matches the preexposure outcome trends well will also give an unbiased estimate of the potential outcome after the exposure time point. 31 A long preexposure time series on which to optimize the weights provides the best justification for this assumption under many data-generating processes. 31 For multiple exposed units and/or multiple postexposure periods, the individual estimators can be combined to target the desired estimand. 29 , 33

Extensions of the synthetic control method

One reason for the growth of SCM in comparative case studies is its interpretability: All unexposed units have a nonnegative weight showing their contribution to the estimated counterfactual, allowing discussion of the reasonableness of the counterfactual. However, this also imposes restrictions on the model; SCM does not work when the outcomes of the exposed unit fall outside the convex hull (loosely, the range) of the unexposed units’ outcomes. 31 Thinking of past outcomes as the “adjustment variables,” this requirement is roughly analogous to positivity requirements in cohort studies: Adjustment fails if there are combinations of covariates for which there are only exposed units.

Several extensions of SCM—including the generalized SCM, 34 augmented SCM (see Figure 1D ), 35 and Bayesian structural time series model 36 —trade off some interpretability by allowing outcome modeling and extrapolation outside of the convex hull. This allows the use of more control series, including those on different scales than the outcome itself. 37 This extrapolation, however, can lead to bias, especially when there are few pretreatment periods or unexposed units. 34

Quantifying uncertainty and negative controls

Pharmacoepidemiologic studies require not just point estimates but also quantification of uncertainty, often through P values, confidence intervals, or Bayesian alternatives. 38 For quasi-experiments, this can be more challenging, as they often involve only 1 or a limited number of exposed observations, and rarely form a sample of an identifiable study population. Because of this, model-based estimates of variability—even in cases when they can be computed, such as regression-based DiD and generalized SCM—may not have the desired interpretation or may require additional design-based assumptions. 27

Beyond statistical inference, it is desirable to quantify the causal or model-based uncertainty. Negative controls, sensitivity analyses, and robustness checks provide a means to assess the required assumptions to some extent. These include assessing the validity of the assumptions for the particular setting through models and graphical inspection of preexposure time trends, as well as assessing the model performance in settings with known effects. 17

Repeated negative controls—often called placebo tests or dummy analyses—conducted for different time points (where no change in exposure occurs), different units (ie, only using untreated units), or different outcomes (where the exposure should have no effect) generate null distributions using cases that should identify effects of zero. 3 , 31 Comparing the observed estimate with these distributions allows hypothesis testing. Bayesian frameworks are also feasible but may be sensitive to the prior distributions used. 36 Properly reporting and interpreting these measures of uncertainty remains a challenge for these quasi-experimental methods, especially as they are applied to new fields.

Case studies of the use of DiD and SCM in vaccine evaluation can illuminate the benefits and challenges of these designs. Vaccine evaluation studies demonstrate the use of large-scale routinely collected datasets in the context of exogenous variation to identify key public health effects as a supplement to randomized trial evidence or when it is not available. They also show potential pitfalls: the risk of concurrent events and misspecification leading to bias and the limited generalizability of targeted estimands.

Case 1: SCM analysis of meningococcal vaccines

Prunas et al analyzed the impact of early childhood meningococcal vaccination programs in Brazil and England in the 2010s (see Table 1 ). 39 Real-world estimates of vaccine effectiveness for hard-to-predict and highly variable diseases like invasive meningococcal disease are challenging, making quasi-experiments particularly useful. Using SCM on the logarithmic scale with Bayesian time-series modeling, the authors compared meningococcal disease incidence after the program roll-out with a synthetic control constructed from time series of other (nontargeted) diseases and the targeted disease in older age groups who were ineligible for vaccination.

Summary of meningococcal vaccine analyses in Prunas et al, a 2022.

