Making sense of qualitative research: a new series

This chapter introduces the historical background of qualitative research in medical education and its practical use in medical education and research today. The goal of qualitative research is to help us gain an understanding as to how or why certain things occur. Qualitative research seeks that understanding through observation and interviews, both of which provide insight into the research question. Qualitative research is not bound by the same restrictions of quantitative research (such as standardization of procedures to remove the influence of external variables). Qualitative researchers study phenomena in their natural setting and include everything that may impact that setting by identifying variables and how they impact the outcome. Seven qualitative research methods are presented, defined and cited in the current literature. The qualitative research methods presented include: ethnography, grounded theory, case study, phenomenology, hermeneutics, narrative research, and action research. Data collection techniques used in all of the qualitative methods are presented and defined and examples are given in current journal articles. These include: single or group interviews; focus groups; the written narrative; written responses to open-ended questions; and observations of people, events, or situations. The data-collection technique is driven by the qualitative research method chosen to complete the research. The research methodology is driven by the research question. Together these present a detailed response to the research question, rich with details of the issue being studied. Mixed method research is being used more frequently in current medical education and healthcare research so the chapter covers its definition, application and use in the current literature. Mixed method research typically uses either the Delphi method or nominal group technique to build consensus among experts. As qualitative research has become more important in all of healthcare research, it is important to understand and identify both the research methodology as well as the data collection methodology. They are both equally important in supporting the rigour and validity of research outcomes and are most effective when used together.

<p>Background: Qualitative research explains observations, focusing on how and why phenomena and experiences occur. Qualitative methods go beyond quantitative data and provide critical information inaccessible through quantitative methods. However, at all levels of medical education, there is insufficient exposure to qualitative research. As a result, residents and fellows complete training ill-equipped to appraise and conduct qualitative studies. As a first step to increasing education in qualitative methods, we sought to create a curated collection of papers for faculty to use in teaching qualitative research at the graduate medical education (GME) level.</p> <p>Methods: We conducted literature searches on the topic of teaching qualitative research to residents and fellows and queried virtual medical education and qualitative research communities for relevant articles. We searched the reference lists of all articles found through the literature searches and online queries for additional articles. We then conducted a three-round modified Delphi process to select papers most relevant to faculty teaching qualitative research.</p> <p>Results: We found no articles describing qualitative research curricula at the GME level. We identified 74 articles on the topic of qualitative research methods. The modified Delphi process identified the top nine articles or article series most relevant for faculty teaching qualitative research. Several articles explain qualitative methods in the context of medical education, clinical care, or emergency care research. Two articles describe standards of high-quality qualitative studies, and one article discusses how to conduct the individual qualitative interview to collect data for a qualitative study.</p> <p>Conclusions: While we identified no articles reporting already existing qualitative research curricula for residents and fellows, we were able to create a collection of papers on qualitative research relevant to faculty seeking to teach qualitative methods. These papers describe key qualitative research concepts important in instructing trainees as they appraise and begin to develop their own qualitative studies.</p>

<p>Background: Qualitative research explains observations, focusing on how and why phenomena and experiences occur. Qualitative methods go beyond quantitative data and provide critical information inaccessible through quantitative methods. However, at all levels of medical education, there is insufficient exposure to qualitative research. As a result, residents and fellows complete training ill-equipped to appraise and conduct qualitative studies. As a first step to increasing education in qualitative methods, we sought to create a curated collection of papers for faculty to use in teaching qualitative research at the graduate medical education (GME) level.</p> <p>Methods: We conducted literature searches on the topic of teaching qualitative research to residents and fellows and queried virtual medical education and qualitative research communities for relevant articles. We searched the reference lists of all articles found through the literature searches and online queries for additional articles. We then conducted a three-round modified Delphi process to select papers most relevant to faculty teaching qualitative research.</p> <p>Results: We found no articles describing qualitative research curricula at the GME level. We identified 74 articles on the topic of qualitative research methods. The modified Delphi process identified the top nine articles or article series most relevant for faculty teaching qualitative research. Several articles explain qualitative methods in the context of medical education, clinical care, or emergency care research. Two articles describe standards of high-quality qualitative studies, and one article discusses how to conduct the individual qualitative interview to collect data for a qualitative study.</p> <p>Conclusions: While we identified no articles reporting already existing qualitative research curricula for residents and fellows, we were able to create a collection of papers on qualitative research relevant to faculty seeking to teach qualitative methods. These papers describe key qualitative research concepts important in instructing trainees as they appraise and begin to develop their own qualitative studies.</p>

