Qualitative Research In Medical

Education

Sher Bahadur
Senior Research Officer, RMC
 Introduction

1. Research, being a systematic enquiry, necessitates a

step-wise approach

2. Each step follows the prior step in a logical manner

3. All steps must be accomplished to complete the

research study

4. Understanding of each step is vital to conducting a

meaningful research study
Qualitative Research
 Qualitative Research

‘.....involves finding out what people think, and how they feel
- or what they say they think and how they say they feel.
This kind of information is subjective. It involves feelings
and impressions, rather than numbers’

Involve the collection and analysis of primarily non numerical data

obtained from observation, interviews, taped information, documents etc.
Why Qualitative Research
 Why Qualitative Research?

• The underlining belief of qualitative research is that the world is

neither stable, coherent, nor uniform, and therefore, "truth" as
sought by quantitative researchers cannot be obtained because
perspectives and understandings differ from group to group.

• Thus, with its mainly inductive approach qualitative research is

suitable for problem identification, hypothesis generation, theory
formation and concept development.

• Answer questions like "why", "how" and "what" about human

behavior, motives, views and barriers.
 Why Qualitative Research?

• It allows researchers to explore, examine and describe

people’s lives using their own words.

• It can further our understanding of patient experiences

and interpretations, determine processes of human
experience, and reveal socio-cultural elements in
everyday clinical care.
 Elements of research proposal
• A research proposal is a document written for the
purpose of obtaining funding for a research project.
1. Title
2. Abstract
3. Study Problem (Formulating the Research
Question)
4. Rationale/relevance of the project
5. Aim, Objectives, Purpose & Hypothesis
6. Specific study objectives.
7. Literature Review
 Elements of research proposal
8. Methods and Materials: – Procedure.
– Study Design – Sample size
– Subjects – Data analysis
• Inclusion and Exclusion – Interpretation
criteria 10. Ethical consideration
• Sampling – Consent form
• Recruitment plans – Privacy of information
9. Data collection tool 11. Work plan
• Variable/ outcome 12. Budget
• Guideline 13. Research team
14. Dissemination plan
 1. Title of the study

1. The title should be descriptive and concise

2. Should be adequately describe the contents of the paper

in the fewest possible words

3. It should not be too long or too short; generally, it

should consist of 10-15 words

4. Reflect the subjective experiences or meanings?

Title of Qualitative studies looks like?
Qualitative insights into the experience of teaching
shared decision making within
adult education health literacy programmers for
lower-literacy learners
Factors Influencing Medical Students' Clinical
Judgment: A Qualitative in Pakistani Context
Exploring the components of physician volunteer engagement:
a qualitative investigation of a national Canadian simulation-
based training program.
 Impractical CME programs and Influential
parameters in Pakistan: perspectives of teaching
faculty
Student’s Reflection third professional year result
in Khyber Medical university 2017; A Qualitative
case Study.
A qualitative formative evaluation of a patient-
centred patient safety intervention delivered by
Medical Students
 Prioritization for selecting a topic
A C
D F P T P O
R U E P I O S
P I E T
R N E P A L M T L
L L S I E S
O T H E
E I I C L A C
J E I F
R V C B A I C C F O
E A A I B N C
E A E R
C N T L I E E
S L C E
T C I I L S P
S T E O T I S T T
N Y T I
Y V
E

Score scale 1 – 5 per

item
The Process of Designing a Qualitative Study

• Qualitative research generally falls within the process of

scientific research, with common phases whether one is
writing qualitatively or quantitatively.

• All researchers seem to start with:

– issue or problem
– examine the literature in some way related to the problem,
– pose questions
– gather data and then analyze them, and write up
 The Qualitative research process

Define Assumption Analyze Interpret

Literature Design Collect
Research Paradigm Data And
Review Research Data
Problem Framework Report

A B C D E F G
 Quantitative vs. qualitative methods

Steps Quantitative Qualitative

Identifying Description and Exploration and
a research explanation understanding
problem

Reviewing -Major role -Minor role

the -Justification for the -Justification for the
literature research problem research problem
 Quantitative vs. qualitative methods

Steps Quantitative Qualitative

Specifying -Specific and narrow -General and broad
a purpose -Measurable and -Participants’ experiences
observable
Collecting -Predetermined -Emerging protocols
the data instruments -Text or image data
-Numeric data -Small number of
-Large number of individuals or sites
individuals
 Quantitative vs. qualitative methods
Steps Quantitative Qualitative
Analyzing -Statistical analysis -Text analysis
and -Description of trends, -Description, analysis, and
interpreting comparison of groups, or thematic development
the data relationships among -The larger meaning
variables
Determining -Reliability -Verification, rather than
the quality -Validity internal validity
of data -Transferability, rather than
generalizability
Reporting -Standard and fixed -Flexible and emerging
the research -Objective and unbiased -Reflexive and biased
The Research Process and Degree of Structure
 Literature Search and Review