Research questionDid meningococcal vaccination programs reduce early childhood invasive meningococcal disease incidence?
ExposureWithin the target age group (<1 year and 1-4 years) of the MenC vaccination programWithin the target age group (18-51 weeks and 1 year old) of the MenB vaccination program
OutcomeTotal MenC cases (monthly)Total MenB cases (quarterly)
SettingBrazil, 2007-2013England, 2011-2019
Control seriesCases for various off-target infectious diseases in target age group; outcome of interest in nontargeted age groups
MethodSCM with Bayesian variable selection
Identification assumptionWeighted average of control series is the expected outcome absent vaccination program
ResultsVaccine effectiveness:Vaccine effectiveness:
• 69% (95% CrI, 51-80) in < 1-year-old age group• 75% (95% CrI, 69-80) in 18-51–week age group
• 64% (95% CrI, 55-70) in 1-4–year-old age group• 72% (95% CrI, 65-79) in 1-year-old age group
Negative controls/placebo tests• Models tested on nontargeted age groups and compared with other methods
• Sensitivity analyses excluding nontargeted age groups as control series
Research questionDid meningococcal vaccination programs reduce early childhood invasive meningococcal disease incidence?
ExposureWithin the target age group (<1 year and 1-4 years) of the MenC vaccination programWithin the target age group (18-51 weeks and 1 year old) of the MenB vaccination program
OutcomeTotal MenC cases (monthly)Total MenB cases (quarterly)
SettingBrazil, 2007-2013England, 2011-2019
Control seriesCases for various off-target infectious diseases in target age group; outcome of interest in nontargeted age groups
MethodSCM with Bayesian variable selection
Identification assumptionWeighted average of control series is the expected outcome absent vaccination program
ResultsVaccine effectiveness:Vaccine effectiveness:
• 69% (95% CrI, 51-80) in < 1-year-old age group• 75% (95% CrI, 69-80) in 18-51–week age group
• 64% (95% CrI, 55-70) in 1-4–year-old age group• 72% (95% CrI, 65-79) in 1-year-old age group
Negative controls/placebo tests• Models tested on nontargeted age groups and compared with other methods
• Sensitivity analyses excluding nontargeted age groups as control series

Abbreviations: CrI, credible interval; MenB, meningococcal serogroup B; MenC, meningococcal serogroup C; SCM, synthetic control method.

a Prunas et al. 39

To demonstrate the value of the method, the authors conducted placebo tests using other quasi-experimental designs and found that the SCM better captured seasonality and nonlinear time trends; notably it avoids the need to specify a parametric time trend. It thus likely suffers from less bias in the desired analyses, although there could still be extrapolation bias due to the time series modeling. 32 , 36

Within-region controls (here, time series of nontargeted populations and outcomes) are particularly valuable for quasi-experimental evaluation of vaccines and drugs. By avoiding comparisons across geographic areas, they mitigate the risk of bias due to concurrent events or changes. However, they come with a potential increased risk of spillover or contamination, especially in infectious disease settings. 40 For the nontargeted age groups, bias could be caused by indirect protection of the vaccine (ie, a younger child receiving the vaccine is less likely to infect an older child in the household). For the nontargeted diseases, there is perhaps less risk of bias, but it could still occur due to off-target effects of vaccination or changes in health-seeking behavior and diagnosis in the wake of the vaccination policy. The authors used placebo tests and sensitivity analyses that dropped the older age groups as candidate control series, finding robust results that suggest these biases were minimal in this setting. 39

The results demonstrated effectiveness of the vaccination program against the targeted infections. Within each country of analysis, results on different early childhood age groups showed remarkable similarity, indicating that there may be some generalizability of these effects. However, as ATT estimands, these may still not be appropriate to transport to other countries with different infection risks. On the other hand, these estimates assess the overall effect of the program, rather than the individual-level direct effect, and so can provide an additional piece of evidence that is rarely achieved in preauthorization trials. 41 This is useful for public health policy-makers as real-world evidence of both the vaccine itself and the vaccination program. 42

Case 2: DiD analysis of an off-target vaccine against COVID-19

Early in the COVID-19 pandemic, researchers sought to use existing drugs and vaccines to prevent infection, illness, and severe outcomes until COVID-19-specific drugs and vaccines could be developed and authorized. The bacille Calmette-Guérin (BCG) vaccine against tuberculosis was one such candidate because of its hypothesized off-target effects, 43 which were supported by cross-sectional analyses showing better COVID-19 outcomes in countries with high BCG vaccination coverage. 44 While randomized controlled trials would eventually occur in specific populations, 43 the emergency situation called for interim evidence to confirm or refute this hypothesis. A preprint by Matsuura et al in 2020 reexamined this hypothesis with a DiD analysis using existing country-level data (see Table 2 ). 44

Summary of BCG vaccine off-target effects vs. COVID-19 analysis in Matsuura et al, a 2020.