Qualitative research explains observations, focusing on how and why phenomena and experiences occur. Qualitative methods go beyond quantitative data and provide critical information inaccessible through quantitative methods. However, at all levels of medical education, there is insufficient exposure to qualitative research. As a result, residents and fellows complete training ill-equipped to appraise and conduct qualitative studies. As a first step to increasing education in qualitative methods, we sought to create a curated collection of papers for faculty to use in teaching qualitative research at the graduate medical education (GME) level. We conducted literature searches on the topic of teaching qualitative research to residents and fellows and queried virtual medical education and qualitative research communities for relevant articles. We searched the reference lists of all articles found through the literature searches and online queries for additional articles. We then conducted a three-round modified Delphi process to select papers most relevant to faculty teaching qualitative research. We found no articles describing qualitative research curricula at the GME level. We identified 74 articles on the topic of qualitative research methods. The modified Delphi process identified the top nine articles or article series most relevant for faculty teaching qualitative research. Several articles explain qualitative methods in the context of medical education, clinical care, or emergency care research. Two articles describe standards of high-quality qualitative studies, and one article discusses how to conduct the individual qualitative interview to collect data for a qualitative study. While we identified no articles reporting already existing qualitative research curricula for residents and fellows, we were able to create a collection of papers on qualitative research relevant to faculty seeking to teach qualitative methods. These papers describe key qualitative research concepts important in instructing trainees as they appraise and begin to develop their own qualitative studies.

Qualitative Research in CKD: How to Appraise and Interpret the Evidence

The purpose of this focused issue is to advance understanding of qualitative research methods in the international business context. Debates on qualitative research methods in the key international business (IB) journals have been rare. There has been no focused issue on this topic previously, either in mir or in other journals in the field, making this a 'special' issue. During the process of editing a recent handbook on qualitative research methods (Marschan-Piekkari/Welch 2004), we realized that while this collection covered many topics, often for the first time in the IB field, there were many others still outstanding. There was thus scope for continuing a dialogue about qualitative methods in the IB research community. The challenge of making qualitative research count in the quantitative world of IB remains. Qualitative research is difficult to define, since the term encompasses many different research traditions, research strategies and methods for data collection and analysis (Prasad 2005). A typical definition is that everything non-numerical is qualitative research (Marschan-Piekkari/Welch 2004, p. 19). However, even this very simplistic definition soon breaks down, since research strategies which are typically considered to be qualitative, such as case studies, can combine numerical with non-numerical data (Hurmerinta-Peltomaki/Nummela 2004). There is also no clear divide between qualitative and quantitative research in terms of research traditions, with much qualitative research in management and IB sharing the positivist assumptions of quantitative research (Prasad/Prasad 2002). This focused issue is not about reporting the empirical findings of IB studies applying qualitative methods; rather it is about the process of undertaking qualitative research in the IB field. Of course, there is a large volume of literature on qualitative research methods already. However, we would argue that the IB context warrants special treatment. As the authors of this focused issue discuss, the distinctiveness of the field stems from its multiple linguistic and cultural settings; organizational complexity; and its intellectual roots in post-War academic institutions in the USA. These issues receive little treatment in general texts on qualitative methodology. There has been some methodological debate in previous issues of mir. Earlier articles in mircan be grouped into three categories: first, reviews of existing methodological practices in IB publications (e.g., Cavusgil/Das 1997, Nasif et al. 1991); second, proposals for new quantitative techniques (e.g., the use of key informants in cross-cultural studies, as proposed by Lenartowicz and Roth 2004 and a linguistic-based measure of cultural distance as developed by West and Graham 2004); and third, calls for new methodological approaches (Boddewyn/Iyer 1999). The absence of qualitative research methods in this debate perhaps reflects the limited amount of empirical qualitative research published in this journal. A recent analysis of mir issues between 1990 and 1999 revealed that only 5 percent of articles published in this period used qualitative methods (Welch/Welch 2004). This focused issue is therefore a response to those, such as Boddewyn and Iyer (1999) in this journal, who have called for alternatives to surveys and secondary data analysis. This focused issue attracted 39 submissions from more than 15 countries. Given that there have been limited outlets for methodological articles in IB, this is a considerable number. It perhaps suggests a level of interest to which IB journals have not responded to date. Of the total number of submissions, 11 were selected for review. On the basis of reviewers' comments, six of these papers were ultimately rejected. The final five papers underwent two and, in some cases, up to four rounds of revisions. In selecting the articles, we used the following criteria: appropriateness of the topic for the focused issue; demonstrated knowledge of IB and methodological literature; quality of argument; originality and innovativeness of the contribution to IB methodology; organization and clarity of the paper; and potential application to research practice in IB. …

