Delphi Method In Medical Education For PhD Research Scholars

Introduction

The Delphi method was created in the 1950s with the goal of gathering expert input and reaching a consensus (Dalkey & Helmer, 1963, p. 458). It got its name because it was created as a systematic, participatory way of forecasting or predicting the future, similar to how ancient Greeks went to the Oracle at Delphi to hear their fortunes. The method gathers views from a panel of experts in a field of real-world expertise and then aggregates those judgments to achieve a consensus on an issue. It differs from typical surveys in that it aims to discover what could or should be, rather than what is (Miller, 2006).

According to Delbecq, Van de Ven, & Gustafson( 1975, pp. 11), Delphi  study are used for the following:

• Determine or create a variety of programme choices.
• Investigate or reveal the assumptions or knowledge that lead to differing conclusions.
• Look for facts that might lead to a consensus among the respondents.
• Connect well-informed judgements about a topic that spans a variety of fields.
• Educate the response group on the topic’s many and connected elements.

Other major aspects of Delphi Survey Research include the fact that the participants are strangers to one another and that the procedure is iterative, with each round generated from the preceding one’s conclusions. In other words, each participant is given a summary of the variety of ideas expressed in the previous round, as well as the chance to reconsider their own views in light of the feedback provided by the other panellists. This regulated feedback helps to decrease the influence of noise, which is described as communication that distorts data due to personal prejudice and interests rather than issue solving.

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Delphi studies have been utilized in clinical education to establish evaluation techniques that are not always straightforward to describe. Clinical educators are concerned in changeable behaviors and clinical competence, not so much in the knowledge and abilities presented in the classroom as in their application in practice. Because it is impossible to assess all potential combinations of knowledge and abilities, assessments of the information and skills necessary for competent practice generally take the form of a sampling of a small fraction of the total possible range of things. Furthermore, not all physicians agree on the most critical aspects of practice and assessment.

As a result, the Delphi method is an acceptable methodological technique for gaining consensus on the crucial question of what to assess, how to assess it, and what measures to apply to improve practise. In healthcare, Delphi studies have been used for service planning, study of professional traits and skills, assessment instrument creation, and curriculum development (Cross, 1999; Powell, 2003; Joseph, Hendricks & Frantz, 2011).

Designing a Delphi study

Participants in a Delphi survey are generally experts in their fields, and their contributions should help to enhance knowledge of issues, opportunities, and solutions.

Although there are no defined criteria for selecting the panel, potential members should have similar backgrounds and experiences in the subject, be capable of making useful contributions, and be willing to change their minds in order to achieve consensus. It is not sufficient for participants to have a basic understanding of the topic under investigation (Pill, 1971; Oh, 1974). While a diverse panel is suggested for General Delphi Research (Delbecq et al., 1975), Jones and Hunter (1995) propose that domain specialists be employed in clinical investigations. Due to the aforementioned considerations, it is critical to demonstrate the panel’s credibility in order to back up the claim that they are true experts in the subject.

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The panel size is the next factor to consider. This is frequently determined by the breadth of the problem and the number of competent informants / experts available, and there is no consensus in the Literature On The Ideal size (Hsu & Sandford, 2007). Depending on the situation, the higher the degree of dependability of the given elements, the more participants there are. However, if the individuals’ backgrounds are homogenous, it has been proposed that 10 to 15 people may be adequate (Delbecq, Van de Ven & Gustafson, 1975).

The first round of questionnaires generally comprises of open-ended questions designed to collect particular information on a topic of expertise, and it acts as a foundation for later rounds (Custer, Scarcella, & Stewart, 1999). This questionnaire may be developed from the literature (Hsu & Sandford, 2007) and does not require validity or reliability testing. The Data Analysis Methodologies used to establish agreement will be determined by the structure of the questionnaires, the sorts of questions asked, and the number of participants. While the procedure might potentially go on indefinitely, most experts believe that three rounds of surveys is generally enough to reach a decision.

Procedure

The first round’s results are frequently utilised to detect key themes arising from open-ended questions. The replies are then compiled into questions that will serve as the foundation for the future rounds. The data is generally statistically analysed after the second round, using either a rank order or rating approach (this is usually dependent on larger sample sizes). The data is analysed to establish the degree of agreement in the ranking order.

Researchers warn that this degree of agreement should be determined prior to the start of Data Collection And A Strategy for how the data will be analysed so that a clear cut-off point for inclusion and exclusion can be established. The degree of agreement is often set at 75%, although this can be changed if no agreement is obtained. Participants may be requested to justify their ranking judgments in some circumstances, particularly when panellists express opinions that differ from the groups’ consensus on a subject or issue.