Research questionDid prior BCG vaccination recommendation reduce COVID-19 incidence?
ExposureWithin age-group cohort covered by national BCG vaccination recommendation
OutcomeConfirmed COVID-19 cases per 1000
SettingVarious countries, unknown dates of analysis for outcome
Control seriesOutcome of interest in age group cohorts not included in national BCG vaccination recommendations
MethodDiD TWFE model, with country and age-group fixed effects
Identification assumptionExpected ratio of infection rates across age-groups and countries are equal absent BCG vaccination recommendation
ResultsDo not support hypothesis of protective effect of BCG vaccine
Negative controls/placebo testsNone reported
Additional details• Includes BCG strain as a covariate to address hypotheses generated from cross-sectional analysis of countries
• Exposure onset is by age cohort, not calendar time
Research questionDid prior BCG vaccination recommendation reduce COVID-19 incidence?
ExposureWithin age-group cohort covered by national BCG vaccination recommendation
OutcomeConfirmed COVID-19 cases per 1000
SettingVarious countries, unknown dates of analysis for outcome
Control seriesOutcome of interest in age group cohorts not included in national BCG vaccination recommendations
MethodDiD TWFE model, with country and age-group fixed effects
Identification assumptionExpected ratio of infection rates across age-groups and countries are equal absent BCG vaccination recommendation
ResultsDo not support hypothesis of protective effect of BCG vaccine
Negative controls/placebo testsNone reported
Additional details• Includes BCG strain as a covariate to address hypotheses generated from cross-sectional analysis of countries
• Exposure onset is by age cohort, not calendar time

Abbreviations: BCG, bacille Calmette-Guérin; COVID-19, coronavirus disease 2019; DiD, difference-in-differences; TWFE, 2-way fixed effects.

a Matsuura et al. 44

The authors identified countries that changed BCG vaccination recommendations at some point in the past and determined for various age groups in each country whether they were in a national vaccination cohort or not. They then conducted a TWFE analysis of the relationship between being in a BCG vaccination cohort and the log of confirmed COVID-19 cases for that age group and country, finding no protective effect of the vaccine. 44

In this study, incorporating within-country controls helped mitigate the bias of comparing across countries cross-sectionally. However, the use of age cohorts as the distinguishing feature risks contamination—as individuals of different ages interact and may provide indirect protection—and concurrent events, since many nonpharmaceutical interventions and recommendations in the COVID-19 pandemic were targeted to specific age groups. Identification for this design requires that the difference in log-cases between age cohorts would be constant (parallel multiplicative trends) across countries absent differential BCG vaccination policies. This would be threatened by differential age-targeted policies.

As in the previous study, the generalizability of the ATT is limited, since it is specific to the age cohorts and countries studied, as well as the time since BCG vaccination inherent in those age groups. However, the staggered adoption that occurs in this setting (different countries changed vaccination rules for different age cohorts) risks a larger problem of bias or incorrect interpretation of the ATT. The estimate given by the TWFE model is a weighted average of individual effects in each country-age cohort combination, with some given potentially negative weights. 21 Careful specification of the estimand and the analysis method in quasi-experimental analyses, especially with staggered adoption, is thus crucial. In this case, individual 2-by-2 DiD analyses may be more useful, providing a range of estimated treatment effects in the different age group-country combinations. 21 , 45

The challenges of estimand interpretation and generalizability limit the internal and external validity of this approach. Nonetheless, it provided useful exploratory evidence that controlling to some extent for country-level factors could account for the correlation observed in a cross-sectional analysis. As this negative finding was borne out by a randomized controlled trial, 43 this study provided immediate useful interim evidence before that trial was concluded.

Case 3: DiD and SCM analyses of the indirect protection of a COVID-19 vaccine

After the authorization of COVID-19 vaccines to prevent symptomatic and severe illness in adults, questions remained about the effectiveness of the vaccines in providing indirect protection by preventing infection and transmission. 41 Winner et al 46 sought to assess the indirect protection of children via adult vaccination by comparing infection rates among Austrian children in the district of Schwaz—which had high adult vaccination uptake due to a campaign during a localized outbreak—to other districts with much lower rates as of March 2021. They used both SCM analysis with other Austrian districts as controls and DiD analyses comparing Schwaz municipalities to neighboring municipalities outside the district (see Table 3 ). 46 All analyses reported strong indirect protection of children. 46

Summary of COVID-19 vaccine indirect protection analyses in Winner et al, a 2022.