• The literature search follows the same principles as used

in quantitative study
• The difference only the use of key words

Key terms used for locating qualitative research studies

1.Explore Exploratory study
2.Feeling Case study
3.Attitude "Phenomenological Research*“
4.Perceptions "Grounded Theory
5.Qualitative research* Interview, or Focus Groups
Data base for qualitative studies

1. CINAHL
2. EMBASE
3. MEDLINE
4. PsycINFO

See page number 16 of guidbook

Section 1: Introduction
1. Problem statement
2. Literature
3. Assumptions
4. Research Paradigms
5. Theoretical framework /Conceptual frame work
6. Writing format
7. Rationale of study
8. Research questions
9. Aim and objectives
 Start of Qualitative study

Theoretical
Ontology Epistemology Methodology Methods Source
perspective

What
What & how I What What tools
procedure What data
What is can know the approach ca can we use to
can we use to can we
reality? reality/ we use to get acquire
acquire collect ?
knowledge? knowledge? knowledge?
knowledge?
 A. Philosophical Assumptions
Ontology is about the existence nature of things (Nature
Ontological of reality)…..What is existence? and What is the nature
of existence?

Epistemology is about the way we know things

The researcher here, collaborate, spend time in field and
Epistemological lessen the gape ……become insider

The philosophical study of value

Researcher openly discuss the value that shape the
Axiological narratives and includes his/her own interpretations in
conjugation with interpretation of participant s
 B. Qualitative research Paradigms
A paradigm is a “worldview” or a set of assumptions
about how things work.
The set of common beliefs and agreements shared between
scientists about how problems should be understood & addressed
These are broadly classified into four paradigms
1. Postpositivism
2. Constructivism
3. Advocacy/participatory
4. Pragmatism
 Research paradigms/world views

Positivism
A philosophical system recognizing only that which can be
scientifically verified or which is capable of logical or
scientific proof

Determination

Empirical observation and measurement

Theory verification
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 Research paradigms/ world views
Postpositivism
Understanding

Scientific reasoning and common sense reasoning are

essentially the same process

Multiple participant meanings

Social and historical construction

Theory generation
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 Research paradigms/ world views

Advocacy/participatory
 Post-positivist imposes structural laws and theories that do not fit
marginalized individuals or groups
 Consequences of actions
 Problem centered
 Real-world practice oriented
 Research should contain an action agenda for reform that may
change the lives of participants, the institutions in which they
live and work

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 Research paradigms/ world views

Pragmatism
 An approach that evaluates theories or beliefs in terms of the
success of their practical application.

 Focus on the outcomes of the research-the actions, situations, and

consequences of inquiry-rather than antecedent conditions (as in
postpositivism).

 "what works "-and solutions to problems

34
Conceptual and theoretical frame work
 1. Framework

 Described as the logical structure of meaning that guide

the development of the study.

 All frameworks are based on the identification of key

concepts and the relationships among those concepts
 2. Concept

• Describes an object or phenomenon, thus providing it

with a separate identity and meaning.

• An intellectual representation of some aspect of reality

that is derived from observations made from phenomena.

• Example of concept - Anxiety or Stress or Pain

3.Construct

• Concepts at very high levels of abstraction that

have general meanings.

Example:
• A construct associated with the concept of
anxiety.
 4. Variables

• A variable is specific characteristics and is measurable.

• Framework can be derived from related concepts

(conceptual) or existing theories (theoretical).

• The terms conceptual framework and theoretical

framework are sometimes used interchangeably, but they
have different meanings.
 A. Conceptual framework
1. This consists of concepts that are placed within a
logical and sequential design.

2. Represents less formal structure and used for studies in

which existing theory is inapplicable or insufficient.

3. Based on specific concepts and propositions, derived

from empirical observation and intuition.
 Purposes of Conceptual Framework

1. To clarify concepts and propose relationships among

the concepts in a study.

2. To provide a context for interpreting the study

findings.

3. To explain observations

4. To encourage theory development that is useful to

practice
Organizational Factors Social Factors
◘ Working Condition ◘ Clear job discretion ◘ Community Expectation
◘ Incentive ◘ Resources available ◘ Patient expectation
◘ Supervision ◘ Reward and feedback
◘ Peer pressure
◘ Training ◘ Complexity of task

Provider Motivation Provider competency

Individual Value Knowledge
Self efficacy Skills
Expectation Ability

Competency
Performance according to the
expectation

Health Outcome

Framework used to explore factors influencing competency and performance

 B. Theoretical framework
Theory:

1. The theory provides a point of focus for attacking the

unknown in a specific area.

2. If a relationship is found between two or more variables

a theory should be formulated to explain why the
relationship exists.

3. Theories are purposely created and formulated, never

discovered; they can be tested
 Theoretical framework

1. The theoretical framework consists of theories that seem

to be interrelated.

2. The explanation concerns the relationship between two

or more variables or phenomena.