Qualitative research was originally developed within the social sciences. Medical education is a field that comprises multiple disciplines, including the social sciences, and utilizes qualitative research to gain a broader understanding of key phenomena within the field. Many clinician educators are unfamiliar with qualitative research. This article provides a primer for clinician educators who want to appraise or conduct qualitative research in medical education. This article discusses a definition and the philosophical underpinnings for qualitative research. Using the Standards for Reporting Qualitative Research as a guide, this article provides a step-wise approach for conducting and evaluating qualitative research in medical education. This review will enable the reader to understand when to utilize qualitative research in medical education and how to interpret reports using qualitative approaches.

Purpose: The paper aims to explore the role and significance of qualitative methods in the research process, particularly focusing on their ability to interpret and understand complex social phenomena. It highlights the complementarity between qualitative and quantitative approaches and their joint use in comprehensive research. Design/methodology/approach: This paper utilizes a theoretical approach to describe and analyze qualitative research methods, including observation, interviews, and group discussions. The discussion is grounded in a comparison with quantitative methods, emphasizing the interpretive and subjective aspects of qualitative research, which allows for a deeper understanding of phenomena. Findings: The paper finds that qualitative methods play a crucial role in providing insights into phenomena that cannot be quantified. It highlights the importance of qualitative research in building theories from observed experiences, the value of respondents’ personal experiences, and the essential interaction between researchers and participants. The findings also support the argument that qualitative and quantitative research are complementary, and using both approaches can enhance research outcomes. Research limitations/implications: The paper acknowledges that purely qualitative research may lack generalizability due to its focus on individual or small group data. It suggests future research should continue to integrate both qualitative and quantitative methods to enhance the validity of the results. Practical implications: While not directly aimed at providing commercial or economic recommendations, the findings emphasize the importance of incorporating qualitative methods in research processes to gain richer, more contextually grounded insights that can inform policy- making, social programs, and educational practices. Social implications: The research can influence public attitudes by promoting a more nuanced understanding of social phenomena. It underscores the value of qualitative research in capturing human experiences and behaviors, which could be used to inform social policy and educational reforms. Originality/value: This paper contributes to the field by offering a comprehensive exploration of qualitative research methods, highlighting their relevance in capturing the complexities of social phenomena. It is of value to researchers in social sciences, education, and policy development who seek to integrate qualitative approaches into their research methodologies. Keywords: qualitative research, observation, interviews, social phenomena, research methodology. Category of the paper: Research Paper, Conceptual Paper.