Research questionDid a mass vaccination campaign in adults reduce COVID-19 incidence in children?
ExposureWithin ineligible age cohort (under 16 years old) in the district of Schwaz
OutcomeCumulative daily SARS-CoV-2 infections per 100 000
SettingSchwaz District of Austria, January to May 2021
Control seriesOutcome of interest in other districtsOutcome of interest in bordering municipalities
MethodSCM using infection history, population size, geographic area, and number of municipalities as covariatesDiD, 2 models: • TWFE (municipality and week), with effect size varying by week • 2-by-2, averaging across weeks
ScaleLinear• Linear (TWFE)
• Logarithmic (2-by-2)
Identification assumptionWeighted average of control series is the expected outcome absent vaccination campaignAdditive (TWFE) or multiplicative (2-by-2) change in expected outcome pre- to postcampaign is the same across municipalities
ResultsVaccine effectiveness:Vaccine effectiveness:
675.3 avoided infections per 100 000 children in Schwaz (95% CI, 146.9-1232.6)• Significant decrease after second dose in campaign (TWFE)
• 64.5% (95% CI, 30.2-82.0) (2-by-2)
Negative controls/placebo testsIn-space placebo testPreexposure trends
Additional detailsAll analyses reported results also for adults aged 16-50 (targeted by vaccination program and thus expected to exhibit a larger effect)
Research questionDid a mass vaccination campaign in adults reduce COVID-19 incidence in children?
ExposureWithin ineligible age cohort (under 16 years old) in the district of Schwaz
OutcomeCumulative daily SARS-CoV-2 infections per 100 000
SettingSchwaz District of Austria, January to May 2021
Control seriesOutcome of interest in other districtsOutcome of interest in bordering municipalities
MethodSCM using infection history, population size, geographic area, and number of municipalities as covariatesDiD, 2 models: • TWFE (municipality and week), with effect size varying by week • 2-by-2, averaging across weeks
ScaleLinear• Linear (TWFE)
• Logarithmic (2-by-2)
Identification assumptionWeighted average of control series is the expected outcome absent vaccination campaignAdditive (TWFE) or multiplicative (2-by-2) change in expected outcome pre- to postcampaign is the same across municipalities
ResultsVaccine effectiveness:Vaccine effectiveness:
675.3 avoided infections per 100 000 children in Schwaz (95% CI, 146.9-1232.6)• Significant decrease after second dose in campaign (TWFE)
• 64.5% (95% CI, 30.2-82.0) (2-by-2)
Negative controls/placebo testsIn-space placebo testPreexposure trends
Additional detailsAll analyses reported results also for adults aged 16-50 (targeted by vaccination program and thus expected to exhibit a larger effect)

Abbreviations: CI, confidence interval; COVID-19, coronavirus disease 2019; DiD, difference-in-differences; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SCM, synthetic control method; TWFE, 2-way fixed effects.

a Winner et al. 46

With a clear time point for the mass vaccination campaign, quasi-experimental methods are a natural design for this setting, and the neighboring municipalities and other districts in the country form a large pool of potential controls. Selecting unexposed units within the same country increases the plausibility of similar nonpharmaceutical interventions and other policies, supporting the assumptions of stable weights and parallel trends. The risk of cross-border contamination through indirect protection remains but would, if anything, yield conservative estimates. Negative controls included an in-space placebo test for SCM (ie, using the same method on nontargeted districts to create a null distribution) and assessment of preexposure parallel trends for DiD. 46

While policies spurred by a particular need create variation, there is risk in using them as quasi-experiments. In this case, a large outbreak in Schwaz spurred the vaccination campaign. This creates concurrent events and anticipation: The past outbreak and the vaccination both influence infection dynamics going forward and may violate the assumptions needed for these methods. 8 The authors sought to use districts with similar prior infection trends to mitigate this bias. Parallel trends could also be threatened by the use of linear functional forms for a nonlinear outcome like infections, although the authors used both a linear TWFE model and a logarithmic 2-by-2 DiD model here. 8 , 17 , 47

