Analytical Essay Types

1. Analytical Essay on Health Policy

One of the CanMEDS competencies relate to being a Health Advocate. A critical analysis of health policy addresses this competency, in addition to the Scholar competencies. Residents could choose a “hot topic” or a traditionally controversial topic and prepare to search and critically appraise the literature to come to a conclusion or recommendation, supported by the evidence. Frequently such topics involve considerations of cost, including opportunity cost, and other risks and benefits of supporting or not supporting the topic at hand. For example, residents may choose to analyze the risks and benefits of the legalization versus decriminalization of marijuana versus maintaining the status quo. Other possible topics may include the various ways of funding health care (private versus public), how physicians are compensated (including using chronic disease incentives), physician-assisted suicide, or other health policy issues.  Some recommendations for an analysis of health policy are listed below.

When considering health policy through an equity and anti-oppressive lens, special consideration must be taken into considering who wrote the policy and who the policy is written about.  Appropriateness, applicability and accessibility of the policy current contextualizing systemic oppressions is foundational to the critical appraisal expected of an analytical essay on health policy.

Recommendations for a scholar project analyzing health policy

• Description of the problem
• Research question
• Description of the literature search strategy
• Critical appraisal of the evidence looking at all sides of the issue

-Ideally a body of evidence would be considered as opposed to a single study.

-ideally including what might be considered ‘grey literature’ but is representative of population perspective of the policy being evaluated

• Application of the evidence to the problem at hand

-Include considerations on cost, opportunity cost, legal ramifications, ethical considerations, and other considerations as appropriate.

• If research evidence has already tried to evaluate the hypothesis you are exploring, this should be presented and once again critically appraised
• Conclusion/Summary

-Directly relate to the answers found to the research question.

An essay is a way of presenting your research and knowledge about a topic in a succinct and coherent way so that others may learn from your work.  An essay usually presents your idea (or thesis) in an objective way with a critique of available evidence.

Therefore, an essay must include a review and critical analysis of the existing situation and relevant literature.  It should have a traditional structure with introduction, body, conclusion, and annotated references.  The introduction should include a brief orientation to the topic, your thesis, and a brief summary of the main points.

Some essay topic examples:

• clinical controversy or ethics (Eg.  “the right to die”)
• connecting basic science to clinical practice (E.g.  hypothesis that genome research will achieve a cure for type 1 diabetes)
• advocacy initiative (E.g. refugee health services)
• innovation
• new program (E.g. safe injection sites)
• health policy (E.g. aboriginal children in foster care)

2. Analytical Essay on Basic Science

Analytical Essay on the Clinical implications of basic research and basic implications of clinical observations

The New England Journal of Medicine (NEJM) has a series of publications that explores the bi-directional relationship between basic science and clinical practice.[1] This is based on the premise that the path between the laboratory and bedside runs both ways: basic science research can lead to clinical advances; and clinical observations can pose new questions for basic science, that can subsequently inform clinical practice (aka the “bedside-to-bench” flow of information).

Residents may choose to develop an example of basic science research findings that have led to insights relevant to clinical practice, or clinical findings that pose questions or reveal insights relevant to the basic sciences.

In critical analysis of the basic science, careful consideration of the population studied and/or impacted by this research must be explored.  Please see references to TriCouncil Policy Statemtn Chapter 9, CIHR Indigenous Health and other resources on biomedical research of oppressed populations to contextualize the development of the basic science research, its delivery from bench to bedside and subsequent analysis and evaluation thereof.

A scholar project in these areas should include a directed, comprehensive literature review, and critical appraisal of the evidence. Basic science literature should be derived (at least in part) from preclinical journals. Although a single basic science concept may be of interest, there should be an effort to seek out the body of evidence on this topic where multiple laboratory studies of the same concept are included. This type of scholar project should involve hypothesis generation, in other words the resident should propose an idea of how a relationship between basic science and clinical practice occurs. If this hypothesis has already been proposed and tested, the resident should include this literature and critically appraise it.

Recommendations for a scholar project examining clinical observations > basic science

• Description of clinical encounter(s)/observation(s) of interest
• Research question
• Description of the basic science literature search strategy

-The search should include (but does not have to be limited to) papers from preclinical journals.

• Critical appraisal of the basic science evidence

-Ideally a body of evidence would be considered as opposed to a single study.

• Application of basic science evidence to the clinical findings.

-This should include an exploration of whether or how the laboratory evidence provides insights into the clinical context; whether gaps remain (e.g., in explaining the clinical observations); and how future research might address these gaps.

• If research evidence has already tried to evaluate the hypothesis you are exploring, this should be presented and once again critically appraised
• Conclusion/Summary

– Published examples of each of these categories are provided below, although it should be noted that a scholar project would need to explore the issue more comprehensively than these brief published works.

Example of article examining clinical implications > basic science

Loscalzo J. Basic implications of clinical observations: venous thrombosis in the nephrotic syndrome. New England Journal of Medicine 2013; 368(10).

Recommendations for a scholar project examining basic science > clinical observations.

The purpose of this is to highlight laboratory research that could lead to advances in clinical therapeutics.

• Description of basic science finding(s) of choice

-These should be derived from preclinical journals.

• Research question
• Description of the search strategy to identify literature to inform consideration of the relationship between the basic science findings a clinical practice issue.

-Ideally this will produce a body of evidence.