'It is a capital mistake to theorise before you have all the evidence. It biases the judgement.' Sir Arthur Conan Doyle, A Study in Scarlet Evidence-based medicine came into existence because doctors too readily made Sherlock Holmes''capital mistake' of treating patients before they had all the evidence. Woe betide modern day doctors who, at interview, do not say they will let their clinical practice be guided by meta-analyses of randomised controlled trials (RCTs) and use online literature sources at the bedside. Is there not, however, an opposite, equally capital mistake? A prevalent belief in the 'evidence era' is that concerted research effort can deliver a single best answer to everyday questions, leaving little scope for a best guess based on the current state of knowledge. The belief that concerted research effort can deliver a single best answer to everyday questions leaves little scope for a best guess in the current state of knowledge The founders of evidence-based medicine were pilloried for imposing such pseudo-simplicity onto the complex world of medicine, although, in reality, they made it quite clear that the craft of practice lies in applying general evidence to specific patients, each of whom is unique.1 This commentary considers how medical educators and education researchers stand in the evidence era. Evidence-based practice is not the concern of only scientific medicine. The Campbell Collaboration website,2 for example, currently lists 5 completed reviews of evidence-based practice in education, 9 in crime and justice, and 16 in social welfare. Medical teaching's own evidence movement, 'Best Evidence Medical Education' (BEME), came into existence in 1999 and was brought to a wider audience by several articles in an issue of Medical Teacher the following year. One article in that issue argued that there was a need for evidence because, when it came to education, scientists often forsook intellectual rigor for seductive but misleading 'intuition and tradition'.3 Those arguments did not fall on deaf ears: with 6 reviews published and 13 more on the way, BEME is now part of the medical education landscape. With 6 reviews published and 13 more on the way, Best Evidence Medical Education is now part of the medical education landscape It was recently suggested by Todres et al.4 that all is not well in medical education research. These authors enumerated some of its shortcomings as involving: a paucity of externally funded studies; a focus on learners rather than on patient outcomes; a predominance of 'observational designs' rather than experiments; a lack of statistical meta-analysis, and poorly conducted RCTs. Any call for research to 'raise its game' will never be out of place and neither will a criticism of shoddy work, but critical readers must decide if Todres et al.'s more fundamental criticisms of the methodologies of medical education research are pushing such research up its learning curve or pulling it back down. Must we accept the standard of quality that Todres et al. apply? Their argument that lack of premier research funding equates with lack of quality hinges on that standard. Writing 7 years before Todres et al., Professor Geoff Norman, a leading educational methodologist who has declared elsewhere that RCT stands for 'results confounded and trivial',5 said: 'There is little reason to continue with an attitude of despair and hand-wringing about the quality of educational research.' For Norman, '…methodological rigor is not necessarily unidimensional', and 'attempts to examine the strength and extent of evidence presuppose a single worldview'.5 To amplify that point, a research paper published at about the same time as that of Todres et al. purports to show a correlation between external funding and methodological quality but completely excludes qualitative research from consideration.6 By their implicit advocacy of RCTs, which require massive external funding to meet requisite standards of rigor, Todres et al. could be accused of imposing a 'single best answer' way of thinking. How well, we should ask, do the research methods of scientific medicine fit a discipline like education where 'the best answer' for a particular student in a specific context may be the worst answer for a different student in a different context? The best answer for a particular student in a specific context may be the worst answer for a different student in a different context Professor Henk Schmidt gave a helpful perspective when he overviewed the entire research effort directed at problem-based learning (PBL) in a 2005 keynote address. He divided publications into 3 categories, as follows: 'this is what we did': descriptive accounts that are not truly 'research'; 'justification research', which answers questions such as 'How much better is PBL than conventional education?', and 'clarification research', which, for example, tells educators how PBL can benefit people with specified attributes, and how it could most effectively be applied in specified educational contexts. Todres et al.4 might have been dismayed to hear Professor Schmidt call for more clarification research, but other audience members might have been glad to hear him praise observational studies focused on learners rather than patient outcomes that could be well conducted without external funds. Against that background, a paper in this issue of Medical Education discusses empirical data that are as far removed from the impersonal objectivity of clinical trial end-points as it is possible to get: personal, subjective narrative. Sceptics of subjectivity in research might do well to note that the article comes from the pens of authors who have written equally well about 'objective' evidence-based practice. Greenhalgh and Wengraf conducted a Delphi exercise to guide researchers, reviewers and ethics committees as to when use of narrative can correctly be described as 'research', and what constitutes 'good' narrative research. The 20 'guiding principles' resulting from this exercise help readers understand what narratives are, how a collection of them can be assembled, and the important ethical and intellectual issues that surround their collection and interpretation. Would-be narrative researchers may be disappointed, however, to receive no more guidance on how to analyse narratives than 'rigorously and transparently', making 'logical and coherent links between findings and conclusions'. Thus, Greenhalgh and Wengraf's very act of constructing a set of principles seems to support Norman's prediction that 'the range of methodologies used by educational researchers, and the range of possible findings, many of which can never be reduced to an effect size, will frustrate any attempt to devise objective standards of evidence, whether these are formulated as checklists or ratings'.5 Researchers who have experienced the creative buzz of conducting good qualitative research will understand why Greenhalgh and Wengraf, like the authors of a quality checklist for qualitative research,7 are so non-prescriptive about how to analyse narrative research just when novices most feel the need for cut-along-the-dotted-line instructions. BEME is currently identifying 'logical and coherent links' within and between the narratives of its early topic reviewers so their successors can more easily assemble disparate evidence into interpretations that will guide education practice (Hammick et al.; in preparation). History will judge whether, by doing so, BEME is perpetuating what the British Medical Journal characterised as a state of 'stagnation' in medical education research (in a banner headline to the article by Todres et al.),4 or whether it is helping a fledgling discipline find its own way forward. But what did Sherlock Holmes' mean by 'all the evidence' and is evidence collection ever complete? We should not be so naïve as to regard medical education research as a Whodunit. We should select the best from the rich variety of research disciplines that can inform education To raise the game in a way that is neither confounded nor trivial, we should select the best from the rich variety of research disciplines that can inform education. We should follow Norman's advice not to use arbiters of rigor that are 'unidimensional'.5 We should conduct education research that, like Greenhalgh and Wengraf's narrative research, begins and ends in the real world of practice. We should conduct education research that begins and ends in the real world of practice