Once again, the results are highly contingent on the campaign and the setting in which it was enacted. The differential outcomes result from both the vaccination itself and any changes in behavior that may have resulted from a mass vaccination campaign; this point is well-described in the quasi-experimental literature for policy evaluation. 1 , 19 For pharmacoepidemiologic purposes, then, this makes it difficult to ascribe the full effect to the pharmaceutical itself in such cases. In addition, indirect protection in infectious disease outbreaks is specific to the prior evolution of the outbreak and the population at risk, limiting the generalizability and interpretability of estimates. 23 , 40 , 48 , 49 Nonetheless, the finding of a large indirect effect could inform public health practice and motivate the study of this effect in other settings, even if precise estimates are not transportable. 41 , 42

Quasi-experimental methods provide a promising set of designs for pharmacoepidemiology. The designs discussed here, among others, provide a class of observational study designs that can target useful public health-relevant estimands and provide meaningful real-world evidence in advance of or as a supplement to randomized controlled trials. 14 , 50 , 51 In the case of vaccines, for example, these designs can identify potential off-target effects of pharmaceutical products, encouraging further research into those effects, 44 , 51 and identify rare safety signals through the use of large, routinely collected datasets. 52 In addition, these studies can provide important postmarketing evaluation of the effects of products on their target outcomes in actual use, including indirect effects and changing effectiveness over time as conditions change. 53 , 54

By avoiding the need to measure and model all confounders between exposure and outcome, quasi-experimental methods can achieve high internal validity with routine data sources. 3 , 4 , 32 , 52 This, however, requires other counterfactual assumptions, such as parallel trends or stable weights. Justifying these assumptions, especially the appropriate functional form, requires an understanding of the setting and likely effect. 8 , 17 , 24 As seen in the case studies, both linear and logarithmic scales are used in vaccine evaluation studies, leading to different assumptions and different estimands.

Moreover, spillover and contamination of control units by the exposure and anticipation or lagged effects of the intervention can cause bias, often towards the null. 8 , 27 , 32 For pharmacoepidemiology, this could occur through off-label prescribing or, as in the vaccine cases, indirect effects within networks and communities. Attributing the observed causal effect to the exposure also requires a lack of concurrent events in the study units, which may be threatened by changes in behavior that co-occur with pharmaceutical interventions, like behavior changes that follow vaccination. 5 , 8 , 9 , 17

As in all medical studies, understanding the estimand targeted by these methods is crucial to properly using the evidence. 55 When aggregate population data are used, these methods target aggregate or population-level effects, and thus cannot be transported to individuals. 19 But this also provides useful real-world evidence, such as the overall effect measure in vaccine studies, as seen in the case studies. 23 This is rarely targeted by randomized trials and provides useful additional regulatory and public health evidence. 41 , 42 , 53

ATT estimands from quasi-experimental studies, however, are specific to the setting, exposure, outcomes, and exposed unit(s), as well as the contrast identified and other statistical analysis choices. Since the exposed units are rarely randomly selected (ie, the mass vaccination campaign in Schwaz occurred because of a prior outbreak 46 ), the ATT differs from the average treatment effect that is usually targeted by randomized trials and used in regulatory decisions. 56 It may be of specific interest in safety studies, as it represents the effect of removing the exposure from all exposed units (eg, compare Cowger et al 6 ). In general, however, it may be less transportable to populations yet to be exposed or require further assumptions. 5 , 16

Compared with other observational study designs, quasi-experimental designs tend to trade away some external validity for internal validity, although these aspects should ideally be considered in concert. 3 , 57 Researchers need to be careful about generalizing results of these methods to other settings and populations, especially for outcomes that have marked spatiotemporal patterns (eg, infectious diseases) or for populations with specific health needs and vulnerabilities (eg, specific age groups or people with co-morbidities). 19