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 Procedure of running a Delphi study

• Determine what you want to achieve. What do you want your panellists to come to an agreement on?
• Create your first set of questions after doing a thorough examination of the literature. Make sure that the initial set of questions is based on the goals you want to attain.
• Check for ambiguity, timing, and appropriateness of replies in your questions. Send it to a small group of specialists or at the very least coworkers, and evaluate their replies to confirm that your questions are relevant to your goal.
• The first round of the survey should be sent out.
• Send a reminder to panellists around 1-2 weeks after the original survey was sent, however the exact time periods may depend on the study.
• Analyze the first round’s replies and use the information to create the second round’s survey.
• Round two should be tested on a limited group of panellists to ensure that the replies will give the information you want.
• Send out the second round of the survey.
• Send a reminder for the second round. Again, the precise duration will be determined by your specific requirements and the context of your research.
• Analyze the findings of round two’s survey and utilise them to create the survey for round three.
• For the third round, test the survey and send it out when you’re happy. If necessary, remind panellists to finish.
• Examine the results of the third round.
• Check to see whether your goals have been met. If you find that you require more information, add more rounds.

Analysis of results

Quantitative analysis

The panel size and questionnaire design are two factors to consider when doing Quantitative Analysis. As a result, the scale of the problem and the quantity of competent informants/experts accessible to you are frequently factors. Some studies feel that the greater the number of participants, the better the degree of dependability of the listed factors. Obtaining an agreement level is the most commonly utilised approach for achieving consensus in this paradigm.

Although there is debate over the degree or cut-off point for agreement, several writers have suggested that 75% agreement is a good starting point. Other rating procedures are often employed to establish consensus in addition to getting a degree of agreement. Ranking components in order of significance and computing the mean to determine the most important to the least important aspects are two of these grading approaches.

Likert-type scales are also used to decide whether or not an element should be included. As a result, the nature of the analysis will be heavily influenced by the questionnaire structure, types of questions, and number of participants.

Qualitative analysis

The establishment of agreement among participants in a Qualitative Delphi Research does not rely on statistical measurements. The conclusion is derived from the study of emerging themes (assuming no structure was previously supplied). Open-ended question responses are typically in the form of brief narratives, which should be analysed using qualitative methods. The researcher will look over the replies and group them into themes that emerge. Advantages and disadvantages of using the Delphi method

Whereas dominating individuals in committees and face-to-face meetings may monopolise the conversation’s direction, the Delphi approach eliminates this by placing all replies on a “even” basis. Anonymity also means that attendees should only consider the facts in front of them, rather than the speaker’s reputation. By allowing for the revision of previous judgements, anonymity also allows for the expression of personal ideas, free critique, and acknowledgment of errors. Furthermore, the researcher may filter, summarise, and eliminate unnecessary data, which might be distracting for face-to-face meeting participants. As a result, potentially distracting group dynamics are eliminated (Hsu & Sandford, 2007).One of the most significant drawbacks is the high likelihood of poor response rate and attrition. Furthermore, a Delphi study generally consumes a substantial amount of time and adds significantly to the researcher’s burden. The advantages of employing a Delphi research in the proper setting, however, are thought to offer value that is difficult to attain with other approaches.

Conclusion

The Delphi method is a good way to reach an agreement on subjects that have no clear answers and are open to dispute. If you want your study’s results to be regarded seriously, the trustworthiness of the panel you choose is critical.

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References

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Custer, R. L., Scarcella, J. A., & Stewart, B. R. (1999). The modified Delphi technique: A rotational modification. Journal of Vocational and Technical Education, 15 (2), 1-10

Dalkey, N. C. & Helmer, O. (1963). An experimental application of the Delphi Method to the use of experts. Management Science, 9(3), 458 – 468

Delbecq, A.L., Van de Ven, A.H. & Gustafson, D.H. (1975). Group Techniques for Program Planning: a guide to nominal group and Delphi processes

Hsu, C.-chien, & Sandford, B. (2007). The Delphi Technique: Making sense of consensus. Practical Assessment, Research and Evaluation, 12(10)

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Joseph, C., Hendricks, C., & Frantz, J. (2011). Exploring the Key Performance Areas and Assessment Criteria for the Evaluation of Students’ Clinical Performance: A Delphi study. South African Journal of Physiotherapy, 67(2), 1-7

Judd, R. C. (1972). Use of Delphi methods in higher education. Technological Forecasting and Social Change, 4 (2), 173-186

Kaplan, L. M. (1971). The use of the Delphi method in organizational communication: A case study. Unpublished master’s thesis, The Ohio State University, Columbus

Miller, L. E. (2006, October). Determining what could/should be: The Delphi technique and its application. Paper presented at the meeting of the 2006 annual meeting of the Mid-Western Educational Research Association, Columbus, Ohio

Murphy M.K., Black N., Lamping D.L., McKee C.M., Sanderson C.F.B., Askham J. et al. (1998) Consensus development methods and their use in clinical guideline development. Health Technology Assessment 2(3)

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Skulmoski, G. J., & Hartman, F. T. (2007). The Delphi Method for Graduate Research. Journal of Information Technology Education, 6