This methodological brief gives an overview of qualitative research methods used in medical education and offers resources to help researchers explore qualitative methods more deeply. We discuss five common qualitative approaches used in medical education research, including case study, ethnography, grounded theory, narrative inquiry, and phenomenology. We review specific qualitative methods and data collection techniques, considering the potential advantages, challenges and biases of each technique. We address the importance of rigor in qualitative research, and give recommendations for what to include in the methods and results section of a qualitative medical education research manuscript.

Imagine a physician who wants to research options to help her patients lose weight. As a clinical researcher, she may first explore the efficacy of a medication. Not only is there an instrument that accurately collects patient weight but also the link between the intervention (medication) and the outcome (weight) has been established. Her study manipulates the behavior of the physician (what should be prescribed), and the intervention is administered to the patient, who in this case, is a relatively passive recipient.

1. Michelle Butina, PhD, MLS(ASCP)CM[⇑][1] 1. University of Kentucky, College of Health Sciences, Lexington, KY 2. Suzanne Campbell, PhD, MLS(ASCP)CM 1. Seward County Community College/Area Technical School, Liberal, KS 3. Wendy Miller, EdD, MT(ASCP)SI 1. Elgin Community College, Elgin, IL <!-- --> 1. Address for Correspondence: Michelle Butina, PhD, MLS(ASCP)CM, Assistant Professor and Program Director, Medical Laboratory Science, University of Kentucky, College of Health Sciences, 900 South Limestone Street, CTW Bldg. Rm. 126E, Lexington, KY 40536-0200, (859) 218-0852, Michelle.Butina{at}uky.edu 1. Compare and contrast qualitative and quantitative research methods and their uses. 2. Identify the five commonly used qualitative research methods. > "Within the last twenty years qualitative research has become a mature field of study with its own literature base, research journals, special interest groups, and regularly scheduled conferences". > > - Dr. Sharan B. Merriam, professor of adult education and continuing education, University of Georgia, 2009 INTRODUCTION Medical laboratory practitioners know how to perform experiments and have participated in surveys. However qualitative research and its methods remain an unknown to many in the medical laboratory science profession. This series provides readers with an introduction to qualitative research methods. A simple definition of qualitative research is not possible; therefore a description of its purpose and characteristics is provided. As Merriam (2009) described, "Qualitative researchers are interested in understanding how people interpret their experiences, how they construct their worlds, and what meaning they attribute to their experiences." The primary characteristics of qualitative research include: 1) the focus on understanding peoples' experiences with intent to convey experiences into meaning, 2) the researcher is the key instrument for data collection and analysis, 3) the research process is inductive and not deductive, and 4) the product of qualitative research is richly descriptive. Other characteristics of qualitative research include that the study design is often emergent and flexible, data is often collected in the natural setting, multiple forms of data may be collected, and sample selection is usually purposeful and small.1,2 Qualitative versus Quantitative There are three approaches to research, qualitative, quantitative and mixed methods. The qualitative research approach was introduced and described in the section above. A… 1. Compare and contrast qualitative and quantitative research methods and their uses. 2. Identify the five commonly used qualitative research methods. [1]: #corresp-1