Achieving the potential benefits of these designs will require further research and careful reporting and interpretation. The general methodology of these designs in the field of pharmacoepidemiology—as well as how to report results and place evidence in the context of other studies routinely conducted in the field—will be important for ensuring validity and appropriate interpretation. 9 , 11 Connecting the literature across various disciplines will improve uptake of the most appropriate methods as well. Moreover, research on the most appropriate designs for specific settings, considering the populations, interventions, and outcomes, is crucial. 50 This can include simulation studies in those settings to observe the relationship between estimates and true estimands. 15

For example, quasi-experimental vaccine evaluation studies will need to determine appropriate lag times, functional forms, and time frames for the necessary DiD and SCM assumptions to hold. 14 , 52 This can build on the existing health policy and stepped-wedge trials literature. 8 , 47 , 48 Understanding and communicating the trade-offs of identifying population-level effects but potentially losing generalizability will be key to appropriately contextualizing this evidence.

Negative controls, placebo tests, and sensitivity analyses also have an important role to play. Assessing methods for sensitivity to the selection of control units and time periods can inform both internal and external validity. Quantitative placebo tests can also allow the reporting of causal uncertainty alongside statistical uncertainty. 3 Investigators can improve generalizability by using multiple populations (as in the meningococcal vaccine case study 39 ), different methodological approaches or models (as in the COVID-19 vaccine case study 46 ), or multiple units and exposure points (as in the BCG vaccine case study 44 ). The latter, however, targets an estimand that averages potentially heterogeneous treatment effects, which may or may not have greater generalizability—depending on the setting—and can be statistically inefficient. 21 , 30 , 48 The proposed alternatives vary in their targeted estimands, required assumptions, and statistical properties. 25 , - 27 , 45 , 58 Investigation of the assumptions and relative performance of these methods in specific pharmacoepidemiologic settings (see, eg, multiple references 8 , 9 , 17 , 47 ), alongside the appropriate reporting of these challenges, is needed.

Quasi-experimental methods can alleviate some of the challenges of pharmacoepidemiology, while introducing others. Understanding and using them provides another tool for regulators, physicians, and public health policy-makers to understand the benefits and risks of drugs and biologics.

None declared.

The author declares no conflicts of interest.

The views expressed in this article are those of the author alone.

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    "LATISS - Learning and Teaching is a peer-reviewed journal that uses the social science disciplines of sociology, anthropology, politics, international relations and social policy to reflect critically on learning and teaching practices in higher education and to analyse their relationship to changes in higher education policies and institutions."

  25. The Effects of Case-Based Teaching in Nursing Skill Education: Cases Do

    Basic nursing course is the core course of nursing major, and it is one of the main courses to cultivate the core competence of nursing students. 1 Basic nursing course is a comprehensive subject in clinical nursing with coverage of a wide range of content. Previous studies 2,3 have reported that students in nursing colleges have poor cultural foundations, unclear learning motivation, weak ...

  26. Frontiers

    This study was conducted on two higher education institutes in the United Arab Emirates with different academic scopes and contexts. The first institute (herein referred to as Institute X) is a purely academic, research-intense university offering programs to almost 13,000 students at the Bachelor, Master, and Ph.D. levels through nine Colleges.

  27. Vol. 42 No. 2 (2024)

    Perspectives in Education (PiE) is is a fully open access journal, which means that all articles are freely available on the internet immediately upon publication. PiE is also a professional, peer-reviewed journal that encourages the submission of previously unpublished articles on contemporary educational issues. As a journal that represents a variety of cross-disciplinary interests, both ...

  28. Case Study Research: Journal of Geography in Higher Education: Vol 29

    Glynis Cousin. Case study research aims to explore and depict a setting with a view to advancing understanding. This note explores the dimensions of case study research in higher education, with special reference to geographical fieldwork. It explores Stake's three categories of case study research: intrinsic, instrumental and collective.

  29. Who enabled Biden? A case study

    WHO ENABLED BIDEN? A CASE STUDY. On June 4, the Wall Street Journal published a story headlined, "Behind Closed Doors, Biden Shows Signs of Slipping." Based on interviews with 45 people, the ...

  30. Quasi-experimental methods for pharmacoepidemiology: difference-in

    Case studies are presented for 3 vaccine evaluation studies, showcasing some of these challenges and opportunities in a specific field of pharmacoepidemiology. These methods provide feasible and valuable sources of evidence in various pharmacoepidemiologic settings and can be improved through research to identify and weigh the advantages and ...