Researching Medical Education

Jennifer Cleland, Steven J. Durning

• Editorial: Wiley-Blackwell
• Año: 2015
• ISBN:
  9781118839188
• Edición: 1
• Categoría: Medicina
• Categoría: Formazione medica

Researching Medical Education is an authoritative guide to excellence in educational research in the health professions. Presented by the Association for the Study of Medical Education and the Association for Medical Education in Europe, Researching Medical Education includes contributions from a team of international clinicians and non-clinical researchers in health education, representing a range of disciplines and backgrounds.

This accessible reference provides readers with the basic building blocks of research, introduces a range of theories and how to use them, illustrates a diversity of methods and their use, and gives guidance on practical researcher development.

By linking theory and design and methods across the health profession education research spectrum, this book supports the improvement of quality, capacity building and knowledge generation. Researching Medical Education is the ideal resource for anyone researching health education, from undergraduate, through postgraduate training, to continuing professional development.

Part 1
A primer of healthcare education research

Chapter 1
Exploring versus measuring: considering the fundamental differences between qualitative and quantitative research

Jennifer Cleland

I overheard some of the trainees/residents talking about the things that are important to them in terms of career decision making. It struck me that things are a bit different from ‘my day’: for example, they seem much more concerned with work-life balance. After looking at the literature, a colleague and I decided that there were various gaps in terms of what is known about the factors that influence medical student and trainee careers decision making in our country, particularly since the training pathway changed about 10 years ago. We wanted to explore this further, so first carried out some telephone interviews to gather the views of students and trainees. The participants suggested a number of factors, which we had not thought of, as particularly important in careers decision making. We then wanted to find out which factors were most important to the majority of trainees and if there were differences across students and trainees at different stages of training. To achieve this, we used the data from our literature review and the interviews to design a questionnaire, which we sent out to all students and trainees nationally.

Introduction

This true scenario, one which has underpinned, to date, a 5-year programme of work,^1–3 highlights some of the differences between quantitative and qualitative research, but also how they can be used in a complementary manner in the same programme of research.

It is easy to assume that the differences between quantitative and qualitative research are solely about how data is collected – the randomised controlled trial (RCT) versus ethnographic fieldwork, the cohort study versus the semi-structured interview. These are, however, research methods (tools) rather than approaches (methodologies). There are very important consequences of choosing (implicitly or explicitly) a particular methodological stance or position to guide and inform your research practice or an individual study. Quantitative and qualitative approaches make different assumptions about the world,^{4, 5} about how science should be conducted and about what constitutes legitimate problems, solutions and criteria of ‘proof’.⁶ They also use completely different languages (see Fig. 1.1).

‘When we speak of ‘quantitative’ or ‘qualitative’ methodologies we are in the final analysis speaking about an interrelated set of assumptions about the social world which are philosophical, ideological and epistemological. They encompass more than just data collection methodologies’ (Rist, 1977, p. 62⁷)

Figure 1.1 Word clouds of quantitative and qualitative language.

In this chapter, drawing on Bryman,⁸ I will talk about these assumptions and their implications for research practice. I will then compare and contrast the two approaches in terms of research design, methods are tools, analysis and interpretation. I will draw on examples from healthcare education research to illustrate these points. I will also discuss combined (‘mixed-methods’) approaches. The content of this chapter is more heavily ‘weighted’ towards quantitative research is but cross-referenced with corresponding key information about qualitative research, which is presented in other chapters in this volume.

Philosophical differences

Research philosophies differ on the goals of the research and the way to achieve these goals. For example, is the purpose to test theories and discover general principles, or is it to describe and explain complex situations? Quantitative and qualitative research comes from different underlying assumptions of what is reality (ontology) and what is knowledge (epistemology) (see also chapters by McMillan, and Mann and Macleod in this book).

Quantitative research philosophies

Quantitative research draws originally from the positivist paradigm. The underlying premise of this paradigm (basic belief systems, or universally accepted models providing the context for understanding and decision making) is that the goal of knowledge is simply to describe the phenomena that we experience, and hence can observe and measure (i.e. objectivity). The researcher and the focus of the research are in this way independent of each other: the researcher has no influence on the research process. In a positivist view of the world, the goal of knowledge is to observe, measure and describe the phenomena experienced. The positivist perspective is founded on the idea that reality is tangible and measurable. Knowledge of anything beyond that (a positivist would hold) is impossible. In positivism, science was seen as the way to get at truth, to understand the world well enough so that we might predict and control it. This might seem a little extreme to us now, and it is fair to say that quantitative research has moved on from purely positivist views to post-positivism. Post-positivism does not reject the basic tenets of observation and measurement, but it recognises that all observation is fallible and that all theory is revisable. Post-positivitism is also characterised by an acceptance that the theories, background, knowledge and values of the researcher can influence what is observed.

In post-positivism, a variety of epistemologies underpin theory and practice in quantitative research⁹. One of the most common post-positivism stances is that of critical realism or criticality. A critical realist believes that there is a reality independent of our thinking about it that science can study, and questions (hence the ‘critical’ label) the infallibility of observation and theory. Moreover, they also believe that while everyone is influenced by their cultural experiences, world views, and so on, researchers can put aside their biases and beliefs to strive for objectivity. The differences between positivism and critical realism are discussed further in the chapter by MacMillan later in this book. For the purposes of the current chapter, however, it is sufficient to know that those working from a (post-) positivist position believe that the scientific method (i.e. the approaches and procedures of the natural sciences such as chemistry, biology and physics) is appropriate for the study of social phenomena (e.g. learning).

Qualitative research philosophies

The premise of qualitative research is subjectivity¹⁰. Qualitative research is concerned with how the social world is interpreted, understood, experienced or produced. Reality cannot be measured directly. It exists as perceived by people and by the observer. Reality is relative and multiple, perceived through socially constructed and subjective interpretations¹¹. There are many structured approaches to apprehending such realities and the methods and procedures of the natural sciences are not (generally) suitable for doing so (see later). The qualitative tradition is also underpinned by a number of different theories. These give researchers different ‘conceptual lenses’ through which to look at complicated problems and social issues, focusing their attention on different aspects of the data and providing a framework within which to conduct their analysis.¹² Many of these are described elsewhere in this book (for example, see chapters by Mann and McLeod, Monrouxe and Rees, Varpio and colleagues) and see also Reeves et al.¹³ for a very useful overview.

So what do these differences mean in practice?

Broadly speaking, quantitative research involves hypothesis testing and confirmation whereas qualitative research is concerned with hypothesis generation and understanding (see Table 1.1). Expanding on this, quantitative research tends to be deductive, seeking to validate an idea or theory by conducting an experiment and analysing the results numerically (see Table 1.1). Theory is often seen as something from which to derive a hypothesis, a tentative explanation that accounts for a set of facts and can be tested by ...