Qualitative Research Methods for Medical Educators

&lt;div class="WordSection1"&gt;&lt;p&gt;I am honored for being an alumnus of KEMC, and am delighted to write this editorial for the Annals. I have, ever since done my research and taught qualitative methods, felt that clinical methods are quite akin to qualitative research. Then, why only few clinical researchers use qualitative methods? A witness to this assumption is the research published in the Annals. In this treatise, I try to identify some parallels between the two types of methods and argue for the clinicians to invest in learning qualitative research methods to practice clinical methods well.&lt;/p&gt;&lt;p&gt; Qualitative research is to identify and interpret issues from the perspective of participants, their experience of: illness or disability, using health service, and to appreciate the meanings they give to the behaviour, events or objects in the context of their social and cultural norms. In this type of research, the emphasis is on exploring the associations and understanding the phenomenon in its holism; and not, like in quantitative research, from an outsider’s perspective and for certain specific aspects.&lt;sup&gt;1&lt;/sup&gt; It requires participants with specific characteristics, selected purposely that can best inform the research topic. More participants, identified inductively during data collection, are added to develop full and multiple perspectives about the cases.&lt;sup&gt;2&lt;/sup&gt;&lt;/p&gt;&lt;p&gt; No preset data collection tool is used, instead qualitative researcher guided by a research question acts as an instrument, since the line of enquiry he changes during data collection as new understanding is gained and/or the situation changes.&lt;sup&gt;3&lt;/sup&gt; The data for research is derived from the observation, interviews or verbal interactions, focus group discussions, document reviews, life histories etc. and the researcher asks why, how and under what circumstances things occur; and not just what, where and when. It is recorded in words or pictures and log book is used to record notes arising from interviews, observations, extracts from documents etc.&lt;/p&gt;&lt;p&gt; In health care settings patients are the subjects for clinical methods. The clinician, even prior to any verbal communication, observes the patient, e.g. for his gait and appearance. If in a bed or examination couch, his posture could give some clue to the illness. Inspection, a clinical method, is like systematic observation, which is qualitative method, should be holistic. In my third year during bedside teaching, Professor (late) Rashid Ahmed Qureshi said, &lt;em&gt;“patient has come to you as a whole and not his stomach in a tray”&lt;/em&gt;, when a student straight went to examine abdomen of a patient with acute abdomen. History taking, another clinical method, is like conducting semi structured in depth interview – a qualitative research method. In both disciplines, we are told, &lt;em&gt;“not to ask leading, but follow up and probing questions”; &lt;/em&gt;and Professor (late) Alamgir Khan, while teaching clinical methods, would add, &lt;em&gt;“if a good history is taken, you will establish diagnosis in over 65% of cases”. &lt;/em&gt;Likewise, as part of history taking, documents related to patient’s illness history and treatment are reviewed similar to document review in qualitative research.&lt;/p&gt;&lt;p&gt; The two approaches however differ in how the data is analysed. In clinical practice, diagnosis is established based on the pathophysiological knowledge or patient’s clinical condition is discussed in clinicopathological conference.&lt;sup&gt;4&lt;/sup&gt; On the other hand, qualitative research employs meaning based data analysis, whereby the qualitative data is transformed into some form of explanation, understanding or interpretation of people and situation that is investigated.&lt;sup&gt;5,6&lt;/sup&gt;&lt;/p&gt;&lt;p&gt; In conclusion, the history, the observation and the review of document related to patient are since obtainned using qualitative methods, the clinician trained in these methods could not only conduct these methods well but also interpret the data to identify and detect obstacles to the change in clinical condition and the reasons why improvement does or does not occur.&lt;sup&gt;7&lt;/sup&gt; Finally, while it is heartening that research forums are organised in the institutions affiliated with KEMU, in order the research is richer, the researchers’ skills in qualitative research methods should be built.&lt;/p&gt;&lt;/div&gt;

Qualitative and mixed methods research in trials