3. More formal and used for studies based on existing

theories.
 Lack of existing information on evolution of Medical
Education in Pakistan

Tool
In-depth Interviews with the key
informants

Base line data for

Object understanding the
Subject
Understanding the evolution process and also to
Key informants
in medical education
provide ground for
further research

Rules Community Division of Labour

Institutional inputs of Community of doctor and role such as team leader
national and students/medical educationist multiple roles of a teacher,
international level s policy makers etc hierarchies

Role of Universities, Increased awareness and Contribution of individual

Colleges, R&D, Regulatory community expectation. role players’ policy makers,
authorities in Pakistan, Contribution of national and politicians, government,
WHO, individual international community leaders etc
commitments,Resource .(Medcial professionals)
Methodology
 Study Designs in Qualitative Research

1. Case study
2. Grounded theory
3. Phenomenology
4. Ethnography
5. Historical
 Case Study

Aim/purpose:
“To describe an entity that forms a single unit (case) such as
a person, organization or institution”

• Case studies describe, explain, or assess and evaluate a

phenomenon” [e.g., event, person, program, etc.]

• In a case study, a single person, program, event, process,

institution, organization, social group or phenomenon is
investigated within a specified time frame
Case Study
Process:
• The data gathering process is often interactive as the
researcher associate with persons involved in the “case”
under study.
Data Collection:
• Data is collected primarily by fieldwork, but secondary
data collection is usually employed as well.
• It is important that the researcher(s) understand the
phenomenon from the perspective of the participants.
2. Ethnography

Purpose:
• To have“[an] analytical description of social scenes and
groups that recreate for the reader the shared beliefs,
practices, artifacts, folk knowledge, and behaviors of those
people.”
1. Great emphasis is given to the relationship between
culture and behavior.
2. Ethnography involves the study of an intact group,
logically defined, in its natural context for a sustained
time interval.
 Ethnography

Process:
1. Ethnographic research is very labor and time intensive,
involving extensive fieldwork in a natural setting.
2. Usually a general research question(s) is (are) identified.
3. Once entry is gained and rapport (or trust) is established,
4. The research questions are continually refined becoming
more focused.
5. It is not uncommon for the larger research question(s) to
be segmented into more numerous, focused ones
3. Phenomenology:
Purpose:
“To describe/understand phenomena” (which may be events,
situations, or experiences).

1. Phenomenology seeks to understand a persons’

perspectives as he/she, or they experience and understand
an event, relationship, program, emotion, etc.

2. The researcher often has a significant personal interest in

the phenomenon under study as well
 Phenomenology

• The researcher develops an understanding of a subject’s or

subjects’ “reality” how he, she, or they so perceive.

• In essence, this approach investigates an individual’s or

group’s perception of reality

Process:
• Once a phenomenon is selected, the researcher engages in
much the same process as used in ethnographic study.
 4. Grounded Theory

Purpose:
“To generate a theory of explanation/description grounded in
a phenomenon under study”.

1. Using naturalistic iterative data collection and

relationship analysis processes, researchers derive, from
the data, a theory.

2. The theory is the expected outcome of the inquiry.

 Grounded Theory

• Grounded theory is a general research methodology used

in building naturalistic theory and is rooted in sociology

Process:
• Using the iterative processes of data collection and
analysis, relationships between concepts are continually
identified and refined so as to enable theory
development.
 5. Historical Research
1. Historical research relies on records, diaries, oral histories,
photographs, and other artifacts to describe, analyze, and
explain past events, philosophies, etc.

2. The artifacts and records used are driven by the particular

study and its research question(s).

3. Historical research relies significantly on inductive, logical

reasoning.
 Summary
Attempts to shed light on a phenomena by studying in-
Case study depth a single case example of the phenomena. The case
can be an individual person, an event, a group, or an
institution.
Grounded Theory is developed inductively from a corpus of data
theory acquired by a participant-observer.
Phenomenol Describes the structures of experience as they present
ogy themselves to consciousness, without recourse to theory
Focuses on the sociology of meaning through close field
Ethnograph
observation of socio-cultural phenomena.Typically,
y
focuses on a community.
Systematic collection and objective evaluation of data
related to past occurrences in order to test hypotheses
Historical concerning causes, effects, or trends of these events that
may help to explain present events and anticipate future
events.
Sample Size and Random Sampling
Techniques
 Sampling

 It refers to the method of selecting a sample from

a given universe or population with a view to
draw conclusion about the universe.
 Sample Size

 Qualitative researchers are not as concerned about

representativeness

 Sample size does not have to be determined in advance.

– Selection of cases gradually over time till the
– POINT OF Saturation
 Sampling Techniques used in Qualitative
studies

Nonrandom (“nonprobability”)

Does not have random sampling at any state of the

sample selection
Increases probability of sampling bias
 Nonrandom sampling methods...

1. Convenience sampling
2. Purposive sampling
3. Quota sampling
4. Snow ball
 Tasks 1

1. Please guidebook from page 6-11

2. Each group have to select one paradigm and
make presentation on flip chart
 Tasks 2

1. Identify a problem from Medical Education

Discipline
2. Construct a catchy title of qualitative research
3. Conduct literature search
4. Chose your research paradigm (justify)
5. Construct a tentative conceptual farmwomen.
Thank You