• Critical appraisal of the evidence
• Discussion of the application of evidence to a hypothesized relationship between the laboratory and clinical context

-This should include an exploration of whether or how the laboratory evidence can inform insights into clinical therapeutics; whether gaps remain; and how future research might address these gaps.

• If research evidence has already tried to evaluate the hypothesis you are exploring, this should be presented and once again critically appraised.

Conclusion/Summary: directly relating to the answers found to the research question

-Published examples of each of these categories are provided below, although it should be noted that a scholar project would need to explore the issue more comprehensively than these brief published works.

Example of article examining basic science > clinical implications

Friedland JS. Targeting the inflammatory response in tuberculosis. New England journal of medicine 2014; 371(14).

3. Analytical Essay Innovation in Health Care

The intent of this category is to provide a directed, comprehensive evidence-based discussion of innovations in medicine. These may include new devices, diagnostic tools, decision rules or therapies. Novel uses of older treatments may also be applicable.

The Canadian Medical Association Journal (CMAJ) provides a guide for authors in developing a publication in this category, and these recommendations are presented and expanded in Box 5 to provide structure for how an innovation-focused project can be produced as a scholarly work.

An innovations scholar project must encompass a comprehensive, directed evidence review. There should be both a presentation of evidence, as well as critical appraisal of that evidence. This include a discussion of the types of studies that provide evidence, the quality of the studies, their results, whether the results support or contradict each other, the types of populations the studies are conducted among and considerations for generalizability, etc.  It is encouraged to critically appraise the evidence through an equity lens especially around accessibility of innovations given social and colonial determinants of health and systemic oppression resulting in tangible barriers to accessing healthcare and its innovations.

Recommended structure of an innovation-focused scholar project

1. Description of the innovation
   • What is it?
   • How is it delivered?
   • Who is eligible? (Include who is likely to benefit from the innovation) Note that visual or auditory resources (e.g. photos, sound clips, videos or other images) may be helpful to present the new technology, especially if it is something new. If a patient photograph is used, consent must be obtained from the patient or his/her representative.
2. Research question
3. Background/Context
   • Why should we know about this innovation?
   • Why was it developed?
   • What is the background?
   • Is the innovation needed?
   • Indications?
4. What are the possible harms?
   • Are there any contraindications?
5. What is the evidence so far?
   • Comprehensive review of the evidence
   • Critical appraisal
   • Is more evidence needed before general adoption?
6. What can we expect in the future?
   • Should this innovation be widely adopted?
   • Predict how likely this innovation is to be adopted. Outline what might prevent or help the innovation in being established in mainstream practice (e.g., money, availability, adverse effects, results of planned/in progress studies, etc.)
   • What research is currently underway?
7. Summary/Conclusion

Directly addressing what information was learned to answer original research question.

Examples

Examples of innovation publications are presented below (note that the Innovation-focused articles in this journal are intended to be brief, therefore the depth of literature review may not be as comprehensive as would be required for a scholar project):

Lee SK, O’Brien K. Innovations: Parents as primary caregivers in the neonatal intensive care unit. CMAJ 2014; 186: 845-847.

Aziz AAA, Isaac M, Tehrani NN. Innovations: Using telemedicine to screen for retinopathy of prematurity. CMAJ 2014; 186: 1012-1014.

4. Analytical Essay on Health Advocacy

Health Advocacy is a core competency in Family Medicine.1 In their role as Health Advocates, family physicians are able to identify and respond to a range of issues that influence the health and well-being of individual patients, communities, and populations.

Through individual or collective action, family physicians work to promote health and prevent disease, address the social, colonial, racial, cis heteronormative, economic, educational, and political factors that influence health outcomes, and direct their efforts at various levels to address the root causes of illnesses and inequities in health.

Healthy Advocacy is encouraged to be analyzed through an equity, anti-oppressive and epistemically pluralistic lens with robust representation from all sides.

Health Advocacy

Selecting the Issue and type of advocacy

Advocacy efforts must have an assessable impact on the health and well-being of a population group or population at large to justify the efforts (see VCH Population Health: Advocacy Guideline and Resources) Residents must demonstrate collaboration/partnership with this population (the participants) in identifying the issue and plans for advocacy:

• Bottom-up approaches involve a process that actively engages the community. Community members are involved in identifying critical issues that affect their community.
• Top-down approaches are based on the identification of an issue by someone outside the community (e.g., healthcare professionals, civil society organizations, NGOs, etc.), nevertheless, the community would still need to be consulted for input around the objectives, design, scope and outcomes related to the issue of concern.

Approaches to solving the issue/problem must be identified and clearly defined, and evaluation plan outlined.

 Description of Initiative should be explained in sufficient detail for someone else to reproduce it. The identified issue/problem should be addressed by the health advocacy initiative. To determine success or impact, a concise evaluation or approach to evaluation of the initiative should be described along with any data collected and analyzed.

Evaluation/Outcomes should be presented in a concise manner. To determine if the health advocacy initiative was successful, qualitative and/or quantitative information is needed. An evidence-informed approach is required. Obtaining relevant and credible information to achieve these outcomes requires research. Research gives your advocacy credibility: new information is obtained and validated, enabling you to advocate in an informed and credible fashion.

Ethical approval will likely be required from the UBC Research Ethics Board (REB). Not all advocacy projects will require REB approval – if you believe your project does not require REB approval because you do not plan to collect data directly from people, then ask the REB for written confirmation that REB approval is not required. Document this in your report.

If your project requires REB approval, this will be necessary BEFORE starting your project. For more information read the section on Research Ethics.